Appraisal of dental anxiety and fear questionnaires: a review

This article reviews and assesses six dental anxiety and fear questionnaires. The construct aimed at by the questionnaires, the data collected, their reliability, validity and normative scores are considered. Some attention is given to the correlations between the questionnaires, their ambiguity, the presence of manuals, and whether the questionnaires tap the three segments distinguishable on theoretical ground in dental anxiety/fear. All questionnaires are open to criticism. In the final assessment Kleinknecht's Dental Fear Survey is preferred to Corah's Dental Anxiety Scale. The latter, however, appears useful in getting a quick impression of anxiety and in evaluative studies. Three recently developed questionnaires, Stouthard's Dental Anxiety Inventory, Weiner's Fear Questionnaire and Morin's Adolescents' Fear of Dental Treatment Cognitive Inventory are considered promising, but for the last two instruments more data, in particular with regard to their validity, are needed. It is concluded that in dental anxiety research more than one questionnaire should be used and that it may be worthwhile to include other, non-anxiety questionnaires as well.     

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.     

Treatment of dental anxiety by cue-controlled relaxation.

The consequences of high dental anxiety may include decreased patient cooperation or the avoidance of dental care. Drug therapy may be contraindicated or may produce undesirable side effects. 10 adult women, self-referred for dental anxiety, were given 4 wks of cue-controlled relaxation treatment. Nonorthogonal planned comparisons indicated significant pre- to posttreatment decreases on the Dental Anxiety Scale, the Anxiety Differential, and the State Anxiety scale, and systolic blood pressure; these persisted at the follow-up testing 4 wks later. Some evidence was found to suggest that there may have been some generalization of effect beyond just the dental setting. In a 6-mo follow-up, 8 of 9 participants contacted reported that the treatment had been helpful in controlling their anxiety when visiting their dentist. Some implications for the practice of counseling and further research are mentioned. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability and validity of the Social Phobia and Anxiety Inventory for adolescents.

Although social anxiety is known to be common among adolescents, there are no self-report measures with demonstrated reliability and validity for this population. The Social Phobia and Anxiety Inventory (SPAI) is a measure of social anxiety developed for adults. The purpose of this study was to determine the reliability and validity of the SPAI for adolescents. The sample consisted of 223 adolescents (aged 12–18 yrs) from both clinical and community sources. Confirmatory factor analysis established the validity of the 2 separate factors of Social Phobia and Agoraphobia. Reliability estimates by Cronbach alpha were acceptable for the SPAI subscales and total. The SPAI demonstrated good construct validity, showing statistically significant relationships with independent measures of social phobia and other anxiety variables. The results demonstrate that the SPAI is a reliable and valid measure of social phobia for adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new inventory to assess childhood social anxiety and phobia: The Social Phobia and Anxiety Inventory for Children.

The development, reliability, and validity of a new instrument, the Social Phobia and Anxiety Inventory for Children (SPAI-C), is described. The results indicate that the SPAI-C has high test–retest reliability and internal consistency. In addition, an assessment of concurrent and external validity indicates statistically significant correlations with commonly used self-report measures of general anxiety and fears and parental reports of children's anxiety and social competence. The results of a factor analysis indicate that the scale consists of three factors: Assertiveness/General Conversation, Traditional Social Encounters, and Public Performance. Finally, scores on the SPAI-C successfully differentiate socially anxious and non-socially-anxious children. The instrument appears to be a reliable and valid measure for childhood social anxiety and fear and may prove useful for improving clinical assessment and documenting treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

An empirically derived inventory to measure social fears and anxiety: The Social Phobia and Anxiety Inventory.

The development, reliability, and discriminative ability of a new instrument to assess social phobia are presented. The Social Phobia and Anxiety Inventory (SPAI) is an empirically derived instrument incorporating responses from the cognitive, somatic, and behavioral dimensions of social fear. The SPAI high test–retest reliability and good internal consistency. The instrument appears to be sensitive to the entire continuum of socially anxious concerns and is capable of differentiating social phobics from normal controls as well as from other anxiety patients. The utility of this instrument for improved assessment of social phobia and anxiety and its use as an aid for treatment planning are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological predictors of pain during dental hygiene treatment

This study examined the role of catastrophizing (i.e. a tendency to exaggerate the threat value of potentially painful situations) in predicting pain experience during dental hygiene treatment. Participants in the research were 100 patients undergoing scaling and/or root planing procedures at Dalhousie University's Dental Clinic. Following treatment, participants completed the Pain Catastrophizing Scale, a measure of emotional distress, a pain scale, and the Dental Anxiety Scale-Revised. Participants who scored above the median on the Pain Catastrophizing Scale were classified as catastrophizers, participants who scored below the median were classified as noncatastrophizers. Results showed that catastrophizers reported significantly more dental anxiety, emotional distress and pain than noncatastrophizers; and that distress reactions were more pronounced in men that in women. Discussion focuses on the importance of addressing psychological factors in dental hygiene practice, particularly as they relate to reactions to dental hygiene procedures, and avoidance of dental care.     

