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SSRD > Psychology of Dental Anxiety > Flashcards

Psychology of Dental Anxiety Flashcards

1
Q

social cultural understanding of going to the dentist?

A

no.1 cause for making people nervous (more than fear of heights)

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2
Q

ORAL HEALTH FOUNDATION

how many people in the UK are scared of going to the dentist?

A

almost 50%

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3
Q

of that 50%, what % have a phobia (extreme dental anxiety)?

A

12%

could be a lot higher, people don’t say

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4
Q

consequence of dental anxiety on the patient and population?

A

AVOIDANCE

5-7% of population never/ rarely visit dentist because of their fears

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5
Q

consequence of dental anxiety on dental practitioner?

A

major source of stress treating nervous patients
need to make changes to treatment plan

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6
Q
A
    • level of dental disease BECAUSE AVOIDANCE
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7
Q

causes of dental anxiety? (2)

A

1) 1/2 fear dental procedures/ dental related stimuli
2) 1/2 meet criteria of psychiatric disorder

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8
Q

what is behaviourism?

A

stimulus response
learning through association, learning through behaviours

asserts that behavior is learned through the environment and experiences

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9
Q

how does behaviourism work?

A

BASED ON EXPERIENCE ALONE
stimulus= something dental related
creates response
repeated pairings -> create a conditioned response

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10
Q

what does behaviourism focus on?

A

observable behaviours + influence of environmental factors

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11
Q

two key forms of learning?

A

1) classical
2) operant

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12
Q

before classical conditioning

A
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13
Q

during classical conditioning:

A

= pairing of noise + food together

-> response (salivation)

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14
Q

what happens as a result of repeated pairings?

A

neutral stimulus becomes -> conditioned stimulus
elicits CONDITIONED response= salivation

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15
Q

after classical conditioning?

A

noise= conditioned stimulus
salivation= conditioned response

so even without the food, conditioned stimulus = conditioned response

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16
Q

what is stimulus discrimination?

A

when you discriminate between threatening + non threatening stimuli

through repeated non eventful encounters with whatever triggered you first

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17
Q

stimulus discrimination in dental setting:

A

patient has bad experience, told drill caused them pain

drill= conditioned stimulus
but when their conditioned response is not evoked BY stimuli which are similar to the conditioned stimulus

ie. so scared of drill, but not scaler

= stimulus discrimination

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18
Q

what determines how reliable the conditioned response is?

A

+ often the conditioned stimulus= paired with the unconditioned stimulus

= more reliable the conditioned response would be

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19
Q

reliability of conditioned response in practice:

A

the + Pavlov presented the bell before feeding the dogs
the + the association between the sound of the bell (conditioned stimulus) + the arrival of food (unconditioned stimulus)

= dogs salivate (conditioned response) + reliably at sound of bell
eventually, conditioned response when they heard similar sounds

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20
Q

one traumatic experience can lead to

A

immediate + enduring fear

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21
Q

what is classical conditioning?

A

so if you feel pain during a dental procedure
and there is environmental stimuli at the time
-> you get the same fear just by the environmental cues (without the pain of the procedure)

PAIR 2 STIMULI IN HEAD
unconditioned stimulus = pain
conditioned stimulus= environmental cues

conditioned response= thought of going back

22
Q

what is stimulus generalisation?

A

patient will feel fear when going to new dental practice even though it is not the same dentist

conditioned response evoked by stimuli which are similar to OG conditioned stimulus

‘white coat effect’

23
Q

what is extinction?

A

conditioned response weakens
when conditioned stimulus (dental environment) is repeatedly presented without the unconditioned stimulus (pain)

24
Q

extinction applied to practice:

A

use of anaesthetics + painless procedures
-> gradual reduction + elimination of fear of dentist

24
Q

extinction applied to practice:

A

use of anaesthetics + painless procedures
-> gradual reduction + elimination of fear of dentist

25
Q

what can cause remission of anxiety?

A

extinction!

26
Q

what protects against the conditioning process?

A

bank of years of prior good experiences
so one bad experience wouldn’t trigger anxiety

27
Q

what is spontaneous recovery?

A

after extinction occurs
spontaneous return of conditioned response after a while

28
Q

operant (instrumental) conditioning

A

responses learned in operant are voluntary
all about consequences dictating future behaviour
response learned based off of consequences
behaviour= shaped + maintained by consequences

29
Q

operant conditioning uses reinforcers, what are they?

A

primary- whatever strengthens behaviour
secondary- associated with primary reinforcers

30
Q

reinforcement in dental anxiety: (OC)

A

if you attend dentist -> anxiety
if you don’t attend dentist (avoidance) -> no anxiety (this is their reward)
the reward reinforces the behaviour

reward of non visit will run out, poor OH, will have to get emergency treatment (more pain)

31
Q

reward of non visit leads to

A

poorer consequence overall

32
Q

what is behaviourism?

