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The first part of this review, published last month, dealt with understanding the nature and prevalence of dental fears among children. This article is concerned with investigating ways in which these fears could best be managed.
Idiopathic environmental intolerance (IEI) is a poorly understood condition that may involve disturbances in immunologic, neurologic, endocrine, behavioral, emotional, and cognitive processes. This chapter reviews theories and evidence that behavioral conditioning processes, including pharmacologic sensitization, conditioned immunomodulation, and conditioned odor and taste aversions, may play a role in the development and maintenance of IEI. It also reviews the psychophysiologic concepts of individual response specificity and situational response stereotypy as potential explanations for the individual differences observed in specific responses to environmental stimuli in patients with IEI. Finally, the treatment implications of a conditioning account of IEI are discussed as part of a more comprehensive treatment approach that incorporates other behavioral and nonbehavioral strategies.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
In a randomized controlled trial, eye movement desensitization and reprocessing (EMDR) for panic disorder with agoraphobia (PDA) was compared with both waiting list and credible attention-placebo control groups. EMDR was significantly better than waiting list for some outcome measures (questionnaire, diary, and interview measures of severity of anxiety, panic disorder, and agoraphobia) but not for others (panic attack frequency and anxious cognitions). However, low power and, for panic frequency, floor effects may account for these negative results. Differences between EMDR and the attention-placebo control condition were not statistically significant on any measure, and, in this case, the effect sizes were generally small (eta2 = .00-.06), suggesting the poor results for EMDR were not due to lack of power. Because there are established effective treatments such as cognitive-behavior therapy for PDA, these data, unless contradicted by future research, indicate EMDR should not be the first-line treatment for this disorder.
Virtual Reality (VR) is a new technology that makes humans communicate with computer. It allows the user to see, hear, feel and interact in a three-dimensional virtual world created graphically. Virtual Reality Therapy (VRT), based on this sophisticated technology, has been recently used in the treatment of subjects diagnosed with acrophobia, a disorder that is characterized by marked anxiety upon exposure to heights, avoidance of heights, and a resulting interference in functioning. Conventional virtual reality system for the treatment of acrophobia has a limitation in scope that it is based on over-costly devices or somewhat unrealistic graphic scene. The goal of this study was to develop a inexpensive and more realistic virtual environment for the exposure therapy of acrophobia. We constructed two types virtual environment. One is constituted a bungee-jump tower in the middle of a city. It includes the open lift surrounded by props beside tower that allowed the patient to feel sense of heights. Another is composed of diving boards which have various heights. It provides a view of a lower diving board and people swimming in the pool to serve the patient stimuli upon exposure to heights.
Can virtual reality exposure therapy be used to treat people with social phobia? To answer this question it is vital to known if people will respond to virtual humans (avatars) in a virtual social setting in the same way they would to real humans. If someone is extremely anxious with real people, will they also be anxious when faced with simulated people, despite knowing that the avatars are computer generated? In [17] we described a small pilot study that placed 10 people before a virtual audience. The purpose was to assess the extent to which social anxiety, specifically fear of public speaking, was induced by the virtual audience and the extent of influence of degree of immersion (head mounted display or desktop monitor. The current paper describes a follow up study conducted with 40 subjects and the results clearly show that not only is social anxiety induced by the audience, but the degree of anxiety experienced is directly related to the type of virtual audience feedback the speaker receives. In particular, a hostile negative audience scenario was found to generate strong affect in speakers, regardless of whether or not they normally suffered from fear of public speaking.
This study examined the effects of cognitive-behavior therapy (CBT) compared with traditional behavior therapy (exposure and response prevention [ERP]) in the group treatment of obsessive-compulsive disorder. Of the 76 participants who started treatment, 38 were wait-listed for 3 months before treatment to assess possible course effects. Both treatments were superior to the control condition in symptom reduction, with ERP being marginally more effective than CBT by end of treatment and again at 3-month follow-up. In terms of clinically significant improvement, treatment groups were equivalent on the conclusion of treatment, but 3 months later significantly more ERP participants met criteria for recovered status. Only 1 of 7 belief measures changed with treatment improvement, and the extent of this cognitive change was similar between CBT and ERP groups. Discussion includes consideration of optimal formats for the delivery of different types of treatment.
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Clients with generalized anxiety disorder (GAD) received either (a) applied relaxation and self-control desensitization, (b) cognitive therapy, or (c) a combination of these methods. Treatment resulted in significant improvement in anxiety and depression that was maintained for 2 years. The large majority no longer met diagnostic criteria; a minority sought further treatment during follow-up. No differences in outcome were found between conditions; review of the GAD therapy literature suggested that this may have been due to strong effects generated by each component condition. Finally, interpersonal difficulties remaining at posttherapy, measured by the Inventory of Interpersonal Problems Circumplex Scales (L. E. Alden, J. S. Wiggins, & A. L. Pincus, 1990) in a subset of clients, were negatively associated with posttherapy and follow-up improvement, suggesting the possible utility of adding interpersonal treatment to cognitive-behavioral therapy to increase therapeutic effectiveness.
Pavlovian conditioning models have influenced the development of cue exposure treatments for drug abuse. However, poor maintenance of extinction performance (renewal) after treatment is a common problem. A treatment-analogue experiment tested the role of context in renewal, as well as a potential strategy for reducing renewal. Seventy-eight social drinkers completed extinction trials to reduce saliva and urge reactivity to alcohol cues and were randomly assigned to a renewal test in either the same context as extinction, a different context, or the different context containing a cue from the extinction context (E-cue). As predicted, the different context produced greater renewal than the same context and renewal was attenuated when the E-cue was present. These results offer preliminary evidence for the context dependence of extinction to alcohol cues and for the use of an extinction cue to improve the generalizability of exposure therapies.
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211 Patients followed a special dental fear programme. The Tell-Show-Do Method was the method most often used. Half a year after having finished the programme all patients received a questionnaire. A majority (74%) of the 158 patients that returned the questionnaire reported a good contact with their home dentist.
General dentists, as well as pediatric dentists, treat many children. Behavior management for children is an integral component of pediatric dental practice. Behavior management techniques have been developed based on empirical evidence indicating the importance of social learning theory to change both the causes and consequences of negative behaviors. This paper addresses the theoretical basis of current approaches in guiding children's behavior during dental settings. The relevance of the theoretical areas to the day-to-day treatment of the patient is emphasized.