The effects of visual surround eccentricity and size on manual and postural control

The aim of this study was to compare two different modes of behaviorally-oriented therapies for dental fear. The subjects were chosen consecutively from the waiting-list of a Dental Fears Research and Treatment Clinic. In addition, a control group was selected from patients treated under general anesthesia to compare levels of dental and general fear with the experimental groups. Twenty-two women, with a mean age of 31.8 yr, were included and randomly assigned to two groups. The median time of avoidance of dental care was 9.5 yr. One group received hypnotherapy (HT) and one group a behavioral treatment based on psychophysiological principles (PP). Both therapies included eight sessions followed by standardized conventional dental test treatments. Pre- and posttreatment measures were dental fear, general fear, mood, and patient behavior. Nine patients were not able to conclude the treatment sessions (6 HT and 3 PP); these patients did not differ significantly from the remaining patients before treatment. The PP group reported a statistically significant decrease in dental fear as well as a rise in mood during dental situations, as opposed to the HT group. General fear levels decreased but not significantly. Eleven patients completed conventional dental treatment according to a dentist's behavioral rating scale, indicating that they were relaxed, and no problems occurred during the treatments. These patients were referred to general practitioners within the community dental service. In conclusion, this small size study showed that a majority of the patients, who accomplished the behavioral therapy and the dental test treatments, became less fearful of dental care and were able to manage conventional dental care, including changing dentist.     

A dental fears typology of oral surgery patients: Matching patients to anxiety interventions.

Two studies are described in which dental patients were administered the Dental Fear Survey (DFS) and then received 1 of 5 anxiety reduction interventions to prepare them for extraction of 3rd-molar teeth. Interventions included standard clinic treatment, oral premedications, and several relaxation-based procedures. Dependent variables were self-reported and observer-rated distress. In the 1st study (N?=?231), cluster analyses of the DFS subscales revealed that patients could be subtyped as low-fear, high-fear, or cue-anxious patients who admitted fear only in response to specific stimuli. Dental fear subtypes were distinguishable by situational cognitions reported, and fear subtype interacted with anxiety intervention to predict distress. These results were replicated in the 2nd study (N?=?150). The results are seen as supportive of a multidimensional view of dental anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and psychometric evaluation of the Index of Dental Anxiety and Fear (IDAF-4C+).

The measurement of dental fear is important due to its high prevalence and appreciable individual, clinical, and public health consequences. However, existing measures of dental anxiety and fear (DAF) have theoretical or practical limitations. This study describes the development and subsequent assessment of the reliability and validity of test scores of a new DAF scale for adults. The Index of Dental Anxiety and Fear (IDAF-4C+) contains 3 modules that measure DAF, dental phobia, and feared dental stimuli. The final 8-item DAF module (IDAF-4C) assesses emotional, behavioral, physiological, and cognitive components of the anxiety and fear response. The proposed scale dimensionality received support from exploratory factor analysis. IDAF-4C items showed good internal consistency (Cronbach's α = .94) and test–retest reliability at 4 months (r = .82), and the scale was strongly associated with other dental fear scales as well as with dental visiting patterns, avoidance of the dentist, and dental phobia diagnosis. The convergent and predictive validity of the IDAF-4C compared positively to Corah's (1969; Corah, Gale, & Illig, 1978) Dental Anxiety Scale and a single-item measure of dental fear, and the scale predicted future dental visiting and visit perceptions. Both phobia and stimulus modules showed strong and statistically significant associations with DAF ratings. In all, sufficient evidence is provided to demonstrate that the new scale would be a useful tool to assess DAF in an adult population. The IDAF-4C+ is based on strong theoretical underpinnings, yet the scale is practical enough for application across a variety of potential uses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investigation of ninhydrin reaction (author''s transl)

Nineteen individuals with inordinate fear of dental treatment are presented and discussed with respect to their psychopathology and those aspects of their fear involving feelings of confinement and helplessness in the dental chair, and a negative relationship with the dentist. This material is part of a comprehensive investigation previously reported by the authors into the components and factors contributing to this kind of fear, and the personality and emotional reactions of the individuals suffering from it. The data presented are based on single structured interviews of each patient. Analysis of the patient population suggests division into four major categories: those in whom fear of dental treatment was associated with feelings of inferiority in bodily appearance or function (the largest category); those in whom the fear was associated with neurotic disturbances in which disturbance in body image is not apparent; those in whom the fear was a reflection of a schizophrenic or schizoid process; and those in whom no overt psychopathology was found. The patients in the first category were those who tended most to be afraid of dental treatment due to feelings of confinement or helplessness in the dental chair, or due to a negative relationship with the dentist.     

