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Lecture 1: Attention

This video shows the concept of perception and attention and some clinical implications in dental practice.
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Welcome back to the course Brain, Behaviour, and Dentistry. Now we continue the first session of the course, which will focus on the issues of perception and attention, and some clinical implications in dental practice. After this course, you will learn to define key concepts about attention and recognize the importance of multisensory integration in oral functions. Now we will start some topics which would be more relevant to dental practice. Let’s start with the concept of attention. We all know what attention is. It is the moment when our mind is occupied by something. For example, now you are attending this online course, aren’t you?
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The question is: can we really ‘control’ our attention? In fact, this is a very complicated question because attentional control is associated with both bottom-up and top-down processing. When it comes to bottom-up processing, that means something can quickly catch our attention. For example, we can see the white dot here in the right panel just ‘pops up’, but the grey dot in the middle panel doesn’t. It is not surprising because the colour of the dot shows a higher contrast to the surrounding area in the right panel. From the view of bottom-up processing, the white dot is more salient because its colour stands out in the background. But just keep in mind that such a salience can also be manipulated from top-down processing.
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Imagine that you are an investigator eagerly to find the trace of a UFO in the night sky. Then the pattern of the left panel will catch your attention. It becomes more salient because of your strong expectation and motivation for the encounter of the third kind!
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When we say we can control our attention, most people mean that we can selectively deploy our attention to the things we want to know. However, from the point of information processing, when you ‘shift’ attention to something, you need to disengage from the things you have already paid attention to.
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Therefore, shifting one’s attention consists of two processes: to disengage with an old target and to engage with a new target. This will be important to pain management for dental patients.
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Some dentists try to distract patients from the pain of local anaesthesia by presenting them with some TV shows. This may not always work because patients have already been occupied by the pain of needle injection, they won’t disengage themselves from the pain, let alone watching TV! A better strategy would be to have them watching an interesting show for a while. When they have been fully engaged with the TV show, they may be less occupied by further procedures, such as injection. Still, these may not work for all patients, because compared to an interesting TV show, the pain from needle injection may be a more salient stimulus.
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We cannot exclude the possibility that patients just cannot enjoy the TV show – because they are always expecting the injection!
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The mechanism of attentional shift suggests that when we control our attention, much information competes with each other. For example, the target that we have engaged with is competing with the target we try to engage with. If the latter is more attractive, we will disengage from the current target to focus on the new target. Such a competition is associated with the perceptual load. A greater load means we need to pay more effort to solve the competition among information. For example, now please find a ‘Y’ in the letter array here. It is not very difficult because Y has different features compared to the letter T.
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And we just need to focus on one of the features, say, the different angles here, we can spot Y. Now in the right panel please find a bold-type Y. This would be a little bit more difficult and you may require more time and effort to do this. Because this time you need to consider more perceptual features – not just the angles of symbols but the thickness of lines. Because the mental capacity to deal with all perceptual features is limited, information processing of the thickness feature and the angle feature become competing in this case.
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This is why we need to remember during patient-dentist communication: patients would get lost when they need to pay attention to too many things.
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I need to remind you that the issues of attention are fundamental to patient-dentist communication. I have heard many dentists say that ‘patients won’t listen to me’ or ‘they did not follow my instruction’. Well, we often blame this on, say, patients are too impatient or they don’t get our language. But sometimes it is simply a problem of attention – our messages are not salient enough to catch their attention. There are two things we need to avoid. First, different sources will compete for the attention system. So we need to minimize the things that distract their attention from us. For example, right after tooth extraction, patients will be distracted from your instruction if they still pay attention to their wounds.
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They would listen to you more carefully when they feel comfortable with their wound. Second, there is a bottleneck for information processing. So when we give some instruction to patients, we need some breaks. These breaks can be strategically placed at the end of some key messages, for patients to digest.

In this part, we will focus on the issues of perception and attention and some clinical implications in dental practice.

After this course, you will learn:

  • Define key concepts about attention
  • Recognize the importance of multisensory integration in oral functions

Can we really ‘control’ our attention?

In fact, this is a very complicated question. Since attentional control is associated with both bottom-up and top-down processing, it is very hard to answer the question above. From the point of information processing, when you ‘shift’ attention to something, you need to disengage from the things you have already paid attention to. And in order to do that, we need to disengage with an old target and to engage with a new target. It is very important to pain management for dental patients.

Patients won’t listen to me!

We often blame this on, say, patients are too impatient or they don’t get our language. Really? Maybe sometimes it is simply a problem of attention – our messages are not salient enough to catch their attention.

Try this:

  • Minimize the things that distract patients’ attention from dentists
  • Give patients some breaks while giving some instruction to them
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