Semester

Spring

Date of Graduation

2021

Document Type

Dissertation

Degree Type

PhD

College

Eberly College of Arts and Sciences

Department

Psychology

Committee Chair

Daniel W. McNeil

Committee Co-Chair

Aaron Metzger

Committee Member

Shari Steinman

Committee Member

Robert Stuchell

Committee Member

Constance Toffle

Abstract

Currently, a host of treatments are available for treating anxiety disorders, including specific phobia. Treatment of specific phobia includes pharmacological, psychosocial, and combined approaches. Exposure therapy, however, is considered the leading psychological treatment for specific phobia, and has shown to be effective. Exposure therapy challenges held beliefs about feared stimuli/situations and attempts to integrate new learning about the feared object/situation. Despite exposure being effective to treat specific phobia, it is associated with low adherence and high dropout rates. There is a need to examine, therefore, ways to improve patient adherence for exposure. A way to examine this issue is to assess patient preferences for currently available treatments for specific phobia, and to examine directly the various methods for delivering exposure (e.g., stimuli intensity presentation). Furthermore, it is important to assess individuals’ perception of efficacy on various methods of delivering exposure stimuli (e.g., low intensity versus high intensity). Also, it is essential to examine individual willingness to engage in different presentation of stimuli intensity. Participants (N = 1,065) were assessed for dental care-related fear and anxiety, and 279 of those individuals with high levels of fear/anxiety were included in the analyses regarding treatment preferences. Participants rated their preference for types of treatments (e.g., exposure, flooding, systematic desensitization) and were asked to rank order-based on personal preference. Then participants watched two video examples of exposure (i.e., low intensity and high intensity) and asked to rate their preference for the two methods to deliver exposure stimuli. After, participants rank ordered several approaches for delivering exposure stimuli by personal preference. Finally, participants were given a free choice to watch either a black screen (e.g., avoidance), low intensity exposure video, or high intensity exposure video over three trials. Results indicated that participants rated relaxation as the most preferred type of treatment for dental phobia. In regard to exposure stimuli, participants rated the low intensity exposure stimuli with greater preference (e.g., more efficacious and more willing to engage in the treatment) than the high intensity exposure stimuli. A majority of participants watched the low intensity (39.6%) and the avoidance video (32.8%) two or more times over the three trials demonstrating a behavioral preference for video content. A Latent Class Analysis suggested distinct groups (i.e., Low to Avoidant, and Avoidant) based on the patterns of video choice over the three trials. Findings of this study highlight differences in patient preferences for specific phobia treatment, which ultimately can impact oral health care services and training. Utilizing low intensity exposure stimuli may be a promising way to get patient buy-in and ease into higher intensity stimuli and possible improve treatment outcomes.

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