Assessment of dental anxiety: A facet approach

Dental anxiety is a complicated phenomenon, and its multicomponent nature is often not acknowledged in existing measurement instruments. Using a facet design, a new Dental Anxiety Inventory (DAI) was constructed. Facets chosen were: time (made up of four elements: at home, on your way to the denstist, in the denstist's waiting room, in the dental chair), situation (three elements: introductory aspects, dentist-patient interaction, actual dental treatment), and reaction (three elements: subjective feelings, physical reactions, cognitive reactions). Psychometric qualities of the DAI are good. The internal structure of the DAI was studied by linear and nonlinear techniques, and was partially recovered from the data. The construct and criterion validity of the DAI was supported in several studies.     

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.     

Parental fear of negative child evaluation in child social anxiety

Parental anxiety has been linked to child anxiety in various studies. However, specific mechanisms responsible for this relationship in the context of child social anxiety are still largely unknown. A potential mediator between parental and child social anxiety may be parental fear of negative child evaluation (FNCE). To investigate this concept, we collected self-reported data from families with 9- to 16-year old children in a non-clinical sample (458 mother-child dyads and 336 father-child dyads). While both paternal and maternal FNCE predicted child social anxiety, only maternal FNCE mediated the association between maternal and child social anxiety. Maternal report of FNCE was also found to mediate the association between maternal social anxiety and general childhood emotional problems but not externalising problems. Overall, this study is the first to identify a mediator variable that may explain the association between mother and child social anxiety in school-age children. The results shed new light on the mechanisms by which fear and anxiety may be transmitted across generations.     

Parent–child interactions and anxiety disorders: an observational study

Past research has indicated a potential link between anxiety and parenting styles that are characterised by control and rejection. However, few studies have utilised observational methods to support these findings. In the current study, mother–child interactions were observed while the child completed two difficult cognitive tasks. The sample consisted of clinically anxious children (n=43), oppositional defiant children (n=20) and non-clinical children (n=32). After adjusting for the age and sex of the child, mothers of anxious children and mothers of oppositional children displayed greater and more intrusive involvement than mothers of non-clinical children. Mothers of anxious children were also more negative during the interactions than mothers of non-clinical children. The differences between anxious and non-clinical interactions were equivalent across three separate age groups. The results support the relationship between an overinvolved parenting style and anxiety but question the specificity of this relationship.     

The dental anxiety scale and effects of dental fear on salivary cortisol

Only a few studies have investigated use of the Dental Anxiety Scale in dental fear-induced neuroendocrine changes. The present study examined 19 female patients, each at two timepoints across an educational and a treatment session within periodontitis therapy. Subjective measures included a visual analogue scale, the STAI State scale, and the Dental Anxiety Scale. Salivary cortisol was measured in parallel across all four timepoints. Although patients were significantly more aroused and anxious prior to the treatment session, salivary cortisol remained unchanged. However, patients with high Dental Anxiety were significantly more aroused and anxious and showed significantly higher salivary cortisol during the educational session than those with low scores on Dental Anxiety. In conclusion, the Dental Anxiety Scale differentiated mean neuroendocrine change between patients scoring low and high for Dental Anxiety and its use as an accurate tool to identify patients with high dental anxiety should be further studied predictively.     

Exploring the relationships between maternal and child metacognitions and child anxiety

Research has shown that anxiety may be transmitted through verbal information pathways, for example, when parents share their anxious cognitions with their child. Less is known about the influence of parental metacognitions, that is, beliefs regarding thoughts, on child anxiety. We explored the relations between metacognitions in mothers and their children and anxiety in the children. Our study included 111 non‐clinical children aged 8 to 12 years and their mothers. Children rated their metacognitions, worry and anxiety, and mothers rated their metacognitions. Results indicated agreement between maternal and child metacognitions. Maternal metacognitions were positively associated with children's anxiety symptoms and worry, and this relation was mediated by the children's metacognitions. Our results warrant further examination of the role of parental metacognitions in child anxiety.     

A pragmatic study of child dysfluency

The purpose of this paper was to investigate the conversational breakdowns, repairs, and resolution strategies in a conversation between a young dysfluent female child and her mother. Analysis of the conversation revealed five types of breakdowns, four repair types, and two resolution strategies. The majority of dysfluent moments occured in one particular type of breakdown, where the child elaborated on a comment, thereby departing from the parent's tightly formatted agenda that pervaded the interaction. This may have been an attempt of the child to gain control over the situation. This pragmatic analysis demonstrates a potentially useful way of defining the nature of interaction in which stuttering may occur. Therapeutic implications based on this type of pragmatic analysis are given.     

