Cognitive Behavioral Therapy for Dental Phobia and Anxiety

248 Pages·2013·7.44 MB·English

by  Lars-Göran Öst

171mm 171mm
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It is estimated that up to 15 per cent of the population in Western countries avoid dental d
care due to fear. Yet, cognitive behaviour therapy (CBT), a problem-focused psychological b
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intervention that teaches patients skills for self-management of their anxiety, has proved Ö
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to be a successful intervention for people with this phobia. Bringing together research t

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from the fields of psychology and dentistry, this book is the first to describe evidence- n
d
based treatment of dental phobia using CBT. It helps professionals and students in
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dentistry to understand the complexity of the anxiety phenomenon and those in k
a
psychology to understand the specific situation of the dental phobia patient. re
t
The book includes chapters describing epidemiology, diagnosis and differential diagnosis,
symptoms, clinical characteristics and consequences, and aetiology of dental phobia,
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as well as intra-oral injection phobia. It also covers dental treatment of fearful children o
and the use of conscious sedation and other pharmacological methods to supplement g
n
psychological treatment. The core of the book is built on research from Scandinavia, the i
t
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world leader in dental phobia research, and the editors are experts in clinical psychology v
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and dentistry. The Scandinavian contributions are augmented by chapters from noted
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authorities in the US and UK. It also demonstrates how to implement CBT principles for e
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dental phobia and anxiety in one or more treatment sessions, using an adaptation of a
v
Lars-Göran Öst’s pioneering single-session treatment for use in clinical or dental settings. i
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Lars-Göran Öst is Professor and Chair of Clinical Psychology at Stockholm University, r T Edited by
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Sweden, and Professor of Clinical Psychology at the University of Bergen, Norway. e Lars-Göran Öst 24
Considered the pioneer of one-session treatment of specific phobias, he is a regular r 6
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keynote speaker at major CBT conferences and has lectured at universities worldwide. p m
y and Erik Skaret
He is a former editor of the Scandinavian Journal of Behaviour Therapy and Behavioural f
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Psychotherapy, and serves on the editorial boards of Behaviour Research and Therapy, r

Cognitive Behaviour Therapy, Journal of Anxiety Disorders, Behavioural and Cognitive D
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Psychotherapy, Applied and Preventative Psychology, Journal of Experimental n
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Psychopathology, Behaviour Therapy, and Clinical Psychology: Science and Practice. a
l P Cognitive Behaviour
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Erik Skaret is Professor Emeritus in Behavioral Sciences in Dentistry. He was Professor
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in the Department of Pediatric Dentistry and Behavioural Sciences, University of Oslo, b
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Norway from 2008 to 2012. His previous positions were Acting Director at the Dental

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Fears Research Clinic, University of Washington, Seattle, USA from 1999 to 2000 and n Therapy for Dental
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Head of Center for Odontophobia, University of Bergen, Norway from 2001 to 2008.

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He has extensive clinical experience with psychological treatment of dental phobia and
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anxiety. His research areas are avoidance of dental care in children and adolescents and x
ie Phobia and Anxiety
treatment of dental phobia and intra-oral injection phobia in adults. He has published t
y
widely in peer-reviewed journals.

