Distress Tolerance and Dental Phobia

Objectives: Distress tolerance is the degree to which one is able to cope with and endure negative emotional states, and can be assessed using self-report measures such as the Distress Tolerance Scale (DTS). As dental phobia has avoidance as a hallmark feature, which may be related to intolerance of distressing physiological and cognitive states, it was hypothesized that individuals with dental phobia would manifest less distress tolerance on the DTS, relative to a matched healthy comparison group. Additionally, it was predicted that distress tolerance would be moderately related to other measures of negative emotionality.
Methods: There were 21 adults with dental phobia and avoidance of dental care for > 1 year, who were seeking treatment for their phobia, whose diagnosis was confirmed using the Anxiety Disorders Interview Schedule (ADIS-IV). This patient group was compared to 21 age-, sex-, and income-matched community volunteer adults without dental phobia. In addition to the ADIS-IV interview and DTS, other assessments focused on fear of pain (Fear of Pain Questionnaire-III), anxiety sensitivity (Anxiety Sensitivity Index-III), and depression (Beck Depression Inventory-II).
Results: The dental phobia group had lower levels of distress tolerance than the healthy comparison group (t(40) = 4.17, p < .001). Bivariate correlational analyses indicated that distress tolerance was negatively associated with anxiety sensitivity (r = -.76), fear of pain (r = -.59), and depression (r = -.69).
Conclusions: Individuals with dental phobia may be particularly sensitive and less able to tolerate fear of pain, anxiety, and other negative emotions. Low distress tolerance, therefore, may be an etiological component of dental phobia. Further, given the association between distress tolerance and fear of pain, it is proposed that in a dental phobia sample, distress tolerance and pain tolerance may be related constructs. Future research should focus on possible mechanisms for the development and maintenance of dental phobia and avoidance that involve distress tolerance.