Exploring the feasibility of conducting a randomised controlled trial to test the impact of a computer-assisted online cognitive-behaviour therapy intervention for child dental anxiety


COPE-A-LOT-SCOT is a CSO-funded feasibility study to test the effect of an online Cognitive Behavioural Therapy (CBT) to reduce child dental anxiety and its economic impact on service provision of dental general anaesthesia and inhalation sedation for child dental anxiety.  

Children may feel worried about going to the dentist, in fact, the prevalence of dental anxiety in children is about 10%.  This anxiety may result in children resisting dental treatment and may in turn exacerbate their fear for dental treatment in the future. The role of family in the child's anxiety has also been shown to be important in the management of child dental fear.  Online CBT programmes such as COPE-A-LOT have been supported by research evidence which shows reduction in children's anxiety problems.   COPE-A-LOT is an evidence-based online CBT programme for children with anxiety disorders. Parents and children were provided with a resource pack with downloading instructions. Parental and child general anxiety, dental anxiety and child quality of life were assessed using self-report measures. Dentists completed a measure of their ability to engage children for dental treatment. Questionnaires were administered at baseline and on completion of COPE-A-LOT.

Aims and Objectives

To explore the feasibility of conducting a RCT to test the effectiveness of an evidence-based online COPE-A-LOT intervention to reduce child dental anxiety (primary outcome) and sedation (RA) and/or dental general anaesthetic (DGA) extractions costs (secondary outcome).

22 children whose dental anxiety levels were generally high have been so far recruited.  Some of these children are enjoying the programme and it has assisted in reducing their dental fear as well as other anxieties.  We have had excellent communication and help from the team of clinical psychologists who developed COPE-A-LOT over in the U.S. It is exciting to be part of developing this new method of delivering CBT for child anxiety.

Research Team

Dental Health Services Research Unit

University of St Andrews

  • Professor Gerry Humphris

NHS Tayside

  • Dr Morag Curnow
  • Dr Katharine Blain


  • The study will inform current oral health strategy, dental involvement in the Early Years Collaborative and oral health care development.
  • Websites: Executive Summary (from our study report to CSO) to be uploaded onto University website.
  • Publications: A systematic review article currently under review with Joural of Anxiety Disorders.
  • Presentations: NHS venues and research conferences.


Rooksby, M., Elouafkaoui, P., Humphris, G., Clarkson, J., Freeman, R. (under review) "Internet-assisted delivery of cognitive behavioural therapy (CBT) for childhood anxiety: Systematic review and meta-analysis". Currently under review by Journal of Anxiety Disorders.