Treatment of specific phobias of clinical procedures in adults
- Yujuan Choy, MD
Yujuan Choy, MD
- Assistant Clinical Professor of Psychiatry (volunteer faculty)
- University of California, Irvine
Acute procedural anxiety is an excessive fear of medical, dental, or surgical procedures resulting in acute distress or interference with completing necessary procedures.
Specific phobias, a subset of presentations of acute procedural anxiety, are diagnosed only when the patient’s fears are specific to the procedure and its immediate effects (rather than, for example, fear of a potentially serious diagnosis or of discomfort during the procedure) . The most prominent specific phobias of clinical procedures are:
●Dental phobia – Experiencing pain during dental treatment
●Blood injection-injury phobia – Seeing blood during venipuncture
●Magnetic resonance imaging claustrophobia – Suffocating during a magnetic resonance imaging scanTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
- Lim L, Chow P, Wong CY, et al. Doctor-patient communication, knowledge, and question prompt lists in reducing preoperative anxiety: a randomized control study. Asian J Surg 2011; 34:175.
- Betti S, Sironi A, Saino G, et al. Effect of the informed consent process on anxiety and comprehension of patients undergoing esophageal and gastrointestinal surgery. J Gastrointest Surg 2011; 15:922.
- Weinreb JC, Maravilla KR, Peshock R, Payne J. Magnetic resonance imaging: improving patient tolerance and safety. AJR Am J Roentgenol 1984; 143:1285.
- De Jongh A, Adair P, Meijerink-Anderson M. Clinical management of dental anxiety: what works for whom? Int Dent J 2005; 55:73.
- Choy Y, Fyer AJ, Lipsitz JD. Treatment of specific phobia in adults. Clin Psychol Rev 2007; 27:266.
- Berggren U, Hakeberg M, Carlsson SG. Relaxation vs. cognitively oriented therapies for dental fear. J Dent Res 2000; 79:1645.
- Moore R, Abrahamsen R, Brødsgaard I. Hypnosis compared with group therapy and individual desensitization for dental anxiety. Eur J Oral Sci 1996; 104:612.
- Hammarstrand G, Berggren U, Hakeberg M. Psychophysiological therapy vs. hypnotherapy in the treatment of patients with dental phobia. Eur J Oral Sci 1995; 103:399.
- Jöhren P, Jackowski J, Gängler P, et al. Fear reduction in patients with dental treatment phobia. Br J Oral Maxillofac Surg 2000; 38:612.
- Hakeberg M, Berggren U, Carlsson SG, Gröndahl HG. Long-term effects on dental care behavior and dental health after treatments for dental fear. Anesth Prog 1993; 40:72.
- Savanheimo N, Sundberg SA, Virtanen JI, Vehkalahti MM. Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service. BMC Oral Health 2012; 12:45.
- Spindler H, Staugaard SR, Nicolaisen C, Poulsen R. A randomized controlled trial of the effect of a brief cognitive-behavioral intervention on dental fear. J Public Health Dent 2015; 75:64.
- Tellez M, Potter CM, Kinner DG, et al. Computerized Tool to Manage Dental Anxiety: A Randomized Clinical Trial. J Dent Res 2015; 94:174S.
- Shapiro F. Eye Movement Desensitization and Reprocessing: Basic Protocols, Principles, Guilford, New York 1996.
- Institutes of Medicine. Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence, National Academies Press, Washington, DC 2008.
- Doering S, Ohlmeier MC, de Jongh A, et al. Efficacy of a trauma-focused treatment approach for dental phobia: a randomized clinical trial. Eur J Oral Sci 2013; 121:584.
- Moscovitch DA, Antony MM, Swinson RP. Exposure-based treatments for anxiety disorders: Theory and process, Oxford University Press, New York 2009. p.461.
- Haukebø K, Skaret E, Ost LG, et al. One- vs. five-session treatment of dental phobia: a randomized controlled study. J Behav Ther Exp Psychiatry 2008; 39:381.
- de Jongh A, Muris P, ter Horst G, et al. One-session cognitive treatment of dental phobia: preparing dental phobics for treatment by restructuring negative cognitions. Behav Res Ther 1995; 33:947.
