Efficacy of virtual reality exposure therapy for treatment of dental phobia: a randomized control trial.

Kumar Raghav,Md Nurul Islam,Ad De Jongh,Marc Bernatchez,Aj Van Wijk,Fawzia Abdullah

doi:10.1186/s12903-016-0186-z

Abstract

BackgroundVirtual Reality Exposure Therapy (VRET) is found to be a promising and a viable alternative for in vivo exposure in the treatment of specific phobias. However, its usefulness for treating dental phobia is unexplored. The aims of the present study are to determine: (a) the efficacy of VRET versus informational pamphlet (IP) control group in terms of dental trait and state anxiety reductions at 1 week, 3 months and 6 months follow-up (b) the real-time physiological arousal [heart rate (HR)] of VRET group participants during and following therapy (c) the relation between subjective (presence) and objective (HR) measures during VRET.MethodsThis study is a single blind, randomized controlled trial with two parallel arms in which participants will be allocated to VRET or IP with a ratio of 1:1. Thirty participants (18-50 years) meeting the Phobia Checklist criteria of dental phobia will undergo block randomization with allocation concealment. The primary outcome measures include participants’ dental trait anxiety (Modified Dental Anxiety Scale and Dental Fear Survey) and state anxiety (Visual Analogue Scale) measured at baseline (T0), at intervention (T1), 1-week (T2), 3 months (T3) and 6 months (T4) follow-up. A behavior test will be conducted before and after the intervention. The secondary outcome measures are real-time evaluation of HR and VR (Virtual Reality) experience (presence, realism, nausea) during and following the VRET intervention respectively. The data will be analyzed using intention-to-treat and per-protocol analysis.DiscussionThis study uses novel non-invasive VRET, which may provide a possible alternative treatment for dental anxiety and phobia.Trial registration numberISRCTN25824611, Date of registration: 26 October 2015.

Highlights

Virtual Reality Exposure Therapy (VRET) is found to be a promising and a viable alternative for in vivo exposure in the treatment of specific phobias
The association between measures will be determined using the Pearson correlation coefficient. The design of this randomized clinical trial offers pathways to address the efficacy of VRET in the treatment of long term trait dental anxiety
We developed (KR, ADJ and MB) a VRET device based on exposure therapy models and will be testing the efficacy of this intervention among people with dental phobia immediately after therapy, 1 week, 3 months and 6 months post therapy, and will be comparing with the results of an informational pamphlet intervention

Summary

Introduction

Virtual Reality Exposure Therapy (VRET) is found to be a promising and a viable alternative for in vivo exposure in the treatment of specific phobias. Raghav et al BMC Oral Health (2016) 16:25 phobias [15] including claustrophobia [16], acrophobia [17], fear of flying [18], and spider phobia [19]. This involves conducting exposure therapy using computer generated Virtual Reality (VR) environments by systematic confrontations of patients with their potentially fearprovoking (i.e., ‘conditioned’) stimuli so that habituation occurs [15, 17]. Administration of VRET may just require a working knowledge of computer operation and basic training to operate the apparatus

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