Anxiety Sensitivity and Pain Expectancy in Dental Anxiety

描述（由申请人提供）：牙科焦虑症是一个主要的公共卫生问题，导致牙科保健利用不足和口腔健康状况不佳。缺乏实证研究 检查可能导致或维持牙科焦虑症的潜在认知情感风险候选人。许多研究将疼痛预期与牙科焦虑增加相关联;然而，并非所有疼痛预期高的患者都会发展牙科焦虑，影响疼痛预期如何影响牙科焦虑的因素仍不清楚。焦虑敏感性是对内部感觉的负面后果的恐惧，可能会放大疼痛预期对牙科焦虑症的影响。高焦虑敏感度的人对疼痛（和其他内部感觉）的后果进行更灾难性的思考;因此，对牙科治疗疼痛的预期可能更有可能增加或维持高焦虑敏感度的人的牙科焦虑。这项研究的中心假设是，焦虑敏感性将缓和疼痛预期与牙科手术应激反应和牙科焦虑增加之间的关系。我们建议使用横断面和实验研究设计来检验这一假设。参与者将是在牙科诊所寻求治疗的成年人，他们表现出一系列牙科焦虑症。合格的参与者将被邀请完成一次实验室会议，在此期间，他们将首先完成焦虑敏感性、疼痛预期和牙科焦虑的自我报告测量。接下来，参与者将观看一系列牙科手术的电影，并测试他们对电影的基线心理和生理应激反应。然后，参与者将经历对疼痛预期的实验操作，其将使用休克威胁范例结合第二系列牙科胶片的管理。参与者将被随机分配到两种疼痛预期条件之一：电击威胁条件（在观看第二系列牙科电影时预计会经历电击）或安全条件（确保他们在观看电影时不会经历电击）。在疼痛预期操作之后，参与者将在另一时间观看牙科手术的第二系列电影，并重新评估他们的压力反应。自我报告的牙科焦虑症也将在疼痛预期操纵后重新评估。我们预计，对于焦虑敏感度高的个体，疼痛预期将表现出与牙科手术应激反应和牙科焦虑更强的关系。从拟议的转化研究中获得的知识将澄清焦虑敏感性是否会调节疼痛预期对牙科焦虑的影响，这将为靶向焦虑的效用提供信息 旨在预防或减少牙科焦虑症的简短干预措施的敏感性，特别是在牙科治疗期间预计会经历疼痛的患者中。这是促进牙科焦虑症患者使用口腔保健的关键一步。

DESCRIPTION (provided by applicant): Dental anxiety is a major public health concern that leads to underutilization of dental care and poor oral health. There is a lack of empirical studies examining potential cognitive-affective risk candidates that may cause or maintain dental anxiety. Much research has associated pain expectancy with increased dental anxiety; however, not all patients with high pain expectancy develop dental anxiety, and the factors that influence how pain expectancy affects dental anxiety remain unclear. Anxiety sensitivity, which is the fear of negative consequences of internal sensations, may amplify the impact of pain expectancy on the experience of dental anxiety. Individuals with high anxiety sensitivity engage in more catastrophic thinking about the consequences of pain (and other internal sensations); therefore, having expectations that dental treatment will be painful may be more likely to increase or maintain dental anxiety for individuals with high anxiety sensitivity. The central hypothesis of th proposed study is that anxiety sensitivity will moderate the relationship between pain expectancy and increases in dental procedure stress reactivity and dental anxiety. We propose to examine this hypothesis by using both cross-sectional and experimental research designs. Participants will be adults seeking treatment at dental clinics who exhibit a range of dental anxiety. Eligible participants will be invited to complete a single laboratory session, during whic they will first complete self- report measures of anxiety sensitivity, pain expectancy, and dental anxiety. Next, participants will watch a series of films of dental procedures and their baseline psychological and physiological stress reactivity to the films will be tested. Participants will thn undergo an experimental manipulation of pain expectancy, which will use a shock threat paradigm in conjunction with an administration of a second series of dental films. Participants will be randomized to one of two pain expectancy conditions: the shock threat condition (expecting to experience electric shocks while watching the second series of dental films) or the safe condition (assured that they will not experience shocks while watching the films). Following the pain expectancy manipulation, participants will view the second series of films of dental procedures another time and their stress reactivity will be re-assessed. Self-reported dental anxiety will also be re-assessed following the pain expectancy manipulation. We expect that for individuals who are high in anxiety sensitivity, pain expectancy will exhibit a stronger relationship with dental procedure stress reactivity and dental anxiety. The knowledge gained from the proposed translational research study will clarify whether anxiety sensitivity moderates the effect of pain expectancy on dental anxiety, which will inform the utility of targeting anxiety sensitivity in brief interventions aimed at preventing or reducing dental anxiety, particularly among patients who report expectations of experiencing pain during dental treatment. This is a crucial step towards bolstering the use of oral health care by dentally anxious patients.