{"paper_id":"4cd63d20-a0c9-4255-9660-2dc4b44f7be9","body_text":"Investigating the Relationship Between Psychophysiological Parameters and Behavioral Patterns in Children aged 7-10 years During Dental Treatment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigating the Relationship Between Psychophysiological Parameters and Behavioral Patterns in Children aged 7-10 years During Dental Treatment Aida Mehdipour, Mohammad Hassan Kalantar Neyestanaki, Masumeh Zamanlu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6943745/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Dental procedures elicit anxiety which can hinder treatment quality. Psychophysiology science provides insights into anxiety in behavior management by measuring autonomic indicators. This study examined the relationship between psychophysiological parameters and behavioral patterns in children during dental treatments. Methods This cross-sectional descriptive analytical study was conducted on 40 eligible children receiving dental treatment. Demographic information, clinical history, Visual Analog Scale (VAS), dental treatment type and local anesthesia were recorded. Galvanic Skin Response (GSR) and heart rate variability (HRV) metrics were assessed. Child behaviors were measured using the Frankl Scale. Data were analyzed using repeated-measures ANOVA and one-way ANOVA. The significance threshold was set at a p-value < 0.05. Results Post-treatment VAS scores were significantly higher (P = 0.003). HRV metrics, including Very Low Frequency (VLF) (P = 0.005), Low Frequency (LF) (P = 0.014), High Frequency (HF) (P = 0.024), and LF/HF ratio (P = 0.022) exhibited significant changes after treatment. The Frankl 2 group demonstrated the largest increases in VAS scores (P = 0.001). The Frankl 3 group exhibited a significant positive GSR shift, while the Frankl 2 group showed a significant negative GSR shift (P < 0.05). Among clinical factors, VLF was significantly correlated with treatment type, particularly in cases involving dental fillings (P = 0.015, r = 4.36). Conclusion GSR are associated with child behavior during dental setting. Behavioral Symptoms Dental Anxiety Psychophysiology Galvanic Skin Response Pediatric Dentistry Figures Figure 1 Figure 2 Figure 3 Background In pediatric dentistry, dental procedures are often associated with considerable anxiety and stress, particularly among children. This anxiety can reduce treatment quality, cause avoidance behaviors, and lead to more serious oral health issues. Disruptive behavior related to anxiety increases both treatment time and the risk of harm to the child, and surveys reveal that uncooperative children are among the most common challenges in pediatric dental clinics. Recent findings indicate that almost 22% of children may exhibit clear disruptive behavior in a dental setting ( 1 ). Dental treatments can provoke autonomic nervous system (ANS) responses, making physiological monitoring especially important in pediatric patients. Given these challenges, there is growing interest in psychophysiological and biofeedback interventions aimed at modulating autonomic activity. The U.S. Food and Drug Administration (FDA) has approved psychophysiological and biofeedback interventions (modulating autonomic activity) for tension reduction, highlighting the potential application of such approaches in pediatric dentistry as well. Current technology has made it possible to assess numerous parameters related to autonomic functions, making the study of these parameters crucial for describing differences in autonomic responses. This concept can lead to more modern therapeutic approaches and help address anxiety-related challenges in this context ( 2 , 3 ). Despite increased interest, many current approaches to understanding dental anxiety in children remain descriptive and lack physiological objectivity. Studies have shown that anxiety in dental settings is multifactorial and influenced by psychological, environmental, and biological variables ( 4 , 5 ). Dental treatment anxiety is associated with a range of psychological, physiological, and environmental factors. Psychological factors such as personality traits, past experiences, and misconceptions about dental treatment play significant roles in the onset and severity of anxiety ( 6 ). On the other hand, physiological factors like increased heart rate (HR), blood pressure, and stress hormone secretion represent natural bodily responses that intensify during dental treatment ( 7 ). Researchers worldwide use various tools to assess physiological, behavioral, and cognitive responses to fear and anxiety, highlighting the need for optimal management strategies in clinical interactions with anxious patients ( 8 ). Studies on both pharmacologic and non-pharmacologic interventions for anxiety relief in patients have shown that reducing anxiety improves oral health, and quality of life and reduces perceived pain. Decreasing stress during dental procedures can improve patient comfort and safety ( 9 , 10 ). These factors differ widely between children and adults; those that trigger fear and stress in children are complex, making identification and intervention challenging ( 11 ). Psychophysiology is a relatively new field that studies the interaction between psychological and physiological phenomena and explores how the mind and body interact. It is a multidisciplinary science examining the physical basis of mental and psychological events ( 12 ). Certain areas of psychophysiology, particularly those related to autonomic neuroscience (sympathetic and parasympathetic systems), have advanced to the point that established therapeutic modalities, known as biofeedback, have emerged. Currently, specialists are trained to work in these therapeutic areas ( 13 ). Dental treatment can induce psychophysiological changes that may affect the course of treatment. Some dental procedures can be particularly uncomfortable, leading to significant tension and autonomic changes in individuals. Pain, anxiety, and cardiovascular stress associated with dental treatments can result in acute physical, neurological, and behavioral changes ( 14 ). Additionally, individuals with previous negative treatment experiences often respond with higher levels of physiological arousal to perceived threats, driven by conditioned fear mechanisms, compared to those with indirect fears. These physiological responses include muscle tension, HRV parameters changes, Galvanic Skin Response (GSR) reactions, and alterations in brain electrical activity ( 15 , 16 ). In pediatric dental sessions, anxiety and pain are generally assessed subjectively. Dentists rely on their subjective judgment based on the child’s verbal and nonverbal cues to make decisions, such as adjusting the anesthetic dosage, pausing treatment, or becalming the patient. This approach may lead to sudden and undesired reactions during dental treatment or result in a negative experience for the child. Therefore, pediatric dental approaches need to shift toward more objective, quantitative, and observable measures. Advances in neuroscience increasingly provide accessible quantitative metrics for assessing patients' mental, emotional, and physical status ( 17 , 18 ). In a study by Ramírez-Carrasco et al., examining the effects of hypnosis combined with behavioral management techniques on reducing children's