Dental anxiety,oral health‐related quality of life,and general well‐being: A self‐determination theory perspective

The aim of this study was to test a structural equation model (SEM) with the following hypotheses: (1) patients’ perceptions of oral health care professionals’ (i.e., dentists and dental hygienists) controlling interpersonal styles would positively predict patients’ dental anxiety through their basic psychological need frustration in treatment; (2) in turn, high dental anxiety would positively predict dysregulation of dental anxiety, which through a feedback loop contributes to perception of oral health care professionals’ controlling styles; and, (3) in addition, both dental anxiety and dysregulation of dental anxiety would predict poor Oral Health‐Related Quality of Life (OHRQoL) and subsequently poor general well‐being. A cross‐sectional study was conducted among 322 students at the University of Oslo. Participants responded to a survey with validated questionnaires. All variables in the model tested were acceptably normally distributed. The SEM did fit the data well and all hypotheses were supported. A bootstrapping procedure indicated that all indirect links in the model were supported. Analysis indicated that common method variance (CMV) did not seriously distort the results in this setting. Although the majority of oral health care professionals are perceived as being noncontrolling by their patients (51%), the proportion perceived as moderately (38%) or highly (11%) controlling represent a challenge for oral health care education and practice. It would be useful for oral health care professionals to be trained in avoiding a controlling treatment style.     

Motivation and anxiety for dental treatment and dental attendance: The roles of the locus of causality personality and treatment styles

The purpose of the present study was to test a self-determination theory model with the following hypotheses: (1) Patients’ autonomous causality personality orientation and oral health care professionals’ autonomy-supportive treatment styles, as perceived by patients, would both be positively indirectly associated with dental attendance through patients’ autonomous motivation for dental treatment. (2) Patients’ controlled causality personality orientation and oral health care professionals’ controlling treatment styles, as perceived by patients, would both be positively indirectly associated with avoidance of making a dental clinic appointment through patients’ anxiety for dental treatment. A sample size of about 200 patients was estimated to be acceptable in detecting moderate effect sizes (independent variables: 5–6; power: .80; p < .05). Student patients (N = 226) responded to a survey with validated questionnaires. Using LISREL, both hypotheses were supported. In addition, patients’ perception of a controlling treatment style moderated the controlled personality—dental anxiety relation, so that a lower controlling treatment style mitigated dental anxiety substantially among patients with a high control orientation. Effect sizes were moderate to large. Analyses (Z-scores) also revealed that the autonomous personality is more strongly linked to situational autonomous motivation than situational autonomy support, whereas a controlled personality and a perceived controlling treatment style are equally and significantly associated to dental anxiety. Both patient personalities and oral health care professionals’ treatment styles are substantially linked to autonomous motivation and anxiety for dental treatment, which are relatively strongly associated with dental attendance and avoiding dental clinic appointments, respectively.     

One-session cognitive treatment of dental phobia: preparing dental phobics for treatment by restructuring negative cognitions

The purpose of this study was to investigate the effectiveness of a single session of cognitive restructuring in a sample of phobic dental patients. Fifty-two patients were randomly assigned to one of three conditions: cognitive restructuring (modification of negative cognitions), provision of information (about oral health and dental treatment), and a waiting list control condition. Both interventions maximally lasted one hour. In comparison with the waiting list control condition and the information intervention condition, the cognitive intervention condition not only showed a large decrease in frequency and believability of negative cognitions, but also exhibited a clear decline in dental trait anxiety. Analysis at a follow-up of one year demonstrated a further, drastic reduction in dental anxiety in both intervention conditions, wherein the difference among these conditions was not maintained. It is concluded that it is possible to obtain substantial reductions of dental trait anxiety through a single session of cognitive restructuring. Nevertheless, repeated exposure to the dental situation seems necessary for a further reduction of anxiety.     

Psychosocial effects associated with dental fear in adult dental patients with avoidance behaviours

Abstract

The most obvious consequence of a genuine dental phobic reaction is the avoidance of necessary dental care. Previous research has indicated that such avoidance has adverse effects on an individual's oral health status, and also reduces the quality of life. However, systematic investigations in this area of dentistry are few and clinical observations and interviews may often fail to elicit information regarding the impairment created outside the dental situation. The present investigation assessed the presence and levels of emotional and social life effects among dental phobic patients with regard to the prevalence of dental and general fears and the length of time for which dentistry had been avoided. It was shown that a majority of the patients felt that they had to curtail their social relations, and many, especially long-term avoiders, reported wide-spread negative social life effects. Often this had extended into feelings of loneliness or to overt social isolation. It remains to be seen whether fear of dentistry itself produces disadvantage or whether these effects are mainly related to personality factors, which can also promote the development of dental fear. Alternatively, poor dental health, which is probably more frequent in anxious patients, may be perceived by these patients and thus impair social relationships.     

