By teaching people to tune into their emotions with intelligence and expand their circles of caring, we can transform organizations from the inside out and make a positive difference in our world.

—Daniel Goleman, psychologist, author, and journalist

Emotional intelligence (EI), also known as emotional quotient or EQ, is the ability to monitor our own and others’ feelings and emotions, to discriminate among them, and to use this information to guide our own thinking and actions (Salovey and Mayer 1990). High EI allows us to understand what we and others are feeling, regulate our emotions in positive ways to relieve stress, communicate effectively, empathise with others, and defuse conflict.

The first ‘E’ of the PERLE model spotlights emotional intelligence and its crucial role in building resilience. This is split into three interplaying parts: self-awareness, emotional regulation, and positive emotions. Due to the sheer vastness of this pillar and topic, we explore EI over three chapters.

Tuning to our emotions with intelligence is critical for dental professionals. Our emotions drive our every behaviour. And as the old adage goes in dentistry, patients do not remember what we say but rather how we make them feel. In this chapter, we will explore the transformative benefits of developing EI for dental professionals and how to do so.

EI Benefits in Dentistry

Developing high EI has numerous advantages for dental professionals. Self-awareness – that is, knowing how we are feeling – and emotion regulation, the ability to downregulate from stress to calm, helps us build greater resilience and psychological well-being. The ability to manage our emotional life without being hijacked by it is a tremendous learnable skill. With it, we are better equipped to respond well under the pressures of dentistry. High EI leads ultimately to us developing increased empathy with our patients, resulting in better quality of patient care. Recognising emotions in our patients and attempting to understand how they are influencing behaviours is one of the building blocks of empathy. Furthermore, greater connection to patients enhances our levels of engagement at work and hence career satisfaction.

Facets of Emotional Intelligence

Additionally, high EI is essential for effective communication, leadership, and teamwork. Ensuring patients understand the information we are conveying to them is essential for obtaining valid informed consent and for building strong patient relationships that may prevent or reduce the risk of complaints. The ability to recognise by facial expression when a patient is anxious or confused allows a dental professional to pause the consultation and explore any questions or concerns before continuing.

What are Emotions?

Emotions are pieces of information that tell us something about how we are experiencing our world. Emotions are often feared and avoided, as they can be painful; however, they are designed to help us survive, relate to other people, communicate how we feel, and respond to our world. Emotions give us feedback on our environment, that is, whether it is dangerous or friendly. They tell us what we need so that we take action to meet our needs. They also are influenced by our thoughts or perceptions and can trigger physical responses and behaviours. All emotions are forms of energy that drive our behaviours. This is explained through the cognitive-behavioural therapy (CBT) model (see Figure 5.1) that conveys the interconnected relationship between our feelings, thoughts, and actions.

Our emotional reaction was learnt from our childhood experiences. If we were predominantly fearful as a child, we may overprotect ourself as an adult, and this may present as anxiety. Emotions are also modified by the genetic makeup of a person (temperament) and the socialisation process.

Taking Off the Mask

With our patient-focused role in dentistry, we need to keep some of our emotions and feelings under the surface and lean into a calm, compassionate, empathetic, and confident state. Although this is of course necessary, it is important, outside our time with patients, to experience our emotions with acceptance and non-judgment and release them. Keeping our feelings bottled up can cause us to blow up or develop stress-related illnesses. Pushing down feelings only means they will resurface at a later date.

The Broadening Effect of Positive Emotions

What do positive emotions do to our thinking? Barbara Fredrickson, leading researcher in positive emotions, has been studying this area with avid interest. Her Broaden and Build Theory (Fredrickson 2001), backed up with research, describes the transformative effects of positive emotions on our success and well-being. The experience of positive emotions, from joy to serenity, gratitude, awe, inspiration, and amusement, opens our minds and broadens our ability to think ‘outside the box’ (Figure 5.2). Our outlook on our environment changes. The world appears larger. We see more possibilities relative to negative or neutral states. This is the opposite case for stress, in which our thinking considerably narrows.

The broadening effect of positive emotions in turn helps us to build personal resources when we need them: intellectual (problem solving, open to learning), physical (cardiovascular health, coordination), social (maintain relationships and create new ones), and psychological (resilience, optimism, sense of identity and goal orientation) (see Figure 5.2). This in turns helps us transform our lives. Interestingly, the impact of positive emotions extends beyond us just feeling better, as they can impact our physical health. Positive emotions can ‘undo cardiovascular after effects of negativity’ (Fredrickson 2009). Positive emotions can help our bodies return to normal physiological functioning significantly faster than other emotions (Fredrickson and Levenson 1998).

Personality and Emotion

Which personality traits bring us all together? Which traits separate us as individuals? Personality psychology can give us insight into this and acknowledges the individual differences in how we think, feel, and act. The most widely used personality test comes from research by Costa and McRae (1992). They identified five main personality traits across cultures, known as the Big Five. Table 5.1 summarises these traits. How do you think you would score on each trait?

