Subjective anxiety and stressful medical procedures : anxiety sensitivity, control and coping during endodontics

Abstract

The relationship between subjective anxiety and anxiety sensitivity, felt control and dispositional (monitoring and blunting) coping styles during endodontic dental treatments was investigated. The transactionalcognitive appraisal model of coping process (Folkman & Lazarus, 1984), an expectancy model of fear (Reiss, 1991), and a dispositional model of coping (Miller, 1981, 1990) provided the theoretical context. An integral part of the study involved the evaluation of reliability and construct validity of the instruments commonly used to index these psychological constructs. Ninety-four participants completed questionnaires preand post-treatment in a large southern university student dental clinic. Reliability and construct validity analysis of the data revealed that item-level revisions or perhaps major revisions were indicated for the Anxiety Sensitivity Index, Millers Behavioral Style Scale and the Iowa Dental Control Scale-Desire for Control subscale. Desire for control and underlying factors in dispositional coping instruments may not be well indexed by current measures. Factors labelled mixed-coping style and vigilant-coping style indicated that future investigation of dispositional coping styles reconsider previous models in terms of flexible and non- flexible (vigilant) styles. Canonical correlational analysis was used to evaluate all variables simultaneously relative to a criterion aggregate variable of state anxiety. of the three functions produced, Function I was noteworthy (RC2 54.40%). The variables that contributed most to Function I were Expected Anxiety, Expected Danger, and Felt Control. The strongest relationships in the canonical analysis indicated that individuals experiencing higher levels of subjective anxiety in the medical-dental setting tend to have higher expectations of anxiety and lower perceived personal control. Results were interpreted as supporting further investigation of the components of Reiss' (1991) expectancy model in regard to the subjective dimension of anxiety. Findings supported further study of the major variables in path-analytical model-testing of stress and coping dynamics, following instrument refinement. The present study underscored the need to evaluate reliability and construct validity of data gathered by instruments in the context in which they are being used due to cross-situational instability. Increased initial attention to the evaluation of measurement instruments that are presumed to index psychological constructs will be of benefit in the long-term by producing fewer conflicting outcomes in research. In turn, context appropriate psychological interventions for coping can be developed.