Relaxation versus cognitive therapies for dental fear--a psychophysiological approach

The influence of anxiety on pain perception and its repercussion on endodontic treatment: a systematic review

OBJECTIVE

To evaluate the influence of dental anxiety on the perception of pain before and during endodontic treatments.

MATERIALS AND METHODS

The PRISMA checklist was followed. A search was conducted in Scopus, Medline/PubMed, The Cochrane Library, and Web of Science databases. Based on PECOS criteria, the first outcome was a possible association between pre-operative pain and anxiety. The second outcome was a possible association between intraoperative pain and anxiety. The type of studies was observational. The JBI Critical Appraisal Checklist was used to evaluate the methodological quality of articles. The certainty of the evidence was analyzed using the GRADE approach.

RESULTS

Four articles were included with a total of 471 patients. Two studies found a positive association between pain and pre-endodontic treatment anxiety. Three studies investigated the relationship between anxiety and intraoperative pain; two identified an extremely significant positive association. One article noted that anxiety influences pain expectancy. The studies were of good quality as assessed by the JBI Critical Appraisal Checklist for cross-sectional studies. However, the certainty of the evidence was considered low and very low.

CONCLUSIONS

Dental anxiety can be directly associated with pre- and intraoperative pain during endodontic procedures.

CLINICAL RELEVANCE

It is necessary to identify patients with dental anxiety to employ therapies to bring their anxiety under control, avoiding the increase of endodontic infections, and the postponement and evasion of endodontic treatments.

Treatments for Anxiety Disorders in Malaysia

This current study aims to systematically review the treatments for anxiety disorders in Malaysia. PsycINFO, MEDLINE databases, and 28 local journals were used to search published papers in this area. Eight articles were subjected to review after excluding 273 papers that did not meet the inclusion criteria. A total of 598 participants with various types of anxiety disorders were included in the review. Based on the findings, the combination of pharmacotherapy and psychotherapy provided better treatment outcomes if compared to psychotherapy or pharmacotherapy alone. The combination of selective serotonin reuptake inhibitors and cognitive behaviour therapy was considered as one of the most effective treatment to treat patients with anxiety disorders in Malaysia. This is in line with the clinical practice guidelines from the Ministry of Health Singapore and Canada. Even though there were some limitations in the methodology and reporting of the results, it can be concluded that efforts have been taken to conduct studies related to treatments for patients with anxiety disorders in Malaysia. Future studies are suggested to make conscious efforts to overcome these limitations.

Does Jacobson's relaxation technique reduce consumption of psychotropic and analgesic drugs in cancer patients? A multicenter pre-post intervention study

Background

Cancer patients often suffer from emotional distress as a result of the oncological process. The purpose of our study was to determine whether practice of Jacobson’s relaxation technique reduced consumption of psychotropic and analgesic drugs in a sample of cancer patients.

Methods

This was a multicenter pre–post intervention design. Participants were 272 patients aged over 18 years attending 10 Spanish public hospitals with oncological pathologies and anxiety symptoms. The intervention consisted of a protocol of abbreviated progressive muscle relaxation training developed by Bernstein and Borkovec. This was followed up by telephone calls over a 1-month period. The intervention was performed between November 2014 and October 2015. Sociodemographic variables related to the oncological process, mental health variables, and intervention characteristics were measured.

Results

A reduction in the consumption of psychotropic and analgesic drugs was observed throughout the follow-up period. Improvement was observed throughout the 4-week follow-up for all the parameters assessed: anxiety, relaxation, concentration, and mastery of the relaxation technique.

Conclusions

The practice of abbreviated Jacobson’s relaxation technique can help to decrease the consumption of psychotropic and analgesic drugs. Patients experienced positive changes in all the evaluated parameters, at least during the 1-month follow-up. To confirm these findings, additional long-term studies are needed that include control groups.

Trial registration

ISRCTN 81335752, DOI 10.1186/ISRCTN81335752 17. Date of registration: 22/11/2016 (retrospectively registered).

Putting the Fear Back Again (and Within Individuals): Revisiting the Role of Fear in Persuasion

The overwhelming majority of fear appeal research came from the between-individuals approach and yielded consistent evidence for a linear fear-persuasion relationship. A recent review suggested that the within-individuals approach might be more appropriate. Studies that measured fear at multiple time points have consistently revealed a curvilinear association between fear and persuasion predicted by the drive model. A Web-based experiment (N = 454) using tobacco warning labels was conducted to replicate the inverted-U shape curvilinear relationship between fear and persuasion, and to revisit the role of fear in fear appeal theories. Results showed that the inverted-U fear curve positively predicted persuasion and reduced maladaptive responses, and that the linear trajectory of fear positively predicted maladaptive responses and failure of persuasion.

