Cognitive Behavioral Therapy for Dental Phobia and Anxiety E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 532

Veröffentlichungsjahr: 2013

Beschreibung

The first book to describe evidence-based treatment of dental phobia using brief CBT, based on the pioneering single-session treatment for specific phobias developed by Lars-Göran Öst.

• Brings together research, experience and techniques from clinical psychology and dentistry to describe evidence-based treatment of dental phobia in clinical and dental contexts
• Chapters describe epidemiology, diagnosis and differential diagnosis, symptoms, clinical characteristics and consequences, and aetiology of dental phobia
• Also covers related issues including intra-oral injection phobia, dental treatment of fearful children, and the use of medication to supplement psychological treatment of fear

Leseprobe

Contents

Contributors

Preface

Organization of the Book

Acknowledgements

Part I Background, Assessment and Aetiology

1 Symptoms, Clinical Characteristics and Consequences

Introduction

Symptoms, Characteristics and Consequences of Dental Anxiety and Dental Phobia

Conclusion

2 Background Description and Epidemiology

Background

Dental Fear, Dental Anxiety and Dental Phobia

Consequences

Measurement of Dental Fear and Anxiety

Prevalence

Conclusion

3 Assessment of Dental Phobia and Anxiety

Differential Diagnoses

Assessment Tools

Future Developments

4 Aetiology of Dental Phobia

Introduction

Psychological and Interpersonal Aspects of Dental Treatment

Elements of the Fear Reaction

Aetiological Theories of Dental Fear and Anxiety

The Multi-factorial Aetiology of Dental Phobia

From Dental Fear to Dental Phobia – Three Vicious Circles

General Conclusions

5 Intra-Oral Injection Phobia

Blood-Injury-Injection Phobia

Prevalence, Subtypes and Gender Differences

Catastrophic Beliefs in BII Phobics

Aetiology

Overlap between BII Phobia and High Dental Anxiety

Dental Health in Intra-Oral Injection Phobics

Quality of Life in Persons with BII Phobia

Assessment of BII Anxiety

Clinical Challenges

Case Presentation

6 Dental Anxiety in Children and Adolescents

Definitions of Dental Fear and Anxiety and Dental Behaviour Management Problems

Relationship between Dental Fear and Anxiety and Behaviour Management Problems

Prevalence

Psychological Factors Associated with the Development of DFA and DBMP

Part II Treatments

7 Cognitive Behaviour Therapy

The Birth and Early Development of Behavior Therapy

The Birth and Early Development of Cognitive Therapy

CBT: The Combination of Two Therapies

Characteristic Features of Cognitive Behaviour Therapy

Myths and Misconceptions about CBT

Important CBT Principles

Treatment Principles in CBT for Emotional Disorders

The Evidence Base of CBT

Which CBT Treatments are effective for which Disorders?

8 Multimodal Cognitive Behavioural Treatment

Historical Background

The First Treatment Method

The Revised Treatment

The Current Treatment

9 One-Session Treatment of Dental Phobia

Background

General Description of the One-Session Treatment

One-Session Treatment of Dental Phobia

Training Dentists to do the One-Session Treatment

Evaluation of Dentists Carrying Out OST

10 The Combined Treatment

Background

Characteristics of the Dental Treatment Situation

The Dentist as Therapist

CBT in the Dental Chair

Intra-Oral Injection Phobia

Patients with Blood-Injury-Injection (BII) Phobia

Patients Afraid of Drilling

Patients Afraid of Extractions

Patients Afraid of Endodontic Treatment

Patients with Gagging Problems

Coping with Future Dental Treatment

When Does the Psychologist Need to be There?

Conclusions

11 Dental Treatment under Sedation

Introduction

Pain and Pain Control

Indications for Sedation and General Anaesthesia

Preoperative Assessment

Sedatives and Techniques

Side Effects and Safety

Documentation and Records

Sedation and CBT

12 Effects of Cognitive Behavioural Treatments

Description of Treatments Evaluated in Randomized Controlled Trials

Systematic Review

Meta-Analysis

Summary and Conclusions

Part III Cultural Aspects, Prevention and Future Research

13 Different Treatment Approaches in Different Cultures and Health-Care Systems

Introduction

Dental Fear and Phobia in Non-Western Countries

Considerations for CBT in Non-Western Cultures

Providing CBT in Different Health-Care Systems

Alternatives to Face-to-Face CBT for Dental Phobia

Pharmacological Strategies

Summary

14 Prevention of Dental Phobia

Aetiology as the Background for Prevention

Dentist Behaviour

Meeting the Child and the Parent in the Waiting Room

Child and Parent in the Dental Clinic

Behaviour Shaping

Cognitive Behavioural Therapy in Fearful Children and Adolescents

Exploring the child’s’ negative thoughts

Explaining the fear and the principles of gradual exposure

The Complexity of Pain

Pain Control

Local Anaesthesia in Children with Blood-Injury-Injection (BII) Phobia Activation

