Anxiety and fear


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Behavioral Dentistry
Second Year

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Anxiety and fear

  1. 1. 03/07/1434 1 DENTAL-RELATED ANXIETIES AND FEARS Dr. Mohamed Salah Khalil (Ph.D-Neuropsychology) Associate Professor-Consultant Clinical Psychologist Coordinator of Postgraduate Clinical Psychology Program 5/12/20131 DR. MOHAMED SALAH KHALL ?PHOBIAWHAT IS DENTAL • The distinction between dental anxiety, dental fear, and dental phobia. • DENTAL ANXIETY is a reaction to an UNKNOWN danger. Most people experience some degree of dental anxiety especially if they’re about to have something done which they’ve never experienced before. • DENTAL FEAR is a reaction to a known danger (“I know what the dentist is going to do, --I’m scared!!”), which involves a fight-or-flight response when confronted with the threatening stimulus.
  2. 2. 03/07/1434 2 • DENTAL PHOBIA is basically the same as fear, only much stronger. The fight-or-flight response occurs when just thinking about or being reminded of the threatening situation. • Someone with a dental phobia will avoid dental care at all costs until either a physical problem or the psychological burden of the phobia becomes overwhelming. • Two types of dental anxiety: exogenous (from the outside) and endogenous (from the inside). Exogenous dental anxiety is defined as anxiety due to traumatic dental experiences. Endogenous dental anxiety is thought to have originated from other anxiety disorders. ?PHOBIAWHAT IS DENTAL MEASRING DENTAL PHOBIA • Modified Dental Anxiety Scale (MDAS) • 1. If you had to go to the dentist tomorrow for a check-up, how would you feel about it? – a. I would look forward to it as a reasonably enjoyable experience. – b. I wouldn't care one way or the other. – c. I would be a little uneasy about it. – d. I would be afraid that it would be unpleasant and painful. – e. I would be very frightened of what the dentist would do. • 2. When you are waiting in the dentist's office for your turn in the chair, how do you feel? – a. Relaxed. – b. A little uneasy. – c. Tense. – d. Anxious. – e. So anxious that I sometimes break out in a sweat or almost feel physically sick.
  3. 3. 03/07/1434 3 Causes of Dental Anxiety and Phobia • Bad experiences: (MOST of dental phobias) • Pain • Feelings of helplessness and loss of control • Embarrassment • A history of abuse • Uncaring dentist. • Humiliation. • Vicarious learning • Preparedness • Post-Traumatic Stress. • CONCEPT OF: Posttraumatic Dental-care Anxiety (PTDA), 6 BEHAVIOURAL AND CIGNITIVE BEHAVIOURAL TECHNIQUES •THE TERM BEHAVIOUR MODIFICATION EMERGES FROM EARLY WORK BY SKINNER(1953). •The concept is based on establishment of competent behavioral engineering skills to bring about change in child Behavior.
  4. 4. 03/07/1434 4 7 TECHNIQUES 1.DESENSITIZATION 2.TELL ,SHOW ,DO 3.MODELLING 4.DISTRACTION 5.-CONTINGENCY MANAGEMENT 6. SHAPING 7.VISUALIZATION 8.PROGRESSIVE RELAXATION • Systematic Desensitization Involves the gradual presentation of the feared stimulus while at the same time replacing the anxiety with more calm and relaxed conditions. There are three steps in the self-administered systematic desensitization procedure: 1. Relaxation; 2. Constructing an anxiety hierarchy; 3. Pairing relaxation with the situations described in your anxiety hierarchy.
  5. 5. 03/07/1434 5 Visualisation Combines elements of relaxation and then distraction by imagining a pleasant situation. • Therapist describes the procedure • Patient selects image of place to use STEPS: • Progressive relaxation • Imagine chosen scene • Create detailed multi sensory image • Can be taped and replayed • Practice as homework 5/12/20139 DR. MOHAMED SALAH KHALIL • Tell - Show - Do Technique 1. Use words that the child can understand. 2. Avoid fear-inducing words. 3. Introduce the simplest procedures first. 4. Must be continuous
  6. 6. 03/07/1434 6 Positive reinforcement • Description: In the process of establishing desirable patient behavior, it is essential to give appropriate feedback. • Positive reinforcement is an effective technique to reward desired behaviors and, thus, strengthen the recurrence of those behaviors. Social reinforcers include positive voice modulation, facial expression, verbal praise, and appropriate physical demonstrations of affection by all members of the dental team. Nonsocial reinforcers include Positive Reinforcement Identify target behavior. Select an appropriate reward Reward the target behavior promptly and consistently when it occurs. Ignore undesirable
  7. 7. 03/07/1434 7 -MANAGEMENTCONTINGENCY • Method of modifying the behavior of • Children by presentation or withdrawal of reinforces 1. BEHAVIOR SHAPING : Is the procedure which slowly develops behavior by reinforcing a successive approximation of the desired behavior until the desired behavior comes into being
  8. 8. 03/07/1434 8 Distraction • Description: Distraction is the technique of diverting the patient’s attention from what may be perceived as an unpleasant procedure. Giving the patient a short break during a stressful procedure can be an effective use of distraction prior to considering more advanced behavior guidance techniques. • Objectives: The objectives of distraction are to: • 1. Decrease the perception of unpleasantness; • 2. Avert negative or avoidance behavior. COGNITIVE FACTORS 1. Give the patient A SENSE OF CONTROL 2. Acknowledge
  9. 9. 03/07/1434 9 Voice Control • It is applied when the child’s behavior has caused ongoing treatment to stop. • The technique involves the use of sudden, loud and firm commands as aversive stimuli to suppress the disruptive behavior. • Should be followed by positive reinforcement Different types of relaxation Progressive muscle relaxation. 12 muscle group relaxation. 8 muscle group relaxation. 4 muscle group relaxation. Release only relaxation. Breathing relaxation. Cue controlled relaxation. Holding the breath. Rhythmic breathing. Counting breaths. 5/12/201318 DR. MOHAMED SALAH KHALIL
  10. 10. 03/07/1434 10 Goals in relaxation • A coping mechanism to help patients gain a sense of mastery over their internal world • Aim is to facilitate engagement with activities of everyday living and exposure tasks. • Not an intrinsic therapeutic activity. 5/12/201319 DR. MOHAMED SALAH KHALIL 12 muscle group relaxation These are: • Lower arms. • Upper arms. • Lower legs. • Thighs. • Stomach. • Upper chest and back. • Shoulders. • Back of the neck. • Lips. • Eyes. • Eye brows. • Upper forehead and scalp. 5/12/201320 DR. MOHAMED SALAH KHALIL
  11. 11. 03/07/1434 11 Eight muscle group relaxation 1. Whole arms. 2. Whole legs. 3. Stomach. 4. Upper chest and back. 5. Shoulders. 6. Back of the neck. 7. Face. 8. Forehead and scalp. 5/12/201321 DR. MOHAMED SALAH KHALIL 4 muscle group relaxation. 1. Whole arms. 2. Upper chest and back. 3. Shoulders and neck. 4. Face. • The patient is asked to identify tension and then focus on relaxing that tension. 5/12/201322 DR. MOHAMED SALAH KHALIL