Development and testing of a Cognitive Behavioural Therapy resource for children's dental anxiety

Background: Cognitive Behavioural Therapy (CBT) is an evidence-based treatment for dental anxiety; however, access to therapy is limited. The current study aimed to develop a self-help CBT resource for the reduction of dental anxiety in children and assess the feasibility of conducting a trial to evaluate the treatment and cost effectiveness of this intervention. Method: A mixed methods design was employed. Within phase 1 a qualitative 'Person-based' approach informed the development of the self-help CBT resource. Guidelines for the development and evaluation of complex interventions were also used. Within phase 2 children, aged between 9-16 years, who had elevated self-reported dental anxiety and were attending a community dental service or dental hospital were invited to use the CBT resource. Children completed questionnaires, which assessed their dental anxiety and health-related quality of life (HRQoL), prior to and following their use of the resource. Recruitment and completion rates were also recorded. Acceptability of the CBT resource was explored using interviews and focus groups with children, parents/carers and dental professionals. The Mixed Methods Appraisal Tool criteria were adhered to. Results: 24 families and 25 dental professionals participated in the development and qualitative evaluation of the CBT resource for dentally anxious children. A total of 56 agreed to trial the CBT resource (66% response rate) and 48 of these children completed the study (86% completion rate). There was a significant reduction in dental anxiety (mean score difference=7.7, t=7.9, df=45, p<0.001, Cohen's d ES=1.2) and increase in HRQoL following use of the CBT resource (mean score difference=-0.03, t=2.14, df=46, p<0.05, Cohen's d ES=0.3). The self-help approach had high levels of acceptability to stakeholders. Conclusions: Findings provide preliminary evidence for the effectiveness and acceptability of the resource for the reduction of children's dental anxiety and support further evaluation of this approach in a randomised control trial.