Patient Control

Pharmacological Methods

Aspects of Prevention in the Dental Health Service

The Role of the Dental Hygienist (DH) in Prevention and Treatment of DA and BMP

Counselling and Health Behaviour Change

Conclusions

15 Future Research and Applications

Symptoms, Clinical Characteristics and Consequences

Epidemiology

Assessment

Aetiology

Intra-Oral Injection Phobia

Dental Anxiety in Children and Adolescents

Multi-Modal Cognitive-Behavioural Treatment

One-Session Treatment

The Combined Treatment

The Meta-analysis

Prevention of Dental Phobia

Conclusions

Index

This edition first published 2013© 2013 John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Cognitive behavioral therapy for dental phobia and anxiety / edited by Lars-Göran Öst, Erik Skaret. pages cmIncludes bibliographical references and index.

ISBN 978-1-119-96072-0 (hardback) – ISBN 978-1-119-96071-3 (paper) 1. Fear of dentists. 2. Cognitive therapy. 3. Evidence-based dentistry. 4. Dentist and patient. I. Öst, Lars-Göran, editor of compilaton. II. Skaret, Erik, editor of compilation. RK53.C64 2013616.85¢22–dc23

2012045562

A catalogue record for this book is available from the British Library.

Cover design by Cyan Design

Contributors

Maren Lillehaug Agdal, DDS, PhD, is a dentist at the Center for Odontophobia in Bergen, Norway. The title of her PhD thesis in 2011 is ‘Dental Phobia and Intra-Oral Injection Phobia: Oral Health, Dental Treatment Needs and Quality of Life’.Ulla Wide Boman, PhD, is Associate Professor at the Department of Behavioral and Community Dentistry, University of Gothenburg, Sweden. Her research focuses on ­behavioural aspects of oral health. She also works as a clinical psychologist at the Dental Fear Research and Treatment Clinic (DFRTC), Swedish Public Dental Service.David M. Clark, DPhil, is Professor of Experimental Psychology at Oxford University, UK. He is a world-leading researcher in anxiety disorders and has carried out a large number of randomized controlled trials (RCTs) for various anxiety disorders. Three of his cognitive treatments are evidence-based, for: panic disorder, social phobia and post-traumatic stress disorder.Magnus Hakeberg, DDS, PhD, is Professor of Dental Public Health and Head of the Department of Behavioral and Community Dentistry, Institute of Odontology, the Sahlgrenska Academy, University of Gothenburg, Sweden. He is a research director at the Public Dental Service, Region Västra Götaland, Sweden and a dentist and specialist in endodontology.Kristin Haukebø, PhD, is a psychologist within the Consultation & Liaison team, Oslo University Hospital, Norway. The title of her 2011 thesis is ‘Cognitive, Behavioral and Neural Correlates of Dental and Intra-Oral Injection Phobia. Results from One Treatment and One FMRI Study of Randomized, Controlled Design’.Lisa J. Heaton, PhD, is Acting Assistant Professor of Oral Health Sciences and a clinical ­psychologist, providing cognitive behaviour therapy (CBT) in the Dental Fears Research Clinic at the University of Washington, USA. With Peter Milgrom and Philip Weinstein, she co-authored the third edition of the textbook, Treating Fearful Dental Patients, in 2009.Gunilla Klingberg, DDS, PhD, is senior consultant in paediatric dentistry at Mun-H-Center, the Swedish National Orofacial Resource Center for Rare Diagnoses, and Associate Professor at the Sahlgrenska Academy, University of Gothenburg, Sweden. Her research concerns ­orofacial aspects of rare disorders, behavioural sciences in odontology, pain, and qualitative research methods applied to dental sciences.Gerd Kvale, Dr Psychol, is Professor of Clinical Psychology at the University of Bergen, Norway. She was one of the founders of the Center for Odontophobia, University of Bergen. Her research has focused on dental phobia, social phobia, panic disorder, and obsessive-compulsive disorder.Jesper Lundgren, PhD, is an Associate Professor at the Department of Psychology, University of Gothenburg, Sweden and a psychologist at the Public Dental Service, Region Västra Götaland, Sweden. He has worked for over 15 years in the field of psychology and dentistry with his main focus of research on dental fear and other health psychological issues.Peter Milgrom, DDS, is Professor of Oral Health Sciences and Pediatric Dentistry at the University of Washington, USA. He was Director of the Dental Fears Research Clinic at the university for nearly 25 years. His latest book (with Philip Weinstein and Lisa Heaton), Treating Fearful Dental Patients, was published in 2009.J. Timothy Newton, PhD, is Professor of Psychology as Applied to Dentistry at King’s College Dental Institute in London, UK. In 2008, with Koula Asimakopoulou and Suzanne Scott, he founded the King’s College London Dental Institute Health Psychology Service for individuals who are dentally anxious.Lars-Göran Öst, PhD, is Professor of Clinical Psychology at Stockholm University, Sweden. During the last 40 years he has carried out RCTs on most anxiety disorders in adults and children, and has developed three evidence-based CBT treatments: one-session treatment for specific phobia, applied relaxation for generalized anxiety and applied tension for blood phobia.Magne Raadal, DDS, PhD, is Professor Emeritus (Dentistry) at University of Bergen, Norway. He graduated in 1966, became Specialist in Pediatric Dentistry in 1981, PhD in 1984, and Professor in Pediatric Dentistry in 1993. He was Dean of Faculty of Dentistry, University of Bergen, from 2002 to 2009.Erik Skaret, DDS, PhD, is Professor at the University of Oslo, Department of Pediatric Dentistry and Behavioral Sciences. He was Head of the Center for Odontophobia, University of Bergen, from 2001 to 2008, and has many years of experience with psychological treatment of dental phobia based on cognitive behaviour therapy.Margrethe Vika, PhD, is a clinical psychologist at the Center for Odontophobia in Bergen, Norway. She completed her PhD in clinical psychology at the University of Bergen in 2008. The title of her thesis is ‘Fear of Intra-Oral Injections among Adolescents and Adults – Prevalence, Consequences and Treatment’.Tiril Willumsen, DDS, PhD, is Professor at the University of Oslo and has carried out a randomized control trial on dental phobia using variants of cognitive treatment and applied relaxation. She lectures about dental treatment in vulnerable patients, e.g. with histories of childhood sexual abuse, eating disorders and diseased elderly.

