Development and Testing of a Cognitive Behavioral Therapy Resource for Children’s Dental Anxiety

Abstract

Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for dental anxiety; however, access to therapy is limited. The current study aimed to develop a self-help CBT resource for reducing dental anxiety in children, and to assess the feasibility of conducting a trial to evaluate the treatment efficacy and cost-effectiveness of such an intervention. A mixed methods design was employed. Within phase 1, a qualitative "person-based" approach informed the development of the self-help CBT resource. This also employed guidelines for the development and evaluation of complex interventions. Within phase 2, children, aged between 9 and 16 y, who had elevated self-reported dental anxiety and were attending a community dental service or dental hospital, were invited to use the CBT resource. Children completed questionnaires, which assessed their dental anxiety and health-related quality of life (HRQoL) prior to and following their use of the resource. Recruitment and completion rates were recorded. Acceptability of the CBT resource was explored using interviews and focus groups with children, parents/carers and dental professionals. For this analysis, the authors adhered to the Mixed Methods Appraisal Tool criteria. There were 24 families and 25 dental professionals participating in the development and qualitative evaluation of the CBT resource for children with dental anxiety. A total of 56 children agreed to trial the CBT resource (66% response rate) and 48 of these children completed the study (86% completion rate). There was a significant reduction in dental anxiety (mean score difference = 7.7, t = 7.9, df = 45, P < 0.001, Cohen's d ES = 1.2) and an increase in HRQoL following the use of the CBT resource (mean score difference = -0.03, t = 2.14, df = 46, P < 0.05, Cohen's d ES = 0.3). The self-help approach had high levels of acceptability to stakeholders. These findings provide preliminary evidence for the effectiveness and acceptability of the resource in reducing dental anxiety in children and support the further evaluation of this approach in a randomized control trial. This study details the development of a guided self-help Cognitive Behavioral Therapy resource for the management of dental anxiety in children and provides preliminary evidence for the feasibility and acceptability of this approach with children aged between 9 and 16 y. The results of this study will inform the design of a definitive trial to examine the treatment- and cost-effectiveness of the resource for reducing dental anxiety in children.

Development and evaluation of the children's experiences of dental anxiety measure

“…The research aimed to evaluate the feasibility and preliminary effectiveness of a cognitive behaviour therapy (CBT)‐based guided self‐help intervention designed to reduce dental anxiety. Details of how this sample were recruited to the research and the how the CBT intervention was developed and delivered have been published elsewhere.…”

Non-pharmacological methods of fighting dental anxiety

“…Moreover, after the therapy is finished, 91% of the subjects show no dental anxiety, as rated using various diagnostic criteria, which proves that it is highly effective [25]. The effectiveness of computer-based cognitive-behavioural therapy in reducing dental anxiety (as measured with MDAS) has been confirmed for patients aged 9-16 and 18-70 [6,26]. Another study has shown that four therapeutic sessions using cognitive restructuring are sufficient to significantly decrease dental anxiety levels in patients suffering from the condition [27].…”

Children's experiences following a CBT intervention to reduce dental anxiety: one year on

“…Two respondents (9%) identified as being from a Black and Minority Ethnic group and ten (45%) were from the two most deprived quintiles according to the Index of Multiple Deprivation. Table 1 provides further summary details of the respondents' profile compared to those included in the original CBT study 14 , to illustrate that they were a representative sample. It can be seen that this follow up subgroup had similar mean self-report anxiety scores (MCDAS) to those found for the original study participants as a whole.…”

“…As so little is known of how children, who have received an intervention for their dental anxiety, fare in the longer term, the authors of the current paper contacted the participants of their original CBT study, one-year after discharge from the dental hospital service. 14 This was part of an ongoing CBT service development and evaluation. The specific objectives of this follow up inquiry were to explore children's self-reported levels of dental anxiety, attendance patterns and treatment experiences in general dental practice following a previous CBT intervention.…”

“…Full details of the study, which was completed in 2015, have been previously reported. 14 The study received ethical approval from the NRES Committee York and Humber: Leeds West REC (13/YH/0163). At initial consent, participants were asked to indicate if they would be happy to be contacted again by the research team at some stage in the future.…”