Treatment of dental anxiety disorders. Outcome related to DSM-IV diagnoses
Gerd Kvale
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorMagne Raadal
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorMargrete Vika
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorBjørn Helge Johnsen
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorErik Skaret
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorHerborg Vatnelid
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorIngrid Øiamo
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorGerd Kvale
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorMagne Raadal
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorMargrete Vika
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorBjørn Helge Johnsen
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorErik Skaret
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorHerborg Vatnelid
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorIngrid Øiamo
Center for Odontophobia, University of Bergen, Norway
Search for more papers by this authorAbstract
In this study we evaluated treatment effects in 70 consecutively admitted patients in a specialized university clinic for treatment of dental fear. Thirty-three (47%) of the patients fulfilled the diagnostic criteria for Specific Phobia alone (Dental Phobia, DP), 24 (33%) had severe dental anxiety without fulfilling the criteria for phobia (ND), and 13 (19%) fulfilled the criteria for multiple DSM-IV diagnoses (MD). Dental anxiety was measured prior to, immediately after and at follow-up (mean=19 months) using Corah's Dental Anxiety Scale and Dental Fear Survey. Dental attitudes were measured by Getz′ Dental Beliefs Survey. Dental attendance and everyday functioning were measured by self-report. DP patients received significantly more treatment-sessions as compared to the ND group. Despite significant overall reductions in scores on all psychometric instruments from pretreatment to follow up, patients in the MD group reported significantly more severe anxiety at pre- and post-treatment and at follow-up as compared to patients in the ND group. There was no interaction between diagnostic group and assessment occasion (pre treatment, post treatment and follow up) on the self-reported anxiety. Patients reported significant improvements in self-esteem, social relations and everyday functioning, regardless of diagnostic group. Sixty-three percentage of the respondents had been to the dentist within 1 year after completed treatment. Patients treated by dentists who had received supervised training in exposure treatment had significantly more often seen the dentist at follow-up.
References
- 1 Hakeberg M, Berggren U, Carlsson SG. A 10-year follow-up of patients treated for dental fear. Scand J Dent Res 1990; 98: 53–59.
- 2 De Jongh A, Muris P, Ter Horst G, Van Zuuren F, Schoenmakers N, Makkes P. One-session cognitive treatment of dental phobia: preparing dental phobics for treatment by restructuring negative cognitions. Behav Res Ther 1995; 33: 947–954.
- 3 Aartman IH, De Jongh A, Makkes PC, Hoogstraten J. Dental anxiety reduction and dental attendance after treatment in a dental fear clinic: a follow-up study. Community Dent Oral Epidemiol 2000; 28: 435–442.DOI: 10.1034/j.1600-0528.2000.028006435.x
- 4 Thom A, Sartory G, Johren P. Comparison between one-session psychological treatment and benzodiazepine in dental phobia. J Consult Clin Psychol 2000; 68: 378–387.
- 5 Willumsen T, Vassend O, Hoffart A. A comparison of cognitive therapy, applied relaxation, and nitrous oxide sedation in the treatment of dental fear. Acta Odontol Scand 2001; 59: 290–296.
- 6 Dailey YM, Crawford AN, Humphris G, Lennon MA. Factors affecting dental attendance following treatment for dental anxiety in primary dental care. Prim Dent Care 2001; 8: 51–56.
- 7 Roy-Byrne P, Milgrom P, Khoon-Mei T, Weinstein P. Psychopathology and Psychiatric Diagnosis in Subjects with Dental Phobia. J Anxiety Disord 1994; 8: 19–31.
- 8 Öst L-G. Long-term effects of behavior therapy for specific phobia. In: MR Mavissakalian, RF Prien, eds. Long-Term Treatment of Anxiety Disorders. Washington: American Psychiatric Press, 1996; 121–170.
- 9 APA Diagnostic and Statistical Manual of Mental Disorders: Dsm-IV, 4th edn. Washington DC: American Psychiatric Association, 1994.
- 10 Noyes R, JR. The comorbidity and mortality of panic disorder. Psychiatr Med 1990; 8: 41–66.
- 11 Mellman TA, Uhde TW. Obsessive-compulsive symptoms in panic disorder. Am J Psychiatry 1987; 144: 1573–1576.
- 12 Robins LN, Helzer JE, Weissman MM. Lifetime prevalence of specific psychiatric disorders in three sites. Arch General Psychiatry 1984; 41: 949–958.
- 13 Noyes R, Holt CS, Woodman CL. Natural causes of anxiety disorders. In: MR Mavissakalian, RF Pried, eds. Long-Term Treatment of Anxiety Disorders. Washington: American Psychiatric Press, Inc. 1996; 1–48.
- 14 Mavissakalian M. The relationship between panic disorder/agoraphobia and personality disorders. Psychiatr Clin North Am 1990; 13: 661–684.
- 15 Wesner RB. Alcohol use and abuse secondary to anxiety. Psychiatr Clin North Am 1990; 13: 699–713.
- 16 Roy-Byrne P. Anxiety in primary care depression: how does it lead to poor outcomes and what can we do about it? General Hosp Psychiatry 1999; 21: 151–153.