The Dental Subscale of the Children's Fear Survey Schedule: a factor analytic study in The Netherlands

The Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) is a well-known instrument for assessing dental fear in children. Previous studies have shown that the scale has acceptable reliability and validity. Factor analysis using scores of a group of Finnish schoolchildren resulted in three factors. No other data on the factor structure have been published. In order to report on the factor structure of the Dutch parental version of the CFSS-DS, the present study was undertaken. Factor analysis using scores from a group of Dutch children (n= 150) demonstrated a factor pattern fairly similar to the results found in the Finnish study. Three factors were found: 1) fear of highly invasive dental procedures, 2) fear of less invasive aspects of treatment and 3) fear of medical aspects. Considering that almost all items load substantially (> or =0.20) on more than one factor, it seems that one primary underlying dimension exists: fear of invasive treatment aspects. The CFSS-DS is proposed as a reliable, one-dimensional measure of dental fear.     

Effects of modeling and desensitization in reducing dentist phobia.

Notes that although many persons avoid dentists and dental work, counseling techniques that eliminate dental avoidance behavior and reduce stress have not yet been systematically examined. The present study explored the effects of systematic desensitization and social-modeling treatments with placebo and assessment control groups. Each of the 4 groups contained 9 dental-phobic adults (mean age = 30 yrs). A behavioral measure as well as several attitude and fear arousal scales (e.g., the Fear Survey Schedule) were used as dependent variables. Modeling was more effective than desensitization as shown by the number of Ss who went to a dentist, and modeling and desensitization were more effective in reducing arousal and improving attitudes than placebo and assessment groups. The importance of demonstrating behaviors coupled with covert practice, or self-modeling, is discussed. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cohen syndrome with neutropenia-induced periodontitis managed with granulocyte colony-stimulating factor (G-CSF): case reports

The present study focused on a newly developed questionnaire to assess dental anxiety. The short version of the Dental Anxiety Inventory (S-DAI) contains nine items of the Dental Anxiety Inventory (DAI), which was designed to take into account three situations that may evoke dental anxiety, four time elements in which dental anxiety may be provoked, and three reactions. The aim was to assess the validity and reliability of the S-DAI in a sample of highly anxious dental patients applying for treatment at a dental fear clinic in the Netherlands. Three hundred and twenty-one patients filled out several questionnaires assessing dental anxiety (S-DAI, DAS, and a 10-point Likert-scale) and psychological complaints. Total mean score on the S-DAI for women (mean=40.5, s=5.7) was somewhat higher than for men (mean=38.8, s=6.9) (t(306)=2.35; P=0.019). Cronbach's alpha for the present sample was 0.88. Correlations with other measures of dental anxiety were 0.73 with the DAS (P<0.001) and 0.69 (P<0.001) with the 10-point scale. The results indicated that the S-DAI has good reliability and construct validity. It was concluded that the S-DAI is easy to administer in general dental practices and dental fear clinics and has satisfactory psychometric qualities.     

Blood-injury-injection phobia and dental phobia

The present study was carried out to explore the relation between BII phobia and dental phobia. An additional aim was to determine the fainting tendency of dental phobics and BII phobics during an invasive treatment procedure. Participants were 63 patients undergoing treatment in a dental fear clinic, and 173 patients undergoing dental surgery in a university hospital. They completed measures on fears of particular medical and dental stimuli, fainting history, general trait anxiety, dental anxiety, BII anxiety, BII avoidance, and a questionnaire aimed to define a phobia based on DSM-IV criteria. Immediately after treatment information was obtained on exposures to blood or injections, state anxiety, and feelings of faintness during treatment. The results did not indicate any significant relationship between measures of dental anxiety and BII anxiety or BII avoidance. However, 57% of the dental phobic patients could also be classified as BII phobic. The proportion of dental phobics who reported fainting episodes in their past was similar to that of the BII phobics (37%), but none of the participants fainted during treatment. It is concluded that, albeit the level of co-occurrence for both types of phobias is high, dental phobia should be considered as a specific phobia, independent for the BII subtype within DSM-IV. Further, the findings are inconsistent with the notion that individuals with BII phobia have a remarkably high tendency to faint in the presence of their phobic stimuli.     