EI and Well-being

EI can be thought of as a behaviour and a personality trait. It is impacted by several factors-our personality, attachment style we formed as children, and content and the context of a situation. Higher EI correlates to higher subjective well-being. Our EI does change and adapt over time, perhaps being influenced by the positivity bias as we age. The data suggest that our happiness levels increase as EI increases, such as positively reframing our emotional experiences. High EI is positively related with subjective well-being; mediated by emotional regulation strategies, such as emotional savouring (reliving positive emotions).

The Roadmap to EI

The most supported theory on emotional intelligence comes from the pioneering work of Mayer and Salovey (2007) and their theory on EI. This model considers developing EI as a set of competencies or mental skills that consist of four stages, as shown in Figure 5.3. The stages are summarised below.

We will explore how to regulate difficult emotions and build greater resilience and well-being, using emotional coping tools. Table 5.2 summarises different tools we can select. Some strategies are generally considered to be helpful, such as expressing our feelings, mindfulness, self-compassion, physical exercise, or problem solving, and others mainly unhelpful, for example, alcohol, avoidance, or rumination.

Emotional regulation is the effort to influence which emotions we feel, express, and play out. The key with learning the mind tools to regulate emotions is to understand the range of well-being strategies and experiment with the ones that can help you. This involves reading and understanding the demands of situation and selecting the appropriate emotional regulation skills. Social and cultural contexts also matter. We have to be flexible in the way we use these strategies. Which helpful and unhelpful strategies from Table 5.2 do you already use?

Strategy	Helpful?	What is it?	How?	Evidence
Mindfulness		Paying attention to thoughts and feelings, non-judgmentally.	Get comfortable. Set a time limit. Close your eyes. Notice your body. Feel your breath. Notice mind has wandered. Gently nudge attention back to breath kindly, as you would a young child.	Galante et al. (2018) – 616 Cambridge University students during exam time. Half had eight-week mindfulness course and the others had normal university support. The mindfulness group had reduced stress during exam period.
Acceptance		Nonjudgmental acceptance and tolerance of emotions and negative thoughts. Acceptance predicts lower negative emotions and overlaps with mindfulness.	Let your emotions be. Let yourself have emotions without trying to change them. There is nothing wrong with having certain emotions. Let them run their course. For example, ‘hello sadness. . .there you are. . .you come and go’. Or ‘it’s alright to be anxious. . .just let it be. . . it will die down eventually’. Try not to judge your thoughts and emotions. My thoughts and emotions don’t mean I am good or bad – they just are what they are. They are like clouds passing through my mind. They do not reflect the truth about the world and about me.	Ford et al. (2017) studied 1000 participants. Individuals who accepted rather than judged their mental experiences and emotions had higher well-being and lower depression and anxiety.
Self-compassion		Treating yourself with kindness and compassion when stressed or upset (or when you make a mistake).	Say to yourself: ‘This is a moment of suffering; suffering is a part of life; may I be kind to myself’. When you feel stressed, instead of being critical (‘I’m so stupid, what’s wrong with me, I should be able to cope’), be compassionate to yourself – ‘poor me; it’s hard being human’; ‘what I need in this moment is some self-kindness’. Try physical gestures of self-kindness, for example, give your arm a tender squeeze. Accept that failure is part of learning – you have to be bad at things before you can be good at them. Accept that making mistakes is part of being human.	Leary et al. (2007) found that self-compassion reduced negative emotions after ambivalent feedback and reduced stress, often having a more beneficial effect than self-esteem.
Expressing your emotions		Telling people how you genuinely feel – your hopes, fears, and challenges.	Notice your feelings. Talking to another person about your feelings.	Mendolia and Kleck (1993) – talking helps you to process your emotions.
Assertiveness (open communication)		Being clear and open about what you feel and think without blaming or being critical of others.	Be direct, honest, accepting, and responsible about your feelings as opposed to: Directly aggressive; directly taking it out on others Indirectly aggressive; indirectly taking it out on others Passive.	Sample of over 1000 students, assertiveness linked to greater well-being and less psychological distress.
Cognitive reappraisal		Generating more helpful interpretations of a situation, for example, thinking of a failure as an opportunity to learn. This is most beneficial where we have limited control or no control, for example, grief/loss.	Look at the evidence for and against the thought. Ask yourself what you would say to a friend who thought this. Ask yourself if the belief is helpful or unhelpful. Zoom out of the situation; what will you think about this thought in a year’s time? Does having this thought mean it’s true?	Gross (1998) – reappraisal decreased emotional arousal in participants.
Exposure (feel the fear and do it anyway)		Deliberately exposing yourself to feared situation.	Find something that causes you anxiety. Experiment with doing this and thinking; ‘I’ll feel the fear and do it anyway’. If this is difficult to do in one go, try building up to it in smaller steps.	Sloan and Telch (2002).
Physical exercise		Physical exertion that raises your heart rate.	Even short periods of time exercising can boost your mood. For more long-term mood benefits from exercise: aerobic and/or strength-building exercise for about 30 minutes three times a* week.	Stathopoulou et al. (2006) – exercise had a beneficial effect on mental health, including reducing depression and anxiety.
Problem solving		The process of finding solutions to difficult or complex issues.	Use when you are in a stressful situation that is within your control. Brainstorm all possible solutions and write them down. Be creative, and nothing is off the table. Evaluate the pros and cons of each option. Give each option a score out of 10. Choose an option and do it. See what happens – if your chosen option does not work, go back to steps 2 and 3 and choose a different option.	Cuijpers et al. (2007) – problem solving interventions helped to decrease depression.
Pleasure and mastery		A technique to help with low mood, pleasure and mastery is a way of planning your day to make sure you include things you find pleasurable and things you find give you a sense of achievement.	Write a list of things that give you pleasure. Write a list of things that give you a sense of achievement (mastery). This second list can just be things you have to do but find hard— for example, chores. Plan your day with a mixture of pleasure and mastery. For example, if you have to write an essay (mastery), intersperse, say, one hour of essay writing with one hour of doing something pleasurable, across the day, so you have, for example, three sessions of pleasure and three sessions of mastery.	Jacobson et al. (1996) – activating pleasure and mastery significantly lowered depression.
Suppression	Mainly unhelpful	Hiding emotional states around others and yourself by pushing away the thoughts and emotions. It may be a short-term helpful strategy but not helpful long term. The opposite of suppression is authenticity – we are comfortable expressing our emotional states.	Use instead. . . Mindfulness Reappraisal Acceptance Self-compassion Talking about your emotions.	Najmi et al. (2014) – OCD sufferers who were asked to suppress their negative OCD thought, actually thought about it more and were more distressed by it than OCD sufferers who were asked to accept their negative thought
Avoidance	Mainly unhelpful	Avoiding situations that lead to negative feelings. This can be a positive short-term strategy where we lack control but poor long-term strategy, as it does not address the causal experience.	Try. . . Exposure – do something that you find scary and want to avoid. The more you do it, the less scary it will become. You can combine exposure with. . . Acceptance – ‘it’s OK to feel anxious’ Self-compassion – ‘good for me – I’m finding this difficult and that’s tough – but aren’t I doing well to face it when it’s so hard?’	Aldao et al. (2010) – avoidance was associated with increases in depression and anxiety.
Rumination	Mainly unhelpful	– ‘Dark’ cousin of acceptance, where we actively focus on negative experiences, fixating and chewing over negatives. Rumination contrasts with savouring, where we relive positive experiences. -For example: ‘Why am I like this, why do I feel so low?, I can’t even get out of bed, I’m really stupid, why can’t I be more like Shabana?, I don’t know why she can do it and I can’t. . .’	Try this. . . Talking about your emotions Mindfulness Acceptance Distraction Self-compassion.	Nolen-Hoeksema and Morrow (1993) – depressed people who were asked to ruminate became more distressed, but those who were asked to use distraction (thinking about geographical locations) became less depressed. Broderick (2005) replicated Nolen-Hoeksema and Morrow’s (1993) research but with an added mindfulness meditation condition of self- acceptance and awareness of the breath. This worked even better at reducing negative mood.
Alcohol/drugs	Mainly unhelpful	Taking alcohol or other substances to cope with emotions.	The real problem is the medium- and long-term use of drugs for emotion regulation.	Sher and Grekin (2007) – review of the negative effects of alcohol in emotion regulation.
Self-criticism		Attacking yourself when stressed or having a problem – for example, blaming yourself, or labelling yourself negatively.	For example, telling yourself ‘I’m so lazy, I can’t do anything’, or ‘I’m such an idiot – I really messed that up’ normally has demotivating effects – so it doesn’t help you to ‘work harder’. And it makes you feel worse. Try. . . Self-compassion Mindfulness.	Gilbert and Procter (2006) – overview of the role of self-criticism in psychological difficulties.

