The Dental Subscale of the Children's Fear Survey Schedule: Predictive Value and Clinical Usefulness

This study reports on the predictive value and clinical usefulness of the Dutch parental version of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Parents of 718 children (4–12 years) completed this CFSS-DS version before or during the child's visit. The dentist rated the child's dental fear during treatment on a 5-point Likert-type Scale from 1 (not afraid at all) to 5 (very afraid). Reliability analysis was performed, and correlation coefficients between the two measures were calculated. The reliability of the scale proved to be high (Cronbach's = .93) and significant correlation coefficients were found (r = .58 and r = .68, p < .01). The negative predictive value of the CFSS-DS was high (.96), whereas its positive predictive value was relatively low (0.41). It was concluded that the CFSS-DS might be of clinical value as a screening device of dental fear, whereas its predictive value of fearful behavior should not be overestimated.     

Perceived sources and levels of stress,general self-efficacy and coping strategies in preclinical dental students

Dental education programs are known to be highly stressful and stress can affect general health. The aims were to identify sources of stress among preclinical students and to evaluate their perceived levels of stress, self-efficacy and effective coping strategies in a private dental school. One hundred preclinical students in a Turkish private dental school were surveyed using dental environment stress (DES), perceived stress (PSS), general self-efficacy (G-SES) and brief coping scales (Brief-COPE). Age, gender, history of psychiatric treatment, factors that affected the choice of dentistry, choice rank of dental school, scholarship and income was recorded. ‘Exams and grades’ followed by ‘Fear of failing course or year’ were found to be the most stressprovoking factors. The most and the least stressprovoking DES domains were ‘Workload’ and ‘Social stressors’, respectively. ‘Social stressors’ affected male more than female (p < .05). The most and the least common coping strategies were found to be ‘Planning’, and ‘Drug’, respectively. Female used ‘Instrumental support’ more than male (p < .05). Demographic factors had impact on the perceived stress factors and levels, as well as coping strategies. Unlike previous studies establishing high stress levels in dental students, preclinical students displayed moderate level of stress. Clinical dental education might be more responsible for creating stress.     

Motivation and anxiety for dental treatment: Testing a self-determination theory model of oral self-care behaviour and dental clinic attendance

The present study: (1) developed a Self-Regulation Questionnaire for Dental Treatment (SRQDT) based on Self-Determination Theory (SDT; Deci and Ryan, Psychol Inq 11:227–268, 2000), and (2) used it to test a SDT process model of oral self-care behaviours and dental clinic attendance. Patients’ perceptions of autonomy supportive (relative to controlling) dental professionals were expected to be positively associated with patients’ psychological needs satisfaction in treatment, which was expected to be positively related to relative autonomous motivation for dental treatment and perceived dental competence, and negatively related to anxiety for dental treatment. In turn, relative autonomous motivation for dental treatment and perceived dental competence were expected to be positively associated with oral self-care behaviours and dental clinic attendance. Anxiety for dental treatment was expected to be negatively related to dental clinic attendance and positively linked to putting off making a dental clinic appointment. Confirmatory factor analysis of the 5 factor SRQDT model fit the data very well, and a structural equation model supported the hypothesized process model.     

Predicting dental attendance from dental hygienists’ autonomy support and patients’ autonomous motivation: A randomised clinical trial

Objective: To test the hypothesis that a Self-Determination Theory (SDT) intervention designed to promote oral health care competence in an autonomy-supportive way would predict change in caries competence relative to standard care. Further, to test the SDT process path-model hypotheses with: (1) the intervention and individual differences in relative autonomous locus of causality (RALOC) predicting increases in caries competence, which in turn would positively predict dental attendance; (2) RALOC negatively predicting dental anxiety, which would negatively predict dental attendance; (3) RALOC and caries disease referred to the dentist after an autonomy-supportive clinical exam directly positively predicting dental attendance; and (4) the intervention moderating the link between RALOC and dental attendance.

Design: A randomised two-group experiment was conducted at a dental clinic with 138 patients (M_age = 23.31 yr., SD = 3.5), with pre- and post-measures in a period of 5.5 months.

Results: The experimental model was supported. The SDT path model fit the data well and supported the hypotheses explaining 63% of the variance in dental attendance.

Conclusions: Patients personality (RALOC) and hygienists promoting oral health care competence in an autonomy-supportive way, performance of autonomy-supportive clinical exams and reductions of anxiety for dental treatment have important practical implications for patients’ dental attendance.     

