Stress suppression: why pushing through is holding you back

Rana Al-Falaki explains how changing from suppression to management of stress could transform your performance, your practice, and your life.

Ask any dental clinician how they manage stress, and most will give you some version of the same answer: ‘I just get on with it.’ It is, in many ways, the default setting of the profession. We are trained to perform under pressure, to hold composure in the surgery whatever is happening internally, and to keep moving regardless of how the day feels. In dentistry, pushing through is not just accepted – it is quietly admired.

But here is what that stoicism is costing you. And it is more than you might think.

Dentistry consistently ranks among the most stressful professions in the UK. Figures from the British Dental Association suggest that stress-related issues affect up to three quarters of the profession. Burnout has become a quiet epidemic sitting at the heart of dentistry, yet the dominant cultural response remains the same: keep going, and do not show it.

The question worth exploring is not whether dentistry is stressful – it clearly is – but whether the way most of us have been taught to think about stress is actually making things worse. Because the latest evidence suggests it might be.

‘Stress is part of the job – you just have to push through’

When I first met Dr HC, he was, by every external measure, doing exceptionally well. A high-performing associate in a busy mixed practice, he was technically accomplished, reliable, and popular with his patients. His principal was happy. His diary was full. There was nothing obviously wrong.

Spend any time with Dr HC, however, and a different picture emerged. He described his working days as being on speed – moving from patient to patient with barely a pause, eating at the desk, answering messages between appointments, always just ahead of the next task because falling behind was not an option. The output was impressive. The cost was invisible. Until it was not.

The early signs were subtle. He forgot a patient’s name mid-consultation – someone he had been treating for three years. He missed a follow-up call he had promised. Then, he snapped at his dental nurse over something trivial and felt awful about it for the rest of the day. At home, he was physically present but mentally still in the surgery, running through the day’s cases while his family tried to talk to him.

These are the hallmark signs of early burnout, and they rarely announce themselves dramatically. Burnout tends to arrive quietly: as heightened irritability, difficulty concentrating, a growing sense of detachment from patients, disrupted sleep despite exhaustion, and a creeping feeling that however much you do, it is never quite enough. The most troubling aspect is that the people most at risk are frequently also the most productive,  right up until the point they are not.

When we explored what was underpinning all of this for Dr HC, one belief came through clearly: ‘Dentistry is stressful; it always has been and always will be. You just have to get on with it.’

It is a belief born of training, culture, and professional pride. It feels rational. Stoic, even. But it contains a fundamental misunderstanding about the nature of stress, and is quietly doing enormous damage.

Why pushing through is not resilience – it is suppression

Stress is a biological response to a real or perceived threat. When a stressor hits, a difficult patient, a clinical complication, a General Dental Council concern, a staffing crisis, the body responds predictably: cortisol and adrenaline flood the system, heart rate increases, breathing sharpens, awareness heightens. This is not the enemy. This is your biology doing precisely what it was designed to do: preparing you to meet a challenge with focus and energy.

The problem is not stress – it is what happens when stress becomes chronic. When pressure is relentless and there is no recovery, the very same hormones that help in a short burst begin to erode performance over time. Constantly elevated cortisol impairs the ability to focus, make decisions, retain information, and communicate clearly. People become irritable, fatigued, and emotionally flat, and increasingly vulnerable to conditions including heart disease, high blood pressure, and compromised immunity.

Pushing through, without ever processing or releasing the stress, is not resilience. It is suppression. This suppression has a cost that accumulates invisibly – until the moment it does not.

The truth: your mindset about stress matters as much as the stress itself

Here is where the science becomes genuinely fascinating, and genuinely useful.

If you think of stress as a form of energy, and physics tells us that energy cannot be created or destroyed, only transformed, then the question is not how to eliminate it, but how to work with it. The same stress response that feels overwhelming when you are fighting it can become a source of focus and drive when you understand what it actually is.

Research by Dr Alia Crum, assistant professor of psychology at Stanford University, demonstrated something that ought to be on every dental school curriculum. She found that people who viewed stress as harmful experienced the full negative cascade of chronic stress. Those who understood stress as a physiological response that could be channelled showed measurably better health, higher productivity, and greater emotional wellbeing,  even during periods of intense pressure. The difference was not the amount of stress. It was the relationship with it.

A separate study found that actively trying to avoid stress increased the long-term risk of depression, relationship breakdown, and job loss, because avoidance led people toward unhelpful coping strategies such as procrastinating, withdrawing, and imagining worst-case scenarios.

Where attention goes, energy flows: keeping your focus on eliminating stress keeps you locked in a losing battle with it.

Working with Dr HC: from pushing through to working with

We introduced Dr HC to three mindset shifts:

1. Viewing the body’s stress response as helpful rather than debilitating
2. Recognising your own capacity to grow through difficulty
3. Understanding that stress is a universal human experience, not evidence that you are uniquely failing.

His initial response was familiar. He did not see himself as someone struggling with stress. He was someone who handled it. A pusher-through. That, we explained gently, was precisely the problem.

Through the NAIL-IT in Dentistry Titanium training programme, Dr HC started to shift. The first shift was awareness: becoming conscious of the internal narrative running beneath the surface of his days. Not just the workload itself, but the constant accompanying commentary.

• ‘I cannot drop anything’
• ‘I cannot let anyone down’
• ‘I have to stay ahead.’

These were not neutral observations. They were stress amplifiers, keeping his nervous system in a state of sustained alert long after individual stressors had passed.

The second shift was reframing the stress response itself. Instead of interpreting the physical signs of pressure – the heightened alertness, the racing thoughts – as warning signals to be alarmed by, he began recognising them as his body preparing him to perform. The language changed.

‘I am overwhelmed’ became ‘I am activated’.

This shifted the emotional register entirely, and with it, the physiological response.

The third shift was accepting that stress as energy requires an outlet. Suppressing it does not make it disappear; it redirects into the body, the mood, the snapped remark, the dropped ball, the missed detail.

Within the NAIL-IT programme, Dr HC was introduced to a range of practical regulation tools: structured breathing between patients as a micro-reset, genuine lunch breaks away from the screen, and a brief end-of-day journal – not to catalogue problems, but to note what had gone well. Small practices, consistent habits. The shift in his nervous system within weeks was marked.

The true shift

Six months later, Dr HC describes his experience of work as fundamentally different. Not because the demands have reduced, the diary is just as full, but because his relationship with those demands has shifted.

His treatment conversion rate increased by more than 20%. Not through any change in clinical skill, but through the quality of his presence in the room. Patients respond powerfully to a clinician who is genuinely calm and attentive. When you are running on adrenaline, patients feel it, even when they cannot name it. When you are regulated, they feel that too. Trust builds faster. Consultations feel more natural. Treatment acceptance follows.

His clinical notes are no longer the last thing standing between him and home. With improved concentration and reduced cognitive load, he returned to completing records in real time – a habit he had long since abandoned as impractical. It turned out it was not impractical. It was simply incompatible with a mind running at perpetual high alert.

He started sleeping better, being present at the dinner table, and took up running again. He described, with some surprise, looking forward to Monday mornings for the first time in years.

Most significantly, he told us he had stopped viewing stress as a sign that something was going wrong and started viewing it as a signal that something mattered. That reframe, small in words, significant in impact, is at the heart of what the NAIL-IT leadership model teaches about stress mindset.

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