The impact of muscle relaxation techniques on the quality of life of cancer patients, as measured by the FACT-G questionnaire

INTRODUCTION

Patients with cancer frequently suffer from emotional distress, characterized by psychological symptoms such as anxiety or depression. The presence of psychological symptoms combined with the complex nature of oncology processes can negatively impact patients' quality of life. We aimed to determine the impact of a relaxation protocol on improving quality of life in a sample of oncological patients treated in the Spanish National Public Health System.

MATERIALS AND METHODS

We conducted a multicenter interventional study without a control group. In total, 272 patients with different oncologic pathologies and showing symptoms of anxiety were recruited from 10 Spanish public hospitals. The intervention comprised abbreviated progressive muscle relaxation training, according to Bernstein and Borkovec. This was followed by weekly telephone calls to each patient over a 1-month period. We collected sociodemographic variables related to the disease process, including information about mental health and the intervention. Patients' quality of life was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. Bivariate and univariate analyses were performed, along with an analysis of multiple correspondences to identify subgroups of patients with similar variations on the FACT-G.

RESULTS

Patients showed statistically significant improvements on the FACT-G overall score (W = 16806; p<0.001), with an initial mean score of 55.33±10.42 and a final mean score of 64.49±7.70. We also found significant improvements for all subscales: emotional wellbeing (W = 13118; p<0.001), functional wellbeing (W = 16155.5; p<0.001), physical wellbeing (W = 8885.5; p<0.001), and social and family context (W = -1840; p = 0.037).

CONCLUSIONS

Patients with cancer who learned and practiced abbreviated progressive muscle relaxation experienced improvement in their perceived quality of life as measured by the FACT-G. Our findings support a previous assumption that complementary techniques (including relaxation techniques) are effective in improving the quality of life of patients with cancer.

Parallel study about the effects of psychotherapy on patients with dental phobia determined by anxiety scores and saliva secretion and composition

Background

The aim of this study was to determine the success of psychotherapeutic treatment for dental phobia by measurement of anxiety using the dental anxiety score (DAS), the state trait anxiety score (STAI state), salivary cortisol and protein concentrations and the salivary secretion rate. Primary endpoint of the study was the comparison of the data before and after psychotherapeutic treatment.

Methods

Forty patients were included into the study. Twenty-four were allocated to the phobic group, 16 to the control group. Saliva was collected upon entering the dental clinic and again after three weeks of psychotherapy. The results were compared with those of a control group. The DAS and STAI questionnaires were completed at each visit.

Results

A reduction in DAS values was found after psychotherapy. However, the values remained significantly higher in the phobic group than in the controls. Similar results were found for STAI scores. A slightly higher salivary cortisol level was found in the phobic group. No changes occurred in cortisol or protein concentrations. The salivary secretion rate increased in the phobic patients after psychotherapy.

Conclusions

It could be concluded that psychotherapy is effective in the treatment of dental phobic patients.

Trial registration

This study has been retrospectively registered in the German Clinical Trials Register (# DRKS00009552) on 10/19/15.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-016-0264-2) contains supplementary material, which is available to authorized users.

Relaxation training for anxiety: a ten-years systematic review with meta-analysis

BACKGROUND

Relaxation training is a common treatment for anxiety problems. Lacking is a recent quantitative meta-analysis that enhances understanding of the variability and clinical significance of anxiety reduction outcomes after relaxation treatment.

METHODS

All studies (1997-2007), both RCT, observational and without control group, evaluating the efficacy of relaxation training (Jacobson's progressive relaxation, autogenic training, applied relaxation and meditation) for anxiety problems and disorders were identified by comprehensive electronic searches with Pubmed, Psychinfo and Cochrane Registers, by checking references of relevant studies and of other reviews. Our primary outcome was anxiety measured with psychometric questionnaires. Meta-analysis was undertaken synthesizing the data from all trials, distinguishing within and between effect sizes.

RESULTS

27 studies qualified for the inclusion in the meta-analysis. As hypothesized, relaxation training showed a medium-large effect size in the treatment of anxiety. Cohen's d was .57 (95% CI: .52 to .68) in the within analysis and .51 (95% CI: .46 to .634) in the between group analysis. Efficacy was higher for meditation, among volunteers and for longer treatments. Implications and limitations are discussed.