Gauging the effectiveness of extended imipramine treatment for panic disorder with agoraphobia

BACKGROUND: Imipramine has proven efficacy for panic disorder. This study assesses the net effectiveness of systematic, open imipramine treatment in a homogenous sample of panic disorder patients with agoraphobia. METHODS: One hundred and ten consecutive patients with DSM-III-R moderate to severe panic disorder with agoraphobia were treated with a fixed regimen of imipramine 2.25 mg/kg/day for 24 weeks. No instructions or encouragement for self-directed exposure to phobic situations or other coping strategies with panic or fear were given. Assessments were conducted at the end of the 2-week placebo run-in and at weeks 8, 16, and 24 of treatment. RESULTS: Overall, 53% had a marked and stable response. Most measures revealed that substantial improvement continued beyond week 8 of treatment. Treatment success was accompanied with significant improvements in anxiety sensitivity, dysphoric mood, and functional well-being. CONCLUSIONS: These results provide a clinically relevant reference with which to compare the effectiveness of alternative treatments in providing nearly complete symptom remission in patients with primary panic disorder with agoraphobia.     

Fear behavior, fear imagery, and the psychophysiology of emotion: The problem of affective response integration.

Exp I compared the psychophysiological reactions of 25 Ss with 2 fears, focal phobia and social-performance anxiety. Ss were determined by questionnaire (e.g., Differential Personality Questionnaire, Fenz-Epstein Anxiety Scale) and interview to be at the high extreme of their respective fear reference groups. Each group was exposed to both its own and the other group's primary fear stress (i.e., a snake-exposure test and a public speaking performance). These same Ss were also instructed to imagine both types of fear situations as well as control scenes. Results indicate a different psychophysiological response for the 2 fear groups across the 2 fear contents. Thus, snake-phobic Ss showed greater arousal when exposed to a live snake than did socially anxious Ss. Despite significantly greater verbal reports of fear and arousal by socially anxious Ss, both fear groups showed a similar marked increase in physiological arousal during speech performance. Neither group generated a significant physiological reaction to either fear content during imagery assessment. Exp II examined emotional imagery with 40 undergraduates from the same 2 fear populations. An imagery pretraining program, based on the reinforcement of verbal report of somatic response content in imagery, led to a significant visceral arousal response during fear imagery. Response-trained Ss showed a pattern of heart rate change during imagery that varied between Ss and fear contents. Response-trained Ss also showed relatively greater concordance between verbal and visceral measures than did untrained Ss. (60 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of reciprocal inhibition, psychotherapy, and waiting list control for phobic children.

Randomly assigned 67 phobic 6-15 yr. olds to a 2 * 3 factorial, repeated-measures, covariate design which included 2 male therapists and 3 time-limited treatments: reciprocal inhibition, psychotherapy, and waiting list control. Following 24 sessions or 3-mo wait and at 6-wk follow-up, Ss were reassessed by an independent evaluator and by parents. Results indicate a significant effect due to time and S's age. Clinical evaluation, using initial scores as the covariate, showed no effects of treatment or therapist. Parents reported treatment effects for both target fear and general fear behavior. Therapies were equally efficient, and all treatment effects were achieved with Ss aged 6-10. (48 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety, fear and eating: A test of the psychosomatic concept of obesity.

Tested the psychosomatic hypothesis that overeating by obese individuals represents an attempt to cope with fear, anxiety, or other emotional disturbances. 33 obese and 33 normal weight male undergraduates were subjected to control, interpersonal anxiety, or objective fear treatments. Ss then completed the Multiple Affect Adjective Check List and took a digit span test. Food consumption was measured by having Ss eat crackers for 15 min. under the guise of making taste discriminations. Although there were indications that the experimental treatments had been successful in arousing anxiety for obese Ss, no significant differences in cracker consumption were found. It is concluded that the results cast considerable doubt on the tenability of the psychosomatic concept of obesity. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preoperative anxiety and fear: a comparison of assessments by patients and anesthesia and surgery residents