anxiety during dental treatment, a slight reduction in HR was observed during hypnosis, although GSR remained unchanged ( 19 ). Şimşek et al. observed that rising GSR and HR levels were linked to increased anxiety, especially during tooth extraction ( 20 ). Additionally, Košir et al. reported that dental stimuli elevated HR, while GSR changes depended on the stimulus type, with auditory cues and examinations causing greater effects than visual stimuli ( 21 ). However, these studies primarily focused on isolated physiological markers and did not examine their relationship with observed behavioral responses in children. Given the high prevalence of dental anxiety in children and its negative impact on treatment outcomes, more comprehensive studies are needed. To date, no study has examined the direct relationship between psychophysiological parameters and children's behavioral patterns during dental treatment. This study aims to fill that gap by investigating how real-time physiological signals correlate with children’s observable behaviors in a clinical dental setting. Methods Study Design and Participants This cross-sectional analytical study was conducted between July and November 2024 in Qom, Iran. The study protocols were designed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Total sample size was calculated based on the study by Lueken et al. and using Cochran's formula for sample size estimation, with a Type I error rate (alpha) of 5% and a Type II error rate (beta) of 10% ( 22 , 23 ). All the children’s legal guardians provided informed consent. forty eligible children, aged 7–10, undergoing dental treatment were recruited from a public dental center, Qom (Iran). Inclusion Criteria: Age 7–10 years - Indication for dental treatment - Informed consent from parents and the child’s cooperation Exclusion Criteria: BMI > 35 - systemic diseases (e.g., diabetes, heart disease) - Major psychiatric disorders - Developmental disorders - Recent drug usage affecting the ANS (especially corticosteroids within the past week) - Children with intellectual or physical disabilities. Demographic and clinical information of participants, including age, gender, previous dental treatment experiences, the type of dental treatment, local anesthesia used, and child behavior patterns were recorded. The study was conducted in a relatively quiet dental treatment room at a temperature range of 22–27°C. Each dental session lasted an average of 77.8 minutes. To prevent interference with the psychophysiological measurements, efforts were made to avoid external stimuli, position changes during recordings, and any electrical or mechanical noise. To minimize potential biases from circadian rhythms, treatments were scheduled around noon. Assessment of child’s anxiety Children’s anxiety regarding the dental session was recorded on a 0–10 Visual Analogue Scale (VAS). This scale ranges from 0, indicating complete comfort, to 10, representing extreme, almost unbearable discomfort. VAS is a commonly used subjective measurement tool in clinical and psychological research to evaluate pain or discomfort levels in patients. The scale provides an accessible and intuitive measure of emotional response, which is particularly suitable for pediatrics ( 24 ). Measurement of psychophysiological Parameters The psychophysiological parameters recorded included - GSR: Electrodermal response indicating galvanic skin response, which reflects sympathetic nervous activity. This parameter is sensitive to emotional arousal and stress, commonly rising with increased anxiety. - Heart Rate Variability (HRV) metrics included: Very Low Frequency (VLF), Low Frequency (LF), High Frequency (HF), Heart Rate (HR), and LF/HF Ratio (Used to assess the balance between sympathetic and parasympathetic nervous activity). - Time-Domain HRV Parameters: SDNN (Root mean square of the interval variance between heartbeats over a specific period. This is one of the most common HRV measures in research and provides a broad assessment of autonomic regulation. However, its independent clinical application requires careful conditions and comprehensive information), and PNN50 (Represents the average number of instances (per hour) where the difference in successive heartbeat intervals exceeds 50 milliseconds, a common HRV parameter). Each parameter was recorded twice—before and after the treatment (pre- and post-treatment)—and at three different intervals each time, and the mean value was used for analysis: 1. Resting State (Measured while the child lay on the dental chair before any intervention), 2. Cognitive Challenge (The child was asked to count backward from 50, which served as a cognitive stressor in this study), and 3. Post-Challenge (A few minutes after the cognitive challenge while still in the same position). During each recording, two GSR variables were obtained: Peak GSR level and average GSR level ( 25 ). All measurements were conducted using the BioLine system (Medina Teb, Tehran, Iran) with a blood volume pulse (BVP) sensor and a galvanic skin response sensor from the same manufacturer. Psychophysiological parameters were analyzed using Biosees Evo software, which applies complex algorithms to output these metrics in numerical form. Child Behavioral Assessment The Frankl Behavioral Rating Scale was used to categorize the children’s behavior. This scale is widely employed in both clinical and research settings within pediatric dentistry to rate observed behaviors during dental treatment. The Frankl scale categorizes behavior patterns into four levels, from highly cooperative to extremely uncooperative, providing a structured framework for assessing children’s reactions to dental procedures ( 26 ). (Fig. 1 ) Additionally, the dentist provided an experiential rating based on the child's emotional state (happy or unhappy). Bias : The risk of bias for the clinical assessment was limited by the clinician’s judgment using valid and reliable methods to assess children’s psychophysiological parameters, pain and discomfort and behavior patterns during dental setting. Variables : The main outcomes of the study were psychophysiological parameters included GSR, HRV (VLF, LF, HF and LF/HF ratio), SDNN and PNN50 which were recorded in pre- and post-treatment (at resting state, cognitive challenge and post-challenge). The secondary outcome of the study was VAS score to pain or discomfort level assessment. Secondary variables included demographic data, previous dental treatment experiences, the type of dental treatment and the local anesthesia used. Statistical Analysis Data analysis was conducted using Biosees Evo software and SPSS version 28.0. A repeated-measures ANOVA was applied to evaluate within-subject differences pre- and post-treatment. For examining relationships between psychophysiological parameters and patient characteristics, a one-way ANOVA was used. P-values less than 0.05 were considered statistically significant. Levene’s test was employed to assess the homogeneity of variances, ensuring that the assumptions for ANOVA were met. Results Table 1 shows data on the demographic, clinical history, and behavioral characteristics of the children. A total of eligible 40 children, aged 8–10 years (mean age of 8.2 ± 0.966 years) were evaluated. Among them, 50% were classified in the \"positive\" category according to the Frankl Behavior Scale, while