Preface

This book is a result of a multi-disciplinary research cooperation between dentists and ­psychologists. It is meant to help students and professionals in dentistry to understand the complexity of the anxiety phenomenon, and in psychology to understand the specific situation for the dental phobia patient, and bridge the gap between dentistry and psychology. The book was first planned to be written for Scandinavia, and most of the authors are therefore from these countries. This plan was then changed and a few more authors outside Scandinavia were included. However, we know many researchers in behavioural science in dentistry and in ­psychology around the world that would have been very qualified for being included on the author list of the present book.

Being a practising dentist is in many ways a challenging and stressful job. Before they leave the surgery after a long day with patients they often have a brief glance at the list of scheduled appointments for tomorrow. Some names on the schedule can result in unpleasant feelings: ‘I hope the patient after lunch cancels or does not show up’. The first thought in the morning is: ‘Today this patient is coming again. I always feel stressed and uncomfortable because I don’t know how to treat him. I know the patient is doing his best, but I am afraid of losing my patience and saying things like: “You have to leave my office. It is impossible for me to do my job”. These patients make me feel incompetent and unsuccessful. The treatment doesn’t have the quality it should have, and I am afraid this will have a negative influence on my reputation. I want to be a good dentist’. Being able to help people with dental anxiety or dental phobia to manage ordinary dental treatment provides the job as a dentist a new dimension.

Clinical psychologists know how to treat psychological disorders. They also know that there are different treatment approaches, and they probably also know that cognitive behaviour therapy (CBT) is the treatment of choice for specific phobias. However, they don’t know much about the dental phobia patient. Their knowledge of dentistry is most often only based on their own experiences in the dental chair. We hope this book will be helpful when new patients explain their avoidance of dental care and its consequences for daily life.

Over the years it has gradually been recognized that greater effort should be directed towards behaviour management and psychological interventions aimed at reducing patients’ anxiety in the long run without pharmacological support. CBT is a problem-focused psychological intervention which seeks to teach patients skills for self-management of their anxiety. Treatment of phobia in one or more sessions is not possible to learn by reading a book about the subject, but practising the basic principles of CBT described in this book can start tomorrow. Building a trusting relationship, exploring negative thoughts and performing gradual exposure to the most fear-provoking procedures in a controlled way will help patients attend regular dental care.

Organization of the Book

The first part of this book starts with descriptions of symptoms, clinical characteristics and consequences (Chapter 1), background data and epidemiology (Chapter 2), assessment (Chapter 3), and Aetiology of dental phobia (Chapter 4). These are followed by a chapter on a ‘close relative’ of dental phobia, intra-oral injection phobia (Chapter 5), and dental anxiety in children and adolescents (Chapter 6). The second part of the book focuses on treatment and begins with a general description of the principles, procedures and evidence base of cognitive behaviour therapy (Chapter 7). This is followed by detailed descriptions of some treatments; the multimodal cognitive behavioural treatment developed in Gothenburg (Chapter 8), the one-session treatment developed by the first editor (Chapter 9), the combined treatment developed by the second editor at the Center for Odontophobia in Bergen, Norway (Chapter 10). This part ends with a description of dental treatment under sedation (Chapter 11), which probably is the most common way to treat dental phobia today, and a review and meta-analysis of randomized controlled trials of CBT for dental phobia (Chapter 12). The final part of the book discusses different treatment approaches in different cultures and health-care systems (Chapter 13), prevention of dental phobia (Chapter 14), and future research and applications (Chapter 15).