We sought to compare self-assessment of preoperative anxiety levels and selection of worst fears by surgical patients with the assessments made by the anesthesia and surgery residents providing intraoperative care for those patients. One hundred inpatients at a Veterans Affairs hospital (Group 1) and 45 patients at a University hospital (Group 2) were asked to complete a brief questionnaire; the residents were asked to complete the same questionnaire. Group 1 results showed that median patient visual analog scale (VAS) scores were lower for anxiety about anesthesia compared to surgery (16 vs 22, P < or = 0.05). Anesthesia resident VAS scores were higher than patient or surgery resident scores. Neither type of resident was able to predict their individual patient's VAS score (Kendall's tau). The fear chosen with the greatest incidence by Group 1 patients and residents was "whether surgery would work". A significant number of residents (34%, anesthesia or surgery, P < or = 0.05) matched their patient's fear choice. Residents commonly chose fears related to their specialty (e.g., anesthesia residents chose anesthesia-related fears more often than surgery residents, 50% vs 28%, P < or = 0.001). In Group 2, residents demonstrated an improved ability to predict patient scores. For instance, both surgery and anesthesia residents were able to predict individual University patient VAS scores (P < or = 0.01). The fear chosen with the greatest frequency by Group 2 patients was "pain after the operation". Sixty percent of anesthesia residents matched their patients' fear choice (P < or = 0.001). This study indicates a variable ability of anesthesia and surgery residents to predict patient anxiety and fear which may be due, in part, to difficulty in understanding a Veterans Affairs hospital patient population.     

Expectancy, false galvanic skin response feedback, and systematic desensitization in the modification of phobic behavior.

Compared systematic desensitization and 2 pseudotherapy manipulations with and without false galvanic skin response feedback after every session suggesting improvement in the modification of intense snake and spider fear. Ss were 36 spider- and snake-phobic 18-59 yr old women. Results indicate no consistent differences between the 3 treatment groups, although all treatments were significantly more effective than no treatment in modifying physiological, behavioral, and self-report measures of fear. A 4-mo follow-up showed stability in fear reduction on self-report measures for the 3 treatment groups. Overall results contradict a traditional conditioning explanation of systematic desensitization. An alternate explanation for the operation of systematic desensitization emphasizing the motivational as opposed to conditioning aspects of the procedure is discussed. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of genital wart burden to therapeutic response to fluorouracil/epinephrine injectable gel

The efficacy of a single cycle of a new therapy for genital warts, intradermal fluorouracil/epinephrine (5-FU/epi) injectable gel, has been evaluated in 2 large pivotal trials; the objective of this study was to evaluate a second cycle of treatment. Twenty-two patients with total wart areas of 5-447 mm2 were treated with up to 2 cycles of < or =6 treatments of 5-FU/epi gel. After the first cycle of treatments, patients with warts showing a partial response or no response or new warts were continued into a second cycle. Seventy-three per cent (16/22) of patients had complete responses. Patients with total wart areas < or = 100 mm2 tended to respond completely in the first cycle of treatment (average 4.7 treatments). Patients with numerous warts or large total wart areas (>100 mm2) required an average of 7.5 treatments to achieve a complete response. Thus, a second treatment cycle may be appropriate for difficult-to-treat patients with numerous warts or large total wart areas.     

Imaging vividness and the outcome of in vivo and imagined scene desensitization.

Reexamined the role of imaging vividness in desensitization success. Scores on the Betts Questionnaire on Mental Imagery were used to divide 48 snake-phobic Ss into high, medium, and low vivid groups, who were assigned to imagined scene or in vivo desensitization treatments. The Fear Survey Schedule was used to measure general fearfulness. Imaging vividness was assessed at scheduled points during therapy. Significant decreases in behavioral and self-reported fear were observed after both treatments, although in vivo desensitization produced significantly greater fear reduction. In therapy, imaging vividness scores were significantly correlated with therapeutic success and were superior to pretherapy ratings as predictors of outcome. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hippocampal lesions alter conditioning to conditional and contextual stimuli