none fell into the \"definitely negative\" category. Table 1 Descriptive, behavioral, and clinical characteristics of children. Parameter Category Frequency Percentage (%) Age 7 8 20.0 8 12 30.0 9 10 25.0 10 10 25.0 Gender Female 22 55.0 Male 18 45.0 Mother's education Sub-diplomas 11 27.5 Diplomas 28 70.0 Higher diploma 1 2.5 Father's education Sub-diplomas 14 35.0 Diplomas 24 60.0 Higher diploma 2 5.0 Previous Treatment History Negative 16 40.0 Positive 23 60.0 Frankl Behavior Scale Definitely Negative 0 0.0 Negative 13 32.5 Positive 20 50.0 Definitely positive 7 17.5 emotional state Unhappy 13 32.5 Happy 27 67.5 Type of Anesthesia Infiltration 15 37.5 IAN Block 25 62.5 Type of Treatment Extraction 12 30.0 Filling 10 25.0 Pulpotomy 12 30.0 Fissure Sealant 6 15.0 Total 40 100 IAN Block: Inferior Alveolar Nerve Block. The children's VAS scores showed a significant increase post-dental treatment compared to pre-treatment, indicating a higher level of discomfort after the session (P = 0.003). Most of the psychophysiological parameters related to cardiac autonomic function (including VLF (P = 0.005), LF (P = 0.014), HF (P = 0.024), and LF/HF ratio (P = 0.022)) also displayed significant differences between the pre- and post-treatment measurements. However, parameters such as PNN, SDNN, HR, and all GSR-related measures across the three conditions (rest, cognitive challenge, and post-challenge) did not exhibit significant changes (P > 0.05). (Table 2 ) Table 2 Analysis of psychophysiological Parameters in Children Pre- and Post-Treatment. Parameter Condition N Mean SD P value VAS pre-treatment 40 2.30 2.06 0.003 post-treatment 40 3.52 1.51 Mean GSR (Rest) pre-treatment 40 1.38 0.84 0.321 post-treatment 40 1.22 0.82 Peak GSR (Rest) pre-treatment 40 1.77 1.05 0.690 post-treatment 40 1.69 1.04 Mean GSR (Cognitive challenge) pre-treatment 40 1.81 0.98 0.285 post-treatment 40 1.62 0.93 Peak GSR (Cognitive challenge) pre-treatment 40 2.41 1.34 0.299 post-treatment 40 2.17 1.25 Mean GSR (Post-challenge) pre-treatment 40 1.52 0.783 0.601 post-treatment 40 1.44 .962 Peak GSR (Post-challenge) pre-treatment 40 2.20 1.28 0.162 post-treatment 40 1.89 1.28 VLF pre-treatment 40 13.97 3.20 0.005 post-treatment 40 15.66 3.69 LF pre-treatment 40 26.15 6.55 0.014 post-treatment 40 29.52 5.81 HF pre-treatment 40 60.28 8.07 0.024 post-treatment 40 57.10 6.18 LF/HF Ratio pre-treatment 40 0.44 0.15 0.022 post-treatment 40 0.51 0.14 PNN pre-treatment 40 84.45 3.66 0.463 post-treatment 40 85.07 4.08 SDNN pre-treatment 40 234.50 36.59 0.424 post-treatment 40 240.20 31.34 HR pre-treatment 40 72.28 6.60 0.656 post-treatment 40 72.78 3.77 VAS: Visual Analog Scale, GSR: Galvanic Skin Response, VLF: Very Low Frequency, LF: Low Frequency, HF: High Frequency, LF/HF: Ratio of Low Frequency to High Frequency, PNN: Percentage of Differences Between Normal to Normal Intervals, SDNN: Standard Deviation of Normal to Normal Intervals, HR: Heart Rate. Table 3 shows VAS changes and changes of all GSR variables in the three conditions (rest, cognitive challenge, and post-challenge) were significantly correlated with the children’s behavioral types. Results indicate that changes in VAS were significantly higher in children classified in the negative Frankl category (P = 0.001), with a non-significant increase in post-treatment VAS scores. Although an increase in VAS following treatment was also observed in the positive Frankl group, it was less than in the negative group. Children in the \"definitely positive\" Frankl category showed a decrease in VAS scores post-treatment, rather than an increase (Fig. 2 ). VAS: Visual Analog Scale. Table 3 Analysis of psychophysiological changes during treatment based on children's behavioral characteristics (Frankel scale). Parameter Frankl Scale N Mean SD Min Max P value VAS Negative 13 2.54 0.85 -0.82 4.32 0.001 Positive 20 1.05 0.75 -0.21 3.24 Definitely positive 7 -0.72 0.69 -2.74 1.78 Mean GSR (Rest) Negative 13 -0.62 0.71 -1.91 0.66 0.005 Positive 20 0.33 0.76 -0.82 2.71 Definitely positive 7 -0.72 1.45 -3.27 0.42 Peak GSR (Rest) Negative 13 -0.77 0.93 -2.20 1.10 0.004 Positive 20 0.57 0.98 -1.20 3.41 Definitely positive 7 -0.70 1.91 -3.61 0.99 Mean GSR (Cognitive challenge) Negative 13 -0.73 1.20 -4.39 0.53 0.013 Positive 20 0.30 0.69 -0.45 2.02 Definitely positive 7 -0.58 1.34 -2.97 1.44 Peak GSR (Cognitive challenge) Negative 13 -1.08 1.64 -5.85 0.50 0.006 Positive 20 0.45 .812 -0.70 2.10 Definitely positive 7 -0.69 1.78 -3.75 2.00 Mean GSR (Post-challenge) Negative 13 -0.50 1.06 -2.28 1.80 0.011 Positive 20 0.35 0.68 -0.71 2.47 Definitely positive 7 -0.50 0.82 -1.67 0.34 Peak GSR (Post-challenge) Negative 13 -0.97 1.48 -4.33 2.00 0.012 Positive 20 0.31 0.90 -0.60 3.11 Definitely positive 7 -0.81 1.55 -3.90 0.39 VLF Negative 13 2.45 3.05 -5.20 7.75 0.354 Positive 20 1.77 4.16 -3.40 12.45 Definitely positive 7 0.01 2.36 -2.05 5.00 LF Negative 13 0.81 10.00 -20.30 20.60 0.335 Positive 20 4.00 7.62 -10.75 15.90 Definitely positive 7 6.30 5.90 -0.80 12.70 HF Negative 13 -3.87 10.00 -28.05 12.60 0.860 Positive 20 -3.27 7.54 -14.00 9.65 Definitely positive 7 -1.62 9.80 -11.95 17.85 LF/HF Ratio Negative 13 0.03 0.24 -0.55 0.50 0.514 Positive 20 0.07 0.16 -0.25 0.25 Definitely positive 7 0.13 0.17 -0.10 0.35 PNN Negative 13 2.84 4.21 -5.00 10.00 0.175 Positive 20 -0.70 5.85 -15.00 7.00 Definitely positive 7 0.28 4.92 -9.00 6.00 SDNN Negative 13 24.30 56.05 -26.00 193.00 0.141 Positive 20 0.55 31.93 -57.00 60.00 Definitely positive 7 -14.14 46.03 -60.00 54.00 HR Negative 13 1.26 9.62 -11.60 24.60 0.881 Positive 20 0.28 5.81 -8.50 19.40 Definitely positive 7 -0.31 5.07 -8.20 5.20 VAS: Visual Analog Scale, GSR: Galvanic Skin Response, VLF: Very Low Frequency, LF: Low Frequency, HF: High Frequency, LF/HF: Ratio of Low Frequency to High Frequency, PNN: Percentage of Differences Between Normal to Normal Intervals, SDNN: Standard Deviation of Normal to Normal Intervals, HR: Heart Rate. Furthermore, Fig. 3 illustrates the pre- and post-treatment changes in GSR across various conditions for children grouped according to the Frankl Scale. The analysis revealed that children in the positive Frankl category experienced significant positive changes in GSR across various conditions. Conversely, in the negative and definitely positive groups, GSR changes were negative (P < 0.05). Table 4 shows the relationship between psychophysiological parameters and various demographic and clinical variables. VLF showed a significant correlation with the type of dental treatment, with the highest VLF values observed during dental filling procedures and the lowest during fissure sealant treatments (P = 0.015, r = 4.36). However, there were no significant differences in psychophysiological parameters based on age, gender, emotional state, and previous dental experience (P > 0.05). Table 4 Relationship Between Psychophysiological Changes during Treatment and Demographic Variables. Parameter Gender emotional state Type of Anesthesia Type of Treatment Female Male Unhappy Happy Infiltration IAN Block Extraction Filling Pulpotomy Fissure Sealant Mean GSR (Rest) N 22 18 13 27 15 25 12 10 12 6 Mean -0.10 -0.23 -0.62 0.06 -0.25 -0.10 -0.29 0.02 -0.03 -0.47 SD 1.13 0.86 0.71 1.06 0.61 0.84 0.92 1.05 1.15 0.94 P value 0.690 0.642 0.654 0.745 Peak GSR (Rest) N 22 18 13 27 15 25 12 10 12 6 Mean -0.05 -0.12 -0.77 0.25 -0.21 -0.01 -0.19 -0.02 0.24 -0.63 SD 1.39 1.27 0.93 1.37 1.09 0.62 1.24 1.41 1.29 1.55 P value 0.865 0.604 0.639 0.627 Mean GSR (Cognitive challenge) N 22 18 13 27 15 25 12 10 12 6 Mean -0.03 -0.39 -0.74 0.08 -0.40 -0.06 -0.40 0.03 0.01 -0.53 SD 0.81 1.37 1.20 0.96 1.19 1.07 1.36 1.03 0.72 1.36 P value 0.310 0.828 0.355 0.638 Peak GSR (Cognitive challenge) N 22 18 13 27 15 25 12 10 12 6 Mean -0.18 -0.33 -1.08 0.16 -0.50 -0.09 -0.43 -0.11 0.06 -0.72 SD 1.01 1.92 1.64 1.21 0.95 0.69 1.93 1.42 0.88 1.63 P value 0.751 0.499 0.401 0.717 Mean GSR (Post-challenge) N 22 18 13 27 15 25 12 10 12 6 Mean -0.06 -0.10 -0.51 0.13 -0.32 0.07 -0.10 -0.06 -0.04 -0.15 SD 1.00 0.86 1.06 0.80 0.81 1.58 1.10 1.14 0.65 0.89 P value 0.878 0.147 0.201 0.996 Peak GSR (Post-challenge) N 22 18 13 27 15 25 12 10 12 6 Mean -0.20 -0.43 -0.98 0.02 -0.71 -0.06 -0.31 -0.17 -0.24 -0.65 SD 1.23 1.52 1.48 1.18 0.75 1.06 1.66 1.45 0.80 1.68 P value 0.602 0.371 0.146 0.923 VLF N 22 18 13 27 15 25 12 10 12 6 Mean 1.71 1.66 2.45 1.32 1.79 1.63 2.01 4.36 0.02 -0.07 SD 3.01 4.28 3.05 3.81 2.90 3.40 3.01 3.76 3.19 2.76 P value 0.967 0.142 0.894 0.015 LF N 22 18 13 27 15 25 12 10 12 6 Mean 3.32 3.43 0.82 4.60 3.85 3.08 1.57 6.47 1.47 5.60 SD 7.94 8.88 10.00 7.18 6.25 7.55 10.77 7.89 6.19 6.31 P value 0.969 0.792 0.782 0.398 HF N 22 18 13 27 15 25 12 10 12 6 Mean -4.36 -1.74 -3.88 -2.85 -4.60 -2.33 -4.41 -6.79 -0.12 -0.85 SD 9.16 7.87 10.00 8.02 6.10 9.02 11.09 6.23 8.18 5.45 P value 0.345 0.785 0.426 0.271 LF/HF Ratio N 22 18 13 27 15 25 12 10 12 6 Mean 0.09 0.05 0.03 0.09 0.10 0.06 0.04 0.16 0.03 0.09 SD 0.16 0.22 0.24 0.16 0.16 0.25 0.22 0.19 0.15 0.17 P value 0.565 0.556 0.545 0.420 PNN N 22 18 13 27 15 25 12 10 12 6 Mean 1.27 -0.17 2.85 -0.44 1.27 0.24 1.50 -2.00 3.00 -1.50 SD 5.60 5.03 4.21 5.55 4.48 5.15 4.46 6.79 3.30 6.05 P value 0.403 0.396 0.563 0.104 SDNN N 22 18 13 27 15 25 12 10 12 6 Mean 1.59 10.72 24.31 -3.26 20.67 -3.28 26.25 -2.30 -11.83 13.00 SD 28.7 59.0 56.05 35.74 32.05 28.60 58.53 39.11 27.05 40.88 P value 0.526 0.678 0.101 0.181 HR N 22 18 13 27 15 25 12 10 12 6 Mean -1.40 2.81 1.26 0.13 1.89 -0.34 1.40 2.54 0.18 -4.07 SD 5.63 7.96 9.62 5.54 4.28 5.12 9.38 7.90 3.91 2.93 P value 0.058 0.066 0.339 0.315 VAS: Visual Analog Scale, GSR: Galvanic Skin Response, VLF: Very Low Frequency, LF: Low Frequency, HF: High Frequency, LF/HF: Ratio of Low Frequency to High Frequency, PNN: Percentage of Differences Between Normal to Normal Intervals, SDNN: Standard Deviation of Normal to Normal Intervals, HR: Heart Rate, IAN Block: Inferior Alveolar Nerve Block. Discussion Dental anxiety and fear are common among patients, often causing stress during dental procedures. Psychophysiological parameters provide valuable insights into anxiety, pain, and stress levels, enabling dentists to optimize treatment approaches and improve patient experiences. VAS is a simple and reliable tool for assessing pain and anxiety in children during dental treatments, where higher scores indicate greater discomfort and pain ( 27 ). In the present study, VAS scores significantly increased during dental treatment. Additionally, there was a significant difference in VAS score changes during treatment across different behavioral categories based on the Frankl Scale. Children in the \"Definitely Positive\" group exhibited a reduction in VAS scores during dental treatment, suggesting a decrease in their stress levels. Conversely, children in the \"Negative\" group showed the greatest increase in VAS scores, indicating a higher level of discomfort during treatment. VAS scores also increased in the \"Positive\" behavioral group. Findings from Alshatrat et al. (2022) similarly indicated that VAS scores increase in children undergoing painful dental procedures requiring local anesthesia, but the use of virtual reality distraction techniques can significantly reduce pain intensity during treatment. However, children who underwent non-painful procedures, such as fluoride therapy, showed no significant change in VAS scores ( 28 ). In a study by Dogan et al. (2013) comparing VAS scores in children with hemophilia and healthy children, both groups showed an increase in VAS scores during treatment, however, there was no significant difference between them ( 29 ). Additionally, Yee et al. (2017) explored the use of the electronic Self-Assessment of Anxiety and Information for Dentists (eSAID) system, which allows children to communicate their feelings and preferences to dentists. Their findings demonstrated a significant reduction in VAS scores among children using eSAID during treatment, while VAS scores increased in the control group ( 30 ). In contrast, Jalili et al. (2019) observed no significant difference in children's perceived pain during local anesthesia between the first and second sessions, as measured by VAS scores ( 31 ). Psychophysiological data collection methods offer the capability for quantitative assessment of anxiety levels, providing an objective metric for patient arousal and stress during dental treatment. GSR, as a key psychophysiological parameter, indirectly reflects ANS activity and is thus widely used to evaluate arousal and stress. GSR is primarily influenced by sweat gland activity, which involves both eccrine and apocrine glands. Eccrine glands, dispersed across the body, are controlled by the sympathetic nervous system. Under stress, the sympathetic system activates, releasing norepinephrine and epinephrine, which stimulate the sweat glands. This triggers ion channels in the glands, allowing sodium and chloride ions to be released, attracting water and producing sweat, which in turn increases GSR in stressful or painful situations ( 32 – 34 ). The present study found no significant difference in GSR parameters pre- and post-treatment; however, significant differences were observed among different behavioral groups based on the Frankl Scale. Notably, the GSR changes in the \"Definitely Positive\" group showed a decrease, aligning with a decrease in VAS scores, indicating lower discomfort and stress during treatment. Interestingly, the \"Negative\" group also showed a decrease in GSR, despite their high VAS scores and visibly negative behavior during treatment. This unexpected finding suggests that, although these children display behaviors associated with fear and stress, they may require a different intervention approach than anticipated. Barlow's research indicates that decreased GSR can have two interpretations: a slight reduction below normal levels reflects lower stress, while a significant drop may indicate either reduced stress or extreme stress leading to sympathetic system shutdown. The clinical context determines the explanation ( 1 ). In the \"Positive\" group, GSR increased, corresponding to their elevated VAS scores. In this study, no significant associations were found between GSR parameters and other demographic or clinical characteristics. Şimşek et al. (2021) reported that increases in GSR and HR correlated with heightened anxiety levels as dental procedures progressed, particularly during tooth extraction. They also found a significant relationship between GSR and age, although there was no significant correlation with other demographic factors such as education level or gender ( 20 ). Najafpour et al. (2017) similarly found that GSR was significantly correlated with dental anxiety levels in children aged 5 to 