Dental phobias and anxieties: evidence for conditioning processes in the acquisition and modulation of a learned fear

The present study investigated some of the factors which differentiate individuals with dental anxieties and phobias from those without such fears. In particular, two questions were addressed: (i) What differentiates subjects who have never been anxious about dental treatment from subjects who at some time have been anxious? and (ii) What factors lead to subjects changing their attitudes either from anxious to relaxed or from relaxed to anxious? The results suggest that the factors which influence the acquisition and modulation of dental anxieties are consistent with the associative and representational processes portrayed in contemporary models of human conditioning. Subjects who reported never having had anxieties about dental treatment were less likely to have had a painful dental treatment than subjects who did report an anxiety. Subjects who did report a painful dental experience but did not acquire anxiety reported a history of dental treatment favourable to the operation of latent inhibition. Subjects who reported that they were good at enduring pain were more likely to report a longer interval between their very first dental treatment and their first painful dental treatment. Under some conditions in which latent inhibition should have precluded the acquisition of a dental fear, an anxiety appeared to be acquired because a very painful experience had attenuated the latent inhibition process. Subjects whose dental anxiety did not remit reported significantly more painful and traumatic dental experiences than subjects whose anxiety did remit.     

Expanding the topography of social anxiety. An experience-sampling assessment of positive emotions, positive events, and emotion suppression

The relation between social anxiety and hedonic activity remains poorly understood. From a self-regulatory perspective, we hypothesized that socially anxious individuals experience diminished positive experiences and events on days when they are unable to manage socially anxious feelings adequately. In this 21-day experience-sampling study, we constructed daily measures of social anxiety and emotion regulation. Greater dispositional social anxiety was associated with less positive affect and fewer positive events in everyday life. Among individuals defined as socially anxious from their scores on a global self-report measure of social anxiety, the number of positive events was lowest on days when they both were more socially anxious and tended to suppress emotions and highest on days when they were less socially anxious and more accepting of emotional experiences. Irrespective of dispositional social anxiety, participants reported the most intense positive emotions on the days when they were both least socially anxious and most accepting of emotional experiences. Possible clinical implications are discussed.     

Dental pessimism: Negative cognitions in fearful dental patients

The relationship between pain expectations and pain experiences was examined in a series of dental patients. Results showed that fearless patients had accurate expectations about dental pain, but fearful patients had inaccurate and negative expectations. The results are discussed within the framework of a cognitive theory of anxiety.     

Fear of routine dental treatment in adults: Its nature and management

Abstract

The fear of dental treatment in adults can be characterised in several ways, loosely related, such as anticipating being afraid, avoiding dental check-ups and seeking treatment only under general anaesthesia. Defined thus, at least a quarter of adults are highly afraid of dentistry. The feared experiences are many, including most frequently, pain. Several studies have shown that anxious patients experience less pain during treatment than they expect. It remains to be confirmed that these are typical experiences because other studies show that local anaesthesia can fail to protect patients from sudden pain in 13% of treatments on average. Expectations of pain are highly resistant to change, the result probably of several influences including distortion in recall of pain-free treatment, intermittent experience of sudden severe pain, expecting pain in order to reduce its impact, and uncertainty about treatment. It has yet to be shown that experience free of discomfort can reduce these expectations. However, relaxation instructions and information about pain management and stop signals can reduce pre-treatment fear. To prevent the onset and the maintenance of anxiety: the prevention of pain is essential; controlled behavioural studies of the treatment of pain and other experiences such as panics are needed. Finally, the need for new instruments to assess all aspects of fear of dentistry is described.     

The effect of pre-treatment enquiries on child dental patient's post-treatment ratings of pain and anxiety

Abstract

The aim of this study was to attempt to replicate a study in adults: to determine whether pre-treatment enquiries about anxiety and pain in children, attending the dentist, influenced their subsequent reports of pain and anxiety immediately after treatment. One hundred and ninety five children aged from seven to 16, attending four Community Dental Clinics, were allocated at random to five groups. Before treatment the first group was asked questions about their dental anxiety, expectations and memories of pain. The second group was asked about dental anxiety and expectations of pain. The third group was asked only about dental anxiety; the fourth was asked only about pain. The fifth, the control group, was asked about none of these topics. All the children were asked after treatment to rate 1) their anxiety about dentistry and 2) their experience of pain in the treatment just completed. The children experienced less pain than they had expected. There were no differences between the groups in disruptiveness or in the amount of pain experienced. However, the children who were asked about both pain and dental anxiety (groups one and two) reported significantly less dental anxiety than the control group. These results are consistent with the conclusion that pre-treatment enquiries about both anxiety and pain have no effect on disruptiveness or the experience of pain but do reduce anxiety about dentistry.     

