The present proposal is a competitive continuation of an ongoing research program into the processes underlying behavioral interventions for dental fear. In our first studies we discovered that a variety of elements present in preparatory interventions may contribute to improved coping with oral surgery, and that they appear to act in an additive way. Among these elements were desensitization, autonomic relaxation, perceptions of control, and self-efficacy enhancement. It was discovered, however, that dispositional style (blunting) interacted with type of preparation to moderate outcome, such that high blunters fared better with less involving interventions. Furthermore, it was found that patients appeared to exhibit one of three patterns of dental fear, and that response to intervention was partly determined by that pattern. The general purpose of the current proposed research is to continue to explore those elements that contribute to optimal preparation for patients undergoing a stressful oral surgery procedure, and to test simple means by which to match oral surgery patients to a preparation that will be most useful to them. In addition, we are interested in the cost effectiveness of preparatory interventions. To explore these issues oral surgery patients will be randomly assigned to one of five preparation conditions: (1) standard preparation, in which minimal preoperative information is provided by the oral surgeon (a control condition); (2) oral premedication; (3) a music distraction intervention; (4) a relaxation intervention plus self-efficacy enhancement procedure, in which patients are given positive feedback about their ability to relax; or (5) a relaxation-based desensitization procedure in which self-efficacy is enhanced, but which is also intended to promote mastery related to specific operatory-related stimuli. Outcome measures will be patient's preoperative distress, perioperative distress, and postoperative satisfaction and morbidity. Overall we expect that those patients who perceive more control and self-efficacy will fare best generally. However, we also believe that those patients who are more accustomed to coping by means of distracting attention will fare best in the less involving interventions (i.e., music distraction and oral premedication). Furthermore, we expect that those patients whom we refer to as cue anxious will fare best with an intervention that specifically addresses those cues. The results of the study should provide evidence for the idea of matching patients to appropriate preparatory interventions for dentistry, and should also shed light on the precise active ingredients of preparatory interventions. Finally, the results will give us an indication as to whether such interventions are worth the time and effort they require in comparison to their benefits in satisfaction.
| Litt, M D; Kalinowski, L; Shafer, D (1999) A dental fears typology of oral surgery patients: matching patients to anxiety interventions. Health Psychol 18:614-24 |
| Litt, M D (1996) A model of pain and anxiety associated with acute stressors: distress in dental procedures. Behav Res Ther 34:459-76 |
| Litt, M D; Nye, C; Shafer, D (1995) Preparation for oral surgery: evaluating elements of coping. J Behav Med 18:435-59 |
| 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 |
