{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T09:06:49Z","timestamp":1783933609742,"version":"3.55.0"},"reference-count":59,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Troms County Council","award":["TFK2013-249"],"award-info":[{"award-number":["TFK2013-249"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: The psychological state affects perceived pain and can be modulated by emotions and attention. Pain experiences are prevalent in dental treatment and play a key role in the development of dental anxiety and treatment avoidance. This study hypothesizes that video and audio that are either pain-relevant or neutral will impact pain perception, self-reported stress, and physiological stress in a dental setting differently. Methods: Eighty participants were randomized into a no-stimuli control group and four experimental groups, in which they were exposed to pain-relevant or neutral video or audio recordings. Heat pain was administered to the participants\u2019 forearms before and after the video or audio exposure, and participants rated the pain using a computerized visual analogue scale. Skin conductance levels (SCLs) were measured to indicate arousal levels. Results: Pain reports were significantly higher in the control group compared to all other groups (all p-values &lt; 0.05), except for those who viewed the surgical video. Also, both pain reports and SCLs were significantly higher during the pain-relevant video compared to the neutral video (p &lt; 0.05). Conclusions: The interplay between the psychological state, emotion, attention and pain perception in dental care should be explored further, particularly regarding its potential relevance for pain control and supportive clinical environments.<\/jats:p>","DOI":"10.3390\/dj14070431","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T08:05:31Z","timestamp":1783929931000},"page":"431","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Psychological State on Pain Perception in a Simulated Dental Setting Among Young Adults: A Randomized Comparative Experiment"],"prefix":"10.3390","volume":"14","author":[{"given":"Sonja","family":"Derouiche","sequence":"first","affiliation":[{"name":"Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9299-7260","authenticated-orcid":false,"given":"Per M.","family":"Aslaksen","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6976-6192","authenticated-orcid":false,"given":"Jan-Are K.","family":"Johnsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1037\/0033-2909.133.4.581","article-title":"The biopsychosocial approach to chronic pain: Scientific advances and future directions","volume":"133","author":"Gatchel","year":"2007","journal-title":"Psychol. Bull."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1076\/0360-5310(200008)25:4;1-A;FT485","article-title":"Mind-body dualism and the biopsychosocial model of pain: What did Descartes really say?","volume":"25","author":"Duncan","year":"2000","journal-title":"J. Med. Philos."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.joen.2010.12.016","article-title":"Pain prevalence and severity before, during, and after root canal treatment: A systematic review","volume":"37","author":"Pak","year":"2011","journal-title":"J. Endod."},{"key":"ref_4","first-page":"209","article-title":"Prevalence estimates and associated factors for dental pain: A review","volume":"1","author":"Pau","year":"2003","journal-title":"Oral Health Prev. Dent."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1034\/j.1600-0528.2002.300209.x","article-title":"Psychological factors and perceptions of pain associated with dental treatment","volume":"30","author":"Maggirias","year":"2002","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/j.1600-0722.2010.00740.x","article-title":"Towards a better understanding of dental anxiety and fear: Cognitions vs. experiences","volume":"118","author":"Armfield","year":"2010","journal-title":"Eur. J. Oral Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/ejo\/18.1.349","article-title":"Perception of pain as a result of orthodontic treatment with fixed appliances","volume":"18","author":"Scheurer","year":"1996","journal-title":"Eur. J. Orthod."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1034\/j.1600-0722.2002.11193.x","article-title":"Experience of pain during an orthodontic procedure","volume":"110","author":"Bergius","year":"2002","journal-title":"Eur. J. Oral Sci."},{"key":"ref_9","first-page":"651","article-title":"Effects of psychological state on pain perception in the dental environment","volume":"74","author":"Loggia","year":"2008","journal-title":"J. Can. Dent. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.ejpain.2004.11.001","article-title":"Human brain mechanisms of pain perception and regulation in health and disease","volume":"9","author":"Apkarian","year":"2005","journal-title":"Eur. J. Pain"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S0304-3959(02)00007-6","article-title":"Cognitive modulation of pain: How do attention and emotion influence pain processing?","volume":"95","author":"Villemure","year":"2002","journal-title":"Pain"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"97","DOI":"10.17796\/1053-4625-43.2.5","article-title":"Effect of Virtual Reality Distraction on Pain and Anxiety During Dental Treatment in 5 to 8 Year Old Children","volume":"43","author":"Shetty","year":"2019","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1054\/jpai.2002.125182","article-title":"Anxiety sensitivity, cognitive biases, and the experience of pain","volume":"3","author":"Keogh","year":"2002","journal-title":"J. Pain"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/00002508-199606000-00007","article-title":"Relationship among depression scores, beta-endorphin, and angina pectoris during exercise in patients with coronary artery disease","volume":"12","author":"Krittayaphong","year":"1996","journal-title":"Clin. J. Pain"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.physbeh.2005.06.031","article-title":"Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office","volume":"86","author":"Lehrner","year":"2005","journal-title":"Physiol. Behav."