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Originalia

Die modulierte Schreckreaktion bei Zahnbehandlungsphobie

Published Online:September 30, 2009https://doi.org/10.1026/1616-3443.38.4.213

Abstract

Zusammenfassung.Theoretischer Hintergrund: Die Zahnbehandlungsphobie ist eine spezifische Phobie, die mit Vermeidung der Zahnbehandlung und dadurch schwerwiegenden Folgen für die Zahngesundheit einher geht. Zahnärzte gaben an, Zahnbehandlungsphobiker nur ungern behandeln zu wollen, wobei einer der Gründe die erhöhte Schreckhaftigkeit dieser Patienten war, die das Unfallrisiko bei der Behandlung erhöht. Fragestellung: Kann bei Zahnbehandlungsphobikern bei phobiebezogenen Hintergrundreizen eine überhöhte modulierte Schreckreaktion nachgewiesen werden? Methoden: 90 Zahnbehandlungsphobikern und 30 Kontrollprobanden wurden Zahnbehandlungsgeräusche und – als Kontrollbedingung – Vogelgesang dargeboten, wobei nach jeweils drei von ihnen ein Schreckreiz erfolgte. Zusätzlich zur EMG-Lidschlussreaktion auf den Schreckreiz, wurden die Herzratenreaktion (HR) und die elektrodermale Aktivität (EDA) auf die Hintergrundreize erfasst. Ergebnisse: Zahnbehandlungsgeräusche wurden von beiden Gruppen als angsterregender eingeschätzt als Vogelgesang. Dennoch zeigte die Kontrollgruppe im Vergleich zu Phobikern eine Hemmung der Schreckreaktion auf die phobiebezogenen Geräusche. Phobiker zeigten eine HR-Beschleunigung und die Kontrollgruppe eine HR-Verlangsamung auf die phobierelevanten Geräusche. Bei Phobikern war die Ausprägung der Schreckreaktion auf die Zahnbehandlungsgeräusche mit der tonischen HR vor Beginn des Experiments positiv korreliert. Schlussfolgerungen: Die Ergebnisse lassen vermuten, dass die Schreckreaktion bei Nicht-Phobikern durch eine konkurrierende erlernte Reaktion, in diesem Fall das erforderliche Stillhalten während der Zahnbehandlung, gehemmt werden kann, während das bei Zahnbehandlungsphobikern nicht der Fall ist.


The modulated startle-response in dental phobia

Abstract.Background: Dental phobia is a specific phobia associated with avoidance of dental treatment and dire consequences for dental health. Dentists are reported to dislike treating dental phobics with one of the reasons being the latter’s startle reactions which increase the risk of accidents during dental treatment. Objective: Can it be shown that dental phobics have an exaggerated startle reaction modulated by phobia-related background stimuli? Methods: Ninety dental phobics and 30 control participants were presented with noises associated with dental treatment and – as a control condition – with birdsong. Three of the two types of background stimuli were immediately followed by a startle stimulus. EMG-eyeblink response was recorded to the startle stimuli and heart-rate (HR) response and electrodermal activity (EDA) to background stimuli. Results: Although both groups rated dental treatment noises as being more fear-eliciting than birdsong, control participants showed inhibition of the startle reaction following phobia-related stimuli compared to dental phobics. The latter evidenced HR acceleration and controls HR deceleration to phobia-related stimuli. Among phobics, the magnitude of the modulated startle reaction was positively correlated with resting HR prior to the experimental procedure. Conclusions: The results suggest that the startle reaction can be inhibited in non-phobics by a competing, learned reaction, in this case, remaining still during dental treatment, which dental phobics are not able to comply with.

Literatur

  • American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV (4th Edn.). Washington, DC. First citation in articleGoogle Scholar

  • Anthony, B. J. (1985). In the blink of an eye: Implications of reflex modification for information processing. In P. K. Ackles, J. R. Jennings, M. G. H. Coles, (Eds.), Advances in psychophysiology (Vol. 1) (pp. 167–218). Greenwich: JAI Press. First citation in articleGoogle Scholar

  • Azevedo, T. M. , Volchan, E. , Imbiriba, L. A. , Rodrigues, E. C. , Oliveira, J. M. , Oliveira, L. F. , Lutterbach, L. G. , Vargas, C. D. (2005). Psychophysiology, 42, 255–269. First citation in articleCrossref, Google Scholar

