Psychology of Dental Anxiety Flashcards
social cultural understanding of going to the dentist?
no.1 cause for making people nervous (more than fear of heights)
ORAL HEALTH FOUNDATION
how many people in the UK are scared of going to the dentist?
almost 50%
of that 50%, what % have a phobia (extreme dental anxiety)?
12%
could be a lot higher, people don’t say
consequence of dental anxiety on the patient and population?
AVOIDANCE
5-7% of population never/ rarely visit dentist because of their fears
consequence of dental anxiety on dental practitioner?
major source of stress treating nervous patients
need to make changes to treatment plan
- level of dental disease BECAUSE AVOIDANCE
causes of dental anxiety? (2)
1) 1/2 fear dental procedures/ dental related stimuli
2) 1/2 meet criteria of psychiatric disorder
what is behaviourism?
stimulus response
learning through association, learning through behaviours
asserts that behavior is learned through the environment and experiences
how does behaviourism work?
BASED ON EXPERIENCE ALONE
stimulus= something dental related
creates response
repeated pairings -> create a conditioned response
what does behaviourism focus on?
observable behaviours + influence of environmental factors
two key forms of learning?
1) classical
2) operant
before classical conditioning
during classical conditioning:
= pairing of noise + food together
-> response (salivation)
what happens as a result of repeated pairings?
neutral stimulus becomes -> conditioned stimulus
elicits CONDITIONED response= salivation
after classical conditioning?
noise= conditioned stimulus
salivation= conditioned response
so even without the food, conditioned stimulus = conditioned response
what is stimulus discrimination?
when you discriminate between threatening + non threatening stimuli
through repeated non eventful encounters with whatever triggered you first
stimulus discrimination in dental setting:
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
what determines how reliable the conditioned response is?
+ often the conditioned stimulus= paired with the unconditioned stimulus
= more reliable the conditioned response would be
reliability of conditioned response in practice:
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
one traumatic experience can lead to
immediate + enduring fear
what is classical conditioning?
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
what is stimulus generalisation?
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’
what is extinction?
conditioned response weakens
when conditioned stimulus (dental environment) is repeatedly presented without the unconditioned stimulus (pain)
extinction applied to practice:
use of anaesthetics + painless procedures
-> gradual reduction + elimination of fear of dentist
extinction applied to practice:
use of anaesthetics + painless procedures
-> gradual reduction + elimination of fear of dentist
what can cause remission of anxiety?
extinction!
what protects against the conditioning process?
bank of years of prior good experiences
so one bad experience wouldn’t trigger anxiety
what is spontaneous recovery?
after extinction occurs
spontaneous return of conditioned response after a while
operant (instrumental) conditioning
responses learned in operant are voluntary
all about consequences dictating future behaviour
response learned based off of consequences
behaviour= shaped + maintained by consequences
operant conditioning uses reinforcers, what are they?
primary- whatever strengthens behaviour
secondary- associated with primary reinforcers
reinforcement in dental anxiety: (OC)
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)
reward of non visit leads to
poorer consequence overall
what is behaviourism?
focus= observation
we infer things from the behaviour we observe
cons
does not account for processing that cannot be observed
what happens if you build a connection between stimuli and response?
forms a habit
why is it hard to use behaviourism to understand the stimulus contained response in patient?
so many stimuli/ triggers in dental setting
critiques of behaviourism: (3)
- 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!
what is cognitivism?
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
are changes in behaviour still observed in cognitivism?
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
cognivitism’s metaphor of a computer?
info comes in
processed
leads to certain outcomes
general theory of anxiety:
anxiety= natural protective process which protects us from danger
fear response= natural
= adaptive mechanism which is modified by how the individual perceives the threat
another theory of anxiety
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
how is fight or flight impaired when anxious?
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
memory alteration as a cause of anxiety?
in state of high anxiety:
alters memory
selective remembering of negative info
intrusive memories
flashbacks
schema
so WHY are people afraid to go to the dentist? (5)
- behavioural
- cognitive
- differing levels of attention and processes when in state of anxiety
- social learning theory
- personality differences
social learning theory?
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!
pain + anxiety cycle
never ending
real life example of high levels of anxiety affecting pain thresholds?
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
how does anxiety affect pain thresholds?
- 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
how do our cognitive factors affect the way we process things and develop a fear/ anxiety?
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
cognitive factors (individual differences): affect how we interpret/ process an event
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
factors of dental anxiety
- psychological co morbidity
generally being anxious
- familial dental attitudes
- attachment style
- evolutionary factors
- fear of the unknown
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
