Manifestations, acquisition and diagnostic categories of dental fear in a self-referred population

This study aimed to clarify how manifestations and acquisition relate to diagnostic categories of dental fear in a population of self-referred dental fear patients, since diagnostic criteria specifically related to dental fear have not been validated. DSM III-R diagnostic criteria for phobias were used to compare with four existing dental fear diagnostic categories, referred to as the Seattle system. Subjects were 208 persons with dental fear who were telephone interviewed, of whom a subsample of 155 responded to a mailed Dental Anxiety Scale (DAS), State-Trait Anxiety Inventory and a modified FSS-II Geer Fear Scale (GFS). Personal interviews and a Dental Beliefs Scale of perceived trust and social interaction with dentists were also used to evaluate a subsample of 80 patients selected by sex and high dental fear. Results showed that the majority of the 80 patients (66%), suffered from social embarrassment about their dental fear problem and their inability to do something about it. The largest cause of their fear (84%) was reported to be traumatic dental experiences, especially in childhood (70%). A minority of patients (16%) could not isolate traumatic experiences and had a history of general fearfulness or anxiety. Analysis of GFS data for the 155 subjects showed that fear of snakes and injuries were highest among women; heights and injections among men. Fear of blood was rarely reported. Spearman correlations between GFS individual items and DAS scores indicated functional independence between dental fear and common fears such as blood, injections and enclosures in most cases. Only in specific types of dental fear did these results support Rachman and Lopatka's contention that fears are thought to summate.(ABSTRACT TRUNCATED AT 250 WORDS)     

A clinical study of child dental anxiety

Dental fear in children was studied using Rachman's theory of fear acquisition. Sixty children from two age groups (7-10 years, 11-14 years) participated in the project. The children were new patients attending a paediatric consultation clinic for specialised dental treatment. Thirty-one were diagnosed as being clinically anxious regarding dentistry and 29 were found to be nonanxious. Information regarding children's past experiences and present level of anxiety was obtained from the examining dentist, the children and their parents. Mothers were also interviewed and observed to ascertain their own anxieties and behaviour. The results showed that of Rachman's three pathways to fear, conditioning appeared largely responsible for the children's development of dental fear. Children's fear was more strongly associated with subjective experience of pain and trauma than with objective dental pathology. Indirect learning processes were found to be of only minor importance in this study.     

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.     

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.     

Anxiety sensitivity, body vigilance and fear of pain

The aim of the present study was to investigate the role of anxiety sensitivity (AS) as a factor relevant to pain and pain persistence. Two studies were conducted to examine the relationship between AS, body vigilance and the experience of pain in non-clinical samples. Study 1 investigated the relationship between AS and body vigilance that was operationalized by the detection latency for innocuous electrical stimuli; trait anxiety and neuroticism were also included as covariates. Results indicated that the high AS group (N=69) presented shorter detection latency than the low AS group (N=70); neuroticism and trait anxiety did not have significant effects on detection latency. Using another sample, Study 2 investigated the relationship between AS, body vigilance, pain tolerance, catastrophizing, and self-reported distress and pain during a cold pressor task. Neuroticism, trait anxiety and fear of pain were included as covariates. Results showed significant differences between high- (N=66) and low- (N=69) AS groups in body vigilance, catastrophizing and tolerance. The covariates neuroticism, trait anxiety and fear of pain did not have any significant effects. No significant differences were found in pain and distress ratings. Results from both studies support the importance of AS in body vigilance and the experience of pain. The theoretical, preventive and clinical implications of these findings are discussed.     

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.     

Is pain sensitivity associated with dental avoidance?

The present investigation examined whether pain sensitivity is associated with dental avoidance. Whereas the aim of the first study was to determine whether pain sensitivity can be distinguished from dental fears and health concerns, the aim of the second study was to examine the structure of cognitive aspects of pain sensitivity, and the aim of the third study was to examine the relationships of pain sensitivity to anxiety sensitivity, fear, pain, and avoidance. In the first study (n = 222), a factor analysis performed with items from the Dental Phobia and Pain Sensitivity Inventory distinguished a pain sensitivity factor from factors relating to dental phobia and health concerns. The factor structure of the Pain Sensitivity Index was examined in the second study (n = 181), and similarly, a pain sensitivity factor was interpreted in the data. The third study (n = 65) found that although pain sensitivity correlated significantly with anxiety sensitivity, these constructs are not identical to each other. For instance, pain sensitivity but not anxiety sensitivity correlated significantly with blood-injury phobia. Pain sensitivity should be taken into account in future studies of dental phobia as pain sensitivity was found to be predictive of pain intensity, and pain intensity was found to be predictive of dental avoidance.     