Inconsistent parenting and anxiety in the child

Abstract

This study has examined children's estimates of dental anxiety and pain before and after a standard dental treatment session consisting of a local analgesic and drilling procedures. A method of assessing intensity of pain while receiving dental treatment was devised, and measures of the child's uncooperativeness and the dentist's supportive behaviour including treatment time was collected. Results showed that there was an immediate reduction in dental anxiety following exposure to dental procedures for those children referred because of their previous uncooperativeness. The reduction in anxiety was not attributed to supportive behaviour of the dentist. Children referred as unco-operative recorded higher pain intensity to comparison children.     

The interaction model of anxiety and dental treatment

An empirical test of the interaction model of anxiety was provided by assessing the state anxiety and trait anxiety of 20 female and 7 male dental patients undergoing periodontal surgery. Measures of A-State (PARQ IV), A-Trait (S-R GTA), and perceptions (PSRF) were administered in both a high-stress condition (30 min prior to surgery) and a low-stress condition (4 to 6 days after surgery). It was hypothesized that undergoing periodontal surgery would be perceived as a combination ambiguous/physical danger situation. Accordingly it was predicted that high-ambiguous A-Trait subjects would experience greater decreases in A-State than low-ambiguous A-Trait subjects in proceeding from the high-stress to the low-stress condition. Similarly it was predicted that high-physical danger A-Trait subjects would show greater decreases in A-State than low-physical danger A-Trait subjects. Significant A-Trait × stress condition interactions were not expected to occur for noncongruent A-Trait facets (social evaluation and innocuous). Results indicated that, while the high-stress condition was perceived as an ambiguous/physical danger situation, the A-Trait × stress condition interactions were not significant for ambiguous, physical danger, or innocuous A-Trait facets. Contrary to prediction, a significant interaction was observed between social evaluation A-Trait and stress condition. This finding was explained in terms of the complex relationship between situation perception and situation reaction.     

Generalised anxiety: A controlled treatment study

The effects of anxiety management training were evaluated by allocating 66 generally anxious clients to either a wait list condition, non-directive counselling, or a combination of relaxation and brief cognitive therapy. Anxiety management was significantly more effective than the wait list condition on a number of relevant measures at post-treatment, but there were relatively few differencs between anxiety management and non-directive counselling, either at post-treatment or at 6 months follow-up. Those differences which were found could plausibly be explained in terms of the demand characteristics of training in relaxation or cognitive therapy. It was concluded that anxiety management is clearly better than a non-treatment control condition, but that its superiority to plausible alternatives which lack the specific components thought to be responsible for improvement has yet to be demonstrated.     

Personality and environmental variables associated with dental anxiety

94 adult dental patients' anxiety was assessed. Scores on Spielberger, et al.'s inventory showed attractiveness of the waiting room, age, and Edwards' Harmavoidance were significantly related to anxiety.     

A longitudinal study of the etiology of separation anxiety

A longitudinal examination of the relation between separation experiences and the development of separation anxiety at age 3, 11 and 18 years was conducted. Three associative pathways (Rachman, S.J. (1978). Fear and courage. San Francisco: W.H. Freeman) were assessed. Conditioning events were not related to separation anxiety at age 3. Vicarious learning (modelling) in middle childhood (age 9 years) was the conditioning variable most strongly related to separation anxiety at age 11, accounting for 1.8% of the variance in symptoms. Separation experiences (hospitalisations) before the age of 9 were inversely correlated with separation anxiety at age 18. That is, more overnight hospital stays in childhood were related to less separation anxiety in late adolescence. However, none of these conditioning correlates remained significant predictors of separation anxiety in adjusted regression models. In contrast, certain “planned” separations in early–mid childhood were associated with lower levels of separation anxiety at later ages. Generally, the findings were consistent with predictions from the non-associative theory of fear acquisition. That vicarious learning processes appeared to modulate, albeit to a minor degree, the expression of separation anxiety during mid–late childhood suggests that there may be critical periods during which some individuals are susceptible to the interactive effects of both associative and non-associative processes. These findings serve to illustrate the complexity of fear acquisition, the relevance of developmental factors and the likely interplay between associative and non-associative processes in the etiology of fear and anxiety.