Development and Testing of a Cognitive Bias Protocol for Dental Fear and Anxiety

University Of Washington, Seattle WA

Investigators

Abstract

DESCRIPTION (provided by applicant): 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.