(PS2-36) Reduction in Avoidant Coping Style Following an Exposure-based Cognitive Behavioral Intervention for Dental Anxiety: A Mixed-methods Study

Introduction: Patients who experience dental anxiety often use coping mechanisms to manage their levels of fear and anxiety at the dentist. These coping mechanisms range from taking medication before an appointment, practicing mindfulness and meditation, to more avoidance-based techniques like listening to music or playing games on a phone or tablet. This mixed-methods study explored associations between distraction-based coping strategies and dental anxiety severity following an online cognitive behavioral therapy intervention to treat dental anxiety.

Methods: Adult dental patients were recruited to participate in a clinical trial testing the efficacy of an exposure-based CBT intervention for dental anxiety. Participants were asked to describe coping mechanisms they used while at the dentist as part of the Anxiety and Related Disorders Interview Schedule (ADIS). Subjects were asked to describe their coping mechanisms at baseline, one-month follow-up, and three-month follow-up after completing the intervention or control condition. Qualitative data was coded in NVivo. A dummy code was created to indicate whether a participant endorsed the use of any of the 30 coping mechanisms identified in the dataset. Of those coping mechanisms, 9 were determined to be avoidant. Subjects who endorsed the use of any of these 9 coping mechanisms were then compared by treatment condition, and changes in both the Modified Dental Anxiety Scale (MDAS) and Fear Questionnaire – Blood Injury Injection (FQBII) were assessed across time points. Quantitative data were analyzed using SPSS.

Results: Participants (N=499) were primarily female (70.6%) and Black/African American (62.4%), with an average age of 49 years (SD=14.9). The use of avoidant coping strategies was relatively equal between the intervention group (39.3%) and control group (38.4%) at baseline. A reduction in the use of these coping strategies was observed among the intervention group at both one-month (29.5%) and 3 months (30.3%) but not the control group (39.1% at both follow-up timepoints). Significant differences in both MDAS (F=8.8, p< .001) and FQBII (F=.230, p< .003) were observed at one month. When comparing the intervention and control sample based on their use of avoidant coping mechanisms, the association between these coping mechanisms and mean differences in MDAS and FQBII remained significant in the intervention group, with higher scores on both measures reported by subjects who endorsed avoidant coping strategies. However, the association of avoidant coping strategies and the FQBII was no longer significant in the control group (p >.05).

Conclusion: a one-time CBT-based dental anxiety treatment reduced the use of avoidant coping strategies, which may in turn reduce patient fears during a dental visit. More research is needed to determine what coping strategies are most effective for patients, and how they can be further reinforced.

This research was supported by the National Institute Of Dental & Craniofacial Research of the National Institutes of Health under Award Number U01DE027328. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.