Cross-Field Differences in Creative Problem-Solving Skills: A Comparison of Health,Biological, and Social Sciences

In this study, 258 doctoral students working in the health, biological, and social sciences were asked to solve a series of field-relevant problems calling for creative thought. Proposed solutions to these problems were scored with respect to critical creative thinking skills such as problem definition, conceptual combination, and idea generation. Results indicated that health, biological, and social scientists differed with respect to their skill in executing various operations, or processes, involved in creative thought. Interestingly, no differences were observed as a function of the students' level of experience. The implications of these findings for understanding cross-field, and cross-experience level, differences in creative thought are discussed.     

The problem of creating habits: establishing health-protective dental behaviors.

We describe three experiments testing treatments to promote the performance of health-protective dental behaviors. Subjects included 55 women from an introductory psychology course (Experiment 1), 45 men and women (Experiment 2), and 81 older-than-average students identified as at risk for gum disease (Experiment 3). The interventions, derived from social cognitive theory, included health education, skills training, and self-monitoring. In each study, we examined the contribution of additional treatment components, including social support (Experiment 1), intensive contact (Experiment 2), and flexible goal setting (Experiment 3). Across experiments, the behavioral results were remarkably similar: Subjects exhibited excellent adherence while in the study but, at follow-up, reported behavior that differed little from baseline. We discuss parallels between attempts to promote health-protective dental behaviors and other health-promotion programs, and we describe different perspectives from which to address the problem of creating healthy habits.     

The Relationship Between Spirituality,Health Beliefs,and Health Behaviors in College Students

The United States is a country in which religion and spirituality play a significant role in people’s lives. The relationship between religion, spirituality and health has long been investigated. However, most of these studies have focused only on patient populations and the elderly. The present study examines whether the same pattern of relations reported earlier is seen in a sample of healthy, college students using measures of both spirituality and religion. Health beliefs and behaviors were also examined. The results show that individuals with higher spirituality scores are more active and hold difference health beliefs than those who scored in the low spirituality group. However, some contradictions from previous research were reported in this sample. The study suggests religion may have some different pattern of relations in the overall health and health behaviors of younger, healthier populations. Dr. Sgoutas-Emch teaches at the University of San Diego. Erik Nagel received his BA from there.     

Oral health and dental well‐being: testing a self‐determination theory model

This study tested a self‐determination theory (SDT) process model of oral health and subjective dental well‐being. The results showed that: (1) patients' perceptions of autonomy‐supportive dental professionals were significantly positively predictive of patients' psychological needs satisfaction in treatment; (2) needs satisfaction was significantly related to perceived dental competence (positive), autonomous motivation (positive), and controlled motivation (negative) for dental care; (3) perceived competence was significantly positively, and controlled motivation was significantly negatively associated with self‐rated oral health and oral‐health‐related quality of life; (4) autonomous motivation for dental treatment was significantly positively associated with valuing continued dental treatment; and (5) the three oral‐health‐related variables were all significantly positively linked to subjective dental well‐being. A structural equation model supported the SDT process model.     

Physical activity to address multimorbidity among survivors of sexual violence: A comprehensive narrative review

BackgroundSexual Violence (SV) is highly prevalent and experienced by women and men throughout the United States and world. Survivors of SV often experience poor mental and physical health, and poor health-related quality of life. Studies have explored the associations between SV survivorship and maladaptive health behaviors, but few have examined SV and health promoting activities such as exercise.PurposeThe aim of this narrative review is to describe available peer-reviewed literature regarding SV and physical activity and provide recommendations for future research. Specifically, this review aimed to identify information relevant for promoting and designing exercise interventions that can integrate into clinical treatments for adult survivors of SV.MethodsA search of electronic databases identified 18 articles on SV and exercise behavior.ResultsFour of these studies were exercise interventions, 10 were observational studies, and 4 were qualitative interviews. Results broadly indicate that levels of physical activity among survivors of SV is unclear. Findings from trials indicate exercise may have a positive impact on mental health in survivors of SV. Qualitative interviews found survivors often enjoyed exercising and identified several health benefits, suggesting exercise interventions may be feasible and acceptable in this population. Interviews also identified valuable information about survivors' experiences with exercise.ConclusionsResearch in this area would benefit from: representative samples of adults among populations at high risk for victimization, more consistent and in-depth reporting of SV history and exercise levels, consistent and trauma-informed outcome measurements, and more diverse study designs and interventions. Increased exploration of exercise in this population is warranted given the well-established evidence base indicating the health promoting qualities of exercise for mental and physical health among trauma affected populations.     

