Cognitive Behavioural Therapy for Dental Fear, Anxiety and Phobia Flashcards
Why are both pharmacological and psychological techniques important for anxiety management?
- pharmacological provides immediate results
- psychological is effective long term
What guidance is available surrounding management of patients with anxiety about dental treatment?
- GDC Standards for the Dental Team
- Standards for Conscious Sedation in the Provision of Dental Care
- SDCEP Conscious Sedation in Densitry
How is CBT relevant to IV sedation?
- CBT can complement sedation
- preparation for sedation
- patient provided with tools to manage anxiety
What is cognitive behavioural therapy?
- brief psychological therapy
- talking therapy
- useful for a range of problems
- anxiety
- depression
- PTSD
- specific phobias
- dental phobias
- thoughts, feelings and behaviours linked
- psychoeducation and behaviour modification
- cognitive restructuring
- challenge unhelpful beliefs and behaviours
What is dental anxiety?
a general type of fear which occurs without a present triggering stimulus, emotional response to an unknown danger of perceived threat, anticipatory due to previous negative experience
What is dental fear?
an intense biological response to immediate danger which is specific, encourages caution and safety
What is dental phobia?
overwhelming and debilitating fear of an object or place which interferes with daily life
What is the aetiology of dental fear, anxiety and phobia?
- direct experiences
- painful injection
- extraction
- ACE/trauma
- observations
- seen family members at dentist
- told
- friends and family
- media
- personality
- some traits more susceptible
- genes
- can run in families
- not born with phobia
- more prone to developing one
What are possible triggers of dental fear, anxiety and phobia?
- fear of specific stimuli
- injections
- smell of practice
- drill
- sound
- sight
- dental setting
- fear of medical catastrophe
- something happens at appointment
- medical emergency occurs
- faint
-allergy - choking
- faint
- generalised dental anxiety
- significant anxiety
- cannot identify a single trigger
- likely has other worries
- heights
- flying
- exams
- mistrust of dental personnel
- not being in control
- loss of self esteem
- fear of judgement
- OH
-diet
- OH
What is trauma?
an event or actual extreme threat of physical or psychological harm which an individual experiences as traumatic, and which has long-lasting effects
Why may past traumas cause dental fear and anxiety?
- lack of control
- authority figure
- things being done
- full consent not given
- smells
- noises
- sensations
- unexpected
- unable to say no
What is universal precaution?
- treating all patients the same
- e.g. all are dentally anxious
- provides safety and empowerment
What is commonly used to measure dental anxiety and what are the threshold scores?
- Modified Dental Anxiety Scale
- MDAS
- > 16 years old
- scores from 5-25
- severe anxiety/phobia
- > 19
- 5/5 on LA question
- severe anxiety/phobia
What fears are contraindications to IV sedation?
- needle phobia
- cannulation required
- loss of control
What is commonly used to measure dental anxiety in children and what are the threshold scores?
- Modified Child Dental Anxiety Scale-faces version (MCDASf)
- 8-15 years old
- scores from 9-45
- > 27 is severe DFA/phobia
What can a patient expect from CBT?
- collaboration with clinical for a personalised plan
- understating the ability to test their negative thinking
- psychoeducation and learn coping skills to allow behavioural exposure
- encouraged to participate in ‘homework’
- learn to face anxiety and disengage from avoidance
- challenge anxiety and learn to reduce reliance on cyclical treatment under sedation
What are the 5 components of fear and anxiety?
- situation
- thoughts and images
- body/physical sensations
- moods/emotions
- behaviours
What does the emotional component of fear and anxiety include?
- anxiety
- fear
- shame
- guilt
- anger
What does the physiological component of fear and anxiety include?
- increased heart rate
- dry mouth
- increased perspiration
- butterflies in stomach
- flushed face
- increased muscle tension
- fight/flight/freeze
What does the cognitive component of fear and anxiety include?
- expectation of failure
- catastrophising
- fortune telling
- magnifying and minimising
What does the behavioural component of fear and anxiety include?
- avoidance
- disruptive behaviour
- especially children
- increased muscle tension
- safety behaviours
- hold water bottle
- fear of choking
- problem if forgets to bring
- hold water bottle
Describe the cycle of fear and avoidance
- encounter fear
- thing about what could happen
- feel afraid
- avoid and move away
- feel immediately relieved
- beliefs about fear remain the same
How can the cycle of fear and anxiety be broken?
- breathing control
- deep, controlled breaths
- reduces autonomic
- increases parasympathetic
- deep, controlled breaths
- relaxation
- progressive muscle relaxation
- tensing and relaxing
- systematically
- good for refocussing
- progressive muscle relaxation
- this will pass
- stepping back
- grounding
- 5, 4, 3, 2, 1
- stress ball
- essential oils
- STOPP
What happens during the fight/flight/freeze response?
- brain hijacked
- eyes widen
- vision improves or blurs
- mouth dries
- body heats and sweats
- heart rate increases
- blood pressure increases
- hands tingle and legs tremble
- bladder relaxes
- stomach churns
- fast and shallow breathing
- head dizzy