Acknowledgements

This volume is based on the considerable clinical research of many of our professional ­colleagues around the world, which shows that research is a gigantic international collaboration. We also appreciate the input from all the patients, young and old, who have participated in our research over the last four decades. It is through these contacts that we have learned how to treat ­phobias in general and dental phobia in particular. Without them this book would not exist. We would also like to thank all our authors for their time, expertise and contributions to this volume. Without them, the volume would be very thin.

Finally, we would like to extend special thanks to our families, friends and loved ones. I (Erik Skaret) would like to offer my sincerest gratitude and appreciation to Magne Raadal, Gerd Kvale, Einar Berg, Ulf Berggren (d. 2009), Peter Milgrom, Philip Weinstein and Tracy Getz for inspiring and supporting me on my way into the academic area of behavioural sciences in dentistry. I am greatly indebted to Lars-Göran Öst who taught me one-session treatment of specific phobia. I feel very privileged for having had the opportunity to work with him both clinically, as a researcher, and co-editor of this book. I want to thank my patients who believed in me enough to be willing to explore their anxiety and test their strong catastrophic beliefs with me.

Some days ago I crossed the beautiful Norwegian mountains by car on my way to a wedding. I was sitting next to the driver with my laptop on my knees, writing a draft of this preface. I am warmly grateful to the driver of the car, my lovely wife, Eli, for her endless understanding nature and for reminding me very gently about all the things that are much more important in life than writing this book. I also want to thank Kristine, Bebbe and my grandchild Agnete for never complaining when I did not have time to do things together with you.

I am very eager to share my enthusiasm about the CBT approach. Some months ago I met a colleague, a dentist who had passed our course on psychological and pharmacological treatment of dental phobia. This is what my colleague said: ‘The course has changed my day completely. I have implemented the principles of CBT in my daily practice, and I am no longer worried about any patient on my schedule for tomorrow!’ My hope is that this book may give some of these feelings to our readers.

I (Lars-Göran Öst) wish to thank Magne Raadal and Gerd Kvale for their early and never-ending interest in dental phobia and for convincing me to, once more, work with this group of patients, and Erik Skaret for developing the idea of this book with me. The collaboration on this project has been stimulating and reinforcing. I also wish to thank my wife Margareta, our daughters Ulrika, Cecilia and Magdalena, and our grandchildren Rebecca, Anton, Engla, Alvin and Alice. Without their continuous support over the years much less would have been achieved in terms of clinical and research development.

Erik Skaret and Lars-Göran ÖstOslo and Stockholm, December 2012

Part I

Background, Assessment and Aetiology

1

Symptoms, Clinical Characteristics and Consequences

Magnus Hakeberg and Jesper Lundgren

Introduction

This chapter will discuss the underlying factors concomitant with dental fear and anxiety and dental phobia and how such different symptoms interact in the maintenance of the irrational fear and possible future consequences. In the text fear and anxiety will be used ­interchangeably. However, phobia has another grading, which is related to the definition according to DSM-IV, and will not be interchanged with other terms.

The phenomena of dental anxiety, where individuals typically show different signs and symptoms related to dental care, have been revealed to be similar, irrespective of country, culture and other living conditions (Armfield, Spencer and Stewart 2006; Hakeberg, Berggren and Carlsson 1992; Milgrom et al. 1988; Moore et al. 1993; Neverlien 1990; Stouthard and Hoogstraten 1990).

The prevalence of high dental anxiety ranges between 3 per cent and 10 per cent depending on measurement methods and sample selections. Moreover, since the first scientific reports on the epidemiology of dental anxiety it seems that it is as common today as it was 40 to 50 years ago (Armfield et al. 2006; Freidson and Feldman 1958; Hakeberg et al. 1992; Milgrom et al. 1988; Moore et al. 1993; Neverlien 1990; Stouthard and Hoogstraten 1990). We may ask why the prevalence has not changed during this period of time despite the continuing progress of dental care. Greater awareness of the problem, technological advances and better ­undergraduate curriculum and postgraduate education should possibly have decreased the prevalence of dental anxiety. One answer may be that the majority of the group of individuals with moderate dental anxiety has become less anxious. Several scientific reports indicate such a development when comparing cohorts over time in repeated cross-­sectional studies (Hägglin 2000). However, there are still individuals who are highly fearful of dental care and ­procedures. These persons report that being highly fearful or even phobic of dental care affects their life situations in many different ways. This chapter introduces the major symptoms related to high dental anxiety or dental phobia.