Cognitive-Behavioral Intervention in School Discipline: A Preliminary Study

This study assessed the utility of a pilot program in rational behavior therapy (RBT) in the disciplinary processes at a large, urban junior high school. Treatment and control students were contrasted on recidivism rate and teacher behavior assessments after they participated in a condensed RBT treatment program. For two behavior ratings and recidivism rate, students who participated in the intervention differed significantly from those in the control group. Such empirical support demonstrates the potential of cognitive-behavioral interventions in school disciplinary procedures and merits further implementation and research.     

Racial healthcare disparities: A social psychological analysis

Around the world, members of racial/ethnic minority groups typically experience poorer health than members of racial/ethnic majority groups. The core premise of this chapter is that thoughts, feelings, and behaviours related to race and ethnicity play a critical role in healthcare disparities. Social psychological theories of the origins and consequences of these thoughts, feelings, and behaviours offer critical insights into the processes responsible for these disparities and suggest interventions to address them. We present a multilevel model that explains how societal, intrapersonal, and interpersonal factors can influence ethnic/racial health disparities. We focus our literature review, including our own research, and conceptual analysis at the intrapersonal (the race-related thoughts and feelings of minority patients and non-minority physicians) and interpersonal levels (intergroup processes that affect medical interactions between minority patients and non-minority physicians). At both levels of analysis, we use theories of social categorisation, social identity, contemporary forms of racial bias, stereotype activation, stigma, and other social psychological processes to identify and understand potential causes and processes of health and healthcare disparities. In the final section, we identify theory-based interventions that might reduce ethnic/racial disparities in health and healthcare.     

The Organization of a Mental Hospital on the Basis of Group Participation

Group treatment of the chronically mentally ill has often been a fruitless and exasperating experience. The intense emotional responses of group leaders in working with this chronic population reinforces a spiral of repetitive failures. An attempt to intervene in this chronic spiral will be presented by the author's experience in leading a training group of mental health workers who, in turn, lead groups of chronic patients. In particular, the effects of projective identification on various holding environments will be examined by using the methodology of object relations. Understanding and utilizing countertransference responses of the training leader illuminate the unconscious aims of chronic patients to perpetuate their internal and interpersonal lives by their effect on the group leaders who work with them and on each other. This understanding can lead to interventions that have more constructive outcomes.     

The Effect of Parental Stress on the Oral Health of Children

Purpose: Examine the hypothesis that parenting stress was associated with poorer oral health in children. Methods: Ninety primary care-givers of children aged 5–12 years seen for routine dental visits completed the Parenting Stress Index (PSI) and demographic measures. The child's oral health was assessed by the number of decayed, filled, and missing teeth, and by the difference between recommended and actual times for return visits. Results: Lower levels of care-giver age, education, and Child Domain scores on the PSI predicted poorer dental health. Older children were significantly more likely to return on time for their next visit. Conclusions: In this economically stressed sample, children whose parents rate them as easy to care for and children of younger and less well-educated parents were more likely to have poorer oral health. Research on a more diverse population would determine if the results from this study can be generalized to other populations.     

Examining Immediate and Maintenance Effects of a Reading Intervention Package on Generalization Materials: Individual Verses Group Implementation

Fluency has been identified as an important outcome of effective reading instruction, and intervention packages utilizing the method of repeated readings have been shown to improve oral reading fluency. In order to improve the efficiency of these intervention packages, more research is needed on the effectiveness of small group reading interventions. An alternating treatments design was used to compare the effects of two versions of an intervention package that included repeated readings on generalization and maintenance of oral reading rate for 6 second grade students. Both intervention packages included listening passage preview, repeated readings, error correction, and contingent reward. The intervention packages differed only in whether intervention components were provided to students individually or in groups of three. Gains in oral reading rate were observed across conditions, with individual and small group interventions resulting in comparable gains for most participants. Individual differences in performance and implications for reading instruction are discussed.     

Reflective practice and foreign language classroom anxiety: video-stimulated recall at work

Reflective practices have been shown to improve the effectiveness of learning and teaching processes. In this study, video-stimulated recall technique was employed as a method of motivating language learners to reflect on their oral production tasks. In this experimental study, the Foreign Language Classroom Anxiety Scale (FLCAS) was administered to control and treatment groups before and after an eight-week module during which video-stimulated recall interviews were conducted with students in the treatment group. Statistical analyses revealed that pre- and post-test FLCAS scores differed within the treatment group but not within the control group. The results also suggested that stimulated recall is an effective reflective tool which assists students in noticing and reflecting upon the symptoms and causes of anxiety in the classroom.     

