Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Dr. Sandra E. Gramling


The temporomandibular disorders (TMD) diminish quality of life and can be costly for both individuals and the health care system. Stress from a variety of factors, including daily hassles and maladaptive thought patterns, has been commonly cited as a contributing factor in TMD. Support for this hypothesis comes from research demonstrating masseter muscle hyperactivity in response to experimental stressors, such as painful or frustrating stimuli. Many believe the link between stress and increased masseter muscle pain is parafunctional oral habits, including teeth clenching, grinding, and lip biting. Habit reversal has been used effectively to treat parafunctional oral behaviors and facial pain. Treatment entails teaching individuals to detect, interrupt, and reverse maladaptive oral behaviors. Positive results have been achieved in a group treatment format. Problems with prior research suggest that high attrition resulted from scheduling demands of the group treatment format. To address these problems, this study modified the habit reversal protocol used by Gramling, et al. (1996, 1999) into a minimal contact therapy (MCT) format. MCT has been applied effectively with many problem behaviors, including chronic headaches. Twenty individuals (10-treatment and 10-waitlist control) participated in the seven-lesson, manualized treatment. Participants completed a pre- and post-treatment assessment and an 18-month follow-up. Individuals met with the therapist one time and received weekly feedback via telephone or e-mail. Participants submitted homework and quizzes for each lesson. Those in the control condition spoke with the therapist on a weekly basis as an attention control. Treatment lasted a mean of about 20 weeks. Significant improvement in pain severity including mean pain levels, highest weekly pain levels, and number of pain free days was noted in the treatment group relative to controls. The number and frequency of maladaptive oral habits revealed a strong trend towards lower levels from pre- to post-treatment for individuals in the treatment condition relative to controls. Additional measures of pain symptomotology and personality functioning also revealed significant improvements in the treatment group. Results suggest that a standardized treatment for facial pain is well suited for adaptation to a MCT format. Minimal contact therapy is flexible and as effective as similar group treatments.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

June 2008

Included in

Psychology Commons