Expectancy Model of Fear The expectancy model of fear (Reiss & McNally, 1985) is another fear of pain conceptualization that is quite relevant in dentistry. The expectancy model is based on two components to fear: expectations that certain events and/or experiences (heart palpitation, embarrassment, or losing control of emo- Hons) will occur in particular situations, and anxiety sensitivity, which refers to the belief that those expected experiences are dangerous or threatening. Taken together, these factors influence behavioral responses in the context of (potential) threat, and in particular avoidance and escape behavior. It is believed that anxiety sensitivity is a predisposing variable linked to responding with fear to anxiety-related events (Reiss, 1991) and operates as. a vulnerability to the development of an anxiety disorder (Craske, 1999). The vast majority of empirical support for the expectancy model is taken from re- search on anxiety disorders (e.g,, Taylor et al., 1992) and chronic pain (eg, Greenberg, & Burns, 2003; Zvolensky et al., 2001). Gross (1992a) applied the expectancy model of fear to dental avoidance with the development of the Pain Sensitivity Index (PSI). Using the PSI, Gross found that pain sensitivity among dental patients predicted pain intensity, and pain intensity predicted denial avoidance. Although Gross asserts that anxiety sensitivity and pain sensitivity are distinct constructs, they both ate founded on the same model of fear learning and are closely related (Gross, 1992a; 1992b), Norton and Asmundson (2003) integrated anxiety sensitivity, as it relates to physiological responding, into the fear-avoidance model of chronic pain. The authors indicated that although the fear-avoidance model focuses on cognitive and behavioral aspects of pain responding, it does not highlight the contributions of physiological arousal toward pain avoidance. The amended fear-avoidance model suggests that anxiety sensitivity will impact avoidance behavior at the level of pain catastrophizing; physiological activ- ity (e.g., muscle tension), along with anxiety sensitivity, will contribute to fear of pain (see Norton & Asmundson for a review). Thus, it is a patient's experience of physiological arousal during dental treatment, and the belief that treatment may lead to pain or lasting harm (e.g. a catastrophe in the dental chair, such as myocardial infarction) that initiates dental fear, The maintenance of avoidance behavior occurs through negative reinforcement. Fear is reduced when the dental office is avoided, and the reduction of fear increases the likelihood of the response (ie., avoidance) in the future.