  • Blumenthal, T. D. (1996). Inhibition of the human startle response is affected by both prepulse intensity and eliciting stimulus intensity. Biological Psychology, 44, 85–104. First citation in articleCrossref, Google Scholar

  • Bradley, M. , Gianaros, P. , Lang, P. J. (1995). As time goes by: Stability of affective startle modulation [Abstract]. Psychophysiology, 32, p.21. First citation in articleGoogle Scholar

  • Bradley, M. M. , Lang, P. J. (2000). Measuring emotion: Behavior, feeling, and physiology. In R. D. Lane, L. Nadel (Eds.), Cognitive Neuroscience of Emotion. Oxford: Oxford University Press. First citation in articleGoogle Scholar

  • Brown, J. S. , Kalish, H. I. , Faber, I. E. (1951). Conditioned fear as revealed by magnitude of startle response to an auditory stimulus. Journal of Experimental Psychology, 41, 317–328. First citation in articleCrossref, Google Scholar

  • Cook, E. W., III , Hawk, L. W. , Davis, T. L. , Stevenson, V. E. (1991). Affective individual differences and startle reflex modulation. Journal of Abnormal Psychology, 100, 5–13. First citation in articleCrossref, Google Scholar

  • Cook, E. , Turpin, G. (1997). Differentiating orienting, startle and defense responses: The role of affect and its implications for psychopathology. In Lang P. J. , Simons R. F. , Balaban M. T. (Eds.), Attention and orienting: Sensory and Motivational Processes (pp. 137–164). Hillsdale, NJ: Lawrence Erlbaum Associates. First citation in articleGoogle Scholar

  • Corah, N. L. , Gale, E. N. , Illig, S. J. (1978). Assessment of a dental anxiety scale. Journal of the American Dental Association, 97, 816–819. First citation in articleCrossref, Google Scholar

  • Corah, N. L. (1969). Development of a dental anxiety scale. Journal of Dental Research, 48, 596–602. First citation in articleCrossref, Google Scholar

  • Davis, M. , File, S. E. (1984). Intrinsic and extrinsic mechanisms of habituation and sensitization: Implications for the design and analysis of experiments. In H. V. S. Peeke, L. Petrinovich (Eds.), Habituation, sensitization, and behavior (pp. 287–324). New York: Academic Press. First citation in articleCrossref, Google Scholar

  • Graham, F. K. (1975). The more or less startling effects of weak prestimulation. Psychophysiology, 12, 238–248. First citation in articleCrossref, Google Scholar

  • Grillon, C. , Ameli, R. , Merikangas, K. , Woods, S. W. , Davis, M. (1993). Measuring the time course of anticipatory anxiety using the fear-potentiated startle reflex. Psychophysiology, 30, 340–346. First citation in articleCrossref, Google Scholar

  • Grillon, C. , Ameli, R. , Woods, S. W. , Merikangas, K. , Davis, M. (1991). Fear-potentiated startle in humans: Effects of anticipatory anxiety on the acoustic blink reflex. Psychophysiology, 28, 588–595. First citation in articleCrossref, Google Scholar

  • Hamm, A. O. , Cuthbert, B. N. , Globisch, J. , Vaitl, D. (1997). Fear and the statle reflex: Blink modulation and autonomic response patterns in animal and mutilation fearful subjects. Psychophysiology, 34, 97–107. First citation in articleCrossref, Google Scholar

  • Hautzinger, M. , Bailer, M. , Worall, H. , Keller, F. (1995). Beck-Depression-Inventar (BDI). Bern: Huber. First citation in articleGoogle Scholar

  • Hoffman, H. S. , Fleisher, M. (1963). Startle reaction: Modification by background acoustic stimulation. Science, 141, 928–930. First citation in articleCrossref, Google Scholar

  • Ison, J. R. , Hammond, G. R. (1971). Modification of the startle reflex in the rat by changes in the auditory and visual environments. Journal of Comparative and Physiological Psychology, 75, 435–452. First citation in articleCrossref, Google Scholar

  • Ison, J. R. , McAdam, D. W. , Hammond, G. R. (1973). Latency and amplitude changes in the acoustic startle reflex of the rat produced by variation in auditory prestimulation. Physiology and Behavior, 10, 1035–1039. First citation in articleCrossref, Google Scholar

