2. Psychometric Measures of Fear Anxiety and Phobia
Presented by –
Deepti Awasthi

3. contents Introduction Difference between anxiety, fear & phobia
Methods to measure anxiety
Anxiety rating scales
Conclusion
References

4. Introduction

5. Difference between anxiety, fear & phobia
Dental anxiety
Dental fear
Dental phobia
Textbook of Pedodontics – Shobha Tandon

6. Methods to measure anxiety
Physiological
Behavioural
Hormonal
Psychometric
Advances in psychology research

7. Advances in psychology research
Physiological
Anxiety leads to change in Vitals
Measures:
Heart Rate
Pulse
Oxygen saturation
B.P.
Palmer Sweating
Respiratory rate
Muscle tone
Advances in psychology research

8. Advances in psychology research
Disadvantage
Requires expensive instruments
Instruments itself may introduce anxiety
Therefore not correct measure of anxiety
Anxiety may be of instrument only not of dental T/t
Dentists not trained to use these instrument ( will require training)
Time consuming
Advances in psychology research

9. Advances in psychology research
Hormonal
Stress activates production of adrenal hormone and salivary cortisol is equal to free cortisol in serum.
Disadvantage
Time consuming
Special instrument required
Not possible in all set-ups
costly
Advances in psychology research

10. Advances in psychology research
Psychometric
Inexpensive, flexible, easy to administer and results in score ranges that can be easily compiled & processed statistically
Advances in psychology research

11. Anxiety rating scales Corah Modified Corah’s
Klienknecht’s Dental fear survey
Dental Anxiety Question
Photo Anxiety Questionnaire
Children’s Fear Survey Schedule
Venham Picture Scale
Adolescents’ Fear of Dental Treatment Cognitive Inventory.
Behaviour Profile Rating Scale
Hamilton anxiety rating scale
Zung Self-Rating Anxiety Scale (SAS )
Fear Survey Schedule

12. CORAH Dental anxiety scale
Norman Corah(1969)
4 item measure
Respondents are asked about 4 dentally related situations and are asked to indicate which of four responses is closest to their likely response to that situation.
ANXIETY AND PAIN MEASURES IN DENTISTRY: A GUIDE TO THEIR QUALITY AND APPLICATION, JADA, Vol. 131, October 2000

13. 1.If you had to go to the dentist tomorrow, how would you feel about it? -I would look forward to it as a reasonably enjoyable experience. -I wouldn't care one way or the other. -I would be a little uneasy about it. -I would be afraid that it would be unpleasant and painful. -So anxious that I sometimes break out in a sweat or almost feel physically sick
2.When you are waiting in the dentist's office for your turn in the chair, how do you feel? -Relaxed -A little uneasy -Tense -Anxious -So anxious that I sometimes break out in a sweat or almost feel physically sick
Corah DAS , revised

14. .3.When you are in the dentist's chair waiting while he gets his drill ready to begin work on your teeth, how do you feel? -Relaxed -A little uneasy -Tense -Anxious -So anxious that I sometimes break out in a sweat or almost feel physically sick
4.You are in the dentist's chair to have your teeth cleaned. While you are waiting and the dentist is getting out the instruments that he will use to scrape your teeth around the gums, how do you feel? -Relaxed -A little uneasy -Tense -Anxious -So anxious that I sometimes break out in a sweat or almost feel physically sick
Corah DAS , revised

15. Total scores ranged from 4 to 20. Anxiety rating: 4-5 = No Anxiety
6-8 = Mild Anxiety
= moderate anxiety
= high anxiety
= severe anxiety or phobia
Corah DAS , revised

16. Advantages :
Adults & children
Internal consistency & reliability is high.

17. Disadvantages :
range of total scores is too narrow to be used effectively in clinical studies.

18. Modified Corah’s anxiety Scale
Humphris- 1995
Addition of a fifth item that asks responses to administration of local anesthetics
most frequently used dental anxiety questionnaire in the United Kingdom.
High reliability & validity.
Advances in psychology research

19. Each item scored as follows: Not anxious = 1 Slightly anxious = 2 Fairly anxious = 3 Very anxious = 4 Extremely anxious = 5
Total score is a sum of all five items
range 5 to 25:
19 or above which indicates a highly dentally anxious patient, possibly dentally phobic .