Influence of response time frame on mood assessment

Abstract

Dental anxiety and the related avoidance of dental treatment can result in severe impairment of health. We investigated the influence on avoidance behavior of phobic severity, gender, characteristics related to generalized anxiety and depression, such as dysfunctional cognitions and sensitivity of bodily symptoms, as well as personality traits of self-efficacy and locus of control. Forty-eight dental phobics were given an initial assessment and avoidance behavior was determined by the degree of observance of three subsequent dental appointments. Principal component analysis revealed separate factors for trait and phobic anxiety as well as for avoidance and dysfunctional cognitions. Women showed a higher degree of avoidance than men. Regression analysis revealed a high desire for control over dental treatment combined with a low level of perceived control as the only significant predictor variable of avoidance. The results suggest that avoidance behavior in dental phobia could be reduced by extending patients’ control over treatment conditions.     

The Affective Style Questionnaire: Development and Psychometric Properties

Affective style is an individual difference variable that refers to tendencies for regulating emotions. The emotion research literature has consistently identified three general strategies to handle emotional reactions: some strategies are aimed at re-adjusting affect to adapt successfully to situational demands; other strategies are intended to conceal or suppress affect; and a third approach is to tolerate and accept emotions, including unwanted and aversive reactions. We conducted two studies to develop a self-report measure to assess these affective styles. In the first study (n = 434), a list of 127 items related to this construct was administered. A factor analysis supported three factors: habitual attempts to conceal or suppress affect (Concealing subscale; 8 items), a general ability to manage, adjust, and work with emotions as needed (Adjusting subscale; 7 items), and an accepting and tolerant attitude toward emotions (Tolerating subscale; 5 items). The scale showed satisfactory internal consistency. Furthermore, the respective subscales showed different patterns of relations with existing instruments measuring similar constructs. Findings were cross-validated in an independent sample (n = 495). The factor structure and results of psychometric analyses were replicated. The final 20-item Affective Style Questionnaire is a brief instrument to measure individual differences in emotion regulation.     

Changing dominance in mixed profession groups: putting theory into practice

An extended professional identity theory is proposed to enhance interprofessional collaboration. The purpose of this study is to investigate whether comparative feedback on interprofessional interaction can decrease the degree of profession-based dominance and general dominance in mixed profession groups. This observational study comprised a randomized double-blind pretest-posttest control group design with 19 mixed profession groups (10 intervention and nine control groups, each with three dental and three dental hygiene students). All groups received reflective feedback during two consecutive two hour team development meetings. Intervention groups also received comparative feedback. Profession-based dominance concerned the sum of three observation items (conversational turn-taking, dominance and contributing ideas) with a three-point scale: ?1 = dental dominance, 0 = no dominance, +1 = dental hygiene dominance. Polychoric correlations confirmed positive associations with the latent trait and an unidimensional underlying structure. Observation items were internally consistent (α > .70). General dominance concerned the sum of absolute values of observation items with a minimum value of zero (no dominance) and the maximum value of three (strong dominance). A two-way factorial ANOVA was performed. The results revealed a significant interaction effect with regard to general dominance, F(1,17) = 6.630, p = 0.020 and large effect size (partial eta squared = 0.28). Comparative feedback on interprofessional interaction decreases general dominance in mixed profession groups.     

The self and others in the experience of pride

Pride is seen as both a self-conscious emotion as well as a social emotion. These categories are not mutually exclusive, but have brought forth different ideas about pride as either revolving around the self or as revolving around one’s relationship with others. Current measures of pride do not include intrapersonal elements of pride experiences. Social comparisons, which often cause experiences of pride, contain three elements: the self, the relationship between the self and another person, and the other person. From the literature on pride, we distilled three related elements; perceptions and feelings of self-inflation, other-distancing, and other-devaluation. In four studies, we explored whether these elements were present in pride experiences. We did so at an implicit (Experiment 1; N?=?218) and explicit level (Experiment 2; N?=?125), in an academic setting with in vivo (Experiment 3; N?=?203) and imagined pride experiences (Experiment 4; N?=?126). The data consistently revealed that the experience of pride is characterised by self-inflation, not by other-distancing nor other-devaluation.     

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.     

Stress reactions following acute situations involving moral challenges among health care professionals

Many health care professionals have to make morally difficult decisions during acute, stressful situations. The aim was to explore the applicability of an existing qualitatively developed model of individual reactions among professional first responders following such situations using a quantitative approach. According to the model, the interaction of antecedent individual and contextual characteristics affect the immediate emotional reactions to acute, stressful events involving a moral dilemma. Continuous coping efforts and the quality of social support will also affect the long‐term positive and negative reactions to the event. The participants (n = 204, about 50% response rate) represented three Swedish health care professions stationed at a university hospital and a regional hospital: Physicians (n = 50), nurses (n = 94) and “others” (n =60, mainly social welfare officers and assistant nurses). Except for the personality dimension emotional stability which was measured using an established instrument, all measurement scales were operationalizations of codes and categories from the qualitative study (ten scales altogether). Four multiple regression analyses were performed with long‐term positive and negative reactions in everyday acute and morally extremely taxing situations respectively as dependent variables. The outcome showed that long‐term positive reactions covaried with much use of the coping strategies Emotional distancing and Constructive emotional confrontation and a perception of a well‐functioning Formal social support. Regarding long‐term negative reactions, higher age and little use of Emotional distancing accounted for much of the variance. Immediate emotional reactions also contributed significantly. Conclusion: the results largely supported the model concepts and their assumed relationships.     

Dental pain related to quality of life and mental health in South Korean adults

High levels of stress, anxiety and depression have been reported in patients with orofacial pain. Dental pain has the potential to reduce quality of life (QOL), and pain relief is important aspect of QOL. The purpose of this study was to assess the relationships of dental pain with QOL and mental health using a nationally representative, population-based study. This study analyzed data from the 2012 Korea National Health and Nutrition Examination Survey (N = 5469). Oral health status was assessed using the oral health questionnaire, and oral examination was performed by trained dentists. Health-related QOL (HRQOL) was evaluated using EQ-5D and EQ-VAS, and mental health was evaluated by questionnaires. Logistic regression was applied to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Among 5469 adults, 1992 (36.42%) presented self-reported dental pain. Participants with anxiety/depression or pain/discomfort, and participants with stress, melancholy, suicidal thought or depression showed significantly higher prevalence of dental pain. After adjusting for covariates, five aspects of QOL and five aspects of mental health were related with dental pain. The AORs (95% CI) for dental pain were 1.39 (1.06–1.81) for mobility, 1.77 (1.19–2.63) for self-care, 1.38 (1.02–1.85) for usual activities, 1.73 (1.43–2.09) for pain/discomfort and 1.50 (1.13–1.98) for anxiety/depression. For mental health status factors, the AORs (95% CI) for dental pain were 1.29 (1.11–1.51) for stress, 1.37 (1.09–1.74) for melancholy, 1.26 (1.01–1.58) for suicidal thoughts, 1.43 (.93–2.19) for consultation to psychiatrist and 1.53 (1.07–2.19) for depression. This study showed that dental pain has an association with lower HRQOL and worse mental health status in South Korean adults.     

General and specific fears in referred and self-referred adult patients with extreme dental anxiety.

The levels of, and relationships between, dental fear and general fears and phobias were studied in 109 adult patients at a specialized dental fear clinic using two dental fear scales (the Dental Anxiety Scale and the Dental Fear Survey) together with the Fear Survey Schedule II (FSS-II) and some additional fear items. Referred and self-referred fearful dental patients answered mailed questionnaires in conjunction to being put on a 1 yr waiting list for treatment. Among feared objects and situations the separate item 'pain' revealed the highest mean scores for both men and women, followed by fear of suffocating, death of a loved one and sharp objects among women, and death of a loved one, suffocating and hypodermic needles among men. With few exceptions, women scored higher than men. The frequencies of extreme fears (6 and 7 on a 7-point scale) were high and 92.7% of the patients reported at least one extreme fear. Half of the subjects (49.5%) reported five fears or more. It was also shown that a number of FSS-II items correlated to dental fear indicating a relationship between general and dental fear. These results indicated that a large proportion of these dentally fearful individuals were prone to fear-associated reactions and behaviors, which has previously been shown to negatively influence the prognosis of treatment.     

Effort and negative affect interact to predict cardiovascular responses to stress

Objective: Although traditional models posit that negative emotional responses to stress increase cardiovascular reactivity (CVR), laboratory studies have generally not found a strong emotion–CVR association. In this paper, we took a multidimensional approach to examining psychological reactions to stress in three studies.

Methods: In each study we assessed the amount of effort exerted by a participant and the negative affect (NA) felt by the participant with different self-reported measures and an effort behavioural measure.

Results: Our findings consistently demonstrated that NA was associated with CVR when effort was relatively high, but not when effort was relatively low.

Conclusion: This suggests that the weak NA–CVR correlations reported in past research may have been confounded by a third effort-related variable and that CVR is significantly associated with NA under certain circumstances. Furthermore, our findings suggest that by considering the multidimensional nature of psychological responses to stress, we may come to better understand the links between stress-related emotion and physiology.     

What motivates lay third parties to take sides in a conflict? Examining the relationships between the Big Five personality traits and side‐taking motives

Taking sides is one of the reactions available to third parties in handling a dispute. From the perspective of individual differences, this study was aimed at identifying lay third parties' motives for side taking and exploring their relations with the Big Five personality traits. We tested our assumptions using three samples: A Dutch student sample (n = 111), a Dutch employee sample (n = 101) and a Chinese student sample (n = 124). The findings revealed four types of side‐taking motives: Moral, relational, reward‐approaching and sanction‐avoiding motives. The results also showed that individuals' personality traits were relevant to the four types of side‐taking motives: Agreeableness was associated with the relational motive for side taking, and intellectual autonomy was associated with the reward‐approaching motive, the sanction‐avoiding motive and the relational motive for side taking. Implications and explanations of these findings are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Spared at Random: Survivor Reactions in the Gay Community1