CONCLUSION

The results show consistent and significant efficacy of relaxation training in reducing anxiety. This meta-analysis extends the existing literature through facilitation of a better understanding of the variability and clinical significance of anxiety improvement subsequent to relaxation training.

Relaxation training for anxiety: a ten-years systematic review with meta-analysis

BACKGROUND

Relaxation training is a common treatment for anxiety problems. Lacking is a recent quantitative meta-analysis that enhances understanding of the variability and clinical significance of anxiety reduction outcomes after relaxation treatment.

METHODS

All studies (1997-2007), both RCT, observational and without control group, evaluating the efficacy of relaxation training (Jacobson's progressive relaxation, autogenic training, applied relaxation and meditation) for anxiety problems and disorders were identified by comprehensive electronic searches with Pubmed, Psychinfo and Cochrane Registers, by checking references of relevant studies and of other reviews. Our primary outcome was anxiety measured with psychometric questionnaires. Meta-analysis was undertaken synthesizing the data from all trials, distinguishing within and between effect sizes.

RESULTS

27 studies qualified for the inclusion in the meta-analysis. As hypothesized, relaxation training showed a medium-large effect size in the treatment of anxiety. Cohen's d was .57 (95% CI: .52 to .68) in the within analysis and .51 (95% CI: .46 to .634) in the between group analysis. Efficacy was higher for meditation, among volunteers and for longer treatments. Implications and limitations are discussed.

CONCLUSION

The results show consistent and significant efficacy of relaxation training in reducing anxiety. This meta-analysis extends the existing literature through facilitation of a better understanding of the variability and clinical significance of anxiety improvement subsequent to relaxation training.

Minimising barriers to dental care in older people

Background

Older people are increasingly retaining their natural teeth but at higher risk of oral disease with resultant impact on their quality of life. Socially deprived people are more at risk of oral disease and yet less likely to take up care. Health organisations in England and Wales are exploring new ways to commission and provide dental care services in general and for vulnerable groups in particular. This study was undertaken to investigate barriers to dental care perceived by older people in socially deprived inner city area where uptake of care was low and identify methods for minimising barriers in older people in support of oral health.

Methods

A qualitative dual-methodological approach, utilising both focus groups and individual interviews, was used in this research. Participants, older people and carers of older people, were recruited using purposive sampling through day centres and community groups in the inner city boroughs of Lambeth, Southwark and Lewisham in South London. A topic guide was utilised to guide qualitative data collection. Informants' views were recorded on tape and in field notes. The data were transcribed and analysed using Framework Methodology.

Results

Thirty-nine older people and/or their carers participated in focus groups. Active barriers to dental care in older people fell into five main categories: cost, fear, availability, accessibility and characteristics of the dentist. Lack of perception of a need for dental care was a common 'passive barrier' amongst denture wearers in particular. The cost of dental treatment, fear of care and perceived availability of dental services emerged to influence significantly dental attendance. Minimising barriers involves three levels of action to be taken: individual actions (such as persistence in finding available care following identification of need), system changes (including reducing costs, improving information, ensuring appropriate timing and location of care, and good patient management) and societal issues (such as reducing isolation and loneliness). Older people appeared to place greater significance on system and societal change than personal action.

Conclusion

Older people living within the community in an inner city area where NHS dental care is available face barriers to dental care. Improving access to care involves actions at individual, societal and system level. The latter includes appropriate management of older people by clinicians, policy change to address NHS charges; consideration of when, where and how dental care is provided; and clear information for older people and their carers on available local dental services, dental charges and care pathways.

Muscle relaxation therapy for anxiety disorders: it works but how?

Muscle relaxation therapy (MRT) has continued to play an important role in the modern treatment of anxiety disorders. Abbreviations of the original progressive MRT protocol [Jacobson, E. (1938). Progressive relaxation (2nd ed.). Chicago: University of Chicago Press] have been found to be effective in panic disorder (PD) and generalized anxiety disorder (GAD). This review describes the most common MRT techniques, summarizes recent evidence of their effectiveness in treating anxiety, and explains their rationale and physiological basis. We conclude that although GAD and PD patients may exhibit elevated muscle tension and abnormal autonomic and respiratory measures during laboratory baseline assessments, the available evidence does not allow us to conclude that physiological activation decreases over the course of MRT in GAD and PD patients, even when patients report becoming less anxious. Better-designed studies will be required to identify the mechanisms of MRT and to advance clinical practice.