A bifactor model of negative affectivity: fear and distress components among younger and older youth

The Positive and Negative Affect Schedule for Children (PANAS-C) is a 27-item youth-report measure of positive affectivity and negative affectivity. Using 2 large school-age youth samples (clinic-referred sample: N = 662; school-based sample: N = 911), in the present study, we thoroughly examined the structure of the PANAS-C NA and PA scales and fit a bifactor model to the PANAS-C NA items. Our exploratory factor analytic results demonstrated that negative affectivity is comprised of 2 main components-NA: Fear and NA: Distress-specifically among older youth. A bifactor model also evidenced the best model fit relative to a unidimensional and second-order factor structure of the PANAS-C NA items. The NA: Fear group factor evidenced significant correspondence with external criterion measures of anxiety. However, the original PANAS-C NA scale evidenced equal (and in some cases greater) correspondence with criterion measures of anxiety. We thus recommend continued usage and interpretation of the full PANAS-C NA scale despite the identification of the fear and distress group factors underlying general negative affectivity. The identification of these fear and distress group factors nonetheless suggest that negative affectivity may be comprised largely of a fear and distress component among older youth. The implications of these findings are discussed in relation to better understanding the structure of psychopathology across childhood development and informing the development of future treatments of negative emotions.     

Trauma-related sequelae in individuals with a high level of dental anxiety. Does this interfere with treatment outcome?

This study assessed trauma-related sequelae of 56 highly anxious patients attending a dental fear clinic. It was also examined whether such symptomatology interferes with anxiety reduction in response to a cognitive-behavioral treatment approach. About 34 patients (59%) indicated that they had experienced one or more aversive dental events that could explain the onset of their dental anxiety. There was no difference between the dental anxiety scores of patients who reported such a background and those who did not. Severity of trauma-related symptomatology was indexed by the Impact of Event Scale (IES). The mean IES score of patients with a traumatically induced dental fear was remarkably high (33.0; SD=19.7). Furthermore, there was a strong direct relationship between severity of trauma-related symptomatology and severity of dental anxiety (shared variance was 38%). Two patients (10%) met all DSM-IV diagnostic criteria for Posttraumatic Stress Disorder (PTSD) on the basis of the Self-Rating Scale for PTSD. However, no evidence was found to suggest that either a traumatic background, or level of trauma-related symptomatology, has a negative effect on treatment outcome.     

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.     

The Role of Emotional Distress Tolerance on Fear Responding in a Heights-Fearful Sample: Perceived Versus Actual Behavior

Emotional distress tolerance (EDT)—or the ability to withstand negative emotional states—is considered a transdiagnostic risk factor for psychopathology. Although EDT is theorized to play a role in anxiety development and maintenance, research aiming to delineate the relationship between anxiety and EDT is lacking. The current study tested whether self-reported EDT predicted self-reported and actual avoidance in the presence of feared stimuli using a heights-fearful sample. Moreover, the study tested whether EDT predicted other in-the-moment fear responses, such as peak anxiety, anxious cognitions, and bodily sensations. Participants (N = 128) completed questionnaires assessing fear of heights, negative affect, anxious cognitions, and bodily sensations, as well as two heights behavioral avoidance tasks (BATs). Results demonstrated that EDT did not predict actual avoidance or other in-the-moment fear responses, except for peak anxiety in one BAT. However, EDT predicted self-reported avoidance of heights beyond fear of heights and negative affect. Taken together, results suggest that perception of ability to tolerate emotional distress predicts perception of avoidance of heights, but not actual avoidance of heights or reactions to heights (with the exception of peak anxiety in one BAT). Given these findings, self-reported EDT may not adequately predict how individuals react in anxiety-provoking situations.     

Health care utilisation in patients with non-cardiac chest pain: A longitudinal analysis of chest pain,anxiety and interoceptive fear

Chest pain can be a frightening experience that leads many to seek medical evaluation. The symptom results in costly health care utilisation. Over half of patients referred for cardiac evaluations of chest pain do not obtain definitive medical explanations for their symptoms; these cases are described as non-cardiac chest pain (NCCP). Some patients with NCCP are not reassured after being informed their chest pain is non-cardiac in origin and seek repeated medical evaluation. Co-morbid anxiety and mood disorders often coexist with NCCP and are associated with health care utilisation. The current study examined chest pain, general anxiety, interoceptive fear and health care utilisation in a sample of 196 chest pain patients near the time of cardiac evaluation (Time 1), and 70 of these patients one year later (Time 2). Results indicate that anxiety and interoceptive fear were significantly associated with health care utilisation at Time 1, and only interoceptive fear (at Time 1) predicted health care utilisation at Time 2. This study develops research in this area by examining the relation of anxiety and health care utilisation longitudinally in patients with NCCP.     

Shame-related social anxiety: Replicating a link with various social interaction measures

Abstract

In the present study, 182 young adults (131 men, 51 men: M age=20.2) completed self-report measures of shame and social avoidance/distress, anxiety, desirability, and negative social evaluation. Results supported Lewis (1985) in that shame-proneness was related to social avoidance/distress, interaction anxiety, and fear of negative social evaluation (even when controlling for social desirability). Social distress/avoidance and interaction anxiety also were significant predictors of shame-proneness. Results suggeste that attention to social anxiety may be valuable in the treatment of shameprone individuals.     

