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Lecture 1: Fear

In fear conditioning, we need to experience the association between the cue and the stimuli by ourselves.
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Welcome back to the course Brain, Behaviour, and Dentistry. Now we will have the third session of the course, which will focus on the issues of emotion. After this class, you will learn to distinguish between the concepts of fear, anxiety, and catastrophizing, and to identify the situation when these emotional experiences influence your patients during treatment.
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Now we may need to go further for a difficult question: how do we ‘know’ something is threatening? A spider may be threatening because it would be poisonous. But what about the attacker in a computer game? In the experiment that I just showed you, when subjects were caught by the attacker, there would be a painful electrical shock! Therefore, even though the attacker is just a pictorial figure, it becomes threatening because its presence is paired with electrical shock. Therefore, when we identify something as a threat, what we learn is its association with a threat.
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For example, in fear conditioning, a visual cue can be threatening, as the conditional stimulus, CS, when it is linked with the presence of an electrical stimulus, i.e., the unconditional stimulus, US. Moreover, what we learn is not the identity of the CS or the US, but the contingency that these two come together. The strength of the link will be stronger with there is a high contingency. For example, when there is a light cue, there is a painful stimulus, and when there is no light cue, there is no painful stimulus. The strength will become weaker when the contingency is violated. For example, pain occurs in the absence of the light cue.
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Remember, in our first class, I have mentioned that during dental treatment, patients will learn all kinds of stimuli from the environment. And it is not surprising that they would learn the link between each of them. For example, they may learn that the noise of drilling is threatening when they pair the noise with the sensitivity during tooth preparation. That’s why fear is acquired in dental settings. That’s bad news for dentists!
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But here comes the good news: our brain does not just learn what is dangerous but also learn what is safe. In other words, we learn to discriminate between danger and a safe signal. For example, here, both a triangle and an inverse triangle may come together with painful stimuli. However, after several trials, we may find that only the inverse triangle predicts pain. On the contrary, the triangle would be the safety signal because its presence does not predict pain. To learn ‘what means to be safe’ is very important for dental patients, and in our latter course, we will see that dental fear and anxiety are much associated with a weaker ability for patients to learn the safety signals.
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And I think it’s necessary to mention that conditioning is not the only way for us to learn fear and anxiety. In fear conditioning, we need to experience the association between the cue and the stimuli by ourselves. However, it’s very often that patients become panic about things that they don’t actually know. For example, a boy may be scared by dental treatment when he found his brother is crying on the dental chair. And adult patients may be scared of root canal treatment when they heard about something bad about the treatment from their friends. This is nothing new for psychologists and neuroscientists because fear can be acquired by observation and communication.
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In other words, social interaction may be a powerful ‘link’ for bringing out fear. Especially, observation is a critical mechanism for emotional experience. According to the famous Bobo Doll experiment, children would mimic adults to attack a doll just because they watch what the adults did. We should keep in mind that not only the emotional feeling but also behaviour can be spread between patients.

Which one may be a threat to you…

a spider, or an attacker in a computer game? How do we ‘know’ something is threatening?

And how can we acquire fear? In this video, we will talk more about this.

After this step, you will learn to distinguish between the concepts of fear, anxiety, and catastrophizing, and to identify the situation when these emotional experiences influence your patients during treatment.

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Brain, Behaviour, and Dentistry

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