Aversive Conditioning and Management of Phobia
Many children who are either too anxious, used to having their own way at home or harbour genuine phobia regarding various aspects of dental treatment, require more specialised approaches to management. For this reason an understanding of the theories of learning and development is important and will help the dentist not only to provide the immediate care that the child requires but also help shape the child’s positive attitude for future dental treatment.
Aversive conditioning is a form of behaviour therapy in which an aversive stimulus, which is an object or event that causes strong feelings of dislike or disgust, is paired with an undesirable behaviour in order to reduce or eliminate that undesirable behaviour.
The purpose of aversive conditioning is to decrease or eliminate undesirable behaviours and it focuses on changing a specific behaviour in order to bring out changes. In such situations, both the type of behaviour and the type of aversive stimulus used will influence the treatment that is being undertaken.
In aversive conditioning negative reinforcement is deployed.
Negative reinforcement procedure consists of presenting a stimulus until a response is performed that removes or reduces the effects of a stimulus. This is not to be confused with punishment, because the removal of the negative reinforcement strengthens the desired behaviour.
Behaviour Modification Strategies
Aversive conditioning and negative reinforcement are usually employed in situations where all other avenues to establish communication with the child have been exhausted. These approaches are not used again and again in the same child but on one occasion to establish communication, following which conventional techniques based on positive reinforcement are introduced.
Flooding is defined as a type of desensitisation for the treatment of phobias without being able to escape until the lack of reinforcement of the anxiety response causes its extinction. Essentially, flooding is “exposure treatment” where the patient is exposed to their greatest fear but are not in danger or harmed in any way. A simple example is to help the child confront their fears of sitting in the dental chair, the child is lifted and placed in the dental chair which allows the child to realise that this was not so threatening after all.
Selective Exclusion of the Parent
When the child exhibits tantrum behaviour and communication between dentist and child is lost, the parent is requested by the dentist to leave the treatment room. Before this is done a full explanation should be provided to the parent, who must agree to comply. Also, the child must be told the conditions for the recall of the parent before they are sent out. Once the desired behaviour is exhibited, the parent is recalled into the surgery, which being the negative reinforcement will strengthen the desired behaviour.
Phobia should be distinguished from anxiety.
Dental anxiety is a state of apprehension regard/>