Pain perception in patients undergoing bone marrow puncture--a pilot study

The objective of this study was to establish the relationship between the perception of pain, anxiety, and depressive tendency in performance of bone marrow puncture. 93 consecutive patients (62% men, 38% women) from a hematological oncology outpatient department ages 20 to 85 years (M age = 53.7, SD = 15.1) were questioned. On average, the patients had undergone 2.5 (+/- 2.6) punctures. The underlying disease was leukemia in 49%, malignant lymphoma in 41%, another malignant disease in 2%, and there was a benign condition in 8%. Depression and general anxiety were measured using the Hospital Depression and Anxiety Scale (HADS-D). Fear of puncture and perception of pain were registered with visual analog scales. Patients with increased scores of anxiety or depressive tendency on the HADS-D suffered significantly more severely from fear of puncture and pain than patients with normal scores. However, the puncture-related fear in the group as a whole correlated markedly more closely with the intensity and tolerability of pain than did general fear and depressive tendency. This finding must be considered when planning psychological interventions in this group of patients.     

When time stands still: fear-specific modulation of temporal bias due to threat

The current study was designed to test the fear-specific nature of temporal bias due to threat. A temporal bisection procedure was used in which participants (N = 46) were initially trained to recognize short (400 ms) and long (1,600 ms) standard durations. In the test phase, participants were asked to judge whether the duration of computer-generated faces drawn to appear threatening, fearful, and neutral, was closer to either the short or long duration they had learnt earlier. Past research was replicated-the durations of the arousing facial expressions were overestimated relative to a low arousal (neutral) expression. Overestimation for threat was positively correlated with individual differences in fearfulness, trait anxiety, and distress. Multiple regression analyses were carried out to test the hypothesis was that individual differences in anxiety and fearfulness but not other traits would uniquely predict temporal overestimation due to threat. The results showed that fearfulness but not other traits (trait anxiety, anger, distress, activity, and sociability) was a unique and strong (partial r = .47) predictor of increased overestimation for both threatening and fearful expressions. The findings support the hypothesis that threat-related expressions activate a fear-specific system (?hman & Mineka, 2001) or fear representations (Beck & Clark, 1997) in fearful individuals.     

I am going to gag: Disgust cognitions in spider and blood-injury-injection fears

There is mounting evidence that disgust plays an important role in certain anxiety disorders, yet little is known about disgust's cognitive component. The current study introduces a measure of cognitions associated with disgust and contamination to assess the role of disgust-specific primary and secondary appraisals in phobic responding. A multi-modal assessment of blood-injury-injection (BII) and spider phobia was conducted using BII (N=29) and spider (N=30) fearful groups, and a non-fearful control group (N=30). The Disgust Cognitions scale showed good reliability and validity, and distinguished among the groups. For example, relative to the other groups, the spider fear group reported higher disgust cognitions following presentation of a live spider, whereas the BII Fear group reported higher disgust cognitions following a surgery video. Moreover, the scale was associated with multiple phobic indicators (behavioral avoidance, subjective distress, symptom endorsement), suggesting cognitions may be critical to understanding how disgust contributes to anxiety disorders.     

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.     

Enhancing the prediction of self-handicapping

Levels of test anxiety, Type A and Type B coronary-prone behavior, fear of failure, and covert self-esteem were studied as predictors of self-handicapping performance attributions for college women who were placed in either a high- (N = 49) or low- (N = 49) evaluative test or task situation. We hypothesized that test anxiety. Type A or Type B level, and their interaction would account for reliable variance in the prediction of self-handicapping. However, we also theorized that underlying high fear of failure and low covert self-esteem would explain the self-handicapping claims of test-anxious and Type A subjects. The results indicated that only high levels of test anxiety and high levels of covert self-esteem were related to women's self-handicapping attributions.     

Determinants of early- vs late-onset dental fear in a longitudinal-epidemiological study.

A longitudinal investigation of risk factors for early- and late-onset dental fear was conducted. Early-onset dental fear was related to conditioning experiences (indexed via caries level and tooth loss), service use patterns, stress reactive personality and specific beliefs about health professionals. Late-onset dental fear was related to aversive conditioning experiences, irregular service use and an external locus of control. In contrast to recent findings for dental anxiety, personality factors were not strongly related to the onset of dental fear in young adulthood. The key role played by conditioning events in the development of both early- and late-onset dental fear was confirmed. Conditioning events appear to play a different role in the development of dental fear vs dental anxiety. This may reflect important, but largely ignored differences between these two closely-related constructs. Interventions for early-onset dental fear should aim to modify both the dental fear and the personality vulnerabilities that may contribute to the development of dental fear early in the life-course.