RCT of Internet-based Cognitive Behavioral Therapy for Children with Dental Anxiety

Objectives: Dental anxiety affects around 9 % of children and is considered one of the largest obstacles to treatment in pediatric dentistry. Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for anxieties and phobias. However, access to CBT treatment in dentistry is limited and therefore we developed an internet-based CBT (ICBT) to increase availability.
Methods: The ICBT is based on exposure therapy and the participants complete a 12-week program at home combined with visits at a dental clinic. We used a randomized controlled (RCT) procedure with an intent to treat design to assess the efficacy of the treatment. 30 patients diagnosed with Dental Phobia by a clinical psychologist entered the study. After inclusion they performed the baseline measurement and were randomized to either active treatment (n=16) or a waiting list control group (n=14). After the 12-weeks they performed a posttreatment measurement and the waiting list was given the same 12-week program as the treatment group. The primary outcome measure was Picture Guided Behavioral Avoidance Test (PG-BAT) that consists of 17 hierarchically organized dental-clinical situations. The secondary measure was among others Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS), all measurements were self-reported by both the child and the parent. ClinicalTrials.gov: NCT02588079.

Results: T-tests showed that there was no difference between the groups at any of the pretreatment measures. We then performed a repeated-measures analysis of variance (ANOVA) which showed that the treatment had significant effects on our outcome measures: Effect sizes in Cohen’s d were: Child PG-BAT: 1.6 (P < 0.001), Child CFSS-DS: 1.8 (P < 0.001), Parental PG-BAT 0.9 (P = 0.022), Parental CFSS-DS 1.2 (P = 0.003).
Conclusions: ICBT is an effective treatment for dental anxiety and phobia in children and should be implemented as an evidence-based treatment for this patient group.