Litt M D, Nye C, Shafer D
Department of Behavioral Sciences and Community Health, University of Connecticut School of Dental Medicine, Farmington 06030.
J Dent Res. 1993 Aug;72(8):1237-43. doi: 10.1177/00220345930720081301.
Recent work has suggested that patients' coping could be improved in stressful dental situations if perceptions of self-efficacy and control could be enhanced. To test this hypothesis, 70 first-time third-molar extraction patients were randomly assigned to one of four surgery preparation conditions: standard preparation, oral premedication, relaxation, and a relaxation+efficacy-enhancing feed-back condition in which subjects were given false galvanic skin response (GSR) biofeedback leading them to believe that they were highly skilled at relaxing. Analyses indicated that: (1) all treatments were seen as equally credible (controlling for placebo effects); (2) a priori contrasts showed that both the relaxation-only treatment and the relaxation+efficacy-enhancement treatment were superior to the premedication and standard preparations in raising coping self-efficacy; (3) regardless of treatment condition, increase in reported coping self-efficacy was significantly correlated with pre-operative anxiety, with self-reported peri-operative distress, and with behavioral ratings of peri-operative distress; and (4) the relaxation treatments resulted in lower pre-operative anxiety than the other interventions, and linear contrasts showed significant trends in which the relaxation+efficacy-enhancing condition was superior to the relaxation-only condition, which was in turn superior to the medication condition and the standard preparation in reducing both pre-operative anxiety and behavioral ratings of peri-operative distress. It was concluded that thoughts related to self-confidence and control can be manipulated, and that these thoughts can in part determine how well a person copes in stressful dental situations.
最近的研究表明，如果能增强自我效能感和控制感，那么在压力较大的牙科治疗情境中，患者的应对能力会得到提高。为了验证这一假设，70名首次接受第三磨牙拔除术的患者被随机分配到四种手术准备条件中的一种：标准准备、口服术前用药、放松训练，以及放松训练+效能增强反馈条件，即让受试者接受虚假的皮肤电反应（GSR）生物反馈，使他们相信自己在放松方面非常熟练。分析结果表明：（1）所有治疗方法被认为具有同等可信度（控制安慰剂效应）；（2）先验对比显示，仅放松治疗和放松+效能增强治疗在提高应对自我效能方面均优于术前用药和标准准备；（3）无论治疗条件如何，报告的应对自我效能的提高与术前焦虑、自我报告的围手术期痛苦以及围手术期痛苦的行为评分均显著相关；（4）放松治疗导致的术前焦虑低于其他干预措施，线性对比显示出显著趋势，即放松+效能增强条件在降低术前焦虑和围手术期痛苦的行为评分方面优于仅放松条件，而仅放松条件又优于用药条件和标准准备。研究得出结论，与自信和控制相关的想法是可以被操控的，并且这些想法在一定程度上可以决定一个人在压力较大的牙科治疗情境中的应对效果。
