Internet-based cognitive behavioral therapy for children and adolescents with dental anxiety: open trial
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Abstract
BACKGROUND: Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects. OBJECTIVE: The aim of this study was to test the hypothesis that psychologist-guided ICBT improves school-aged children's and adolescents' ability to manage dental anxiety by (1) decreasing avoidance and affecting the phobia diagnosis and (2) decreasing the dental fear and increasing the target groups' self-efficacy. The study also aimed to examine the feasibility and acceptability of this novel treatment. METHODS: This was an open, uncontrolled trial with assessments at baseline, posttreatment, and the 1-year follow-up. The study enrolled and treated 18 participants. The primary outcome was level of avoidance behaviors, as measured by the picture-guided behavioral avoidance test (PG-BAT). The secondary outcome was a diagnostic evaluation with the parents conducted by a psychologist. The specific phobia section of the structured interview Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) was used. Other outcome measures included level of dental anxiety and self-efficacy. The ICBT, which employed exposure therapy, comprised 12 modules of texts, animations, dentistry-related video clips, and an exercise package (including dental instruments). Participants accessed the treatment through an Internet-based treatment platform and received Web-based guidance from a psychologist. Treatment also included training at dental clinics. Feasibility and acceptability were assessed by measures of engagement, adherence, compliance, completed measures, patient and parent satisfaction scale, and staff acceptability. RESULTS: The level of avoidance (according to the primary outcome measure PG-BAT) and dental anxiety decreased and self-efficacy increased significantly (P<.001), within-group effect sizes for both the primary outcome (Cohen d=1.5), and other outcomes were large in the range of 0.9 and 1.5. According to K-SADS-PL, 53% (8/15) of the participants were free from diagnosable dental anxiety at the 1-year follow-up. At the 1-year follow-up, improvements were maintained and clinically significant, with 60% (9/15) of participants who had been unable to manage intraoral injection of local anesthetics before ICBT reporting having accomplished this task at a dental clinic. The target group showed improvement in all the outcome measures. High levels of feasibility and acceptability were observed for the treatment. CONCLUSIONS: ICBT is a promising and feasible treatment for dental anxiety in children and adolescents. Integrating it into routine pediatric dental care would increase access to an effective psychological treatment. The results of this open trial must be replicated in controlled studies.
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Some non-randomized controlled studies with specific phobias have been conducted, including case studies in adults with small animal phobia, an open trial in children and adolescents with dental anxiety, and a pilot study in children with specific phobias whose parents helped with the intervention.
“Some non-randomized controlled studies with specific phobias have been conducted, like a series of case studies in adults with small animal phobia (Botella et al., 2008), an open trial in children and adolescents with dental anxiety (Shahnavaz et al., 2018), and a pilot study in children with specific phobias whose parents helped with the intervention (Vigerland et al., 2013).”
From An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study (2021) · cites this paper as Shahnavaz et al., 2018
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- Authors
- Shahnavaz, S., Hedman-Lagerlöf, E., Hasselblad, T., Reuterskiöld, L., Kaldo, V., & Dahllöf, G.
- Affiliations
- Karolinska Institutet (SE)
- Stockholm University (SE)
- Corresponding author
- Shahnavaz, Shervin
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2018-01-22
- Volume
- 20
- Issue
- 1
- Pages
- e12
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC5799719
- OpenAlex
- W2784424139
- Cited by
- 48
- References
- 45
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 8 · 2023: 5 · 2022: 8 · 2021: 8 · 2020: 3 · 2019: 7 · 2018: 3
- FWCI
- 6.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Dentistry › Oral Surgery › Dental Anxiety and Anesthesia Techniques
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- internet-based cognitive behavioral therapy, dental anxiety, specific phobia, children and adolescents, avoidance behavior, exposure therapy, self-efficacy, treatment feasibility and acceptability
- MeSH terms
- Adolescent, Child, Female, Humans, Male, Cognitive Behavioral Therapy, Dental Anxiety, Treatment Outcome, Internet
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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