Disseminable Evidence-Based Treatment for the Dental Office: Virtual Exposure Tools for Dental Fear - neVR Fear the Dentist

牙科诊所可传播的循证治疗：针对牙科恐惧症的虚拟暴露工具 - neVR Fear the Dentist

• 批准号: 10081274
• 负责人: Margo Adams Larsen
• 金额: $ 26.5万
• 依托单位: VIRTUALLY BETTER, INC.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-03 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10081274
• 关键词: Adopted; Adult; Affect; Aftercare; American; Anesthesia procedures; Anti-Anxiety Agents; Anxiety; Appointment; Behavioral; Belief; Brain; Businesses; Clinic; Cognitive Therapy; Communication; Costs and Benefits; Data; Dental; Dental Anxiety; Dental Care; Dental General Practice; Dental Offices; Dental Staff; Dentistry; Dentists; Development Plans; Ecosystem; Effectiveness; Environment; Ethnic Origin; Event; Evidence based intervention; Evidence based treatment; Focus Groups; Fright; Future; Gender; Health; Healthcare; Immersion; Individual; Intervention; Learning; Longevity; Mediating; Medicine; Modeling; National Institute of Dental and Craniofacial Research; Operative Surgical Procedures; Oral; Oral health; Outcome; Pain; Patients; Personal Satisfaction; Pharmaceutical Preparations; Phase; Preventive; Private Practice; Procedures; Public Health; Quality of life; Race; Randomized Controlled Trials; Records; Reporting; Research; Sedation procedure; Self Administration; Severities; Signal Transduction; Small Business Technology Transfer Research; Societies; Surgeon; System; Tablets; Testing; Training; United States Dept. of Health and Human Services; United States National Institutes of Health; Universities; Visit; active control; anxiety management; base; clinical practice; cost; demographics; design; eHealth; expectation; experience; follow-up; innovation; intervention effect; medical specialties; negative affect; operation; preference; psychoeducation; psychologic; response; social; standard care; tool; treatment group; treatment services; uptake; virtual; virtual reality exposure

PROJECT SUMMARY/ABSTRACT Each year over 20 million adults with moderate fear and over 14 million adults with severe fear visit the dentist. Because fear portends poor future oral health, patients with dental fear come to experience their worst fears: pain, surgical procedures, and the need for more frequent dental visits. Avoidance is the natural and reinforced response, ironically guaranteeing a repetition of the feared events. Breaking this cycle is the primary target of this proposal. Standard treatment — compassionate but ultimately counterproductive — includes anti-anxiety medication or more substantial anesthesia, which (a) does nothing to reduce subsequent anxiety or avoidance, (b) leads to continued dental problems, and (c) perpetuates the cycle of fear—>avoidance—>dental problems. Alternatively, cognitive-behavioral treatments (CBT) for dental fear have been developed, subjected to dozens of high-quality trials, and found to be efficacious. However, CBT has, almost exclusively, been offered only in a few specialty clinics worldwide associated with universities; there is no disseminable model for integrating CBT into the workflow of dental practices. To fill this gap, this Fast-Track STTR proposal describes plans for development and testing of a marketable product that can bring effective dental fear treatment to dental offices within the currently existing U.S. practice ecosystem. neVR Fear the DentistTM is a commercializable suite of self-administered eHealth tools to treat dental fear that can be implemented in private practice dental offices throughout the U.S. and is eminently scalable. neVR Fear the DentistTM comprises three major evidence-based interventions. First is a self-administered eHealth app for CBT/psychoeducation with exposure therapy — delivered via a mobile tablet — that can be used privately in waiting rooms. Second is a communication-eliciting intervention, in which the patient records a “Pre-Game Plan” — to be reviewed with the dental staff before dental services — comprising (1) pre-treatment fear levels, (2) the factor generating the most anxiety, (3) a stop-signal the patient will use to alert dentist, (4) things the dental team can do to maximize this patient's comfort, and (5) a self-generated anxiety management plan. All patients in the treatment group will receive the first two EBIs as a single intervention on the tablet. Third (for patients who are in the severe range) is a 1-hr virtual reality exposure treatment (VRET). VRET will allow us to provide CBT that can be self-administered within the normal operations of dentistry and will allow every dental practice to be a dental fear specialty clinic. Such an approach is necessary to shift clinical practice, as the nearly 200,000 U.S. dentists will only adopt an approach designed, from the bottom up, to fit both the busy-ness and business of 21st-century dental practices. The research component will use an adequately powered RCT to test both (a) the effectiveness of neVR Fear the DentistTM and, using the NIH's Experimental Medicine Approach to Behavioral Change model, (b) whether inhibitory learning is the mechanism through which it affects change.

项目概要/摘要 每年有超过 2000 万患有中度恐惧的成年人和超过 1400 万患有严重恐惧的成年人访问该中心 因为恐惧预示着未来口腔健康状况不佳，所以患有牙科恐惧症的患者会经历最糟糕的情况。 恐惧：疼痛、外科手术以及需要更频繁地看牙医是自然而强化的反应，具有讽刺意味的是，打破这种循环是首要的。 标准治疗——富有同情心但最终适得其反——包括抗焦虑药物或更有效的麻醉，这（a）对减少随后的焦虑或症状没有任何作用。 回避，(b) 导致持续的牙科问题，(c) 使恐惧->回避->牙科的循环永久化 另外，针对牙科恐惧症的认知行为疗法（CBT）已经被开发出来并接受治疗。 经过数十次高质量的试验，并发现 CBT 是有效的。 仅在全球少数与大学相关的专业诊所进行；没有可传播的模型将 CBT 整合到牙科诊所的工作流程中。为了填补这一空白，本快速通道 STTR 提案描述了这一点。 计划开发和测试可销售的产品，该产品可以为人们带来有效的牙科恐惧治疗 neVR Fear the DentistTM 是一套可商业化的自我管理电子健康工具，用于治疗牙科恐惧症，可在私人诊所实施。 neVR Fear the DentistTM 包括三个主要牙科诊所。 首先是基于证据的干预措施，用于 CBT/心理教育的自我管理电子健康应用程序。 治疗——通过移动平板电脑提供——可以在候诊室私下使用。第二种是交流诱导干预，患者记录“赛前计划”——以便与牙科人员一起审查。 牙科服务前的工作人员 — 包括 (1) 治疗前的恐惧水平，(2) 产生最大焦虑的因素，(3) 患者用来提醒牙医的停止信号，(4) 牙科团队可以采取的措施最大限度地提高患者的舒适度，以及 (5) 治疗组中的所有患者都将接受前两次 EBI 作为平板电脑上的单一干预。 1 小时虚拟现实暴露治疗 (VRET) 将使我们能够提供可在牙科正常操作中自行进行的 CBT，并使每个牙科诊所都成为牙科恐惧专业。 这种方法对于改变临床实践是必要的，因为近 200,000 名美国牙医只会这样做。 采用自下而上设计的方法，以适应 21 世纪牙科的繁忙和业务 研究部分将使用充分有力的 RCT 来测试 (a) 的有效性。 neVR Fear the DentistTM 并使用 NIH 的实验医学方法行为改变模型， (b) 抑制学习是否是影响改变的机制。