Disseminable Evidence-Based Treatment for the Dental Office: Virtual Exposure Tools for Dental Fear - neVR Fear the Dentist

牙科诊所可传播的循证治疗：针对牙科恐惧症的虚拟暴露工具 - neVR Fear the Dentist

• 批准号: 10081274
• 负责人: Margo Adams Larsen
• 金额: $ 26.5万
• 依托单位: VIRTUALLY BETTER, INC.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-03 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10081274
• 关键词: Adopted; Adult; Affect; Aftercare; American; Anesthesia procedures; Anti-Anxiety Agents; Anxiety; Appointment; Behavioral; Belief; Brain; Businesses; Clinic; Cognitive Therapy; Communication; Costs and Benefits; Data; Dental; Dental Anxiety; Dental Care; Dental General Practice; Dental Offices; Dental Staff; Dentistry; Dentists; Development Plans; Ecosystem; Effectiveness; Environment; Ethnic Origin; Event; Evidence based intervention; Evidence based treatment; Focus Groups; Fright; Future; Gender; Health; Healthcare; Immersion; Individual; Intervention; Learning; Longevity; Mediating; Medicine; Modeling; National Institute of Dental and Craniofacial Research; Operative Surgical Procedures; Oral; Oral health; Outcome; Pain; Patients; Personal Satisfaction; Pharmaceutical Preparations; Phase; Preventive; Private Practice; Procedures; Public Health; Quality of life; Race; Randomized Controlled Trials; Records; Reporting; Research; Sedation procedure; Self Administration; Severities; Signal Transduction; Small Business Technology Transfer Research; Societies; Surgeon; System; Tablets; Testing; Training; United States Dept. of Health and Human Services; United States National Institutes of Health; Universities; Visit; active control; anxiety management; base; clinical practice; cost; demographics; design; eHealth; expectation; experience; follow-up; innovation; intervention effect; medical specialties; negative affect; operation; preference; psychoeducation; psychologic; response; social; standard care; tool; treatment group; treatment services; uptake; virtual; virtual reality exposure

PROJECT SUMMARY/ABSTRACT Each year over 20 million adults with moderate fear and over 14 million adults with severe fear visit the dentist. Because fear portends poor future oral health, patients with dental fear come to experience their worst fears: pain, surgical procedures, and the need for more frequent dental visits. Avoidance is the natural and reinforced response, ironically guaranteeing a repetition of the feared events. Breaking this cycle is the primary target of this proposal. Standard treatment — compassionate but ultimately counterproductive — includes anti-anxiety medication or more substantial anesthesia, which (a) does nothing to reduce subsequent anxiety or avoidance, (b) leads to continued dental problems, 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 associated with universities; there is no disseminable model for integrating CBT into the workflow of dental practices. To fill this gap, this Fast-Track STTR proposal describes plans for development and testing of a marketable product that can bring effective dental fear treatment to dental offices within the currently existing U.S. practice ecosystem. neVR Fear the DentistTM is a commercializable suite of self-administered eHealth tools to treat dental fear that can be implemented in private practice dental offices throughout the U.S. and is eminently scalable. neVR Fear the DentistTM comprises three major evidence-based interventions. First is a self-administered eHealth app for CBT/psychoeducation with exposure therapy — delivered via a mobile tablet — that can be used privately in waiting rooms. Second is a communication-eliciting intervention, in which the patient records a “Pre-Game Plan” — to be reviewed with the dental staff before dental services — comprising (1) pre-treatment fear levels, (2) the factor generating the most anxiety, (3) a stop-signal the patient will use to alert dentist, (4) things the dental team can do to maximize this patient's comfort, and (5) a self-generated anxiety management plan. All patients in the treatment group will receive the first two EBIs as a single intervention on the tablet. Third (for patients who are in the severe range) is a 1-hr virtual reality exposure treatment (VRET). VRET will allow us to provide CBT that can be self-administered within the normal operations of dentistry and will allow every dental practice to be a dental fear specialty clinic. Such an approach is necessary to shift clinical practice, as the nearly 200,000 U.S. dentists will only adopt an approach designed, from the bottom up, to fit both the busy-ness and business of 21st-century dental practices. The research component will use an adequately powered RCT to test both (a) the effectiveness of neVR Fear the DentistTM and, using the NIH's Experimental Medicine Approach to Behavioral Change model, (b) whether inhibitory learning is the mechanism through which it affects change.

项目摘要/摘要 每年有超过2000万成年人有中度恐惧，超过1400万成年人有严重的恐惧参观 牙医。因为恐惧预示了未来不良的健康，所以牙齿恐惧的患者开始经历最糟糕的 恐惧：疼痛，手术程序以及更常见的牙科探访需求。避免是自然而强化的反应，具有讽刺意味的是，保证了虚假事件的重复。打破这个周期是主要的 该提议的目标。标准治疗 - 富有同情心但最终适得其反 - 包括抗焦虑药或更严重的麻醉，（a）无济于事以减少随后的焦虑或 避免，（b）导致持续的牙齿问题，（c）延续了恐惧的循环 - >避免 - >牙齿 问题。另外，已经开发了牙齿恐惧的认知行为治疗（CBT） 进行数十项高质量试验，并发现有效。但是，CBT几乎完全提供了 仅在与大学有关的几个专业诊所中；没有可以将CBT整合到牙科实践的工作流程中的可占上风模型。为了填补这一空白，此快速跟踪的STTR提案描述 开发和测试可销售产品的计划，该产品可以为有效的牙齿恐惧治疗带来 当前现有的美国实践生态系统中的牙科办公室。 NEVR担心Dentisttm是一套可自我管理的eHealth工具，可以在私人实践中实施牙科恐惧 美国各地的牙科办公室，非常可扩展。 NEVR担心牙本质包括三个主要 基于证据的干预措施。首先是用于CBT/心理教育的自我管理的EHealth应用程序 治疗 - 通过移动平板电脑交付 - 可以在候诊室中私下使用。其次是通讯引用干预措施，其中患者记录了“赛前计划” - 将与牙科进行审查 牙科服务之前的工作人员 - 完成（1）治疗前的恐惧水平，（2）引起最大焦虑的因素，（3）患者将使用停止信号来提醒牙医，（4）牙科团队可以做的事情以最大程度地提高患者的舒适性，（5）自我生成的动画管理计划。治疗组中的所有患者将在片剂上接受前两个EBIS作为单一干预。第三（对于处于严重范围的患者）是 1小时的虚拟现实暴露疗法（VRET）。 VRET将使我们能够提供可以在牙科正常操作中自我管理的CBT，并且将使每种牙科实践成为一种牙科恐惧专业 诊所。这种方法是要转移临床实践的必要方法，因为近20万美国牙医只会 采用一种从自下而上设计的方法，以适合21世纪牙科的忙碌和业务 实践。研究组件将使用适当的功率RCT来测试（a）（a） NEVR担心牙本质TISTTM，并使用NIH的实验医学方法进行行为改变模型， （b）抑制性学习是否是影响变化的机制。