Health anxiety moderates the effects of distraction versus attention to pain

Little is known about the relationship between health anxiety and chronic pain. The present study explored whether individual differences in health anxiety would influence the response of chronic pain patients to physical therapy. Furthermore, the interaction of health anxiety with coping strategy usage (distraction versus attention) was studied. Participants were 81 chronic pain patients who were interviewed and completed measures of pain, anxiety and cognition following an active physiotherapy session in which they either: (1) attended to physical sensations; (2) distracted from physical sensations or (3) completed the session as usual. Health anxious, compared to non-health anxious, individuals worried more about their health and injury during the session and attended to and catastrophically misinterpreted sensations more frequently. A complex interaction between health anxiety and coping strategy emerged. Among health anxious patients, attention to sensations resulted in lower anxiety and pain than did distraction. It appears as though attention had a short-term anxiety reducing effect for health anxious patients. Among non-health anxious patients, attention resulted in greater worry about health than distraction. Clinical and theoretical implications are discussed.     

Gender and mathematics anxiety: The role of math-related experiences and opinions

Abstract

Research has indicated that women may be particularly prone to experiencing mathematics anxiety and, to account for this, the sex-role socialization hypothesis posits that women are more math anxious because they have had less experience with mathematics and have more negative opinions regarding mathematics. In contrast, the math experiences hypothesis suggests that math anxiety is not truly a gender-related phenomenon, but rather is due to poor mathematical preparation, regardless of gender. The present study pitted the “sex-role” hypothesis against the “math experience” hypothesis in an examination of the relation between gender and math anxiety. One hundred and seventy-one university students completed a measure of math anxiety and a series of questions regarding their math marks, opinions, and experiences throughout their educational history. The findings clearly supported the math experience hypothesis of math anxiety, for differences in math marks, opinions, and experiences were found between non-math-anxious, moderately math-anxious, and highly math-anxious students. The few gender differences that were found indicated that the female students frequently reported higher math marks than those reported by male students. We suggest that the relation between gender and mathematics anxiety may be accounted for by gender-linked reporting biases. The limitations of the study are addressed and suggestions for future research are made.     

Anxiety, pain and type of dental procedure

The anxiety, pain expected and pain experienced of patients arriving for their scheduled dental appointments were measured. The amount of pain expected and experienced was found to be related to the type of dental procedure. Highly anxious patients expected more pain than they experienced when they received drilling/extraction type procedures but the discrepancy was small when they were due to receive a check-up. Low-anxiety patients, by contrast, accurately predicted the amount of pain they would experience, whatever the procedure. The results may explain why anxiety about dentistry is slow to extinguish.     

Interview anxiety across the sexes: Support for the sex-linked anxiety coping theory

The sex-linked anxiety coping theory states that females’ anxiety levels may be less detrimental to their selection test performance because they have more available coping resources and engage in more constructive coping strategies prior to and during selection tests. This research project sought to investigate whether gender moderates the link between interview anxiety and interview performance. Co-op students (N = 125) participated in a mock interview as part of a course requirement. The results indicated that gender moderated the relation between self-rated interview anxiety and interview performance. Males were no more anxious than were females, but experienced significantly greater impairments to performance in the job interview as a result of interview anxiety. Of interest, interviewer-rated interview anxiety did not interact with gender to predict interview performance, which supports preliminary research evidence that perceptions and the experience of interview anxiety are not necessarily congruent.     