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)     

Construction and psychometric characteristics of two self-report questionnaires for the assessment of fear of flying.

This article presents the development of and data on the dimensional structure, reliability, and validity of 2 new inventories for assessing different aspects of fear of flying: the Flight Anxiety Situations questionnaire (FAS), which assesses anxiety related to flying experienced in different situations, and the Flight Anxiety Modality questionnaire (FAM), which measures symptom modalities in which anxiety in flight situations is expressed. Two initial questionnaires were constructed from multiple sources. Factor analytic studies were conducted to assess their internal structure, and the final versions were examined in a sample of 746 patients who experienced fear of flying. A principal-components analysis investigated the optimal dimensional structure in 2 randomly created subsamples. A 3-factor solution for the FAS and a 2-factor solution for the FAM were revealed. The internal consistency and test-retest reliability were good to excellent. Moderately strong correlations between the subscales suggest sufficient factorial specificity and convergent validity. The subscales were sensitive to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

The validation of a new obsessive–compulsive disorder scale: The Obsessive–Compulsive Inventory.

The Obsessive-Compulsive Inventory (OCI) is a new self-report instrument developed to address the problems inherent in available instruments for determining the diagnosis and severity of obsessive-compulsive disorder (OCD). The OCI consists of 42 items composing 7 subscales: Washing, Checking, Doubting, Ordering, Obsessing (i.e., having obsessional thoughts), Hoarding, and Mental Neutralizing. Each item is rated on a 5-point (0-4) Likert scale of symptom frequency and associated distress. One hundred and forty-seven individuals diagnosed with OCD; 58 with generalized social phobia; 44 with posttraumatic stress disorder; and 194 nonpatients completed the OCI and other measures of OCD, anxiety, and depression. The present article describes the psychometrics of the OCI including (a) scale construction and content validity, (b) reliability (internal consistency and retest reliability), and (c) convergent and discriminant validity. The OCI exhibited satisfactory reliability and validity with all 4 samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the Social Interaction Anxiety Scale and the Social Phobia Scale

In the study of social anxiety, it is common to differentiate between social interaction versus performance anxiety. The Social Interaction Anxiety Scale was designed to assess social interaction anxiety, and the Social Phobia Scale to assess fear of scrutiny by others (Mattick and Clarke, 1989). In common use, these scales are typically administered together and treated as subscales of a larger measure. However, the joint factor structure of these instruments has never been examined; therefore, it is unclear whether or not the items on these scales actually represent distinct aspects of social anxiety. In the present study, a confirmatory factor analysis of the pooled items from the SIAS and SPS failed to adequately fit the data. An exploratory factor analysis yielded three factors: (1) interaction anxiety, (2) anxiety about being observed by others, and (3) fear that others will notice anxiety symptoms. However, hierarchical factor analysis suggested that these factors all load on a single higher-order factor, social anxiety. Relationships of the first-order factors to other measures of social and performance fear and avoidance are examined, and implications of our findings for the assessment of social phobia are discussed.     

Factor structure of a measure of anxiety sensitivity in children

Anxiety sensitivity (i.e., the disposition to react to autonomic arousal with fear) has taken a central role in recent conceptualizations of anxiety. However, questions regarding the dimensional nature of anxiety sensitivity remain. In particular, the factor structure of anxiety sensitivity is unexplored in nonadult populations. The factor structure of the Anxiety Sensitivity Index for Children (ASIC) was examined in three studies. Study 1 (N = 95) used a sample of school children in Grades 4-8 to investigate the reliability of items and factor structure. Items with weak psychometric properties were eliminated, and subsequent analyses revealed that the ASIC was best viewed as a hierarchical scale with a higher order factor (Anxiety Sensitivity) and two first-order factors (Fear of Physiological Arousal and Fear of Mental Catastrophe). Study 2 (N = 112) and Study 3 (N = 144) used more distressed samples of youngsters, and they also found the ASIC to be a hierarchical scale. These findings add a developmental perspective to the Anxiety Sensitivity Index factor analytic discussion and are highly consistent with emergent thinking in the adult anxiety sensitivity literature.     

Validation of the Social Interaction Anxiety Scale and the Social Phobia Scale across the anxiety disorders.

The psychometric adequacy of the Social Interaction Anxiety Scale (SIAS; R. P. Mattick & J. C. Clark, 1989), a measure of social interaction anxiety, and the Social Phobia Scale (SPS; R. P. Mattick & J. C. Clark, 1989), a measure of anxiety while being observed by others, was evaluated in anxious patients and normal controls. Social phobia patients scored higher on both scales and were more likely to be identified as having social phobia than other anxious patients (except for agoraphobic patients on the SPS) or controls. Clinician-rated severity of social phobia was moderately related to SIAS and SPS scores. Additional diagnoses of mood or panic disorder did not affect SIAS or SPS scores among social phobia patients, but an additional diagnosis of generalized anxiety disorder was associated with SIAS scores. Number of reported feared social interaction situations was more highly correlated with scores on the SIAS, whereas number of reported feared performance situations was more highly correlated with scores on the SPS. These scales appear to be useful in screening, designing individualized treatments, and evaluating the outcomes of treatments for social phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

DSM-III classification of the anxiety disorders: A psychometric study.

