2017 |
Ollendick, Thomas H. (co-PI) [⬀] Seligman, Laura D |
R34Activity Code Description: To provide support for the initial development of a clinical trial or research project, including the establishment of the research team; the development of tools for data management and oversight of the research; the development of a trial design or experimental research designs and other essential elements of the study or project, such as the protocol, recruitment strategies, procedure manuals and collection of feasibility data. |
A Clinical Trial Planning Grant For One Session Treatment For Dental Phobia in Youth as a Method to Disseminate An Empirically Supported Treatment to An Underserved Population @ University of Texas Rio Grande Valley
PROJECT SUMMARY/ABSTRACT Dental phobia is associated with avoidance of proper dental care, poor dental health, and decrements in social and oral quality of life. Although dental phobia may persist for many years, the disorder usually first manifests during childhood or adolescence. Hispanic youth may be at particularly high risk of developing dental phobia because, on the whole, Hispanic/Latino families are less likely to take a preventative stance toward dental health? meaning that Hispanic youths' first encounters with a dentist are more likely to be for treatment that is associated with pain, discomfort, or shame ? the types of learning experiences related to the development of dental phobia. While our knowledge about the etiology of dental phobia is somewhat well developed, we know considerably less about how to treat it. Recently, however, a one-session exposure therapy treatment (OST) for specific phobias has proven successful in addressing a variety of phobias in youth, but youth with dental/medical phobias have not been included in the trials assessing OST because of the need to include medical professionals in the treatment. However, we have been able to build a research team that includes academic and practicing dentists. Therefore, the aim of this project is to prepare for a trial testing the effectiveness of OST for dental phobia in children and adolescents. More specifically, we propose to prepare the manual of procedures, training manuals, and IRB application necessary for the submission of a U01 application to test the effectiveness of OST compared to treatment as usual (TAU) delivered by dental hygienists in the Rio Grande Valley (RGV) of Texas ? an area with a very high concentration of Hispanic youth at risk for dental phobia. This clinical trial would randomize dental clinics in the RGV to one of the two treatment arms (OST vs. TAU) so that patient response, treatment feasibility (including provider response to treatment and cost-effectiveness), as well as a hypothesized mediator of treatment can be assessed. It is expected that OST can provide a feasible and effective treatment option that can be delivered by hygienists in the dental office. That is, that the treatment can decrease both anxiety and phobic avoidance in youth while giving treatment providers a cost-effective option that will be more acceptable to children and their parents when compared to current treatments such as sedation and restraint. Moreover, although exposure therapy has a high level of empirical support in youth and a good deal of laboratory work has been conducted to develop the theory to explain its effects, to our knowledge, the main hypothesized mechanism of action ? inhibitory learning ? has not been studied within the context of a clinical trial; therefore, the study we propose could advance our understanding of the mechanism driving one of the most promising treatments for individuals with anxiety disorders.
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0.913 |
2021 |
Geers, Andrew L (co-PI) [⬀] Seligman, Laura D |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Identifying the Mechanisms of Latent Inhibition to Prevent Dental Fear @ University of Texas Rio Grande Valley
PROJECT SUMMARY Our recent findings as well as others, show pre-exposure to dental stimuli prior to a conditioning event results in latent inhibition (LI). The reverse is also true, lack of pre-exposure is related to greater fear, poorer oral health, increased likelihood of cancellation of dental appointments, decreased likelihood of compliance with the recommended schedule of dental visits, and failure to maintain an ongoing relationship with a dental office. Although findings across studies converge on LI as clinically relevant for the prevention of dental fear, this fact has not been leveraged to develop prevention programs nor have the necessary experimental investigations been undertaken to identify the target mechanisms responsible for LI of dental fear. There are currently no evidence-based prevention strategies for dental fear and existing prevention strategies for related anxiety disorders are typically low-dose versions of diffuse treatment programs without a specified mechanism of action. The purpose of the proposed study is to identify the mechanism(s) underlying the LI of dental fear, allowing for more precise engagement of these target(s), and to examine whether individual differences related to ethnicity that could help account for the disparities observed in oral health and dental fear, are related to the engagement of these targets. We hypothesize that changes in prediction errors and attention that result from pre-exposure account for latent inhibition of conditioned fear and that higher pain sensitivity increases the engagement of these mechanisms. We propose studies that manipulate pre-exposure in a novel virtual reality paradigm, developed and validated by members of our team, to affect the target mechanisms. In addition to assessing attention and prediction errors, we will examine the endpoint of fear, using measures of behavior, subjective emotion, and physiological change. The proposed research is innovative in that it is the first to apply a well-characterized model of learning to the LI of dental fear using an experimental medicine approach; it uses a newer paradigm that allows for the assessment of behavior in the context of clinically-relevant conditions of mixed approach/avoidance motivation, with environmental contingencies that allow for detection of individual differences, including those with the potential to address oral health disparities. Moreover, the approach used includes participants of both sexes across the lifespan, and short and longterm retention tests, noted omissions in the extant literature on human fear conditioning. These studies are relevant to public health because over 40 million Americans suffer from significant dental fear with the potential to negatively impact oral health and downstream health sequalae. The proposed studies are relevant to clinical practice because the lack of precisely defined and measurable targets for prevention of dental fear is a critical barrier to the development of evidence-based, cost-effective prevention strategies with the scalability to effect change in the population. Moreover, the proposed research responds the priorities identified by NIDCR in the 2030 visioning initiative to integrate oral health and overall health, enable precise, personalized care, and, address oral health disparities.
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0.913 |