A mixed methods exploration of the origin of dental anxiety and coping strategies among participants in a behavioral intervention for dental anxiety.

Introduction: Little is known about the onset and early progression of dental anxiety. The current mixed-methods study aimed to evaluate patient-reported early experiences and onset of dental anxiety, as well as the experience of managing dental anxiety (i.e., coping strategies and symptom severity).

Methods: Adults (N=499) were recruited from a dental school clinic to participate in a clinical trial testing the efficacy of a cognitive behavioral therapy (CBT)-based intervention for dental anxiety. As one aspect of this trial, participants answered the Anxiety and Related Disorders Interview Schedule. During this interview, participants described when they first noticed developing anxiety about dental appointments, as well as how they coped during their appointments. Assessments were repeated at one-month and three-month follow-ups. Bivariate associations (e.g., chi-square and t-test) and repeated measures ANOVA were explored. Qualitative data were coded in NVivo.

Results: The three identified origins for dental anxiety were: "traumatic dental visit in childhood," "traumatic dental visit in adulthood," and "anxiety has always been present." Participants who reported a childhood trauma had the highest levels of dental anxiety relative to the other two groups. In total, 30 unique coping mechanisms were identified. A reduction in avoidant coping strategies was observed among the intervention groups at both one-month and three-months, but not in the control group.

Discussion: Earlier negative dental experiences are more likely to result in greater anxiety severity. A one-time CBT-based dental anxiety treatment reduced the use of avoidant coping strategies, which may in turn reduce patient fears.