20. Klienknecht’s Dental fear survey
asks respondents to rate their anxieties about 27 specific situations—such as
making an appointment or
hearing the dental drill
on a five-point Likert scale ranging from “none” to “great”.
ANXIETY AND PAIN MEASURES IN DENTISTRY: A GUIDE TO THEIR QUALITY AND APPLICATION, JADA, Vol. 131, October 2000

21. Dental Anxiety Question
is a single-item construct:
“Are you afraid of going to the dentist?”
It has four possible responses:
“no,”
“a little,”
“yes, quite,”
“yes, very.”
These responses are scored from 1 to 4 in the direction of increasing anxiety.
ANXIETY AND PAIN MEASURES IN DENTISTRY: A GUIDE TO THEIR QUALITY AND APPLICATION, JADA, Vol. 131, October 2000

22. Useful & brief tool for some purposes – screening people , who are likely to be highly anxious about dental treatment.
it has a tendency to overestimate the prevalence of severe dental anxiety

23. Photo Anxiety Questionnaire
The response scale is nonverbal, consisting of five photographs with facial expressions of differing anxiety levels.
There are different versions for men and women.
Patients indicate which photograph best expresses their feelings.
The scale is scored by summing the item ratings 1 = relaxed,
5 = very anxious
ANXIETY AND PAIN MEASURES IN DENTISTRY: A GUIDE TO THEIR QUALITY AND APPLICATION, JADA, Vol. 131, October 2000

24. Advantages:
internal consistency of the scale is high
Does not rely on verbal markers
problems of differences in the interpretation of words and phrases do not arise

25. Children’s Fear Survey Schedule.
Cuthbert & Malamed (1982)
Commonly used measure of dental fear among children
Child subjects rate their level of fear on a 5-point scale covering 15 situations, ranging from “not afraid at all” to “very much afraid”.
ANXIETY AND PAIN MEASURES IN DENTISTRY: A GUIDE TO THEIR QUALITY AND APPLICATION, JADA, Vol. 131, October 2000

26. The situations are divided into three categories
Fear of highly invasive procedures--drilling and filling
Fear of potential victimisation-- from strangers, taking a choking fit
Fear of less invasive procedures-- opening the mouth and being examined by the dentist.

28. RATING
The possible response to each item was scored between
not afraid
very afraid
Total scores ranged between 15–75.
Children with the scores >38 can be defined as dentally anxious

29. Venham Picture Scale By venham et al (1977)
scale consists of a series of eight paired drawings of a child.
Each pair consists of a child in a non-fearful pose and a fearful pose.
The respondent is asked to indicate which picture more accurately reflects his / her feelings at the time.
Scores are determined by summing the number of instances in which the child selects the high-fear stimulus.
ANXIETY AND PAIN MEASURES IN DENTISTRY: A GUIDE TO THEIR QUALITY AND APPLICATION, JADA, Vol. 131, October 2000

31. Crying

32. Anger

33. Run away

34. Anxious

35. surprise

36. Aloof

37. Feeling of cry

38. sad

39. The more emotional figure of the pair of cartoons is scored one
whereas the more emotionally neutral figure is scored zero.
Scale has a range of 0 – 8
0- no anxiety
8- Severe anxiety

40. Advantages
quick
Child need not be able to read to complete the scale.
Scale especially suitable for young children.
Disadvantages
Failure to interpret photograph

41. Adolescents’ Fear of Dental Treatment Cognitive Inventory.
measures the thoughts and ideas an adolescent may have during dental treatment.
It is unique among the children’s scales in that it focuses solely on the cognitive manifestations of fear.
It is a 23-item scale, with a five-point response format.
Scores ranges from
no fear to
high fear.
ANXIETY AND PAIN MEASURES IN DENTISTRY: A GUIDE TO THEIR QUALITY AND APPLICATION, JADA, Vol. 131, October 2000

42. Factor analysis of the scale revealed four components:
fear of pain
negative perceptions of the dentist
avoidance of the dentist and a
fourth scale that was not interpreted by the researchers.