Expectations of sensations,discomfort and fear in dental treatment

A hundred dental patients and 40 dentists were asked to describe the sensations, discomfort and fear which they associated with a number of dental treatments. A number of patients were also asked to describe their experiences immediately after routine conservation procedures. It was concluded that although patients could accurately anticipate the pattern of sensations involved in treatment (even if they had not experienced some of the procedures), they expected more intense sensations and greater discomfort and apprehension than they were likely to experience. Dentists expressed more realistic ideas about the sensations produced by dental treatment. The discrepancy in patients' expectations appears to persist in spite of many discontinuing experiences, the fear of treatment being fostered by discomfort and the intensity of sensations expected, by lack of experience and, to a modest degree, by uncertainty about the sensations anticipated. Cognitive theories of fear do not appear to explain all these influences adequately. These observations support the need for information about sensations in treatment to help not so much with the experience of dentistry but rather with its anticipation.     

Examining the initial usability,acceptability and feasibility of a digital mental health intervention for college students in India

Generalised anxiety disorder (GAD) is prevalent among college students in India; however, barriers like stigma, treatment accessibility and cost prevent engagement in treatment. Web- and mobile-based, or digital, mental health interventions have been proposed as a potential solution to increasing treatment access. With the ultimate goal of developing an engaging digital mental health intervention for university students in India, the current study sought to understand students' reactions to a culturally and digitally adapted evidence-based cognitive behavioural therapy (CBT) for GAD intervention. Specifically, through theatre testing and focus groups with a non-clinical sample of 15 college students in India, the present study examined initial usability, acceptability and feasibility of the “Mana Maali Digital Anxiety Program.” Secondary objectives comprised identifying students' perceived barriers to using the program and eliciting recommendations. Results indicated high usability, with the average usability rating ranking in the top 10% of general usability scores. Participants offered actionable changes to improve usability and perceived acceptability among peers struggling with mental health issues. Findings highlight the benefits of offering digital resources that circumvent barriers associated with accessing traditional services. Results build on existing evidence that digital interventions can be a viable means of delivering mental healthcare to large, defined populations.     

Assessing theoretical predictors of long-term medication adherence: Patients’ treatment-related beliefs,experiential feedback and habit development

Patient non-adherence to medication is a pervasive problem that contributes to poor patient health and high healthcare costs. Basic research and interventions have focused thus far on behaviour initiation factors, such as patients’ illness and treatment beliefs. This paper proposes two processes that occur after behaviour initiation that are theorised to contribute to prediction of long-term medication adherence: ‘coherence’ of patients’ beliefs from experiences with treatment and habit development. Seventy-one hypertensive patients reported their treatment-related beliefs, experiences related to treatment efficacy and medication-taking habit strength in a baseline interview. Patients then used an electronic monitoring pill bottle for approximately one month. Patients’ medication habit-strength was the strongest predictor of all adherence measures, explaining 6–27% incremental variance in adherence to that explained by patients’ treatment-related beliefs. Patients’ beliefs and experiences did not predict overall adherence, even for patients with ‘weaker’ habits. However, patients’ experiences were found to predict intentional non-adherence and habit strength was found to predict unintentional adherence. Practitioners may assess patients’ medication-taking habits to get an initial view of their likely adherence to long-term medications. Future research should assess the current theoretical predictions in a hypertension inception sample and in populations with symptomatic conditions.     

Cognitive-Behavioral Therapy for Depression in an Older Gay Man: A Clinical Case Study

Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were deduced from the late-life depression literature, culturally adapted CBT protocols for racial minorities, and the emerging social and developmental psychological theories for lesbian, gay, and bisexual populations. Specific treatment interventions, processes, and outcomes are described to illustrate how these literatures may be used to provide more culturally appropriate and effective health care for the growing, older sexual minority population.     

Motivation for Dental Home Care: Testing a Self‐Determination Theory Model1

The present research developed the Self‐Regulation for Dental Home Care Questionnaire (SRDHCQ), based on self‐determination theory (SDT; Deci & Ryan, 2000 ), and used it in an SDT process model of dental health behaviors and self‐rated oral health. In this model, patients' perceptions of autonomy‐supportive (relative to controlling) dental professionals were expected to positively predict patients' psychological needs satisfaction in treatment. Needs satisfaction was expected to be positively related to autonomous motivation for dental home care and perceived dental competence, which were expected to be positively associated with self‐rated oral health and dental health behaviors. Confirmatory factor analysis of the 5‐factor SRDHCQ model fit the data very well, and a structural equation model supported the hypothesized process model.