A

focus= observation
we infer things from the behaviour we observe

cons
does not account for processing that cannot be observed

33
Q

what happens if you build a connection between stimuli and response?

A

forms a habit

34
Q

why is it hard to use behaviourism to understand the stimulus contained response in patient?

A

so many stimuli/ triggers in dental setting

35
Q

critiques of behaviourism: (3)

A
  • makes patient passive in a dentist led environment
  • saying patient only learns through the behaviours we observe
  • does not account for processes we can not observe

BEHAVIOURISM ALONE can not account for all PHOBIAS!

36
Q

what is cognitivism?

A

behaviourism came first
then came cognitivism
people are not programmed animals
we don’t just respond to environmental stimuli
we have active participation
we think about it, doesn’t happen to us
we are rational beings that require active participation in order to learn

our actions= a consequence of thinking

37
Q

are changes in behaviour still observed in cognitivism?

A

yes
but only as an indication of what is occurring in the active rational learner’s head
we process the stimulus
stimulus doesn’t ‘happen’ to you

38
Q

cognivitism’s metaphor of a computer?

A

info comes in
processed
leads to certain outcomes

39
Q

general theory of anxiety:

A

anxiety= natural protective process which protects us from danger
fear response= natural

= adaptive mechanism which is modified by how the individual perceives the threat

40
Q

another theory of anxiety

A

anxiety/ fear (emotional response) = triggered

when the size of the threat= larger than the individual’s perception of their ability to cope

anticipate worst thing that could happen
don’t keep perspective on level of threat situation poses

41
Q

how is fight or flight impaired when anxious?

A

fight or flight
during state of anxiety, attention= selective
isn’t subject to same thought through processes as when you are calm
can’t interpret and take in stimuli in a typical way
see things around you differently

42
Q

memory alteration as a cause of anxiety?

A

in state of high anxiety:

alters memory
selective remembering of negative info
intrusive memories
flashbacks
schema

43
Q

so WHY are people afraid to go to the dentist? (5)

A
  • behavioural
  • cognitive
  • differing levels of attention and processes when in state of anxiety
  • social learning theory
  • personality differences
44
Q

social learning theory?

A

observational learning
learning through imitation- behaviour of others
grew out of cognitivism
(can learn from parents, wider societal view, so prevalent in society so dental anxiety= accepted norm which has been perpetuated for many years)

(children, hit dolls, watched caregivers punch dogs)
live model= watching caregivers hit -> strong response
verbal -> from word of mouth, hearing what happened
symbolic -> messages about dentist in the media (horror dentist in movie), the demon dentist by david walliams. so not just strength of live model, but learning from wider society

symbolic cultural learning teaches dentist= scary!

45
Q

pain + anxiety cycle

A

never ending

46
Q

real life example of high levels of anxiety affecting pain thresholds?

A

pressure on gums could be translated and perceive as pain in those that have anxiety
process info as pain = more anxiety = more pain = more anxiety
this perpetuates the anxiety cycle

47
Q

how does anxiety affect pain thresholds?

A
  • dental phobics have low pain thresholds
  • increased anxiety makes it difficult to discriminate between sensation + pain
  • anticipation of pain through anxiety = higher reporting/ honing in on pain
48
Q

how do our cognitive factors affect the way we process things and develop a fear/ anxiety?

A

one traumatic/ painful dental visit can be sufficient to be the cause of anxiety in anxious + phobic patients
a second episode is not necessary for the development of them

49
Q

cognitive factors (individual differences): affect how we interpret/ process an event

A

1) catastrophising - their cognitive processes always think about worst case scenario, ruminate, selective attention, hone in on negatives

2) imagery- + levels of anxiety and fear, those who can vividly image and ruminate, creates anxiety + pain cycle:

-> anxiety creates pain in imaginative scenarios (of what they think will happen), whatever does happen to them they interpret with lower threshold to pain

3) memory- reliving something very clearly + traumatic, ruminating

4) self efficacy:

belief that you can change the outcome= within your power

5) locus of control:

people have internal/ external locus, some people might have external, they dont believe their own actions have an effect over them, they think they are predestined to have bad teeth, see smoking/ diet/ oh as outside their locus of control, dont take personal attachment to it

50
Q

factors of dental anxiety

A
  • psychological co morbidity

generally being anxious

  • familial dental attitudes
  • attachment style
  • evolutionary factors
  • fear of the unknown
51
Q
A

there is no single aetiology identifiable

WE ALL HAVE DIFF upbringing, personality factors, cognitive ways of processing things

there are commonalities in people who have dental phobic

conditioning in combo with other factors= most common cause

most common way- people have had a traumatic experience with
dentist= why we still use behaviourism to understanding conditioning

lots of diff causes can affect it

SSRD (6 decks)

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