The control of conditioned fear behaviour by a conditional stimulus (CS) and contextual stimuli (CXT) was compared in rats with lesions to the hippocampus (HPC) or neocortex (CO), and operated controls (OC). After classical fear conditioning in a distinctive context, rats were subsequently tested in the presence of the CS and CXT (CS + CXT), the CS alone (CS-only), or context alone (CXT-only). Two experiments were conducted in which conditioned fear was measured by an active avoidance response (experiment 1) or by response suppression (experiment 2). Groups did not differ in acquiring the conditioned fear response, as measured in the CS + CON test but, in both experiments, hippocampal (HPC) groups exhibited more conditioned fear behaviour than controls in the CXT-Only and CS-Only conditions. It was suggested that control rats conditioned the fear response to a stimulus complex that incorporated the CS and CTX. Rats with HPC lesions did not form this association between the stimulus elements; instead they segregated the CS and CXT and formed independent associations between the conditioned response (CR) and each component. In showing that HPC damage disrupts the process of forming associations between environmental stimuli and that the effect is not restricted to contextual cues, the results help to resolve apparently contradictory findings regarding the role of HPC in contextual information processing.     

Mechanisms involved in the observational conditioning of fear.

Three experiments support the hypothesis that mechanisms involved in observational conditioning (OC) of fear are similar to those of direct classical conditioning and involve the organism attempting to detect the causal structure of its environment. Exp 1, a correlational analysis, shows that model monkeys' fear behaviors on snake trials (unconditioned stimulus [UCS]) were highly correlated with observer monkeys' fear (unconditioned response [UCR]) while watching the models' fear. In Exp 2, all observers showed distress while watching the model's fear during Session 1 of OC, but only observers who could see the snake to which the model was reacting continued to show fear during subsequent OC sessions, suggesting that the model's fear is an easily habituable UCS. In Exp 3, observers acquired significant fear of snakes after 1 OC session, indicating that the continued fear of those Exp 2 observers that could see the snake may reflect their own acquired fear of snakes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Local metronidazole application in maintenance patients. Clinical and microbiological evaluation

The purpose of this investigation was to evaluate the clinical and microbiological effect of local antibiotic therapy in comparison with subgingival scaling and root planing in a randomized semi-masked study. Forty-six recall patients who completed systematic periodontal therapy 6 to 24 months prior to the study were enrolled. The inclusion requirements were at least one site with probing depth > or = 5 mm in each quadrant, no scaling, and no antibiotic therapy during the last 6 months. After randomization each patient received 2 different treatments: in 2 quadrants metronidazole 25% dental gel was applied subgingivally to the pockets at day 0 and day 7; scaling and root planing was carried out in the 2 other quadrants, one at day 0 and in the remaining quadrant at day 7. Subgingival microbiological samples were taken from each patient before treatment and on days 21, 91, and 175 after the treatment. The analyses were carried out by indirect immunofluorescence assay. At all treated sites probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded on days 0, 21, 91, and 175. Both treatments resulted in PD reduction and CAL gain. PD reduction was statistically significant (P < 0.01) for both treatment modalities after 6 months. The CAL gain was not significant for either treatment. There was no statistical significance between scaling and antibiotic therapy. Treponema denticola, Porphyromonas gingivalis, and Prevotella intermedia were significantly reduced after therapy; however, there were no statistically significant differences between treatments. If Actinobacillus actinomycetemcomitans was present before therapy, it was also present after treatment in both groups. The conclusion is that, in recall patients, local application of metronidazole and scaling and root planing showed similar clinical and microbiological effects without statistically significant differences.     

Conditioned behavioral responses to a context paired with the predator odor trimethylthiazoline.

Contextual fear conditioning is the learning of a fear response in a specific context in response to repeated application of aversive stimuli (e.g., foot shocks) or danger-related stimuli (predator odors) within that context. Cat odor, a danger-related stimulus common in laboratory studies of fear in the past, has often been replaced recently with trimethylthiazoline (TMT), a component of fox feces. No contextual fear conditioning in response to TMT has been reported so far, whereas cat odor has often been shown to induce such fear conditioning in rats. Using TMT in both a 1-compartment and a 2-compartment setup, the authors found conditioned fear behavior (expressed as avoidance behavior) in the 2-compartment setup but not--as reported by others--in the 1-compartment setup. Detailed analysis revealed 2 different coping strategies in the 2-compartment setup: Half of the rats showed pronounced avoidance behavior, whereas the other half showed intense risk assessment behavior. These results indicate that expression of conditioned fear behavior in response to a TMT-paired context is dependent on the experimental setup used, as well as the strategy of the individual rat. (PsycINFO Database Record (c) 2010 APA, all rights reserved)