International Handbook of Clinical Hypnosis - E-Lib FK UWKS

300 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
In the other direction Molin & Seeman 1970) considered the fear suffered by
dental patients falling under a more diffuse category referred to as `dental fear' or
`dental anxiety' and preferred the term `disproportionate dental anxiety'.
The contemporary classi®cation of dental anxiety is subsumed under the
classi®cation of anxiety disorders in the fourth edition of the Diagnostic and
Statistical Manual of Mental Disorders of the American Psychiatric Association
DSM-IV, APA, 1994).
The anxiety disorders include panic disorder with or without agoraphobia,
agoraphobia without panic disorder, speci®c phobia, social phobia, obsessive compulsive
disorder, post-traumatic stress disorder, acute stress disorder, generalized
anxiety disorders and anxiety disorders due to a medical condition.
CAUSES OF DENTAL FEARS
The earliest explanations of dental fears were in terms of psychodynamic and
personality theories which emphasized `symbolic representations from the unconscious
drives', `the orofacial zone being a highly charged emotional area', `the
mouth in childhood being an erotogenic zone', `orality', `the threat of mutilation'
and `relationship to major instincts and passions'. In recent years behavioral
research has emphasized the role of learned or conditioned responses to negative
stimuli. These include family attitudes, repeated dental trauma, low pain tolerance,
unfavorable dental experience and high generalized anxiety. Many patients demonstrate
multifactorial causes.
Gerschman and colleagues 1979, 1980, 1989, 1991) elucidated the role of
spontaneous trance states with actual or perceived dental trauma in moderate to
highly hypnotizable individuals as being important in both the genesis and the
treatment of phobic individuals.
MANAGEMENT
Treatment should initially be aimed at prevention. This is best achieved by dental
health education and by attempting to make early dental treatment as non-stressful
as possible.
Fear-reducing interventions may involve a combination of psychological treatment
strategies and pharmacological treatment. Aprerequisite is the establishment
of a good dentist±patient relationship.
HYPNOSIS IN THE MANAGEMENT OF ANXIETY
DISORDERS
The psychological treatment of anxiety disorders involves a wide variety of
techniques based on psychotherapeutic, behavioral and cognitive principles. Hyp-