7, supporting its reliability as a clinical measure of dental anxiety in pediatric patients ( 35 ). Ramírez-Carrasco et al. (2017) explored the use of hypnosis combined with behavioral management techniques to reduce anxiety during infiltration injections in children. They measured anxiety using the FLACC scale and recorded both HR and GSR before and after anesthesia. While HR slightly decreased during hypnosis, GSR remained unchanged ( 19 ). Lueken et al. (2011) concluded that GSR only changed in response to dental-specific stimuli and not to non-dental video stimuli, highlighting GSR's sensitivity to treatment-specific stressors ( 23 ). Finally, Caprara et al. (2003) demonstrated a significant relationship between dental stress and GSR, showing an increase in GSR during treatment, particularly with anxiety related to injections, which was reported as the most stress-inducing aspect of dental procedures ( 36 ). Another essential category of psychophysiological parameters is related to cardiac function, which is influenced by both branches of the ANS: the sympathetic and parasympathetic systems. These systems affect the heart via the sinoatrial (SA) node, where they exert opposing effects. During stress, the sympathetic nervous system releases neurotransmitters norepinephrine and epinephrine, increasing the automatic depolarization rate of SA node cells, which raises HR, contractility, and conduction. In contrast, the parasympathetic nervous system, dominant during rest, releases acetylcholine, which counteracts sympathetic effects on the heart ( 33 , 37 ). Specific cardiac measures are tied to the different branches of the ANS: VLF and LF components are typically associated with sympathetic activity and increase under stress, whereas HF is linked to parasympathetic activity and tends to be decreased with stress and pain. The LF/HF ratio reflects the balance between sympathetic and parasympathetic activity, with an increased ratio indicating sympathetic dominance and elevated stress levels ( 38 ). In the current study, we observed significant differences in VLF, LF, HF, and the LF/HF ratio before and after dental treatment. Specifically, during treatment, there was an increase in VLF, LF, and the LF/HF ratio, alongside a decrease in HF, all indicative of heightened stress and discomfort in children undergoing dental procedures. However, no significant pre- and post-treatment differences were found in other cardiac parameters, such as PNN, SDNN, and HR, nor were there any significant differences across different behavioral groups categorized by the Frankl Scale. Additionally, among demographic and clinical variables, only the type of treatment correlated significantly with VLF changes. Tooth filling induced the greatest VLF changes, suggesting that it was the most stress-inducing for children, followed by extraction and pulpectomy. Research by Dragunova et al. (2023) on rats demonstrated that dental procedures involving implants and sinus lifts induced significant activation of the sympathetic branch of the ANS, as shown by an increase in the LF component two days post-operation, reflecting heightened stress response ( 39 ). Košir et al. (2021) found that dental-related stimuli resulted in increased HR. However, GSR levels varied depending on the type of stimulus, with auditory stimuli and dental examinations producing more pronounced changes than visual stimuli alone ( 21 ). Veerabhadrappa et al. (2016) observed that anxiety associated with local anesthesia injections during dental treatments led to an increase in the LF and LF/HF ratio and a decrease in other HRV parameters, such as HF, reflecting increased sympathetic activity and reduced parasympathetic activity during high-stress dental procedures ( 40 ). Santana et al. (2014) assessed HRV across time (SDNN, RMSSD, pNN50) and frequency domains (LF, HF, and LF/HF ratio) during four intervals of root canal treatment: T1 (10 minutes before), T2 (10 minutes post-anesthesia), T3 (during treatment), and T4 (30 minutes post-treatment). Results showed increased SDNN, RMSSD, and pNN50 in T2 relative to T1. Additionally, LF increased in T4 compared to T2, while HF decreased, and the LF/HF ratio in T4 was significantly higher than in T2, indicating elevated sympathetic activation post-treatment ( 41 ). Casap et al. (2008) found that detailed informed consent for third molar extractions led to increased electrodermal activity (EDA) and HR, suggesting that extensive preoperative disclosure can heighten patient stress levels ( 42 ). In another study, Shapiro et al. (2007) reported significant improvement in both behavioral and psychophysiological relaxation measures when patients were treated in a sensory-adapted dental environment (SDE) compared to a standard dental setting, indicating that modifications in the treatment environment can play a crucial role in stress reduction ( 43 ). Our findings were based on a relatively small number of participants due to the ethical considerations and lack of cooperation of children in the use of measuring instruments. Further elucidation about psychophysiological parameters in children during dental procedure needs to be investigated. Conclusion This study showed that children’s behaviors during dental treatment are closely associated with some psychophysiological parameters, with the strongest correlation observed in GSR as a primary indicator of sympathetic nervous system activity. These findings highlight GSR as a probable valuable measure for assessing and managing anxiety in pediatric dentistry. Additionally, this study reveals the sensitivity of cardiac parameters to dental treatment. Further research in clinical neuroscience and behavioral prediction could enhance our understanding of pediatric dental anxiety, supporting the development of improved treatment protocols and fostering a more positive dental experience. Declarations Ethical Considerations: This study was conducted in accordance with the principles outlined in the Declaration of Helsinki and received ethical approval from the Qom University of Medical Sciences (IR.MUQ.REC.1402.242). Participation was entirely voluntary, with no costs or penalties for withdrawal. Informed consent was obtained from both the children (verbally) and their parents (written consent), ensuring awareness and understanding of the study’s purpose and procedures. Consent for Publication: Not applicable. Author Contributions: A.M. conceived the idea. A.M., A.A., and M.Z. designed the study. A.M., M.H.K.N., M.Z., and M.A. collected the data. A.M., M.H.K.N., M.A., and M.Z. analyzed the data. A.M., M.H.K.N., M.Z., M.H.N., and A.A. prepared the manuscript. A.M., M.H.K.N., M.Z., M.A., A.S., M.H.N., and A.A. reviewed the manuscript. Availability of Data and Materials: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing Interests: The authors declare that they have no competing interests. Funding: This research received no specific grant from any funding agency. Acknowledgments: None. Clinical trial number: not applicable References Barlow DH, Durand VM, Hofmann SG. Abnormal psychology: An integrative approach. Cengage learning; 2018. Lee D-W, Kim J-G, Yang Y-M. The influence of parenting style on child behavior and dental anxiety. Pediatr Dent. 2018;40(5):327–33. Xu M, Xu Y, Wu S, Li Z. The relationship between behavioral inhibition and resting electroencephalography: A neuroelectrophysiological study. Int J Psychophysiol. 