Dental phobia is a significant deterrent to seeking regular dental care. Fear contributes to disparities in oral health care because greater frequencies of women and minorities exhibit dental fear than do males and Caucasians. Within urban communities, treatment for such phobia is readily obtained in specialized clinics or from licensed psychologists. However, the density of mental health care workers is disproportionately concentrated in urban rather than rural areas. Mental health workers, particularly psychologists, practice largely in areas with high population densities or universities. Indeed the National Institute of Mental Health has had several initiatives aimed at increasing the presence of psychologists in rural communities and a number of states have initiated programs to address this inequity. In addition to these efforts, there is growing recognition that access to digital information via personal computers and the Internet is a method to provide uniform access to expertise regardless of geographical location. This proposal will investigate the effectiveness of automated and Internet-based psychological interventions for a common dental fear in rural areas. Demonstrations of the effectiveness of such interventions are necessary, and should be conducted within the populations that would be intended to use them. We propose to test CARL (Computer Assisted Relaxation Learning), a computer program designed to administer exposure therapy for dental injection fear, within three rural communities in Washington State. Two of the three communities selected have large proportions of Hispanic farm workers. The program would be implemented in participating dentists' offices and tested against a standard care control group.
The specific aims of the proposed study are to 1) validate existing dental fear measures for use in Hispanic communities, 2) recruit and train a small network of rural dentists to treat dental fear patients using automated exposure therapy, and 3) establish the effectiveness of an automated therapy for dental injection phobia within the network of rural dentists relative to an information only control group. In addition to treating a common dental fear that leads to avoidance of dental care, this study will evaluate the effectiveness of a general approach (distance, computer-assisted psychology) that may be used to provide a broad range of psychotherapeutic interventions.
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