A Stepped-Care Approach to Treating Dental Fear: A Sequential, Multiple Assignment, Randomized Trial For Cognitive-Behavioral Treatment via Mobile App and Evidence-Based Collaborative Care

治疗牙科恐惧症的阶梯式护理方法：通过移动应用程序和循证协作护理进行认知行为治疗的序贯、多重分配、随机试验

• 批准号: 10729822
• 负责人: Richard Eliot Heyman
• 金额: $ 79.56万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729822
• 关键词: Stepped; Care; Approach; Treating; Dental

PROJECT SUMMARY/ABSTRACT Dental fear affects over 53 million American adults. According to the U.S. Surgeon General, it leads to “needless pain and suffering, causing devastating complications to an individual's wellbeing, with financial and social costs that significantly diminish quality of life and burden American society.” Standard treatment — compassionate but ultimately counterproductive — includes anti-anxiety medication or more substantial anes- thesia, which (a) does nothing to reduce subsequent anxiety or avoidance, (b) leads to continued dental prob- lems, and (c) perpetuates the cycle of fear—>avoidance—>dental problems. Alternatively, cognitive-behavioral treatments (CBT) for dental fear have been developed, subjected to dozens of high-quality trials, and found to be efficacious. However, CBT has, almost exclusively, been offered only in a few specialty clinics worldwide as- sociated with universities and there is no disseminable model for integrating CBT into the workflow of dental practices. To fill this gap, we have created a stepped-care approach to dental fear treatment that can be implemented in private practice dental offices throughout the U.S. and is eminently scalable. Stepped-care in- volves starting with the least intensive option and progressing to more intensive options only when necessary. At the low end is a self-administered intervention: (a) a smartphone “app” that can be used privately in waiting rooms by an unlimited number of patients combined with (b) a paper-and-pencil “Pre-Game Plan” in which the patient records — to be reviewed with the dental staff prior to dental services — (1) pre-treatment fear levels, (2) the factor generating the most anxiety, (3) a stop-signal the patient will use to alert the dentist,(4) things the dental team can do to maximize this patient's comfort, and (5) a self-generated anxiety management plan. If patients are not in the “low fear” zone following their dental procedures, they may receive 1-hour (if still in moderate zone) or 2-hours (if still in severe zone) of dental fear CBT in their dentists' offices conducted by a collaborating mental health provider. In the first phase of this study, we will pilot test the approach with fearful patients (N»35,700) at two University dental centers. In the second phase, we will test the it in private dental practices (n = 100 volunteers from a pool of 10,000 practicing dentists in the metropolitan areas of Philadel- phia and New York [and the corridor between them] who graduated from dental school from either New York University or the University of Pennsylvania). The aims are to study factors influencing patients' and dentists' willingness to try stepped-care, to test the efficacy of the approach, to test the dosing of CBT interventions de- pending on patients' fear levels, and to test whether the way in which we believe CBT works (i.e., by helping patients disconfirm their beliefs regarding feared outcomes) is truly the active ingredient. Finally, we will develop dissemination materials for dentists and mental health providers on “How to Effectively Treat Dental Fear with a Stepped-Care Approach.”

项目摘要/摘要 牙齿恐惧影响超过5300万美国成年人。根据美国外科医生的说法，它导致 “不必要的痛苦和痛苦，使个人的福祉，财务和 社会成本大大降低了生活质量并烧毁了美国社会。”标准待遇 - 富有同情心但最终适得其反 - 包括抗焦虑药或更实质性的药物 - （a）无助于减少随后的焦虑或避免的thesia，（b）导致牙齿持续的概率 LEM和（c）永久存在恐惧的循环 - >避免 - >牙齿问题。或者，认知行为 已经开发了用于牙齿恐惧的治疗（CBT），进行了数十项高质量试验，并发现 高效。但是，CBT几乎完全仅在全球几个专业诊所中提供了 与大学社交，没有可以将CBT整合到牙科工作流程的模型 实践。为了填补这一空白，我们为牙科恐惧治疗创建了一种阶梯式护理方法，可以是 在美国各地的私人执业牙科办公室实施，非常可扩展。踏入踏板 自动从最不密集的选择开始，并且只有在必要时才能发展为更密集的选择。 低端是一种自我管理的干预措施：（a）智能手机“应用”，可以私下在等待中 房间由无限数量的患者与（b）纸笔“赛前计划”结合在一起 患者记录 - 将在牙科服务之前与牙科人员进行审查 - （1）治疗前的恐惧水平， （2）引起最焦虑的因素，（3）患者将用来提醒牙医的停止信号，（4） 牙科团队可以做到最大化该患者的舒适感，以及（5）自我生成的动画管理计划。 如果患者在牙科手术后不在“低恐惧”区域中，他们可能会收到1小时（如果仍在 中等区域）或2小时（如果仍处于严重的区域）牙医办公室中的牙齿恐惧CBT 协作心理健康提供者。在这项研究的第一阶段，我们将用可怕的 两个大学牙科中心的患者（N»35,700）。在第二阶段，我们将以私人牙科测试IT 实践（n =来自费城都会区10,000名诊所牙医的100名志愿者 - Phia和New York [以及他们之间的走廊]，他们从纽约的任何一家牙科学校毕业 大学或宾夕法尼亚大学）。目的是研究因素影响患者的牙医和牙医 愿意尝试踩踏，测试方法的效率，测试CBT干预措施的剂量 等待患者的恐惧水平，并测试我们认为CBT是否有效的方式（即，通过帮助 患者否认自己对结局的信念）确实是活跃的成分。最后，我们 将为牙医和心理健康提供者开发传播材料，以“如何有效治疗 牙科恐惧采用阶梯护理的方法。”