Habituation of cognitive and physiological arousal and social anxiety

This study examined differences in habituation between high and low socially anxious Ss. Participants gave three impromptu speeches, each separated by a brief rest interval. Skin conductance and heart rate were monitored during the speeches. Following each speech participants completed self-ratings of nervousness, heart rate, and palmar sweat activity as well as a modified Social Interaction Self Statement Test. Low anxious controls showed significant reduction of negative expectations and self-reported nervousness, heart rate, and sweat activity across the three trials. Actual heart rate of low-anxious subjects also decreased significantly across trials. In contrast, high anxious subjects did not evidence significant decreases in any of the above measures of anxiety and stress across the three trials. Skin conductance measures increased across trials for both groups, but increased more for the high anxious group than low-anxious controls. Results indicate that high anxiety participants are slow to decrease cognitive and autonomic responsiveness to stressful social situations.     

Social skills deficits among the socially anxious: Rejection from others and loneliness

Based on evidence linking social anxiety with social skills deficits, it was hypothesized that socially anxious individuals would exhibit diminished social skills in a naturalistic interaction, relative to socially nonanxious persons, and that they would also elicit rejection from their conversational partners and experience loneliness. Socially anxious and nonanxious persons were surreptitiously videotaped while they waited with partners for an experiment to begin. Analyses of subjects' social skills indicated that, behaviorally, the socially anxious appear very similar to their nonanxious peers. At the same time, however, they exhibited a tendency to negatively misperceive their own social skills. Although socially anxious persons did not elicit significantly more rejection from their conversational partners, they did report being more lonely than nonanxious persons. Socially anxious subjects were also rated by their conversational partners as lower in social skill than were nonanxious subjects. Implications for further study of social skills among the socially anxious are discussed.We would like to thank Richard Davidson for his assistance in recruiting subjects: Dean Geller, Lynn Jorgenson, Joey Kaupie, and Karen Toft for their assistance with data collection; and Andrea Attebery, Monica Bannon, Noreen Checci, Heather Collier, Michelle Givertz, Perry Loeder, Lisa Meyer, Nancy Nell, Beth O'Keefe, Bruce Rist, Becky Sapinski, and Shaunda Wenberg for their assistance as coders.     

Effects of social anxiety and depressive symptoms on the frequency and quality of sexual activity: a daily process approach

Diminished positive experiences and events might be part of the phenomenology of social anxiety; however, much of this research is cross-sectional by design, limiting our understanding of the everyday lives of socially anxious people. Sexuality is a primary source of positive experiences. We theorized that people with elevated social anxiety would have relatively less satisfying sexual experiences compared to those who were not anxious. For 21 days, 150 college students described their daily sexual episodes. Social anxiety was negatively related to the pleasure and feelings of connectedness experienced when sexually intimate. The relationship between social anxiety and the amount of sexual contact differed between men and women—it was negative for women and negligible for men. Being in a close, intimate relationship enhanced the feelings of connectedness during sexual episodes for only individuals low in social anxiety. Depressive symptoms were negatively related to the amount of sexual contact, and the pleasure and feelings of connectedness experienced when sexually intimate. Controlling for depressive symptoms did not meaningfully change the social anxiety effects on daily sexuality. Our findings suggest that fulfilling sexual activity is often compromised by social anxiety.     

Gender differences in social support for socially anxious individuals

Given that social anxiety disorder is a common, chronic, debilitating disorder and socially anxious women appear to have different experiences related to social development and social support than men, it is essential that the gender differences in social anxiety and social support be understood. The present study examined perceived social support quantity and satisfaction in 23 women and 28 men seeking treatment for social anxiety disorder. Contrary to expectations, men and women did not differ on measures of social support. However, younger, unmarried women reported having smaller social support networks and less satisfaction with their social support networks than older, married women. Analyses of socially anxious men did not reveal such a pattern. The current study provides preliminary evidence that younger, single women have social support networks that are less satisfying than the social support networks of older, married women. Inclusion of social support modules within a cognitive behavioral treatment approach for social anxiety disorder may be warranted, particularly for young, unmarried women.     

