Cognitive Behaviour Therapy for Dental Phobia and Anxiety

236 Pages·2013·1.494 MB·English

by  Lars-Göran Öst, Erik Skaret (eds.)

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
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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
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.
Preface
This book is a result of a multi-disciplinary research cooperation between dentists and
psychologists. It is meant to help students and professionals in dentistry to understand the
complexity of the anxiety phenomenon, and in psychology to understand the specific situation
for the dental phobia patient, and bridge the gap between dentistry and psychology. The book
was first planned to be written for Scandinavia, and most of the authors are therefore from
these countries. This plan was then changed and a few more authors outside Scandinavia were
included. However, we know many researchers in behavioural science in dentistry and in
psychology around the world that would have been very qualified for being included on the
author list of the present book.
Being a practising dentist is in many ways a challenging and stressful job. Before they leave
the surgery after a long day with patients they often have a brief glance at the list of scheduled
appointments for tomorrow. Some names on the schedule can result in unpleasant feelings:
‘I hope the patient after lunch cancels or does not show up’. The first thought in the morning
is: ‘Today this patient is coming again. I always feel stressed and uncomfortable because I don’t
know how to treat him. I know the patient is doing his best, but I am afraid of losing my
patience and saying things like: “You have to leave my office. It is impossible for me to do my
job”. These patients make me feel incompetent and unsuccessful. The treatment doesn’t have
the quality it should have, and I am afraid this will have a negative influence on my reputation.
I want to be a good dentist’. Being able to help people with dental anxiety or dental phobia to
manage ordinary dental treatment provides the job as a dentist a new dimension.
Clinical psychologists know how to treat psychological disorders. They also know that there
are different treatment approaches, and they probably also know that cognitive behaviour
therapy (CBT) is the treatment of choice for specific phobias. However, they don’t know
much about the dental phobia patient. Their knowledge of dentistry is most often only based
on their own experiences in the dental chair. We hope this book will be helpful when new
patients explain their avoidance of dental care and its consequences for daily life.
Over the years it has gradually been recognized that greater effort should be directed
towards behaviour management and psychological interventions aimed at reducing patients’
anxiety in the long run without pharmacological support. CBT is a problem-focused
psychological intervention which seeks to teach patients skills for self-management of their
anxiety. Treatment of phobia in one or more sessions is not possible to learn by reading a book
x Preface
about the subject, but practising the basic principles of CBT described in this book can start
tomorrow. Building a trusting relationship, exploring negative thoughts and performing
gradual exposure to the most fear-provoking procedures in a controlled way will help patients
attend regular dental care.
Organization of the Book
The first part of this book starts with descriptions of symptoms, clinical characteristics and
consequences (Chapter 1), background data and epidemiology (Chapter 2), assessment
(Chapter 3), and Aetiology of dental phobia (Chapter 4). These are followed by a chapter on
a ‘close relative’ of dental phobia, intra-oral injection phobia (Chapter 5), and dental anxiety
in children and adolescents (Chapter 6). The second part of the book focuses on treatment
and begins with a general description of the principles, procedures and evidence base of
cognitive behaviour therapy (Chapter 7). This is followed by detailed descriptions of some
treatments; the multimodal cognitive behavioural treatment developed in Gothenburg
(Chapter 8), the one-session treatment developed by the first editor (Chapter 9), the combined
treatment developed by the second editor at the Center for Odontophobia in Bergen, Norway
(Chapter 10). This part ends with a description of dental treatment under sedation (Chapter
11), which probably is the most common way to treat dental phobia today, and a review and
meta-analysis of randomized controlled trials of CBT for dental phobia (Chapter 12). The
final part of the book discusses different treatment approaches in different cultures and health-
care systems (Chapter 13), prevention of dental phobia (Chapter 14), and future research and
applications (Chapter 15).
Acknowledgements
This volume is based on the considerable clinical research of many of our professional colleagues
around the world, which shows that research is a gigantic international collaboration. We also
appreciate the input from all the patients, young and old, who have participated in our research
over the last four decades. It is through these contacts that we have learned how to treat
phobias in general and dental phobia in particular. Without them this book would not exist.
We would also like to thank all our authors for their time, expertise and contributions to this
volume. Without them, the volume would be very thin.
Finally, we would like to extend special thanks to our families, friends and loved ones. I (Erik
Skaret) would like to offer my sincerest gratitude and appreciation to Magne Raadal, Gerd
Kvale, Einar Berg, Ulf Berggren (d. 2009), Peter Milgrom, Philip Weinstein and Tracy Getz
for inspiring and supporting me on my way into the academic area of behavioural sciences in
dentistry. I am greatly indebted to Lars-Göran Öst who taught me one-session treatment of
specific phobia. I feel very privileged for having had the opportunity to work with him both
clinically, as a researcher, and co-editor of this book. I want to thank my patients who believed
in me enough to be willing to explore their anxiety and test their strong catastrophic beliefs
with me.
Some days ago I crossed the beautiful Norwegian mountains by car on my way to a wedding.
I was sitting next to the driver with my laptop on my knees, writing a draft of this preface. I am
warmly grateful to the driver of the car, my lovely wife, Eli, for her endless understanding
nature and for reminding me very gently about all the things that are much more important
in life than writing this book. I also want to thank Kristine, Bebbe and my grandchild Agnete
for never complaining when I did not have time to do things together with you.
I am very eager to share my enthusiasm about the CBT approach. Some months ago I met
a colleague, a dentist who had passed our course on psychological and pharmacological
treatment of dental phobia. This is what my colleague said: ‘The course has changed my day
completely. I have implemented the principles of CBT in my daily practice, and I am no longer
worried about any patient on my schedule for tomorrow!’ My hope is that this book may give
some of these feelings to our readers.
I (Lars-Göran Öst) wish to thank Magne Raadal and Gerd Kvale for their early and never-
ending interest in dental phobia and for convincing me to, once more, work with this group
of patients, and Erik Skaret for developing the idea of this book with me. The collaboration on