43. Behaviour Profile Rating Scale.
By Malamed
27 uncooperative behaviours considered to be related to dental anxiety
overall score is calculated on the basis of the frequency of each behavior, together with a weighing for the severity of the behavior (kicking)
ANXIETY AND PAIN MEASURES IN DENTISTRY: A GUIDE TO THEIR QUALITY AND APPLICATION, JADA, Vol. 131, October 2000

44. Advantages
The face validity of the scale is high,
distinguish between children referred for behavioral management of uncooperative behavior in the dental setting and a control group of children
Disadvantages
Time consuming

45. HAMILTON ANXIETY RATING SCALE
Classification of symptoms:
0 - absent;
1 - mild;
2 - moderate;
3 - severe;
4 - incapacitating.
HAM-A score level of anxiety:
< 17 mild;
mild to moderate;
moderate to severe.
Psychiatric Associates of Atlanta, LLC

46. 1. Anxious mood
• worries
2. Tension
• startles
• cries easily
• restless
• trembling
3. Fears
• fear of the dark
• fear of strangers
• fear of being alone
• fear of animal
4. Insomnia
• difficulty falling asleep or staying asleep
• difficulty with nightmares
5. Intellectual
• poor concentration
• memory impairment
6. Depressed Mood
• decreased interest in activities
• insomnia

47. 7. Somatic complaints - Muscular 0 1 2 3 4
• muscle aches or pains
• bruxism
8. Somatic complaints - Sensory
• tinnitus
• blurred vision
9. Cardiovascular Symptoms
• tachycardia
• palpitations
• chest pain
• sensory of feeling faint
10. Respiratory Symptoms
• chest pressure
• choking sensation
• shortness of breath

48. 11. Gastrointestinal Symptoms 0 1 2 3 4
• dysphagia
• nausea or vomiting
• constipation
• weight loss
12. Genitourinary Symptoms
• urinary frequency or urgency
• dysmenorrhea
• impotence
13. Autonomic Symptoms
• dry mouth
• flushing
• pallor
• sweating
14. Behavior at Interview
.fidgets
• tremor
• paces

49. Zung Self-Rating Anxiety Scale (SAS)
1 I feel more nervous and anxious than usual.
2 I feel afraid for no reason at all.
3 I get upset easily or feel panicky.
4 I feel like I'm falling apart and going to pieces.
5 I feel that everything is all right and nothing bad will happen.
6 My arms and legs shake and tremble.
7 I am bothered by headaches neck and back pain.
8 I feel weak and get tired easily.
9 I feel calm and can sit still easily.
10 I can feel my heart beating fast.
William W.K. Zung. A rating instrument for anxiety disorders. Psychosomatics. 1971

50. 11 I am bothered by dizzy spells.
12 I have fainting spells or feel like it.
13 I can breathe in and out easily.
14 I get feelings of numbness and tingling in my fingers & toes.
15 I am bothered by stomach aches or indigestion.
16 I have to empty my bladder often.
17 My hands are usually dry and warm.
18 My face gets hot and blushes.
19 I fall asleep easily and get a good night's rest.
20 I have nightmares.

51. Fear Survey Schedule Geer, developed the scale
51-item scale consisting of a list of commonly encountered stimuli.
Each stimulus is rated on a seven-point scale, ranging from
0 (no fear) to 6 (terrified).
Scores indicate the extent of general fearfulness
ANXIETY AND PAIN MEASURES IN DENTISTRY: A GUIDE TO THEIR QUALITY AND APPLICATION, JADA, Vol. 131, October 2000

52. Advantages
high levels of internal consistency
and validity
has been used in a number of European countries

53. Conclusion

54. References Textbook of Pedodontics – Shobha Tandon
Frame H. Columbus.Advances in psychology research , vol 43
Corah’s Dental Anxiety Scale, Revised (DAS-R)
Anxiety and pain measures in dentistry: a guide to their quality and application, J.Timoty Newton, Dave buck; Jada, vol. 131, october 2000
William W.K. Zung. A rating instrument for anxiety disorders. Psychosomatics. 1971
Psychiatric Associates of Atlanta, LLC