Cognitive Behaviour Therapy for
Dental Phobia and Anxiety

Cognitive Behaviour Therapy
for Dental Phobia and Anxiety
Edited by
Lars-Göran Öst
and
Erik Skaret
A John Wiley & Sons, Ltd., Publication
This edition first published 2013
© 2013 John Wiley & Sons, Ltd
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Library of Congress Cataloging-in-Publication Data
Cognitive behavioral therapy for dental phobia and anxiety / edited by Lars-Göran Öst, Erik Skaret.
pages cm
Includes bibliographical references and index.
ISBN 978-1-119-96072-0 (hardback) – ISBN 978-1-119-96071-3 (paper) 1. Fear of
dentists. 2. Cognitive therapy. 3. Evidence-based dentistry. 4. Dentist and patient. I. Öst,
Lars-Göran, editor of compilaton. II. Skaret, Erik, editor of compilation.
RK53.C64 2013
616.85¢22–dc23
2012045562
A catalogue record for this book is available from the British Library.
Cover design by Cyan Design
Set in 10/12.5pt Galliard by SPi Publisher Services, Pondicherry, India
1 2013
0001823395.INDD 4 1/5/2013 9:22:16 AM
Contents
List of Contributors vii
Preface ix
Acknowledgements xi
Part I Background, Assessment and Aetiology 1
1 Symptoms, Clinical Characteristics and Consequences 3
Magnus Hakeberg and Jesper Lundgren
2 Background Description and Epidemiology 21
Magne Raadal and Erik Skaret
3 Assessment of Dental Phobia and Anxiety 33
Kristin Haukebø and Margrethe Vika
4 Aetiology of Dental Phobia 45
Tiril Willumsen, Kristin Haukebø and Magne Raadal
5 Intra-Oral Injection Phobia 63
Margrethe Vika and Maren Lillehaug Agdal
6 Dental Anxiety in Children and Adolescents 79
Gunilla Klingberg
Part II Treatments 89
7 Cognitive Behaviour Therapy: Principles, Procedures
and Evidence Base 91
Lars-Göran Öst and David M. Clark
8 Multimodal Cognitive Behavioural Treatment 109
Jesper Lundgren and Ulla Wide Boman
9 One-Session Treatment of Dental Phobia 119
Lars-Göran Öst
vi Contents
10 The Combined Treatment 135
Erik Skaret
11 Dental Treatment under Sedation 153
Magne Raadal
12 Effects of Cognitive Behavioural Treatments: A Systematic
Review and Meta-Analysis 163
Lars-Göran Öst and Gerd Kvale
Part III Cultural Aspects, Prevention and Future Research 183
13 Different Treatment Approaches in Different Cultures
and Health-Care Systems 185
Peter Milgrom, Lisa J. Heaton and J. Timothy Newton
14 Prevention of Dental Phobia 201
Erik Skaret and Magne Raadal
15 Future Research and Applications 221
Lars-Göran Öst and Erik Skaret
Index 231
Contributors
Maren Lillehaug Agdal, DDS, PhD, is a dentist at the Center for Odontophobia in Bergen,
Norway. The title of her PhD thesis in 2011 is ‘Dental Phobia and Intra-Oral Injection Phobia:
Oral Health, Dental Treatment Needs and Quality of Life’.
Ulla Wide Boman, PhD, is Associate Professor at the Department of Behavioral and
Community Dentistry, University of Gothenburg, Sweden. Her research focuses on b ehavioural
aspects of oral health. She also works as a clinical psychologist at the Dental Fear Research and
Treatment Clinic (DFRTC), Swedish Public Dental Service.
David M. Clark, DPhil, is Professor of Experimental Psychology at Oxford University, UK. He
is a world-leading researcher in anxiety disorders and has carried out a large number of
randomized controlled trials (RCTs) for various anxiety disorders. Three of his cognitive treat-
ments are evidence-based, for: panic disorder, social phobia and post-traumatic stress disorder.
Magnus Hakeberg, DDS, PhD, is Professor of Dental Public Health and Head of the
Department of Behavioral and Community Dentistry, Institute of Odontology, the Sahlgrenska
Academy, University of Gothenburg, Sweden. He is a research director at the Public Dental
Service, Region Västra Götaland, Sweden and a dentist and specialist in endodontology.
Kristin Haukebø, PhD, is a psychologist within the Consultation & Liaison team, Oslo
University Hospital, Norway. The title of her 2011 thesis is ‘Cognitive, Behavioral and Neural
Correlates of Dental and Intra-Oral Injection Phobia. Results from One Treatment and One
FMRI Study of Randomized, Controlled Design’.
Lisa J. Heaton, PhD, is Acting Assistant Professor of Oral Health Sciences and a clinical
psychologist, providing cognitive behaviour therapy (CBT) in the Dental Fears Research
Clinic at the University of Washington, USA. With Peter Milgrom and Philip Weinstein, she
co-authored the third edition of the textbook, Treating Fearful Dental Patients, in 2009.
Gunilla Klingberg, DDS, PhD, is senior consultant in paediatric dentistry at Mun-H-Center,
the Swedish National Orofacial Resource Center for Rare Diagnoses, and Associate Professor
at the Sahlgrenska Academy, University of Gothenburg, Sweden. Her research concerns
viii List of Contributors
orofacial aspects of rare disorders, behavioural sciences in odontology, pain, and qualitative
research methods applied to dental sciences.
Gerd Kvale, Dr Psychol, is Professor of Clinical Psychology at the University of Bergen,
Norway. She was one of the founders of the Center for Odontophobia, University of Bergen.
Her research has focused on dental phobia, social phobia, panic disorder, and
obsessive-compulsive disorder.
Jesper Lundgren, PhD, is an Associate Professor at the Department of Psychology, University
of Gothenburg, Sweden and a psychologist at the Public Dental Service, Region Västra
Götaland, Sweden. He has worked for over 15 years in the field of psychology and dentistry
with his main focus of research on dental fear and other health psychological issues.
Peter Milgrom, DDS, is Professor of Oral Health Sciences and Pediatric Dentistry at the
University of Washington, USA. He was Director of the Dental Fears Research Clinic at the
university for nearly 25 years. His latest book (with Philip Weinstein and Lisa Heaton),
Treating Fearful Dental Patients, was published in 2009.
J. Timothy Newton, PhD, is Professor of Psychology as Applied to Dentistry at King’s
College Dental Institute in London, UK. In 2008, with Koula Asimakopoulou and Suzanne
Scott, he founded the King’s College London Dental Institute Health Psychology Service for
individuals who are dentally anxious.
Lars-Göran Öst, PhD, is Professor of Clinical Psychology at Stockholm University, Sweden.
During the last 40 years he has carried out RCTs on most anxiety disorders in adults and chil-
dren, and has developed three evidence-based CBT treatments: one-session treatment for
specific phobia, applied relaxation for generalized anxiety and applied tension for blood phobia.
Magne Raadal, DDS, PhD, is Professor Emeritus (Dentistry) at University of Bergen, Norway.
He graduated in 1966, became Specialist in Pediatric Dentistry in 1981, PhD in 1984, and
Professor in Pediatric Dentistry in 1993. He was Dean of Faculty of Dentistry, University of
Bergen, from 2002 to 2009.
Erik Skaret, DDS, PhD, is Professor at the University of Oslo, Department of Pediatric
Dentistry and Behavioral Sciences. He was Head of the Center for Odontophobia, University
of Bergen, from 2001 to 2008, and has many years of experience with psychological treatment
of dental phobia based on cognitive behaviour therapy.
Margrethe Vika, PhD, is a clinical psychologist at the Center for Odontophobia in Bergen,
Norway. She completed her PhD in clinical psychology at the University of Bergen in 2008.
The title of her thesis is ‘Fear of Intra-Oral Injections among Adolescents and Adults –
Prevalence, Consequences and Treatment’.
Tiril Willumsen, DDS, PhD, is Professor at the University of Oslo and has carried out a
randomized control trial on dental phobia using variants of cognitive treatment and applied
relaxation. She lectures about dental treatment in vulnerable patients, e.g. with histories of
childhood sexual abuse, eating disorders and diseased elderly.