Gender Differences in Social Support for Socially Anxious Individuals

Given that social anxiety disorder is a common, chronic, debilitating disorder and socially anxious women appear to have different experiences related to social development and social support than men, it is essential that the gender differences in social anxiety and social support be understood. The present study examined perceived social support quantity and satisfaction in 23 women and 28 men seeking treatment for social anxiety disorder. Contrary to expectations, men and women did not differ on measures of social support. However, younger, unmarried women reported having smaller social support networks and less satisfaction with their social support networks than older, married women. Analyses of socially anxious men did not reveal such a pattern. The current study provides preliminary evidence that younger, single women have social support networks that are less satisfying than the social support networks of older, married women. Inclusion of social support modules within a cognitive behavioral treatment approach for social anxiety disorder may be warranted, particularly for young, unmarried women.     

Social anxiety, sexual behavior, and contraceptive use

Two hundred and sixty college students completed a questionnaire that provided information regarding their sexual experience, knowledge, and attitudes; their self-evaluations on dimensions related to sexuality; and their level of heterosocial anxiety (anxiety experienced in social interactions with members of the other sex). Compared with subjects low in heterosocial anxiety, highly anxious respondents were less sexually experienced, engaged in sexual activity less frequently, had fewer sexual partners, were less likely to have engaged in oral sex, expressed a higher degree of apprehension about sex, and had a somewhat higher incidence of sexual dysfunctions. In addition, low socially anxious women tended to use the pill, whereas highly anxious women preferred the condom. High and low heterosocially anxious respondents also differed on self-ratings related to their sexuality but did not differ in their attitudes or knowledge regarding sex. The results are discussed in terms of the cognitive, behavioral, and affective concomitants of social anxiety.     

Implicit and explicit memory bias in anxiety

Previous investigations of recall and recognition for threatening information in clinically anxious subjects have yielded equivocal results. The present study contrasts implicit (word completion) with explicit (cued recall) memory and shows that indices of bias for emotional material derived from the two types of memory are independent of one another. The explicit measure was correlated with trait anxiety scores, but did not clearly distinguish between subjects with clinical anxiety states and normal control subjects. On the implicit memory measure, clinically anxious subjects produced more threat word completions, but only from a set to which they had recently been exposed. These results are taken as evidence that internal representations of threat words are more readily or more persistently activated in anxiety states, although they are not necessarily better elaborated.     

Hyperventilation and anxiety in panic disorder, social phobia, GAD and normal controls

Patients with DSM-III Agoraphobia, Panic Disorder, GAD, Social Phobia and normal controls underwent a series of experimental procedures and measures to determine whether panic attack patients show a greater tendency towards hyperventilation that is independent from their anxiety levels. Contrary to expectations, the Agoraphobia and Panic Disorder patients did not show significantly lower levels of expired pCO2 at rest than the other anxious or non-anxious groups. However, the panic attack patients did show significantly higher levels of anxiety and hyperventilatory symptoms during a hyperventilation test and during breathing 5% CO2 in air. A strong relationship was found between hyperventilatory symptoms and anxiety in all groups of patients and in the controls. On the basis of these results it was concluded that Agoraphobia and Panic Disorder patients do not show a unique tendency toward hyperventilation, but rather that their hyperventilatory symptoms and perhaps intermittent overbreathing episodes are a function of the high levels of anxiety they experience.     

Anxious children and their parents: what do they expect?

Assigned 73 children, ages 7 to 14, to 1 of 3 groups (anxious, clinical control, and nonclinical control) according to their diagnostic status. Within the anxious group, children were assigned to 1 of 2 further groups on the basis of self-reported parental anxiety--either the child anxiety only group or the child + parent anxiety group. All children completed an experimental task (giving a brief talk in front of a video camera), which was the focus for a series of structured family discussions between the child and his or her parents. The aims of the study were to measure and compare across groups (a) the evaluations of children and their parents regarding the child's predicted anxiety and skill level and (b) the effect of the family discussion on children's expectations. Results indicated that, prior to the family discussion, anxious children's expectations of their future performance did not differ from those of control children. Similarly, there were no differences in children's expectations between the child anxiety group and the child + parent anxiety group. Second, compared to mothers in the child anxiety group, mothers in the child + parent anxiety group expected that their children would be more anxious and more likely to choose an avoidant problem solution (but not less skilled). Finally, the family discussion was found to produce no changes in anxious children's expectations of their future performance. The implications of these findings are discussed.