  • Jöhren, P. (1999). Validierung eines Fragebogens zur Erkennung von Zahnbehandlungsangst. Zahnärztliche Welt, 108, 104–108. First citation in articleGoogle Scholar

  • Jöhren, P. , Sartory, G. (2002). Zahnbehandlungsangst – Zahnbehandlungsphobie. Hannover: Schlüterer. First citation in articleGoogle Scholar

  • Kahn, R. L. , Cooper, C. , Mallanger, M. , Dentistry: What causes it to be a stressful profession? Intrnational Referendum of Applied Psychoanalytic Studies (in press). Zitiert nach Malamed, S. F. (1995). Sedation, a guide to patient management. New York: Mosby First citation in articleGoogle Scholar

  • Klorman, R. , Weissbert, R. P. , Wiessenfeld, A. R. (1977). Individual differences in fear and autonomic reactions to affective stimulation. Psychophysiology, 14, 45–51. First citation in articleCrossref, Google Scholar

  • Lang, P. J. (1995). The emotion probe: Studies of motivation and attention. American Psychologist, 50, 372–385. First citation in articleCrossref, Google Scholar

  • Laux, L. , Glanzmann, P. , Schaffner , Spielberger, C. D. (1981). Das State-Trait-Angst-Inventar. Weinheim: Beltz. First citation in articleGoogle Scholar

  • Logan, H. L. , Baron, R. S. , Keeley, K. , Law, A. (1991). Desired control and felt control as mediators of stress in a dental setting. Health Psychology, 10 (5), 352–359. First citation in articleCrossref, Google Scholar

  • Margraf, J. , Schneider, S. , Ehlers, A. (1994). Diagnostisches Interview bei psychischen Störungen (DIPS). Berlin: Springer. First citation in articleCrossref, Google Scholar

  • Margraf-Stiksrud, J. (1996). Angst und Angstabbau. In H. G. Sergl (Hrsg.), Psychologie und Psychosomatik in der Zahnheilkunde. München: Urban und Schwarzenberg. First citation in articleGoogle Scholar

  • Mühlberger, A. , Bülthoff, H. H. , Wiedemann, G. , Pauli, P. (2007). Virtual reality for the psychophysiological assessment of phobic fear: Responses during virtual tunnes driving. Psychological Assessment, 19, 340–346. First citation in articleCrossref, Google Scholar

  • Norris, C. M. , Blumenthal, T. D. (1996). A relationship between inhibition of the acoustic startle response and the protection of prepulse processing. Psychobiology, 24, 160–168. First citation in articleGoogle Scholar

  • Putnam, L. E. (1990). Great expectations: Anticipatory responses of the heart and brain. In R. Johnson, J.W. Rohrbaugh, R. Parasuraman, R. Johnson Jr. (Eds.), Event-related brain potentials: Basic issues and applications (pp. 178–209). New York: Oxford University Press. First citation in articleGoogle Scholar

  • Putnam, L. E. , Vanman, E. J. (1999). Long Lead Interval Startle Modification. In M. E. Dawson, A. M. Schell, A. H. Böhmelt (Eds.), Startle Modification. Cambridge: Cambridge University Press. First citation in articleCrossref, Google Scholar

  • Sartory, G. , Eves, F. , Foa, E. (1987). Maintenance of within and between session habituation of cardiac responses to phobic stimulation. Journal of Psychophysiology, 1, 21–34. First citation in articleGoogle Scholar

  • Sartory, G. , Heinen, R. , Pundt, I. , Jöhren, P. (2006). Dimensions of dental anxiety and predictors of avoidance. Anxiety, Stress and Coping, 19, 279–291. First citation in articleCrossref, Google Scholar

  • Schabacker, P. , Pohlmeier, H. (1985). Angst und Zahnbehandlung. In T. Schneller, A. Fleischer-Peters (Hrsg.), Anwendung psychotherapeutischer Medizin in der Zahnmedizin. Frankfurt a. M.: Fachbuchhandlung für Psychologie Verlagsabteilung. First citation in articleGoogle Scholar

  • Spence, K. W. , Runquist, W. N. (1958). Temporal effects of conditioned fear on the eyelid reflex. Journal of Experimental Psychology, 55, 613–616. First citation in articleCrossref, Google Scholar