Fear responding to 35% CO(2) challenge as a vulnerability marker for later social anxiety symptoms

The majority of biological challenge studies have focused on panic disorder though there is a small literature suggesting that patients with social anxiety disorder (SAD) show comparable responding. These cross-sectional studies suggest that CO₂ reactivity may be a marker of vulnerability to social anxiety. However, the nature of this association is unclear due to design limitations in this literature. The present report prospectively evaluated whether response to a 20% CO₂ challenge was predictive of later changes in social anxiety symptoms. A large non-clinical sample of young adults (N = 404) screened for axis I disorders completed a 20% CO₂ challenge and were followed for approximately 18 months. Consistent with the vulnerability hypothesis, those showing greater reactivity to the CO₂ challenge showed increased social anxiety symptoms over time. This significant association was maintained after controlling for gender and trait anxiety. These data provide novel evidence suggesting that CO₂ sensitivity is predictive of the development of social anxiety symptoms.     

A critical review of approaches to the treatment of dental anxiety in adults

Dental anxiety and specific phobia of dental procedures are prevalent conditions that can result in substantial distress and oral health impairment. This paper critically reviews 22 randomized treatment trials aimed at reducing dental anxiety and avoidance in adults, published in peer-reviewed journals between 1974 and 2012. The following treatment techniques are reviewed: various forms of cognitive-behavioral therapy (CBT), relaxation training, benzodiazepine premedication, music distraction, hypnotherapy, acupuncture, nitrous oxide sedation, and the use of lavender oil scent. CBT delivered in a variety of formats, including one-session treatment, has the most evidence for its efficacy. Cognitive techniques, relaxation, and techniques to increase patients’ sense of control over dental care are also efficacious but perform best when combined with repeated, graduated exposure. Other interventions require further study in randomized trials before conclusions about their efficacy are warranted. Limitations of the extant outcome research and implications for future treatment and research are discussed.     

儿童牙科恐惧症产生原因的研究进展

牙科恐惧症是一种防碍人们接受牙科治疗与护理的社会心理疾病,儿童牙科恐惧症发病率高,是急需解决的临床问题。该文就儿童牙科恐惧症的产生原因及其研究进展作一综述。     

Dental anxiety in relation to torture experiences and symptoms of post‐traumatic stress disorder

Torture victims often show symptoms of dental anxiety when receiving dental care, but little systematic research is available. The purpose of this study was to explore torture experiences, symptoms of post‐traumatic stress disorder (PTSD), and dental anxiety in refugees in Norway and to test the hypothesis that refugees with torture experiences are more prone to dental anxiety than refugees with no such experiences. A total of 173 refugees were interviewed shortly after an oral examination. The Modified Dental Anxiety Scale (MDAS) and the Harvard Trauma Questionnaire‐PTSS16 were administered verbally through attending interpreters. Among torture victims (47%, n = 81), the prevalence of torture experiences involving mouth or teeth was 35% and 23%, respectively. Harvard Trauma Questionnaire mean sum scores were statistically significantly higher in torture victims (34.3 vs. 24.8). Torture survivors report a larger number of symptoms of PTSD, and dental anxiety shows a higher prevalence in refugees reporting PTSD symptoms than in refugees who do not report such symptoms. When analysed using logistic regression models, the data showed the odds of high levels of dental anxiety being 6.1 times higher in refugees with torture experiences compared with other refugees and 9.3 times higher in torture victims with PTSD symptoms. Oral health professionals should be aware of these associations when providing dental care to refugees. The hypothesis that tortured refugees are more prone to dental anxiety is supported.     

Autobiographical memory biases in social anxiety

Individuals with social anxiety preferentially attend to threatening social information during and following social events. As such, cognitive models predict that social anxiety should be associated with biases in the recall of social events. However, initial experimental studies examining this assumption either failed to find such biases or found only weak evidence for an autobiographical memory bias. The current review examines an emerging line of evidence offering support for the role of an autobiographical memory bias in the development and maintenance of social anxiety. The review begins by examining current theoretical approaches to autobiographical memory before looking at empirical studies that have examined differences between socially anxious and non-anxious individuals in the recall of autobiographical memories. Specific memory biases include properties of social-threat memories, the imagery associated with these memories, and the cognitive processing styles that have been found to either facilitate or inhibit the recall of emotional memories. Limitations in methodologies used to study retrieval of memories and the implications of findings for future research are discussed.     

Phobias of Attachment‐Related Inner States in the Psychotherapy of Adult Survivors of Childhood Complex Trauma

The clinical case described in this article illustrates the value of taking into account the dynamics of disorganized attachment in the assessment of attachment‐related phobias (phobia of attachment and phobia of attachment loss) during the psychotherapy of chronically traumatized patients. These seemingly opposite phobias typically coexist in the same patient, appear as phobias of both inner states (affect phobias) and relational experiences, and are linked to dissociated representations of self‐with‐other. Theory and research on attachment disorganization provide a clinician‐friendly conceptual framework for capturing both the intrapsychic (e.g., intrusive and nonintegrated mental states) and the relational (e.g., dramatic unsolvable dilemmas in interpersonal exchanges) aspects of the attachment‐related phobias. The therapeutic strategy and the key interventions that logically follow from a case formulation based on this conceptual framework are examined.     

Effectiveness of a smartphone-based,augmented reality exposure app to reduce fear of spiders in real-life: A randomized controlled trial

Although in vivo exposure therapy is highly effective in the treatment of specific phobias, only a minority of patients seeks therapy. Exposure to virtual objects has been shown to be better tolerated, equally efficacious, but the technology has not been made widely accessible yet.We developed an augmented reality (AR) application (app) to reduce fear of spiders and performed a randomized controlled trial comparing the effects of our app (six 30-min sessions at home over a two-week period) with no intervention. Primary outcome was subjective fear, measured by a Subjective Units of Distress Scale (SUDS) in a Behavioural Approach Test (BAT) in a real-life spider situation at six weeks follow-up.Between Oct 7, 2019, and Dec 6, 2019, 66 individuals were enrolled and randomized. The intervention led to significantly lower subjective fear in the BAT compared to the control group (intervention group, baseline: 7.12 [SD 2.03] follow-up: 5.03 [SD 2.19] vs. control group, baseline: 7.06 [SD 2.34], follow-up 6.24 [SD 2.21]; adjusted group difference -1.24, 95 % CI -2.17 to -0.31; Cohen’s d = 0.57, p = 0.010).The repeated use of the AR app reduces subjective fear in a real-life spider situation, providing a low-threshold and low-cost treatment for fear of spiders.