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100","DOI":"10.4103\/2279-042X.141116","article-title":"Dental patient anxiety: Possible deal with Lavender fragrance","volume":"3","author":"Zabirunnisa","year":"2014","journal-title":"J. Res. Pharm. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/S0304-3959(00)00400-0","article-title":"Affective pictures processing, attention, and pain tolerance","volume":"90","author":"Verbaten","year":"2001","journal-title":"Pain"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1155\/2014\/425321","article-title":"Pain-related and negative semantic priming enhances perceived pain intensity","volume":"19","author":"Richter","year":"2014","journal-title":"Pain Res. Manag."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1002\/ejp.2169","article-title":"Vicarious facilitation of facial responses to pain","volume":"28","author":"Reicherts","year":"2024","journal-title":"Eur. J. Pain"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1038\/s41586-025-09796-0","article-title":"Vicarious body maps bridge vision and touch in the human brain","volume":"650","author":"Hedger","year":"2026","journal-title":"Nature"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"29","DOI":"10.11648\/j.ajap.20251401.14","article-title":"Pain and environmental stimuli: A review on research methods, instruments, and findings","volume":"14","author":"Kader","year":"2025","journal-title":"Am. J. Appl. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/j.1600-0722.2007.00500.x","article-title":"What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting","volume":"116","author":"Oosterink","year":"2008","journal-title":"Eur. J. Oral Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1037\/0021-843X.102.2.212","article-title":"Emotional imagery in simple and social phobia: Fear versus anxiety","volume":"102","author":"McNeil","year":"1993","journal-title":"J. Abnorm. Psychol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/j.1469-8986.2007.00620.x","article-title":"Brain activation and defensive response mobilization during sustained exposure to phobia-related and other affective pictures in spider phobia","volume":"45","author":"Wendt","year":"2008","journal-title":"Psychophysiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1177\/00220345690480032001","article-title":"Psychologic Stress in a Video-Simulated Dental Restoration","volume":"48","author":"Corah","year":"1969","journal-title":"J. Dent. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1034\/j.1600-0722.2001.00985.x","article-title":"Psychophysiological reactions in dental phobic patients during video stimulation","volume":"109","author":"Lundgren","year":"2001","journal-title":"Eur. J. Oral Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.pain.2007.08.027","article-title":"Fear of pain and defensive activation","volume":"137","author":"Bradley","year":"2008","journal-title":"Pain"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/S0304-3959(98)00069-4","article-title":"The influence of film-induced mood on pain perception","volume":"76","author":"Weisenberg","year":"1998","journal-title":"Pain"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1037\/0003-066X.56.3.218","article-title":"The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions","volume":"56","author":"Fredrickson","year":"2001","journal-title":"Am. Psychol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1600-0722.2010.00790.x","article-title":"Symptom provocation in dental anxiety using cross-phobic video stimulation","volume":"119","author":"Lueken","year":"2011","journal-title":"Eur. J. Oral Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1177\/0022034516678168","article-title":"Association between Anxiety and Pain in Dental Treatment: A Systematic Review and Meta-analysis","volume":"96","author":"Lin","year":"2016","journal-title":"J. Dent. Res."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Armfield, J.M., Stewart, J.F., and Spencer, A.J. (2007). The vicious cycle of dental fear: Exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health, 7.","DOI":"10.1186\/1472-6831-7-1"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1046\/j.0909-8836.1999.eos107602.x","article-title":"Dental anxiety and dental avoidance among 12 to 18 year olds in Norway","volume":"107","author":"Skaret","year":"1999","journal-title":"Eur. J. Oral Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1080\/00016357.2018.1513558","article-title":"Prevalence of dental anxiety and associations with oral health, psychological distress, avoidance and anticipated pain in adolescence: A cross-sectional study based on the Troms\u00f8 study, Fit Futures","volume":"77","author":"Nermo","year":"2019","journal-title":"Acta Odontol. Scand."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1111\/j.1600-0528.2010.00552.x","article-title":"The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London","volume":"38","author":"Milgrom","year":"2010","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.apacoust.2012.05.010","article-title":"Perception of soundscapes: An interdisciplinary approach","volume":"74","author":"Davies","year":"2013","journal-title":"Appl. Acoust."