Preoperative anexiety in oral surgery patients is a serious and prevalent concern in dentistry. Because of this, cognitive and behavioral interventions to manage patients' aniexty are generating increasing interest. Although these interventions tend to be effective, the reasons for their success are unclear. It has been suggested that behavioral preparation procedures operate by desensitizing patients to feared stimuli as well as by increasing patients' levels of confidence or self-efficacy, and by increasing a sense of control over the procedure. The purpose of the proosed study is to examine the relative effects of behavioral and pharmacological aniexty management procedures on preoperative anxiety, perioperative coping, postoperative recovery, and patients' willingness to pursue additional dental care. In the proposed study, 100 male and female candidates for third molar extraction will be randomly assigned to receive one of four types of preoperative preparation procedures. Each of the four interventions will be designed to provide, sequentially additional factors to enhance coping. The four preparation conditions include oral premedication (lorazepam; intended to decrease arousal), relaxation without performance feedback (intended to decrease arousal, plus enhance attributions of personal control), relaxation with positive self- efficacy performance feedback (to decrease arousal, provide control attributions, and enhance coping self-efficacy), and standard preoperative information provided by the oral surgeon (as a control condition). It is expected that those interventions that most increase patients' sense of self-efficacy and control will lead to the best anxiety management and best preoperative and postoperative outcomes, as measured by self-report, behavioral observation, and physiological measures. In addition, given the present design it will be possible to determine whether certain dispositional characteristics interact with intervention to determine coping, thus shedding light on whether patient can be matched to optimal preoperative interventions. The results of this researxh should offer new insights onto the factors responsible for effective coping with oral surgery procedures, and will offer implications for clinical intervention for preoperative anxiety management generally.
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| Litt, M D; Nye, C; Shafer, D (1993) Coping with oral surgery by self-efficacy enhancement and perceptions of control. J Dent Res 72:1237-43 |
