پرسشنامه شناخت دندانپزشکی در CBT برای هراس از دندانپزشکی در نوجوانان مبتلا به هراس های چندگانه

A case of an adolescent boy with multiple phobias who was treated successfully for his dental phobia is described to illustrate the clinical utility of the Dental Cognitions Questionnaire (DCQ) in aiding effective cognitive-behavior therapy. The client showed drops in dental anxiety that coincided with the use of the DCQ in cognitive restructuring, and there was a close correlation between dental cognitions and degree of dental anxiety over the time-course of therapy and follow up.

Dental phobia is a significant clinical problem because of its great impact on physical health and quality of life, and its high prevalence, at around 5%, which peaks during early adolescence (Kent, 1997). It has been suggested by many authors that multiple fears maintain dental phobia (e.g. Kent, 1997; de Jongh, Muris, Schoenmakers, & ter Horst, 1995b; Chapman & Kirby-Turner, 1999). A comprehensive series of research studies have culminated in the characterization of dental fears using the Dental Cognitions Questionnaire (DCQ; de Jongh et al., 1995b). Patients’ scores on this scale have been shown to account for 70% of the variance in state anxiety while in the chair awaiting dental treatment. The most effective treatment for phobias to date is graded exposure to the fear-provoking stimulus (Öst, 1996). Nevertheless, an important debate concerns the extent to which the mediation of change during therapy may involve cognitive processes (Mansell, 2000), and emerging evidence suggests that cognitive factors are indeed important in facilitating change (De Jongh et al., 1995a; Kamphuis & Telch, 2000). Indeed close inspection of some treatment protocols suggests that ‘graded exposure’ may actually use cognitive methods. For example, Öst, Svensson, Hellström, and Lindwall (2001) suggest that in graded exposure, “the guiding principle of treatment is the cognitive-behavioral analysis of the child's catastrophic cognition concerning what will happen when encountering the feared object or situation” (p. 817). The following case study describes the assessment and treatment of an adolescent with incapacitating dental phobia. The aim of the study was to explore the effectiveness of CBT for dental phobia, in particular using the DCQ as a focus of cognitive intervention. The role of cognitive factors in change was assessed in two ways. First, changes in belief ratings across and during sessions were recorded to test whether the use of the DCQ was associated with a drop in dental anxiety, relative to periods where exposure-based techniques were used. Second, the relationship between changes in dental anxiety and DCQ was assessed by investigating the degree to which they correlated with one another across time.