Relaxation vs. Cognitively Oriented Therapies for Dental Fear

Abstract

Cognitive therapy has been reported for the treatment of dental phobia, but comparisons with other behavioral treatments are scarce. This study investigated the outcome of two modes of treatment for phobic dental fear. Relaxation and cognitively oriented therapy were compared in a sample of 112 adult fearful dental patients. The patient made questionnaire assessments of background and outcome variables, and the specialist dentist rated successful/non-successful outcome. It was shown that a higher number of patients who received cognitively oriented therapy completed the treatment program, while anxiety was more reduced among patients who received relaxation-oriented therapy. Dropout during the initial phobia therapy with a psychologist was related to lower motivation (willingness to engage in treatment), while failures during dental treatment after the completion of therapy were related to higher levels of general fear and anxiety. A multiple logistic regression model explaining 67% of the variance revealed that the risk of failure was only slightly increased by general fears, while patients with low (below median) motivation ran a 3.6-times-higher risk of dropping out. In conclusion, it was shown that the two treatment methods were both effective in reducing dental phobic reactions. However, while cognitively oriented therapy resulted in a higher number of patients completing therapy, relaxation-oriented treatment generally resulted in a more significant reduction in dental fear as well as in general anxiety and fear. Motivation was found to be a significant predictor of successful treatment outcome.

Keywords

dental anxiety motivation outcome relaxation therapy cognitive therapy.

Get full access to this article

View all access options for this article.

References

Berggren U. (1986). Long-term effects of two different treatments for dental fear and avoidance. JDent Res 65:874-876.

Berggren U. , Carlsson SG (1984). A psychophysiological therapy for dental fear . Behav Res Ther 22:487-492.

Berggren U. , Carlsson SG (1985). Usefulness of two psychometric scales in Swedish patients with severe dental fear. Community Dent Oral Epidemiol 13:70-74.

Berggren U. , Carlsson SG (1986). Qualitative and quantitative effects of treatment for dental fear and avoidance. Anesth Prog 33:9-13.

Berggren U. , Linde A. (1984). Dental fear and avoidance: a comparison of two modes of treatment. J Dent Res 63:1223-1227.

Berggren U. , Carlsson SG , Gustafsson JE , Hakeberg M. (1995). Factor analysis and reduction of a Fear Survey Schedule among dental phobic patients. Eur J Oral Sci 103:331-338.

Berggren U. Carlsson SG , Hagglin C. , Hakeberg M. , Samsonowitz V. (1997a). Assessment of patients with direct conditioned and indirect cognitive reported origin of dental fear. Eur J Oral Sci 105:213-220.

Berggren U. , Carlsson SG , Hakeberg M. , Hagglin C. , Samsonowitz V. (1997b). Assessment of patients with phobic dental anxiety . Acta Odontol Scand 55:217-222.

Booth R. , Rachman S. (1992). The reduction of claustrophobia-I. Behav Res Ther 30:207-221.

10.

Carlsson SG , Linde A. , Ohman A. (1980). Reduction of tension in fearful dental patients . J Am Dent Assoc 101:638-641.

11.

Corah NL (1969). Development of a dental anxiety scale. J Dent Res 48:596.

12.

Corah NL , Gale EN , Illig SJ (1978). Assessment of a dental anxiety scale. J Am Dent Assoc 97:816-819.

13.

de Jongh A. , Muris P. , ter Horst G. , van Zuuren F. , Schoenmakers N. , Makkes P. (1995). One-session cognitive treatment of dental phobia: preparing dental phobics for treatment by restructuring negative cognitions . Behav Res Ther 33:947-954.

14.

Gatchel RJ (1989). The prevalence of dental fear and avoidance: expanded adult and recent adolescent surveys. JAm Dent Assoc 118:591-593.

15.

Geer JH ( 1965). The development of a scale to measure fear. Behav Res Ther 3:45-53.

16.

Getka EJ , Glass CR (1992). Behavioral and cognitive-behavioral approaches to the reduction of dental anxiety. Behav Ther 23:433-448.

17.

Hakeberg M. , Berggren U. (1993). Changes in sick leave among Swedish dental patients after treatment for dental fear. Community Dent Health 10:23-29.

18.

Hakeberg M. , Berggren U. , Carlsson SG (1990). A 10-year follow-up of patients treated for dental fear. Scand J Dent Res 98:53-59.

19.

Hakeberg M. , Berggren U. , Carlsson SG (1992). Prevalence of dental anxiety in an adult population in a major urban area in Sweden. Community Dent Oral Epidemiol 20:97-101.

20.

Hakeberg M. , Gustafsson JE , Berggren U. , Carlsson SG (1995). Multivariate analysis of fears in dental phobic patients according to a reduced FSS-II scale. Eur J Oral Sci 103:339-344.

21.

Harrison J. , Berggren U. , Carlsson SG (1989). Treatment of dental fear: systematic desensitization or coping? Behav Psychother 17:125-133.

22.

Jerremalm A. , Jansson L. , Ost LG (1986). Individual response patterns and the effects of different behavioral methods in the treatment of dental phobia. Behav Res Ther 24:587-596.

23.

Kent G. ( 1997). Dental phobias. In: Phobias. A handbook of theory, research and treatment. Davey G , editor. Chichester, UK: Wiley & Sons, Ltd, pp. 107-127.

24.

Kleinhauz M. , Eli I. , Baht R. , Shamay D. (1992). Correlates of success and failure in behavior therapy for dental fear. J Dent Res 71:1832-1835.

25.

Kleinknecht RA , Bernstein DA (1978). The assessment of dental fear. Behav Ther 9:626-634.

26.

Kleinknecht RA , Klepac RK , Alexander LD (1973). Origins and characteristics of fear of dentistry . JAm Dent Assoc 86:842-848.

27.

Kleinknecht RA , Thorndike RM , McGlynn FD , Harkavy J. (1984). Factor analysis of the dental fear survey with cross-validation. J Am Dent Assoc 108:59-61.

28.

Klepac RK (1988). Behavioral treatments for adult dental avoidance. A stepped-care approach. Dent Clin North Am 32:705-714.

29.

Meichenbaum D. (1977). Cognitive-behavior modification. New York: Plenum.

30.

Milgrom P. , Fiset L. , Melnick S. , Weinstein P. (1988). The prevalence and practice management consequences of dental fear in a major US city. JAm Dent Assoc 116:641-647.

31.

Moore R. (1991). Dental fear treatment: comparison of a video training procedure and clinical rehearsals. Scand J Dent Res 99:229-235.

32.

Moore R. , Birn H. , Kirkegaard E. , Brodsgaard I. , Scheutz F. (1993). Prevalence and characteristics of dental anxiety in Danish adults. Community Dent Oral Epidemiol 21:292-296.

33.

Ost LG (1985). Ways of acquiring phobias and outcome of behavioral treatments. Behav Res Ther 23:683-689.

34.

Spielberger CD , Gorsuch RC , Lushene RE (1970). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists' Press.

35.

SPSS for Windows R (1997 ). Chicago: SPSS.

36.

Stouthard ME , Hoogstraten J. (1990). Prevalence of dental anxiety in The Netherlands . Community Dent Oral Epidemiol 18:139-142.

37.

ter Horst G. , de Wit CA (1993). Review of behavioural research in dentistry 1987-1992: dental anxiety, dentist-patient relationship, compliance and dental attendance . Int Dent J 43:265-278.