- 17 Emmanuel J, Simmonds S, Tyrer P. Systematic review of the outcome of anxiety and depressive disorders. Br J Psychiatry 1998; 173: 35–41.
- 18 Barlow DH, Hofman SG. Efficacy and dissemination of psychological treatments. In: DM Clark, CG Fairburn, eds. Science and Practice of Cognitive Behaviour Therapy. Oxford: University Press, 1997; 95–117.
- 19 Corah NL. Development of a dental anxiety scale. J Dent Res 1969; 48: 596.
- 20 Corah NL, Gale EN, Illig SJ. Assessment of a dental anxiety scale. J Am Dent Assoc 1978; 97: 816–819.
- 21 Kleinknecht RA. The assessment of Dental Fear. Behav Res Ther 1978; 9: 626–634.
- 22 Smith T, Getz T, Milgrom P, Weinstein P. Evaluation of treatment at a dental fears research clinic. Spec Care Dent 1987; 7: 130–134.
- 23 Spitzer RL, Williams JB, Gibbon M, First MB. The Structured Clinical Interview for DSM-III-R (SCID). I. History, rationale, and description. Arch General Psychiatry 1992; 49: 624–629.
- 24 Williams JB, Gibbon M, First MB, Spitzer RL, Davies M, Borus J, Howes MJ, Kane J, Pope HG, Rounsaville B. The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. Arch General Psychiatry 1992; 49: 630–636.
- 25 Dillman DA. Mail and Telephone Surveys – the Total Design Method. New York: John Wiley & Sons, 1978.
- 26 Hedges Lvo I. Statistical Methods for Meta-Analysis. . Orlando: FL. Academic Press, 1985.
- 27 Kvale G, Berg E, Nilsen CM, Raadal M, Nielsen GH, Johnsen TB, Wormnes B. Validation of the Dental Fear Scale and the Dental Beliefs Survey in a Norwegian sample. Community Dent Oral Epidemiol 1997; 25: 160–164.
- 28 Kvale G, Berg E, Raadal M. The ability of Corah's Dental Anxiety Scale and Spielberger's State Anxiety Inventory to distinguish between fearful and regular Norwegian dental patients. Acta Odontol Scand 1998; 56: 105–109.
- 29 Moore R, Brodsgaard I. Group therapy compared with individual desensitization for dental anxiety. Community Dent Oral Epidemiol 1994; 22: 258–262.
- 30 Moore R, Abrahamsen R, Brodsgaard I. Hypnosis compared with group therapy and individual desensitization for dental anxiety. Eur J Oral Sci 1996; 104: 612–618.
- 31 Carlsson SG, Linde A, Öhman A. Reduction of tension in fearful dental patients. J Am Dent Assoc 1980; 101: 638–641.
- 32 Jerremalm A, Jansson L, Ost LG. Cognitive and physiological reactivity and the effects of different behavioral methods in the treatment of social phobia. Behav Res Ther 1986; 24: 171–180.
- 33 Hakeberg M, Berggren U, Carlsson SG, Gustafsson JE. Repeated measurements of mood during psychologic treatment of dental fear. Acta Odontol Scand 1997; 55: 378–383.
- 34 Berggren U. Long-term Effects of Two Different Treatments for Dental Fear and Avoidance. J Dent Res 1986; 65: 874–876.
- 35 Moore R, BrØdsgaard I, Birn H. Manifestations, acqusition and diagnostic categories of dental fear in a self-referred population. Behav Res Ther 1991; 29: 51–60.
- 36 Moore R, BrØdsgaard I. Differential diagnosis of odontophobic patients using the DSM-IV. Eur J Oral Sci 1995; 103: 121–126.
- 37
Cohen J.
Statistical Power Analysis for the Behavioral Sciences. New York: Academic Press, 1977.
10.1525/ae.2004.31.4.475 Google Scholar
- 38 Mathews A, Rezin V. Treatment of dental fears by imaginal flooding and rehearsal of coping behaviour. Behav Res Ther 1977; 15: 321–328.
- 39 Ost LG. A maintenance program for behavioral treatment of anxiety disorders. Behav Res Ther 1989; 27: 123–130.
- 40 Hakeberg M, Berggren U, Carlsson SG, Grondahl HG. Long-term effects on dental care behavior and dental health after treatments for dental fear. Anesth Prog 1993; 40: 72–77.
- 41 Berggren U, Hakeberg M, Carlsson SG. Relaxation vs. cognitively oriented therapies for dental fear. J Dent Res 2000; 79: 1645–1651.
- 42 Johansson P, Berggren U, Hakeberg M, Hirsch J-M. Measures of dental beliefs and attitudes: their relationships with measures of fear. Commun Dent Health 1992; 10: 31–39.
- 43 Jerremalm A, Jansson L, Ost LG. Individual response patterns and the effects of different behavioral methods in the treatment of dental phobia. Behav Res Ther 1986; 24: 587–596.
- 44 Moore R. Dental fear treatment: comparison of a video training procedure and clinical rehearsals. Scand J Dent Res 1991; 99: 229–235.
- 45 Liddell A, Di Fazio L, Blackwood J, Ackermann C. Long-term follow-up of treated dental phobics. Behav Res Ther 1994; 32: 605–610.
Citing Literature