Many gay men who have tested negative for HIV were sexually active prior to a general awareness of how HIV is transmitted. Based on the work of Lifton (1980), such HIV-negative gay men may be considered “survivors” since they have witnessed the deaths of many members of their community and have been spared. Survivors may be expected to manifest one or more of three survivor reactions: guilt about surviving (HIV-related guilt), anxiety about dying (AIDS-related death anxiety), and blunted affect. The present study employed structural equation modeling in samples of HIV-negative (N= 129) and HIV-positive (N= 95) gay men to assess psychological and behavioral variables predictive of the presence of a survivor reaction. Survivor reactions were uniquely predicted among HIV-negative gay men. The larger the number of sexual partners HIV-negative gay men reported having had prior to 1984, the more likely they were to experience a survivor reaction. Greater satisfaction with social support from gay friends, and, indirectly, gay-related community group involvement, was associated with being less likely to experience a survivor reaction.     

Applicant Reactions in Selection: Comprehensive meta‐analysis into reaction generalization versus situational specificity

This paper reports a comprehensive quantitative summary into applicant reactions to popular methods of employee selection. A detailed search of published and unpublished studies resulted in a final sample (k) of 38 independent samples covering 10 popular candidate assessment methods. Applicant reactions primary studies included samples from 17 countries internationally. Counter to previous suggestions for the situational specificity of applicant reactions, findings showed considerable similarity supporting the reaction generalizability hypothesis. Reaction favorability was structurally similar across countries and revealed a three‐tier clustering of overall favorability perceptions –most preferred (work samples, interviews), favorably evaluated (resumes, cognitive tests, references, biodata, personality inventories), and least preferred (honesty tests, personal contacts, graphology). Some differences in applicant reactions to dimension‐specific perceptions were found, however. Further analyses revealed strong positive correlations between favorability ratings and their validity and international usage. Implications for future research and ramifications for practice are considered in conclusion.     

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.     

General self-efficacy,dental anxiety and multiple fears among 20-year-olds in Norway

This paper examines the extent to which low general self-efficacy and painful dental and medical experiences are related to dental anxiety, multiple fears and to avoidance of dental care. A total of 754 20-year-olds completed a series of questionnaires, including the General Self-efficacy Scale (GSE), Geer Fear Scale (GFS) and Dental Fear Survey (DFS). Females had lower self-efficacy, higher dental anxiety and higher scores on the GFS than males. Multivariate analyses (linear stepwise regression) indicated that painful dental experiences, a high score on the GFS and negative opinions about own dental health explained 37% of the variance in DFS scores. Self-efficacy had no predictive power for dental anxiety, and only dental anxiety had predictive power for dental avoidance behavior. Thirty-eight percent of the total variance in GFS scores was explained by the following variables: being a female, high dental anxiety (DFS), low general self-efficacy (GSE) and low educational level of the mother.     

Dimensions of information processing: physiological reactions to motion pictures

Information processing is studied using physiological reactions to motion pictures as a major tool. In study I (N=44) physiological reactions are subjected to multivariate analysis revealing three major dimensions: familiarization, effort, and readiness (cf. Pribram and McGuinness, 1992). Each dimension contrasts controlled processing with automatic processing. In study II (N=72) and study III (N=96) the dimensions are tested. In those studies specific information is provided prior to film onset and the effects on the physiological reactions are studied. The results generally confirm the model. Study IV (N=44) is concerned with individual differences in information processing. Reactions to seven films are analysed with generalizability for each dimension separately. The results show that individual dimension scores are highly consistent across different situations. In the discussion it is argued that the three information processing dimensions identified here can be conceived as stable personality dispositions, underlying individual differences in learning and overt behaviour. Copyright © 2000 John Wiley & Sons, Ltd.     

Presence,Content, and Characteristics of Memories of Individuals with Dental Phobia

Knowledge about memories of distressing events underlying fears and specific phobias is limited. This study assessed (1) the presence, content, and characteristics of memories of events that initiated or exacerbated dental anxiety levels; and (2) the relationship between dental trait anxiety and some key features of these memories. This study used a semi‐structured interview and included dental phobics (n = 42), subthreshold dental phobics (n = 41), and normal controls (n = 70). Dental phobics were more likely to report a memory underlying their anxiety than the normal controls. Moreover, dental phobics' memories were reported as more vivid, disturbing, and more intensely relived than the memories of the normal controls. Greater severity of dental trait anxiety was significantly associated with greater disturbance of patients' memories. The results suggest that memories of distressing events play a significant role in the development of dental phobia and that their characteristics are associated with severity of dental trait anxiety. Copyright © 2015 John Wiley & Sons, Ltd.