Avoidance of regular dental care due to anxiety causes many in the United States to seek dental treatment only when in pain. This symptom-driven treatment reinforces the fear and avoidance of dentistry and leads to a worsening of overall oral and general health. An exciting new psychological approach has been developed to reduce fear, based on the well-established observation that anxious individuals process information about feared stimuli differently from non-anxious individuals. A type of Cognitive Bias Modification (CBM) has been developed to modify the attentional bias of anxious individuals so that they learn to direct their attention away from emotionally negative/threatening stimuli, resulting in a meaningful reduction in anxiety. Building on pilot work by our group, this application has 2 specific aims that are the critical next steps in the development of a CBM therapeutic intervention to reduce dental anxiety. The primary goal of Specific Aim 1 is to determine whether individuals who have a strong attentional bias toward threatening dental words are more fearful than those without an attentional bias. In addition, a battery of anxiety and dental fear survey items will be used to create a brief screening tool to predict which individuals have the greatest attentional bias. The goal of Specific Aim 2 is to use a separate sample to validate the ability of the screening tool to predict attentional bias using a refined attentional task based on the results of Specific Aim 1. In both studies, attentional bias will be assessed using a dot-probe attentional bias task, hosted by Project Implicit(R). In this task, the "threatening dental" / "non- dental, non-threatening" word pairs are presented briefly on a computer screen, vertically with one word above the other. When the words disappear, a probe immediately replaces either the dental or non-dental word and subjects are asked to rapidly identify the probe using a specific keystroke. Prior research has shown that compared to non-anxious individuals, those with anxiety respond more quickly when identifying a probe that appears in the location of the fear-related threatening word and more slowly when the probe replaces the neutral word. The threat bias index (TBI) provides a measure of an individual's attentional bias and will be calculated by subtracting the median response times for probes presented in place of the dental threat-related words from the median response times for probes presented in place of the neutral control words. The results obtained from these 2 specific aims will provide pilot data for an NIH application for a clinical investigation to test a CBM treatment battery for dental anxiety.
The public health relevance of the proposed project lies in developing an online cognitive bias modification protocol to reduce dental fear. Dental fear leads approximately 10% of adults in the United States to avoid necessary dental care. Creating an inexpensive, easily accessible treatment for dental fear holds promise to decrease dental fear and thereby increase access to needed dental treatment.