歯科治療恐怖に対する認知行動療法の有効性 : メタ分析による検討  [in Japanese] The Effects of Cognitive Behavior Therapy for Dental Phobia : A Meta-analysis  [in Japanese]

本研究の目的は,歯科治療恐怖に対する認知行動療法(CBT)の有効性をメタ分析によって検討することであった.(1)研究デザインとして無作為化比較試験(RCT)が用いられている,(2)CBTによる介入が行われている,(3)プラセボ群,あるいは未治療統制群との治療効果の比較検討が行われている,(4)不安・恐怖に関する評価項目の平均値と標準偏差が記載されている,(5)英語で書かれている,という5つの選定基準を満たす論文を対象にメタ分析を行った結果,CBTが実施された群の治療効果は有意に大きかった(d=2.18).したがって,CBTは歯科治療恐怖の改善に有効であることが示された.本研究の結果は,歯科治療恐怖の治療において質の高いエビデンスを示すことができた点で有益である.今後は,わが国においても歯科治療恐怖に対するCBTの効果を検討する必要性が示唆された.

Objectives: Recent study suggested that cognitive behavior therapy is effective for dental phobia. However, although effective in many patients with dental phobia, 25% of the patients with dental phobia did not respond to the cognitive behavior therapy. Consequently, the evidence about cognitive behavior therapy for dental phobia is insufficient. The purpose of this meta-analytic study was to clarify the effects of cognitive behavior therapy for dental phobia. Methods: Studies were identified from PsycINFO and Medline database combined with the key words "dental phobia", "dental anxiety", "dental fear" and "randomized controlled trial", and were included if these studies met the following criteria: (1) randomized controlled trial was conducted, (2) the effects of cognitive behavior therapy for dental phobia were examined, (3) comparison between treatment group and placebo control group or no treatment control group were conducted, (4) means and standard deviations about outcome measures for dental phobia were described and (5) published in English. Results: Results of meta-analysis revealed that cognitive behavior therapy was more effective than placebo control or no treatment control at post-session (d=2.18). The fail-safe index was 642.82, and the file-drawer index was 50. These results indicate that participants who received cognitive behavior therapy for dental phobia showed significant improvement at post-session. Conclusion: The results of this study indicate that cognitive behavior therapy was an effective treatment strategy to improve dental phobia. Previous meta-analytic studies on the effects of cognitive behavior therapy for dental phobia included the studies in which the randomized controlled trial was not conducted. The results of this study had been shown that it was beneficial to select the psychosocial interventions for dental phobia. Future research should attempt to clarify the each effect of behavioral approaches and cognitive approaches, and also conduct the randomized controlled trial to clarify the cognitive behavior therapy for dental phobia in the Japanese clinical setting.