89 patients meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for anxiety disorders were administered a battery of self-report inventories, including the State-Trait Anxiety Inventory, the Beck Depression Inventory, an obsessive-compulsive inventory, the Cornell Medical Index—Health Questionnaire, and the Fear Survey Schedule. The validity of the DSM-III subgroups of anxiety states and phobias was substantiated. However, the results indicate that agoraphobia was more similar to the anxiety state than the phobia group, where it is presently classified. The anxiety state group was highly homogenous. On the other hand, the phobia group showed some degree of heterogeneity. Findings are discussed in terms of the validity of DSM-III subcategories of phobias and anxiety states, the reclassification of agoraphobia as an anxiety state, and whether phobias should be included in the anxiety disorders category. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3.

Accumulating evidence suggests that anxiety sensitivity (fear of arousal-related sensations) plays an important role in many clinical conditions, particularly anxiety disorders. Research has increasingly focused on how the basic dimensions of anxiety sensitivity are related to various forms of psychopathology. Such work has been hampered because the original measure--the Anxiety Sensitivity Index (ASI)--was not designed to be multidimensional. Subsequently developed multidimensional measures have unstable factor structures or measure only a subset of the most widely replicated factors. Therefore, the authors developed, via factor analysis of responses from U.S. and Canadian nonclinical participants (n = 2,361), an 18-item measure, the ASI-3, which assesses the 3 factors best replicated in previous research: Physical, Cognitive, and Social Concerns. Factorial validity of the ASI-3 was supported by confirmatory factor analyses of 6 replication samples, including nonclinical samples from the United States and Canada, France, Mexico, the Netherlands, and Spain (n = 4,494) and a clinical sample from the United States and Canada (n = 390). The ASI-3 displayed generally good performance on other indices of reliability and validity, along with evidence of improved psychometric properties over the original ASI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbid anxiety disorders and treatment of depression in people with multiple sclerosis.

Objective: Anxiety is highly comorbid with depression, but little is known about the impact of anxiety disorders on the effectiveness of empirically supported psychotherapies for depression. We examined such outcomes for people with Multiple Sclerosis (MS) and depression, with versus without comorbid anxiety disorders. Design: Participants with MS (N = 102) received 16 weeks of telephone-administered psychotherapy for depression and were followed for one year post-treatment. Results: Participants with comorbid anxiety disorders improved to a similar degree during treatment as those without anxiety disorders. Outcomes during follow-up were mixed, and thus we divided the anxiety diagnoses into distress and fear disorders. The distress disorder (GAD) was associated with elevated anxiety symptoms during and after treatment. In contrast, fear disorders (i.e., panic disorder, agoraphobia, social phobia, specific phobia) were linked to depression, specifically during follow-up, across 3 different measures. Conclusions: People with GAD receiving treatment for depression may benefit from additional services targeting anxiety more specifically, while those with comorbid fear disorders may benefit from services targeting maintenance of gains after treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric properties of the French and English versions of the Social Phobia Inventory.

The Social Phobia Inventory (SPIN; Connor et al., 2000) is a self-report measure assessing fear, avoidance, and physiological symptoms associated with social anxiety. To date, the psychometric properties of this English-language measure have been examined primarily in individuals with social phobia. This study examined the psychometric properties of the English SPIN and a newly developed French version of the SPIN in nonclinical groups of undergraduate students. The SPIN, along with several other questionnaires, was completed by 202 English-speaking and 222 French-speaking participants in their respective languages from three different universities. A subset of participants completed the questionnaire a second time approximately one month later to assess test-retest reliability. The SPIN total score exhibited excellent internal consistency and test-retest reliability, as well as strong convergent and divergent validity in both English and French. A revised confirmatory factor analysis suggested the three-factor model of the SPIN was a good fit in French and English; however, the psychometric properties of the fear, avoidance, and physiology subscales were not as strong as those of the total score of the SPIN. The excellent psychometric properties of the English and French SPIN total score support the use of this measure not only in clinical populations, but now also in a nonclinical student sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dystrophinopathies: an alternative to the structural hypothesis

Two studies with college students were conducted to further explore the reliability and construct validity of fear of emotion, as assessed by the Affective Control Scale (ACS), a measure of fear of anxiety, depressed mood, anger, and strong positive emotion. The ACS fared well in tests of internal consistency and of convergent and divergent validity. In an analogue study of panic onset with college students with no history of panic, the predictive and incremental validity of the ACS was demonstrated: the ACS predicted students' fear of induced panic-like bodily sensations even once trait and state anxiety were statistically controlled. A second aspect of the investigation was an analogue test of the hypothesis that stress from interpersonal conflict (induced via remembrance of conflictual interactions with an important person) would moderate the ACS's effects on anxiety and fear of induced bodily sensations. This hypothesis was not confirmed.