Chapman H R, Chipchase S Y, Bretherton R
Paul Lowe Dentistry, 31 Farmhouse way, Monkspath, Solihull, B90 4EH.
School of Psychology, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS.
Br Dent J. 2017 Aug 25;223(4):261-271. doi: 10.1038/sj.bdj.2017.712.
Introduction Stress and burnout are widely accepted as a problem for primary care dental practitioners. Previous programmes to address this issue have met with some success. Burnout is associated with poor coping skills and emotion regulation, and increased rates of clinical errors. Anxiety is associated with poor decision-making and is thought to be associated with poor clinical decision-making. Attempts to improve decision-making use increasing meta-awareness and review of thinking processes. Bibliotherapy is an effective method of delivering cognitive behavioural therapy as self-help or guided self-help (with some therapist input) formats.Objective To evaluate the efficacy of a specially designed CPD package which was designed to improve coping skills, build resilience and reduce the impact of anxiety on dentists' clinical decision-making.Design A multi-centred quasi-experiment.Setting Lincolnshire and Nottinghamshire (England) 2014.Materials and methods Thirty-five volunteer primary care dentists used two versions (self-help [SH] and guided self-help [GSH], which included a 3 hour workshop) of a specially written cognitive behavioural therapy bibliotherapy programme designed to improve well-being and decision-making.Main Outcome Measures The main outcome measures were dentists' burnout, depression, anxiety, stress and decision-making style. Data were also collected on use and evaluation of the programme.Results At 6 weeks there was a clinically and statistically significant reduction in depression, anxiety and stress levels, a statistically significant reduction in burnout (emotional exhaustion) and hypervigilant decision-making, and an increase in personal achievement. The improvements in depression, stress, emotional exhaustion and hypervigilant decision-making were maintained at 6 months. Dentists were overwhelmingly positive in their evaluation of the project and used most of its contents.Conclusion With the caveat of small numbers and the lack of a no-treatment control, this project demonstrated that a self-help package can be highly acceptable to dentists and, in the short-to-medium term, improve dentists' well-being and decision-making with implications for patient safety.
引言
压力和职业倦怠被广泛认为是基层牙科从业者面临的问题。以往解决这一问题的项目取得了一些成功。职业倦怠与应对技能差、情绪调节能力不足以及临床失误率增加有关。焦虑与决策能力差有关，并且被认为与临床决策不佳有关。提高决策能力的尝试包括增强元认知意识和审视思维过程。阅读疗法是一种以自助或引导自助（有一些治疗师参与）形式提供认知行为疗法的有效方法。
目的
评估一个专门设计的继续职业发展（CPD）套餐的效果，该套餐旨在提高应对技能、增强恢复力并减少焦虑对牙医临床决策的影响。
设计
多中心准实验。
地点
2014年在英格兰林肯郡和诺丁汉郡。
材料和方法
35名志愿基层牙医使用了一个专门编写的认知行为疗法阅读疗法项目的两个版本（自助版[SH]和引导自助版[GSH]，后者包括一个3小时的工作坊），该项目旨在改善幸福感和决策能力。
主要结局指标
主要结局指标包括牙医的职业倦怠、抑郁、焦虑、压力和决策风格。还收集了关于该项目使用情况和评估的数据。
结果
在6周时，抑郁、焦虑和压力水平在临床和统计学上有显著降低，职业倦怠（情感耗竭）和过度警惕的决策方式在统计学上有显著降低，个人成就感有所提高。抑郁、压力、情感耗竭和过度警惕的决策方式的改善在6个月时得以维持。牙医对该项目的评价绝大多数是积极的，并且使用了其大部分内容。
结论
尽管存在样本量小和缺乏无治疗对照组的局限性，但该项目表明一个自助套餐对牙医来说是非常可接受的，并且在短期到中期内可以改善牙医的幸福感和决策能力，这对患者安全有影响。