The Mind Gym fitness menu below is a guide for helpful techniques to manage difficult emotions. Select options from the Mind Gym when you want help in coping with difficult emotions.

Source: Lasse Kristensen / Adobe Stock.

Source: Lasse Kristensen / Adobe Stock.

Lifting the Mask of Self-Doubt: Managing Imposter Syndrome

When did you last hear that voice at the back of your mind tell you are not good enough? That you have managed to fool everyone around you? Imposter syndrome is a set of negative thoughts and beliefs around your capabilities. This can really undermine your resilience and impact career progression. Imposter syndrome can feel like wearing a mask to prevent others finding out your ‘true’ competencies. For some colleagues, the more they accomplish, the more they feel like a fraud. In the short term this may see dental professionals working harder than necessary to make sure that nobody finds out the ‘truth’. Longer term, this self-doubt may cause anxiety or depression.

Imposter syndrome thoughts often impact high-achieving individuals, with a failure to internalise accomplishments and persistent self-doubt or fear of being exposed as a fraud being characteristic. Looking at the media, this type of thinking is often displayed in movies or TV; for example, the character of Betty in Ugly Betty, Andrea in The Devil Wears Prada, Remy in Ratatouille, and Bridget in the Bridget Jones franchise. Just as it is conveyed in the movies, the research shows that imposter syndrome is more common in marginalised groups, such as women and ethnic minorities. Individual factors play a role – such as low self-esteem – as do external factors, such as the toxic environment seen at Runway magazine in The Devil Wears Prada.