Anxiety and Pain psychology

Question 1

Describe the behaviourism theory of learning

Answer 1

All behaviours are learned through interaction with the environment as a stimulus-response, focusing on observable behaviours

Question 2

Conditioning falls into which theory of learning?

Answer 2

Behaviourism

Question 3

what is the difference between classical and operant conditioning

Answer 3

Operant conditioning is changes in behaviour learnt by consequences (‘carrot and the stick’), classical is a learning process that occurs when two stimuli are repeatedly paired

Question 4

How does positive and negative consequences fit into operant conditioning?

Answer 4

Not the same as reward and punishment, positive is the addition of a stimulus (such as receiving a treat) and negative is the removal of a stimulus (no homework)

Question 5

Explain stimulus generalisation and a dental example

Answer 5

Similar stimulus to the conditioned stimulus can cause a response: White coat syndrome

Question 6

What is high order conditioning?

Answer 6

Conditioned response evoked by new stimulus that is paired with a conditioned stimulus that already elicits the response (e.g. cringing at name of dentist)

Question 7

Give the flaws in behaviourism learning theory

Answer 7

Knowledge is given and absolute, patient is passive, doesn’t take into account intrinsic factors (personality, genetics)

Question 8

Define cognitivism

Answer 8

Conditioned response evoked by new stimulus that is paired with a conditioned stimulus that already elicits the response

Question 9

What is social learning theory?

Answer 9

What we do is based on what we see: Live, verbal( what we here), images in the media e.t.c

Question 10

Give the flaws in social learning theory

Answer 10

Does not take into account individuality, context and experience, suggests students/patients learn best as passive receivers of sensory stimuli, as opposed to being active learners , emotions and motivation are not considered important or connected to learning

Question 11

what study showed anxiety made it harder to distinguish between sensation and pain?

Answer 11

Dworkin & Chen (1982): tooth pulp shock was delivered in laboratory and clinical situations. Significantly heightened pain was observed in the clinical dental setting

Question 12

What are some of the problems with questionnaire-style anxiety measurements?

Answer 12

People can lie or just not want to believe their own anxiety, social desirability, central tendency bias (just going neutral on questions)

Question 13

What is the most common measurement technique?

Answer 13

The Modified Dental Anxiety Scale (MDAS), 5 questions based on different aspects of a dental procedure

Question 14

Name an issue with the dental anxiety inventory.

Answer 14

They could have been ok coming in but looking at a big list of the scary parts and asking your responses could cause anxiety you didn’t have initially

Question 15

What are the three areas of the dental belief survey

Answer 15

Professionalism (e.g. the competency of the dentist), communication (I don’t know what is happening) and lack of control

Question 16

Define Pain

Answer 16

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage - it is both physical and emotional

Question 17

Describe the early pain theories and how they fit into 2 categories

Answer 17

Based off of a biomedical framework, pain is caused by tissue damage. Categorises into psychogenic (all in your head) or organic (real pain with an injury)

Question 18

list some of the factors involved in a pain experience

Answer 18

Genetics, Mood, Context, Placebo, Chemical brain structure

Question 19

Is pain the same between individuals

Answer 19

Pain is whatever the experiencing person says it is, existing whenever he/she says it does so no

Question 20

Explain the two types of pain

Answer 20

Acute (recent, adaptive and meaningful)and Chronic (longer than 3 months and lasting, often without observable injury)

Question 21

Explain the gate control theory

Answer 21

There is a neural ‘gate’ at the level of the spinal cord that can open/close to allow/block pain transmission. It is inhibited by large fibres/mechanoreceptors [why rubbing reduces pain] as well as endorphins

Question 22

What is the difference between pain threshold and pain tolerance?

Answer 22

Threshold – the level at which the body 1st perceives stimuli as painful
Tolerance – how much pain a person can take

Question 23

What are all the points in SOCRATES?

Answer 23

Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors, Severity

Question 24

Which methods of sedation are non-rehabilitative?

Answer 24

IV and GA, as the patient won’t be able to remember therefore remember a good experience so won’t help reduce overall anxiety

Question 25

Define conscious sedation.

Answer 25

“A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely.” -remain conscious and cooperative, manage own airway

Question 26

What are some patient scenarios which require sedation?

Answer 26

Phobias, really unpleasant procedures (e.g. impacted lower wisdom), to overcome severe gag reflexes, reduce stress, medical:(e.g. to stop an angina attack, parkinsons)

Question 27

What are the problems with using these drugs (e.g midazolam) when there is a history of alcohol/drug abuse?

Answer 27

midazolam gets metabolised in the liver, suspect any liver damage, liver won't be able to break it down so excess with amount so potentially lose consciousness

Question 28

List some medical contraindications to sedation.

Answer 28

severe/uncontrolled systemic disease, clashing medication, allergy to agent, pregnancy, psychosis, respiratory infection

Question 29

What is the ASA?

Answer 29

American society of Anaesthesiology (scale)

Question 30

Describe the ASA scale

Answer 30

I- normal, healthy ii- A patient with mild systemic disease e.g. well controlled type 2 diabetes or epilepsy, mild asthma, smoker, social alcohol, pregnancy iii - A patient with severe systemic disease limiting activity but not incapacitating  (e.g. angina) iv - incapacitating disease that is a constant threat to life v- Moribund patient not expected to live more than 24 hours

Question 31

What is the cutoff for sedation using the ASA scale?

Answer 31

General practice up to ii, in the LDI/hospital they will go up to 3

Question 32

Give the advantages for oral sedation

Answer 32

simple to administer, cheap, patient friendly, can be self-administered

Question 33

Give the disadvantages for oral sedation

Answer 33

very unpredictable, often rapid recovery, no titration/dose of effect (don't know how much of an effect you will get)

Question 34

Give the advantages of inhalation sedation

Answer 34

safer for children, no needles, reliable and predictable, no special patient arrangements, good safety record, rehabilitative

Question 35

Give the disadvantages of inhalation sedation

Answer 35

Specialist equipment required, requires psychological re-enforcement to produce semi-hypnotic state, nitrous oxide pollution, claustrophobia, nasal obstruction