title: Computerized Tool to Manage Dental Anxiety: A Randomized Clinical Trial.
abstract: Anxiety regarding dental and physical health is a common and potentially distressing problem, for both patients and health care providers. Anxiety has been identified as a barrier to regular dental visits and as an important target for enhancement of oral health-related quality of life. The study aimed to develop and evaluate a computerized cognitive-behavioral therapy dental anxiety intervention that could be easily implemented in dental health care settings. A cognitive-behavioral protocol based on psychoeducation, exposure to feared dental procedures, and cognitive restructuring was developed. A randomized controlled trial was conducted (N = 151) to test its efficacy. Consenting adult dental patients who met inclusion criteria (e.g., high dental anxiety) were randomized to 1 of 2 groups: immediate treatment (n = 74) or a wait-list control (n = 77). Analyses of covariance based on intention-to-treat analyses were used to compare the 2 groups on dental anxiety, fear, avoidance, and overall severity of dental phobia. Baseline scores on these outcomes were entered into the analyses as covariates. Groups were equivalent at baseline but differed at 1-mo follow-up. Both groups showed improvement in outcomes, but analyses of covariance demonstrated significant differences in dental anxiety, fear, avoidance, and overall severity of dental phobia in favor of immediate treatment at the follow-up assessment. Of the patients who met diagnostic criteria for phobia at baseline, fewer patients in the immediate treatment group continued to meet criteria for dental phobia at follow-up as compared with the wait-list group. A new computer-based tool seems to be efficacious in reducing dental anxiety and fear/avoidance of dental procedures. Examination of its effectiveness when administered in dental offices under less controlled conditions is warranted (ClinicalTrials.gov NCT02081365).
authors.affiliation: Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA marisol@temple.edu.
authors.forename: M
authors.initials: M
authors.lastname: Tellez
authors.affiliation: Adult Anxiety Clinic of Temple, Department of Psychology, Temple University, Philadelphia, PA, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Potter
authors.affiliation: Adult Anxiety Clinic of Temple, Department of Psychology, Temple University, Philadelphia, PA, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Kinner
authors.affiliation: Adult Anxiety Clinic of Temple, Department of Psychology, Temple University, Philadelphia, PA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Jensen
authors.affiliation: Adult Anxiety Clinic of Temple, Department of Psychology, Temple University, Philadelphia, PA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Waldron
authors.affiliation: Adult Anxiety Clinic of Temple, Department of Psychology, Temple University, Philadelphia, PA, USA.
authors.forename: R G
authors.initials: RG
authors.lastname: Heimberg
authors.affiliation: Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Myers Virtue
authors.affiliation: School of Medicine, Temple University, Philadelphia, PA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA.
authors.forename: A I
authors.initials: AI
authors.lastname: Ismail
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003201:Computers; D016854:Dental Anxiety / Q000523:psychology / Q000628:therapy*; D003729:Dental Care / Q000523:psychology; D004924:Escape Reaction; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009042:Motivation; D062405:Motivational Interviewing; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D016896:Treatment Outcome; D014741:Video Recording; D055815:Young Adult
keywords: cognitive behavioral therapy; dental attendance; dental fear; dental phobia; efficacy; psychoeducation