},{"key":"ref_37","unstructured":"Audacity Team (Audacity, 2016). Audacity, version 2.1.2."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.pain.2005.09.018","article-title":"Characterizing individual differences in heat-pain sensitivity","volume":"119","author":"Nielsen","year":"2005","journal-title":"Pain"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/0304-3959(83)90126-4","article-title":"The validation of visual analogue scales as ratio scale measures for chronic and experimental pain","volume":"17","author":"Price","year":"1983","journal-title":"Pain"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/j.2044-8260.1978.tb00280.x","article-title":"An inventory for the measurement of self-reported stress and arousal","volume":"17","author":"Mackay","year":"1978","journal-title":"Br. J. Soc. Clin. Psychol."},{"key":"ref_41","unstructured":"Biopac Systems Inc (AcqKnowledge, 2016). AcqKnowledge, version 4.4."},{"key":"ref_42","first-page":"143","article-title":"The Modified Dental Anxiety Scale: Validation and United Kingdom norms","volume":"12","author":"Humphris","year":"1995","journal-title":"Community Dent. Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1177\/147323000503300214","article-title":"Reliability and validity of the Modified Dental Anxiety Scale in Turkish patients","volume":"33","author":"Ilguy","year":"2005","journal-title":"J. Int. Med. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/1469-8986.3710013","article-title":"Mixed-effects models in psychophysiology","volume":"37","author":"Bagiella","year":"2000","journal-title":"Psychophysiology"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"West, B., Welch, K.B., and Galecki, A. (2022). Linear Mixed Models: A Practical Guide Using Statistical Software, CRC Press.","DOI":"10.1201\/9781003181064"},{"key":"ref_47","unstructured":"IBM Crop. (IBM SPSS Statistics for Windows, 2017). IBM SPSS Statistics for Windows, version 25.0."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0005-7967(01)00005-5","article-title":"Is pain-related fear a predictor of somatosensory hypervigilance in chronic low back pain patients?","volume":"40","author":"Peters","year":"2002","journal-title":"Behav. Res. Ther."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1038\/nrn2994","article-title":"The integration of negative affect, pain and cognitive control in the cingulate cortex","volume":"12","author":"Shackman","year":"2011","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.neuroimage.2009.05.059","article-title":"The influence of negative emotions on pain: Behavioral effects and neural mechanisms","volume":"47","author":"Wiech","year":"2009","journal-title":"Neuroimage"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.tics.2008.05.005","article-title":"Neurocognitive aspects of pain perception","volume":"12","author":"Wiech","year":"2008","journal-title":"Trends Cogn. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.pain.2010.11.024","article-title":"The role of working memory in the attentional control of pain","volume":"152","author":"Legrain","year":"2011","journal-title":"Pain"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.cortex.2017.01.010","article-title":"Attention to pain! A neurocognitive perspective on attentional modulation of pain in neuroimaging studies","volume":"89","author":"Torta","year":"2017","journal-title":"Cortex"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1038\/s41593-017-0051-7","article-title":"Generalizable representations of pain, cognitive control, and negative emotion in medial frontal cortex","volume":"21","author":"Kragel","year":"2018","journal-title":"Nat. Neurosci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s40368-014-0145-9","article-title":"Effect of audiovisual distraction with 3D video glasses on dental anxiety of children experiencing administration of local analgesia: A randomised clinical trial","volume":"16","author":"Nuvvula","year":"2015","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.jebdp.2009.03.002","article-title":"Music therapy may reduce pain and anxiety in children undergoing medical and dental procedures","volume":"9","author":"Bekhuis","year":"2009","journal-title":"J. Evid. Based Dent. Pract."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"317","DOI":"10.14219\/jada.archive.2008.0161","article-title":"Brief relaxation versus music distraction in the treatment of dental anxiety: A randomized controlled clinical trial","volume":"139","author":"Lahmann","year":"2008","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.jpain.2018.02.011","article-title":"Pain, Please: An Investigation of Sampling Bias in Pain Research","volume":"19","author":"Karos","year":"2018","journal-title":"J. Pain"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1080\/00016350050217091","article-title":"Avoidance of dental visits: The predictive validity of three dental anxiety scales","volume":"58","author":"Haugejorden","year":"2000","journal-title":"Acta Odontol. Scand."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/7\/431\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T08:24:00Z","timestamp":1783931040000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/7\/431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":59,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["dj14070431"],"URL":"https:\/\/doi.org\/10.3390\/dj14070431","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]}}}