- Bandura A, Blahard EB, Ritter B. Relative efficacy of desensitization and modeling approaches for inducing behavioral, affective, and attitudinal changes. J Pers Soc Psychol 1969; 13:173.
- Egan S. Reduction of anxiety in aquaphobics. Can J Appl Sport Sci 1981; 6:68.
- Wolpe J. Psychotherapy by reciprocal inhibition. Cond Reflex 1968; 3:234.
- Coldwell SE, Wilhelm FH, Milgrom P, et al. Combining alprazolam with systematic desensitization therapy for dental injection phobia. J Anxiety Disord 2007; 21:871.
- Ost LG. Applied relaxation: description of a coping technique and review of controlled studies. Behav Res Ther 1987; 25:397.
- Brunick A, Clark M. Nitrous oxide and oxygen sedation: an update. Dent Assist 2010; 79:22.
- Willumsen T, Vassend O, Hoffart A. A comparison of cognitive therapy, applied relaxation, and nitrous oxide sedation in the treatment of dental fear. Acta Odontol Scand 2001; 59:290.
- Folayan MO, Faponle A, Lamikanra A. Seminars on controversial issues. A review of the pharmacological approach to the management of dental anxiety in children. Int J Paediatr Dent 2002; 12:347.
- Nathan JE, Venham LL, West MS, Werboff J. The effects of nitrous oxide on anxious young pediatric patients across sequential visits: a double-blind study. ASDC J Dent Child 1988; 55:220.
- Berggren U, Linde A. Dental fear and avoidance: a comparison of two modes of treatment. J Dent Res 1984; 63:1223.
- Gordon SM, Dionne RA, Snyder J. Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs. Spec Care Dentist 1998; 18:88.
- Ghezzi EM, Chávez EM, Ship JA. General anesthesia protocol for the dental patient: emphasis for older adults. Spec Care Dentist 2000; 20:81.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, American Psychiatric Association, Washington, DC 2000.
- Ost LG, Sterner U. Applied tension. A specific behavioral method for treatment of blood phobia. Behav Res Ther 1987; 25:25.
- Hellström K, Fellenius J, Ost LG. One versus five sessions of applied tension in the treatment of blood phobia. Behav Res Ther 1996; 34:101.
- Ayala ES, Meuret AE, Ritz T. Treatments for blood-injury-injection phobia: a critical review of current evidence. J Psychiatr Res 2009; 43:1235.
- Ost LG, Fellenius J, Sterner U. Applied tension, exposure in vivo, and tension-only in the treatment of blood phobia. Behav Res Ther 1991; 29:561.
- Dewey M, Schink T, Dewey CF. Claustrophobia during magnetic resonance imaging: cohort study in over 55,000 patients. J Magn Reson Imaging 2007; 26:1322.
- Eshed I, Althoff CE, Hamm B, Hermann KG. Claustrophobia and premature termination of magnetic resonance imaging examinations. J Magn Reson Imaging 2007; 26:401.
- Hricak H, Amparo EG. Body MRI: alleviation of claustrophobia by prone positioning. Radiology 1984; 152:819.
- Bluemke DA, Breiter SN. Sedation procedures in MR imaging: safety, effectiveness, and nursing effect on examinations. Radiology 2000; 216:645.
- Booth R, Rachman S. The reduction of claustrophobia--I. Behav Res Ther 1992; 30:207.
- Ost LG, Alm T, Brandberg M, Breitholtz E. One vs five sessions of exposure and five sessions of cognitive therapy in the treatment of claustrophobia. Behav Res Ther 2001; 39:167.
- Thorpe S, Salkovskis PM, Dittner A. Claustrophobia in MRI: the role of cognitions. Magn Reson Imaging 2008; 26:1081.
- GENERAL PRINCIPLES
- DENTAL PHOBIA
- Approach to treatment
- - Cognitive-behavioral therapy
- Eye movement desensitization and reprocessing
- - In vivo exposure therapy
- - Cognitive restructuring
- - Systematic desensitization
- - Coping strategies
- Progressive muscle relaxation
- Applied relaxation
- - Hypnotherapy
- - Nitrous oxide
- - General anesthesia
- - Benzodiazepines
- BLOOD-INJECTION-INJURY PHOBIA
- Applied tension
- Other interventions
- MRI CLAUSTROPHOBIA
- Positional adjustment
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS