Phobic Patients Research Articles

Effects of rhythmic eye movements during a virtual reality exposure paradigm for spider-phobic patients.

Here, we examined whether the efficacy of a virtual reality exposure therapy (VRET) paradigm for phobic patients could be improved by adding rhythmic eye movements. Spider-phobic patients (N = 53) were randomly assigned to either a group performing rhythmic eye movements or a control group undergoing exposure without such eye movements. During the VRET session, heart rate, electrodermal activity, eye movements, and subjective fear ratings were recorded. Participants underwent behavioural avoidance tests before and after treatment as well as a follow-up 10-14 days later. Questionnaire data were assessed before exposure and at follow-up. There were clear treatment effects in both groups with almost no group differences (i.e., the subjective fear ratings and the skin conductance response). Contrary to our expectation, the implementation of rhythmic eye movements during virtual exposure did not enhance the effectiveness of the treatment. However, the eye movement group did show a significantly lower heart rate during exposure compared with the control group which might indicate a less stressful treatment. One-session Virtual Reality Exposure Therapy reduced fear of spiders effectively. Performing rhythmic eye movements during exposure did not enhance therapy effects. Rhythmic eye movements during exposure resulted in lower heart rate than standard exposure.

Spider Phobia: Neural Networks Informing Diagnosis and (Virtual/Augmented Reality-Based) Cognitive Behavioral Psychotherapy-A Narrative Review.

Recent fMRI studies on specific animal phobias, particularly spider phobia (arachnophobia), have identified a large variety of specific brain regions involved in normal and disturbed fear processing. Both functional and structural brain abnormalities have been identified among phobic patients. Current research suggests that both conscious and subconscious fear processing play a crucial role in phobic disorders. Cognitive behavioral therapy has been identified as an effective treatment for specific phobias and has been associated with neuroplastic effects which can be evaluated using current neuroimaging techniques. Recent research suggests that new approaches using virtual (VR) or augmented reality (AR) tend to be similarly effective as traditional “in vivo” therapy methods and could expand treatment options for different medical or individual scenarios. This narrative review elaborates on neural structures and particularities of arachnophobia. Current treatment options are discussed and future research questions are highlighted.

Desenvolvimento de estratégias de realidade aumentada e virtual para o tratamento de Aracnofobia / Development of augmented and virtual reality strategies for the treatment of Aracnophobia

This article aims to present a Virtual Reality (VR) application for Android smartphones as a method of helping in the treatment of a specific phobia, arachnophobia. The application has an immersive virtual environment that, through the use of VR glasses, allows the phobic patient the gradual contact with virtual spiders in an interactive and non-invasive way.

Improving vaccination uptake with the implementation of an immunisation Nurse Practitioner

Patients at increased risk of vaccine preventable diseases require additional vaccines that are not licensed for Nurse Immunisers to administer without a prescription. An Immunisation Nurse Practitioner (NP) at the Royal Children’s Hospital (RCH) Melbourne was introduced to address deficiencies in the current management of these patients. NP endorsement requires successful completion of a Masters level study program, plus the equivalent of three years (5,000) hours full-time experience in advanced clinical nursing. The Immunisation NP was endorsed in May 2017 and since then, the Immunisation service at RCH has recorded a 140% increase in uptake of Meningococcal B vaccine as well as improved delivery of immunisations to special-risk patients. In addition, there was improved access to specialist immunisation advice as well as improved opportunistic immunisation of inpatients. New initiatives were implemented including immunisation of needle phobic patients using nitrous oxide sedation. This paper describes the outcomes of employing an Immunisation NP at the RCH, Melbourne. What is currently known about the topic? Nurse Practitioners provide excellent, patient-centred care whilst also contributing to research, education, leadership and management. There is much literature on describing Nurse Practitioner specialty roles however, none in the area of Immunisation. What this paper adds: A Nurse Practitioner (NP) role in the specialty field of immunisation can contribute to improving hospital inpatient rates of immunisation, facilitate uptake of non-scheduled vaccines and decrease pressure on wait times for a specialist clinic appointment. The Immunisation NP reflects the full diversity of nursing practice and addresses the many service gaps in the previous delivery model, that can be emulated by paediatric nurses in other specialist areas.

A Case Study on the Deployment of a Tactile Internet Application in a Hybrid Cloud, Edge, and Mobile Ad Hoc Cloud Environment

The tactile Internet is the next step after the Internet of Things (IoT). It enables the steering and control of virtual and real objects through the Internet and requires a very low round trip latency. This article is devoted to a case study on the deployment of a tactile Internet application in a hybrid cloud, edge, and mobile <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ad hoc</i> cloud environment. We deploy a remote phobia-treatment application as a set of components. Remote phobia treatment allows phobia patients to have therapy sessions under the guidance of an expert therapist located remotely, with patients and therapist sharing the same virtual reality (VR) environment. A three-layer architecture (cloud, edge, and mobile <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ad hoc</i> cloud) is proposed for the deployment. A prototype is built with Microsoft Azure at the cloud layer, laptops at the edge layer, and smartphones at the mobile <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ad hoc</i> cloud layer. End-users are equipped with an HTC VIVE headset for VR rendering and Gloveone gloves for haptic sensations rendering. Extensive performance measurements are made by varying the component deployment patterns as well as the distance between the therapist and patient. Our results demonstrate clearly that the addition of mobile <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ad hoc</i> cloud to the edge and cloud does bring added value in terms of latency reduction when deploying tactile Internet applications.

Genes in treatment: Polygenic risk scores for different psychopathologies, neuroticism, educational attainment and IQ and the outcome of two different exposure-based fear treatments

Objectives Evidence for a genetic influence on psychological treatment outcome so far has been inconsistent, likely due to the focus on candidate genes and the heterogeneity of the disorders treated. Using polygenic risk scores (PRS) in homogenous patient samples may increase the chance of detecting genetic influences. Methods A sample of 342 phobic patients treated either for clinically relevant dental fear (n = 189) or other (mixed) phobic fears (n = 153) underwent highly standardised exposure-based CBT. A brief five-session format was used to treat dental fear, whereas longer multi-session treatments were used with the mixed-fear cohort. PRS were calculated based on large genetic studies of Neuroticism, Educational Attainment (EA), Intelligence, and four psychopathology domains. We compared PRS of post-treatment and follow-up remitters and non-remitters and regressed PRS on fear reduction percentages. Results In the dental fear cohort, EA PRS were associated with treatment outcomes, i.e. drop-out, short- and long-term remission state, fear reduction, and attendance of subsequent dental appointments. In the mixed fear treatment cohort, no gene effects were observable. Conclusions Results indicate the importance of EA-related traits for outcomes following brief, but not long, standardised exposure-based CBT. Such use of PRS may help inform selection and tailoring of treatments.

Managing dental phobia in patients

Managing dental phobia in patients

Recognizing and differentiating dental anxiety from dental phobia in adults: a systematic review based on the German guideline "Dental anxiety in adults".

Objectives: The prevalence of "dental anxiety" (DA) is often underestimated and numerous diagnostic methods are available for dental practitioners. It is difficult to differentiate between a dental phobia requiring an interdisciplinary approach and DA, which can be managed by dental practitioners alone. The appropriate use of diagnostic tools is key for the successful management of highly anxious and/or phobic patients. The aim was to provide a guideline to recognize dental fear and to differentiate DA from patients who are highly anxious or even have a phobia. Data sources: In total, 8,929 articles that were selected for the development of the German guidelines for "Dental anxiety in adults" in PubMed, Web of Science, Embase, and MedPilot were filtered for diagnosis of DA disorder. The focus for this review was on the use of scales to measure DA levels. The methods and tools used in the 51 reviewed articles to assess DA levels were evaluated in terms of their practicability and suitability in daily practice to differentiate between phobia (ie, DA disorder) and nonpathologic anxiety. In addition, the internal consistency (Cronbach alpha) of the questionnaires/tools was determined. Conclusion: All identified DA questionnaires validated in the German language had an acceptable to excellent internal consistency (0.7 to 0.986). The only validated questionnaire-free method was galvanic skin reaction measurement. For the assessment of DA and diagnosis of a DA disorder in adults, the survey by means of any suitable questionnaire or even several questionnaires in combination with a behavioral observation of the patient is currently the method of choice.

Neurocognitive Functions in Social Anxiety Disorder

Objective: The purpose of this study was to assess the neurocognitive functions of patients with social phobia and to examine the relation between these functions and the severity of the disease. Methods: The study was performed with 30 patients under monitoring with a diagnosis of social phobia at the Ondokuz Mayıs University Psychiatry Clinic and 30 age- and sex-matched healthy controls. Patients were assessed using the Hamilton Anxiety Rating Scale (HARS), the State-Trait Anxiety Inventory (STAI), and the Liebowitz Social Anxiety Scale (LSAS). Both groups were administered the Wisconsin Card Sorting Test (WCST), the Stroop Test, the Auditory-Verbal Learning Test (AVLT), and the Trail Making Test (TMT) forms A and B, and the two groups’ neurocognitive performances were compared. Results: Social phobia patients exhibited significantly poorer performance than the control group in terms of total number of errors, number of perseverative errors and number of categories completed on the WCST, time taken to complete TMT forms A and B, time taken to complete the first, third, fourth and fifth parts of the Stroop test, and AVLT immediate recall scores. Positive correlation was determined in the patient group between LSAS subscores and time taken to complete the first, third and fourth parts of the Stroop test. Positive correlation was also determined between patients’ time taken to complete the fifth part of the Stroop test and LSAS avoidance and total scores. Conclusion: Greater impairment was observed in the attention, executive function and immediate recall performances of social phobia patients compared to the healthy controls

Neuronal correlates of spider phobia in a combined fNIRS-EEG study

Specific phobia is associated with aberrant brain activation in confrontation paradigms with phobic stimuli. In previous EEG research enhanced event-related potentials (ERPs) in the late-positive potential (LPP) window have been observed. Further, studies with functional near-infrared spectroscopy (fNIRS) and fMRI suggest that spider phobia is associated with enhanced activation within cortical and subcortical areas. In the current study we investigated the neuronal correlates of spider phobia in a combined fNIRS–EEG study. To this end, 37 spider phobic patients (PP) and 32 healthy controls (HC) underwent a symptom provocation paradigm during which subjects watched video clips of spiders and domestic animals (confrontation phase) after being primed on the content of the video (anticipation phase). Simultaneously, fNIRS, EEG, electromyography (EMG), electrocardiography and behavioral measures were assessed. Results showed increased LPP amplitudes, increased hemodynamic responses in the cognitive control network, and increased EMG activity and heart rate during spider conditions in PP in comparison to HC. Furthermore, in behavioral ratings PP showed higher emotional distress and avoidance. Behavioral ratings, fNIRS and EEG data showed positive correlations on a between-subject as well as on a within-subject level. Our results merge the existing data on neurophysiological correlates of phobic stimulus processing in hemodynamic and electrophysiological research and extend those of static visual material (pictures) to dynamic visual material (videos).

Virtual Reality and Fear of Shark Attack: A Case Study for the Treatment of Squalophobia

Research treatment protocols are rare regarding an unusual anxiety disorder, namely the fear of sharks (squalophobia). As a possible solution, the effectiveness of virtual reality (VR) exposure therapy for this phobia was tested. The advantage of using VR becomes clearer when a real life set up is impractical, such as exposing a phobic patient to a feared large marine organism, the shark. The effects were evaluated in a single case study involving multiple context-graded aquatic virtual environments with a virtual shark and using affordable VR apparatus and software. Assessment was based on self-report questionnaires. Scores the psychometric instruments exhibited a discernable reduction in fear toward sharks. Such gains were maintained at a 12-month follow-up. Presence rates indicated immersion when confronted to a three-dimensional (3D) virtual shark. This initial study revealed the potential of VR for the treatment of marine biota phobia and its potential to recreate diverse situations for exposure therapy.

2.5% EMLA Versus 2% Lignocaine with Adrenaline Injection in Small Oral Mucosal Biopsies: A Parallel Group Randomized Controlled Trial.

The study was designed as an open label randomized comparative parallel group design with a 1:1 allocation ratio. All consecutive patients reporting for small biopsies (incisional or excisional) who gave written informed consent were included in the study between October 2018 and October 2019. They were randomized into two groups, Group A and Group B both receiving intervention in the form of 2.5% EMLA cream and 2% Lignocaine with 1:80,000 Adrenaline injectionrespectively, to anaesthetise tissue for small mucosal biopsies in the oral cavity. EMLA was found to be as effective as lignocaine infiltration with a completely painless application and higher satisfaction for overall comfort during procedure. The duration required to achieve anaesthesia was however more. A particular subgroup of pathology was found to be completely resistant to anaesthesia by EMLA. We recommend the use of EMLA as a sole anaesthetic in small mucosal biopsies and shavings in all patients. We suggest it as a higher and first line recommendation for anaesthesia in needle phobic patients and children.

Management of dental anxiety – a cross-sectional survey in private dental practices in the Swiss Romandy

The main aim of the present study was to gain a better understanding of the management of dental anxiety reported by dental practitioners in western Switzerland. In 2013, an 18-item electronic questionnaire was sent to dental practitioners in the Swiss Romandy. A total of 140 (18.6%) questionnaires were included in the analysis. About four out of five practitioners (79.4%) involved with dental emergency service had at least one occurrence with dental phobic patients. The majority of the respondents stated that both dental anxiety and dental phobia increases stress in the dental practice with frequencies of 90.0% and 88.5%, respectively. Among the 119 respondents using anxiety reduction methods (85.0%), an overall of 51 (42.9%) reported using pharmacological methods while 89.9% (n = 107) used psychological methods. Female dentists were using psychological anxiety reduction methods three times more frequently than male dentists reaching borderline statistical significance (OR = 3.0, p = 0.0591). Out of 140 respondents, only 28 (20.1%) received education and training in dental anxiety reduction methods. The majority of these (66.4%; n = 83) stated that their education was inadequate and 55.8% (n = 77) requested further education and training. It can be concluded that more education and training of dental anxiety reduction methods are needed.

Communicating with phobic patients – a dental nurse's role

Dental therapist, tutor and coach Christine MacLeavy suggests the steps you can take to help with anxiety management in practice

Prospective Analysis and Comparison of Periareolar Excision (Delivery) Technique and Pull-Through Technique for the Treatment of Gynecomastia.

Gynecomastia is one of the most common disorders affecting adolescent and adult males. It is a benign disorder but has severe psychological manifestations like low self-confidence, depression, anxiety and social phobia in patients suffering from gynecomastia. Different surgical techniques have been described utilizing a variety of incisions, excisions, lipectomy and liposuction methods. Very frequently, these methods are combined for the gynecomastia treatment with variable reported results. However, there is a lack of studies comparing these techniques. The present study was planned to compare cases of gynecomastia treated by liposuction with periareolar excision (delivery technique) and liposuction with a pull-through technique. A prospective randomized control study was conducted at a tertiary care hospital on 20 patients with gynecomastia. The patients were assigned to either liposuction with periareolar excision (delivery technique) or liposuction with pull-through technique. Anthropometric analysis and breast evaluation questionnaire (BEQ) scores were analyzed and compared before and after the surgery. The majority of the study subjects were between 21 and 30years of age. Low self-confidence was the main reason for surgery in most of the cases. Twelve patients had gynecomastia grade IIa and eight had grade IIb. Both groups had similar responses to BEQ scores before and after the surgery with no statistically significant difference. A statistically insignificant difference was observed between the groups on comparison of anthropometric analysis preoperatively and postoperatively. The mean lipoaspirate volume was 280ml for the pull-through technique and 367ml for the periareolar excision technique. No complications were observed in cases operated on by the pull-through technique, while two cases (10%) operated on by the periareolar excision had hematomas. Both techniques provide excellent cosmetic results with low risk of complications in both small and moderate breast enlargement with skin excess. The pull-through technique combines the benefits of direct excision of glandular tissues along with the minimally invasive nature of liposuction. Thus, performing the procedure via a single incision without the use of drains is a safer alternative to traditional liposuction with the periareolar excision technique. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The essential skill of sedation

Susie Verow on how she is supporting phobic patients

Comparative Evaluation of Intraoral and Extraoral Periapical Radiographic Techniques in Determination of Working Length: An In Vivo Study.

ABSTRACTObjectives/aimsThis study was designed to determine the endodontic working length (WL) of root canals using digital extraoral periapical radiography (EOPAR) technique and comparing its accuracy with the standard digital intraoral periapical radiography (IOPAR).Materials and methodsSixty single-rooted mandibular first premolars indicated for orthodontic extraction were radiographed preoperatively to ensure closed apices. After gaining endodontic access, WL was determined by IOPAR using paralleling technique, followed by EOPAR, by placing a cone at +35° from the contralateral side. Accessed tooth was then extracted to obtain the actual root canal length and was compared with the radiographic lengths. Data were subjected to statistical analysis using paired t test.ResultsThe actual length and the extraoral radiographic length showed no statistical significant difference (p = 0.326). The difference between the mean WL obtained by IOPA and EOPA was also not statistically significant (p = 0.096). The accuracy of IOPA technique was 97.87 ± 0.91% and that of EOPA technique was 94.65 ± 2.57%.ConclusionThe EOPA technique with an angulation of +35° can be used as an alternative to IOPA for mandibular premolars in apprehensive children, dental phobic patients with low pain threshold, neurological difficulties, and exaggerated gag reflex.How to cite this articleSridhara A, Konde S, Noojadi SR, et al. Comparative Evaluation of Intraoral and Extraoral Periapical Radiographic Techniques in Determination of Working Length: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(3):211–216.

Use of Digital Stimulation in the Treatment of Phobias: Results Following EEG and Evoked Potential

To verify the usefulness of visual stimulation in CBT techniques or systematic desensitization and flooding, through the study of neurocognitive responses (ERPs) to specific and repetitive phobic or neutral stimuli, in patients with specific phobias. The study involved 2 groups, both composed of 20 subjects: an experimental group and a control group. Slideshows consist of randomized phobic images, whose characteristics are personalized for the specific phobia, and neutral images identical for all subjects. The ERPs recorded during visual stimulation were analyzed, distinguishing the potentials generated by phobic and neutral stimulations. The ERPs present typical waves (P1, P2, P3a, and P3b) that represent the cortical processing of the image. The study shows, in phobic subjects with specific phobic stimuli, an increase in P2 component amplitude due to greater activation of cortical networks by emotional response and the increase in amplitude of P3b component compared with the control group, probably in relation to looking for specific details of the phobic image. It is interesting to note that P3b component tends to regress during repetitive stimulation. The study showed that, through digital stimulation, phobic patients become accustomed to the presentation of phobic stimuli with an average decrease of 12–13% in P2 and an average reduction of 25% in N2. This result allows the hypothesis that this stimulation is useful to replace stimulation in vivo, or as a preparation for it. The variation of the potential evoked during the stimulation can help the therapist modulate the stimulation itself. The authors also propose to continue the development of this research also using the development of augmented reality (VR).

The impact of dental treatment and age on salivary cortisol and alpha-amylase levels of patients with varying degrees of dental anxiety

BackgroundThe purpose of this study was to assess the salivary cortisol and salivary alpha-amylase levels in children aged between 6 and 9 years, 3 months and 1 year after the successful completion of dental treatment through either pharmacological or non-pharmacological behavior management techniques.MethodsA total of 1567 patients aged between 6 and 9 years who had completed dental treatment were screened. A total of 703 patients who were caries free at the end of 3 months were classified based on Frankl behavior score and administered the Arabic version of the Children’s Fear Survey Schedule- Dental Subscale (CFSS-DS) and accordingly allocated to one of three groups; (Phobic Patients, Anxious Patients, Control Group). A total of 183 patients met the inclusion criteria and were followed up for 1 year. A total of 151 patients completed the study. Patients’ heart rate on recall, salivary cortisol and salivary amylase were compared between the groups.ResultsThe results of the study showed that amylase and cortisol levels had a significant association with the level of dental fear. The phobic patients had the highest levels of salivary amylase and salivary cortisol levels with no significant associations observed with either heart rate or extent of dental treatment. Control and anxious patients had significantly lower amylase levels when compared to phobic patients. There was no significant difference between the salivary cortisol levels of anxious and phobic patients. These findings were replicated on 1-year recall.ConclusionsWithin the limitations of this study we can conclude that salivary amylase is an indicator of of acute stress that can differentiate between anxiety and dental fear; while salivary cortisol appears to be a marker of long-term stress that lacks the sensitivity to differentiate between the two.

Efficacy of Cognitive-Behavioral Group Therapy versus Group Hypnotherapy on Brain/Behavioral Systems of Social Phobia Patients

Efficacy of Cognitive-Behavioral Group Therapy versus Group Hypnotherapy on Brain/Behavioral Systems of Social Phobia Patients