A comparison of stress inoculation training and stress education in the treatment of stress associated with dental procedures

Abstract

Stress inoculation training has been suggested as a viable approach to the treatment of such stress-related behaviors as self reported distress, physiological arousal, and behavioral avoidance. Previous research has concluded that training in coping skills constitutes the"active ingredient" of the treatment package, while education about the nature and effects of stress is not sufficient to produce behavior change. The data-base supporting these conclusions however, is composed primarily of experimental results with analogue or non clinical populations. The present study was designed to compare the relative effectiveness of stress inoculation training and stress education in reducing stress related behaviors in a population confronting a personally relevant stressor. The study utilized a four group repeated measures design which included two treatment groups composed of subjects who were fearful of dental procedures (stress inoculation and stress education) and two control groups. The high fear no treatment control group was also composed of subjects who were fearful of dental procedures but were unable to participate in treatment because of scheduling difficulties. The low fear validation.control subjects were included in order to validate the dependent measures utilized in the study with respect to their ability to discriminate high fear from low fear individuals. Subjects were 13 adult males and 19 adult females. All high fear subjects were either self-referred, referred by their personal dentists, or identified as fearful of dental procedures by their responses to the Dental Anxiety Scale, using a score of one standard deviation above the mean as the criterion for inclusion. Low fear subjects all scored at least one standard deviation below the mean of the same scale. Analysis of covariance, using pre-treatment scores as the covariate, indicated that stress inoculation subjects differed from high fear controls at treatment on the variables of trait anxiety, overall rating of fear of dentistry, number of negative self-statements. the anticipation factor of the Dental Fear Survey, and the behavioral avoidance test. Stress education subjects did not differ from high fear controls on any measure at post treatment. Analysis of covariance aJso indicated however, that there were no significant differences between stress inoculation training and stress education at posttreatment. Because of the regression model's poor fit in the analysis of covariance for the plasma cortisol values (R-square=.12) a repeated measures analysis of variance was utilized for that variable. Results indicated that both stress inoculation and stress education subjects showed significant reductions in plasma cortisol values from pre treatment to post treatment assessment. A small and statistically insignificant reduction was observed for high fear no treatment control subjects. A 10-month follow-up revealed that 100 percent of both the stress inoculation and stress education subjects had seen a dentist whereas only 60 percent of the high fear control subjects had made and kept a dental appointment. Results are discussed in terms of the relative efficacy of the two treatment procedures for use with fearful dental patients and findings are related to predictions generated by Bandura's theory of self-efficacy.