2025:112516. de Vilas-Boas M, Vieira A, Diniz JOS. Child’s behavior and its relationship with the level of maternal-child anxiety during dental care. Pesquisa Brasileira em Odontopediatria e Clin Integrada. 2017;17(1):1–9. Armfield JM, Heaton L. Management of fear and anxiety in the dental clinic: a review. Aust Dent J. 2013;58(4):390–407. Muneer MU, Ismail F, Munir N, Shakoor A, Das G, Ahmed AR et al. Dental Anxiety and Influencing Factors in Adults. Healthc (Basel). 2022;10(12). . 7, Chu B, Marwaha K, Sanvictores T, Physiology et al. Stress Reaction [Updated 2024 May 7] In: StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; 2024 Jan- Available from: https://wwwncbinlmnihgov/books/NBK541120/ Eli I. Oral psychophysiology: stress, pain, and behavior in dental care. CRC; 2020. Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Invest dentistry. 2016:35–50. Ferrazzano GF, Salerno C, Sangianantoni G, Caruso S, Ingenito A, Cantile T. The effect of dental treatment under general anesthesia on quality of life and growth and blood chemistry parameters in uncooperative pediatric patients with compromised oral health: a pilot study. Int J Environ Res Public Health. 2020;17(12):4407. Liu R, Bell MA. Fearful temperament and the risk for child and adolescent anxiety: The role of attention biases and effortful control. Clin Child Fam Psychol Rev. 2020;23(2):205–28. Garrett-Ruffin S, Hindash AC, Kaczkurkin AN, Mears RP, Morales S, Paul K, et al. Open science in psychophysiology: An overview of challenges and emerging solutions. Int J Psychophysiol. 2021;162:69–78. Khazan I. Mindfulness-and acceptance-based biofeedback. Biofeedback. 2015;43(3):104–10. Peifer C, Tan J. The psychophysiology of flow experience. Advances in flow research. Springer; 2021. pp. 191–230. Lundgren J, Berggren U, Carlsson SG. Psychophysiological reactions in dental phobic patients with direct vs. indirect fear acquisition. J Behav Ther Exp Psychiatry. 2004;35(1):3–12. Mehdipour A, Fateh R, Fuladvand F, Aghaali M, Keykha E, Hadilou M. Association between sleep pattern, salivary cariogenic bacteria and fungi populations, pH and buffering capacity in children: A comparative study. Dent Med Probl. 2024;61(2):217–24. Kalra N, Sabherwal P, Tyagi R, Khatri A, Srivastava S. Relationship between subjective and objective measures of anticipatory anxiety prior to extraction procedures in 8- to 12-year-old children. J Dent Anesth Pain Med. 2021;21(2):119–28. Jimeno F, Bielsa S, Ndez C, Rodríguez A, Mercadé M. Objective and subjective measures for assessing anxiety in paediatric dental patients. Eur J Pediatr dentistry: official J Eur Acad Pediatr Dentistry. 2011;12:239–44. Ramírez-Carrasco A, Butrón-Téllez Girón C, Sanchez-Armass O, Pierdant-Pérez M. Effectiveness of Hypnosis in Combination with Conventional Techniques of Behavior Management in Anxiety/Pain Reduction during Dental Anesthetic Infiltration. Pain Res Manag. 2017;2017:1434015. Şimşek HO, Aytekin BA. Can Dental Anxiety During Impacted Third Molar Surgery Be Measured Biometrically? Clinical Study with the Galvanic Skin Response Technique. Meandros Med Dent J. 2021;22(1):18. Košir T, Sajovic J, Grošelj M, Fidler A, Drevenšek G, Selič-Zupančič P. Real-life dental examination elicits physiological responses different to visual and auditory dental-related stimuli. PLoS ONE. 2021;16(6):e0252128. Nanjundeswaraswamy T, Divakar S. Determination of sample size and sampling methods in applied research. Proceedings on engineering sciences. 2021;3(1):25–32. Lueken U, Hoyer J, Siegert J, Gloster AT, Wittchen HU. Symptom provocation in dental anxiety using cross-phobic video stimulation. Eur J Oral Sci. 2011;119(1):61–8. Luyk NH, Beck FM, Weaver JM. A visual analogue scale in the assessment of dental anxiety. Anesth Prog. 1988;35(3):121–3. Mindfulness. and Acceptance Approach to Biofeedback. The Clinical Handbook of Biofeedback2013. pp. 1–23. Shinohara S, Nomura Y, Shingyouchi K, Takase A, Ide M, Moriyasu K, et al. Structural relationship of child behavior and its evaluation during dental treatment. J Oral Sci. 2005;47(2):91–6. Facco E, Zanette G, Favero L, Bacci C, Sivolella S, Cavallin F, et al. Toward the validation of visual analogue scale for anxiety. Anesth Prog. 2011;58(1):8–13. Alshatrat SM, Sabarini JM, Hammouri HM, Al-Bakri IA, Al‐Omari WM. Effect of immersive virtual reality on pain in different dental procedures in children: A pilot study. Int J Pediatr Dent. 2022;32(2):264–72. Dogan M, Yazicioglu I, Antmen B. Anxiety and pain during dental treatment among children with haemophilia. Eur J Paediatr Dent. 2013;14(4):284–8. Yee R, Jones L, Hosey M. What the child SAID to the dentist: A UK randomized controlled trial. Child Care Health Dev. 2017;43(6):926–32. Jalali F, Shojaeepour S, Shojaiepour R. Comparison of Two Standard Scales for Pain Perception during Local Anesthetic Injection in Children. J Iran Dent Association. 2020;32(1):37–42. Mackersie CL, Calderon-Moultrie N. Autonomic nervous system reactivity during speech repetition tasks: Heart rate variability and skin conductance. Ear Hear. 2016;37:S118–25. Andrianome S, Gobert J, Hugueville L, Stéphan-Blanchard E, Telliez F, Selmaoui B. An assessment of the autonomic nervous system in the electrohypersensitive population: a heart rate variability and skin conductance study. J Appl Physiol. 2017;123(5):1055–62. Novak P. Electrochemical skin conductance: a systematic review. Clin Auton Res. 2019;29:17–29. Najafpour E, Asl-Aminabadi N, Nuroloyuni S, Jamali Z, Shirazi S. Can galvanic skin conductance be used as an objective indicator of children’s anxiety in the dental setting? J Clin experimental dentistry. 2017;9(3):e377. Caprara HJ, Eleazer PD, Barfield RD, Chavers S. Objective Measurement of Patient’s Dental Anxiety by Galvanic Skin Reaction. J Endod. 2003;29(8):493–6. Shen MJ. The cardiac autonomic nervous system: an introduction. Herzschrittmachertherapie + Elektrophysiologie. 2021;32(3):295–301. Kim H-G, Cheon E-J, Bai D-S, Lee YH, Koo B-H. Stress and heart rate variability: a meta-analysis and review of the literature. Psychiatry Invest. 2018;15(3):235. Dragunova S, Samoilova M, Ezhova E. Heart Rate Variability in the Simulation of Sinus Lifting and Dental Implantation in Rats. OTORHINOLARYNGOLOGY, HEAD and NECK PATHOLOGY (ORLHNP).4:30. Veerabhadrappa ST, Vyas AL, Anand S, Das N, editors. Analysis of cardiac dynamics due to local anesthesia during third molar tooth extraction using heart rate variability. 2016 International Conference on Electrical, Electronics, and Optimization Techniques (ICEEOT); 2016 3–5 March 2016. Santana MD, Sousa ACAD, Assis EVd A, LCd, Valenti VE. Changes in heart period during endodontic treatment. Experimental Clin Cardiol. 2014:1–6. Casap N, Alterman M, Sharon G, Samuni Y. The Effect of Informed Consent on Stress Levels Associated With Extraction of Impacted Mandibular Third Molars. J Oral Maxillofac Surg. 2008;66(5):878–81. Shapiro M, Melmed RN, Sgan-Cohen HD, Eli I, Parush S. Behavioural and physiological effect of dental environment sensory adaptation on children’s dental anxiety. Eur J Oral Sci. 2007;115(6):479–83. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6943745\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":486298237,\"identity\":\"214b07c1-1853-4a8a-be95-2498b8792f83\",\"order_by\":0,\"name\":\"Aida Mehdipour\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYFACHgaJBCjzAA+DDQODBIla0ojUgsQ+TFiLbnvvwRsPd9jImTcwPzzwpuZ8Yv/s5oMPGGpsonFpMTtzLtki8UyascwBNoODc47dTpxx51iyAcOxtNwGXFpu5JhJJLYdTpzBwGBwmIftdmIDSISx4TBuLfffwLSwfzjM8+9c4nyCWm7wwLTwGBzmbTuQuIGgljM5xmC/SDDwFByc25dsvPFGWrJBAj6/HD9jePMnMMQkGNg3f3jzzU523o3kgw8+1Njg1AIGjCBZ+QdgtiNYZQI+5XAtUGBPSPEoGAWjYBSMPAAAlxthi8X8PDoAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Qom University of Medical Sciences\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Aida\",\"middleName\":\"\",\"lastName\":\"Mehdipour\",\"suffix\":\"\"},{\"id\":486298239,\"identity\":\"7536388e-be0c-49fe-8f3e-5b6a37ebd211\",\"order_by\":1,\"name\":\"Mohammad Hassan Kalantar Neyestanaki\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Arak University of Medical 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08:38:16\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6943745/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6943745/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":87269028,\"identity\":\"be53bdf1-a3d9-4470-a1f2-c7bf38e259b6\",\"added_by\":\"auto\",\"created_at\":\"2025-07-22 08:13:12\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":17562,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFrankl Behavioral Rating Scale (26)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6943745/v1/95c6087baeaef37804ab2415.png\"},{\"id\":87269033,\"identity\":\"47d5298f-e24f-416f-b4bf-74f4088bde16\",\"added_by\":\"auto\",\"created_at\":\"2025-07-22 08:13:12\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":14092,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eComparison of VAS Changes Based on Children's Behavioral Characteristics (Frankel Scale),\\u003c/p\\u003e\\n\\u003cp\\u003eVAS: Visual Analog Scale.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6943745/v1/4b0626133ffa798fd4d5eb69.png\"},{\"id\":87269029,\"identity\":\"1a298b4c-2b24-4c6d-8d7a-2614df64e12e\",\"added_by\":\"auto\",\"created_at\":\"2025-07-22 08:13:12\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":44016,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eComparison of changes in all GSR variables across the three conditions (rest, cognitive challenge, and post-challenge), based on children's behavioral characteristics (Frankel Scale), GSR: Galvanic Skin Response.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6943745/v1/e992f6b20ef502ce0ffb4b6e.png\"},{\"id\":98615253,\"identity\":\"e481fbb0-09df-481e-86e9-b5c95a8d6cb2\",\"added_by\":\"auto\",\"created_at\":\"2025-12-19 15:10:35\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1745336,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6943745/v1/916a90d9-7491-45e5-8d08-0d97c31fb4d1.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Investigating the Relationship Between Psychophysiological Parameters and Behavioral Patterns in Children aged 7-10 years During Dental Treatment\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eIn pediatric dentistry, dental procedures are often associated with considerable anxiety and stress, particularly among children. This anxiety can reduce treatment quality, cause avoidance behaviors, and lead to more serious oral health issues. Disruptive behavior related to anxiety increases both treatment time and the risk of harm to the child, and surveys reveal that uncooperative children are among the most common challenges in pediatric dental clinics. Recent findings indicate that almost 22% of children may exhibit clear disruptive behavior in a dental setting (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). Dental treatments can provoke autonomic nervous system (ANS) responses, making physiological monitoring especially important in pediatric patients. Given these challenges, there is growing interest in psychophysiological and biofeedback interventions aimed at modulating autonomic activity. The U.S. Food and Drug Administration (FDA) has approved psychophysiological and biofeedback interventions (modulating autonomic activity) for tension reduction, highlighting the potential application of such approaches in pediatric dentistry as well. Current technology has made it possible to assess numerous parameters related to autonomic functions, making the study of these parameters crucial for describing differences in autonomic responses. This concept can lead to more modern therapeutic approaches and help address anxiety-related challenges in this context (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eDespite increased interest, many current approaches to understanding dental anxiety in children remain descriptive and lack physiological objectivity. Studies have shown that anxiety in dental settings is multifactorial and influenced by psychological, environmental, and biological variables (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). Dental treatment anxiety is associated with a range of psychological, physiological, and environmental factors. Psychological factors such as personality traits, past experiences, and misconceptions about dental treatment play significant roles in the onset and severity of anxiety (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). On the other hand, physiological factors like increased heart rate (HR), blood pressure, and stress hormone secretion represent natural bodily responses that intensify during dental treatment (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e). Researchers worldwide use various tools to assess physiological, behavioral, and cognitive responses to fear and anxiety, highlighting the need for optimal management strategies in clinical interactions with anxious patients (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e Studies on both pharmacologic and non-pharmacologic interventions for anxiety relief in patients have shown that reducing anxiety improves oral health, and quality of life and reduces perceived pain. Decreasing stress during dental procedures can improve patient comfort and safety (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e). These factors differ widely between children and adults; those that trigger fear and stress in children are complex, making identification and intervention challenging (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). Psychophysiology is a relatively new field that studies the interaction between psychological and physiological phenomena and explores how the mind and body interact. It is a multidisciplinary science examining the physical basis of mental and psychological events (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e). Certain areas of psychophysiology, particularly those related to autonomic neuroscience (sympathetic and parasympathetic systems), have advanced to the point that established therapeutic modalities, known as biofeedback, have emerged. Currently, specialists are trained to work in these therapeutic areas (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eDental treatment can induce psychophysiological changes that may affect the course of treatment. Some dental procedures can be particularly uncomfortable, leading to significant tension and autonomic changes in individuals. Pain, anxiety, and cardiovascular stress associated with dental treatments can result in acute physical, neurological, and behavioral changes (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). Additionally, individuals with previous negative treatment experiences often respond with higher levels of physiological arousal to perceived threats, driven by conditioned fear mechanisms, compared to those with indirect fears. These physiological responses include muscle tension, HRV parameters changes, Galvanic Skin Response (GSR) reactions, and alterations in brain electrical activity (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e). In pediatric dental sessions, anxiety and pain are generally assessed subjectively. Dentists rely on their subjective judgment based on the child\\u0026rsquo;s verbal and nonverbal cues to make decisions, such as adjusting the anesthetic dosage, pausing treatment, or becalming the patient. This approach may lead to sudden and undesired reactions during dental treatment or result in a negative experience for the child. Therefore, pediatric dental approaches need to shift toward more objective, quantitative, and observable measures. Advances in neuroscience increasingly provide accessible quantitative metrics for assessing patients' mental, emotional, and physical status (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). In a study by Ram\\u0026iacute;rez-Carrasco et al., examining the effects of hypnosis combined with behavioral management techniques on reducing children's anxiety during dental treatment, a slight reduction in HR was observed during hypnosis, although GSR remained unchanged (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). Şimşek et al. observed that rising GSR and HR levels were linked to increased anxiety, especially during tooth extraction (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e). Additionally, Košir et al. reported that dental stimuli elevated HR, while GSR changes depended on the stimulus type, with auditory cues and examinations causing greater effects than visual stimuli (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eHowever, these studies primarily focused on isolated physiological markers and did not examine their relationship with observed behavioral responses in children. Given the high prevalence of dental anxiety in children and its negative impact on treatment outcomes, more comprehensive studies are needed. To date, no study has examined the direct relationship between psychophysiological parameters and children's behavioral patterns during dental treatment. This study aims to fill that gap by investigating how real-time physiological signals correlate with children\\u0026rsquo;s observable behaviors in a clinical dental setting.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eStudy Design and Participants\\u003c/strong\\u003e\\u003cp\\u003eThis cross-sectional analytical study was conducted between July and November 2024 in Qom, Iran. The study protocols were designed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Total sample size was calculated based on the study by Lueken et al. and using Cochran's formula for sample size estimation, with a Type I error rate (alpha) of 5% and a Type II error rate (beta) of 10% (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e). All the children\\u0026rsquo;s legal guardians provided informed consent. forty eligible children, aged 7\\u0026ndash;10, undergoing dental treatment were recruited from a public dental center, Qom (Iran).\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003eInclusion Criteria: Age 7\\u0026ndash;10 years - Indication for dental treatment - Informed consent from parents and the child\\u0026rsquo;s cooperation\\u003c/p\\u003e\\u003cp\\u003eExclusion Criteria: BMI\\u0026thinsp;\\u0026gt;\\u0026thinsp;35 - systemic diseases (e.g., diabetes, heart disease) - Major psychiatric disorders - Developmental disorders - Recent drug usage affecting the ANS (especially corticosteroids within the past week) - Children with intellectual or physical disabilities.\\u003c/p\\u003e\\u003cp\\u003eDemographic and clinical information of participants, including age, gender, previous dental treatment experiences, the type of dental treatment, local anesthesia used, and child behavior patterns were recorded.\\u003c/p\\u003e\\u003cp\\u003e The study was conducted in a relatively quiet dental treatment room at a temperature range of 22\\u0026ndash;27\\u0026deg;C. Each dental session lasted an average of 77.8 minutes. To prevent interference with the psychophysiological measurements, efforts were made to avoid external stimuli, position changes during recordings, and any electrical or mechanical noise. To minimize potential biases from circadian rhythms, treatments were scheduled around noon.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eAssessment of child\\u0026rsquo;s anxiety\\u003c/strong\\u003e\\u003cp\\u003eChildren\\u0026rsquo;s anxiety regarding the dental session was recorded on a 0\\u0026ndash;10 Visual Analogue Scale (VAS). This scale ranges from 0, indicating complete comfort, to 10, representing extreme, almost unbearable discomfort. VAS is a commonly used subjective measurement tool in clinical and psychological research to evaluate pain or discomfort levels in patients. The scale provides an accessible and intuitive measure of emotional response, which is particularly suitable for pediatrics (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eMeasurement of psychophysiological Parameters\\u003c/strong\\u003e\\u003cp\\u003eThe psychophysiological parameters recorded included\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003e- GSR: Electrodermal response indicating galvanic skin response, which reflects sympathetic nervous activity. This parameter is sensitive to emotional arousal and stress, commonly rising with increased anxiety.\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e- Heart Rate Variability (HRV) metrics included: Very Low Frequency (VLF), Low Frequency (LF), High Frequency (HF), Heart Rate (HR), and LF/HF Ratio (Used to assess the balance between sympathetic and parasympathetic nervous activity).\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e- Time-Domain HRV Parameters: SDNN (Root mean square of the interval variance between heartbeats over a specific period. This is one of the most common HRV measures in research and provides a broad assessment of autonomic regulation. However, its independent clinical application requires careful conditions and comprehensive information), and PNN50 (Represents the average number of instances (per hour) where the difference in successive heartbeat intervals exceeds 50 milliseconds, a common HRV parameter).\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\u003cp\\u003eEach parameter was recorded twice\\u0026mdash;before and after the treatment (pre- and post-treatment)\\u0026mdash;and at three different intervals each time, and the mean value was used for analysis: 1. Resting State (Measured while the child lay on the dental chair before any intervention), 2. Cognitive Challenge (The child was asked to count backward from 50, which served as a cognitive stressor in this study), and 3. Post-Challenge (A few minutes after the cognitive challenge while still in the same position). During each recording, two GSR variables were obtained: Peak GSR level and average GSR level (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e). All measurements were conducted using the BioLine system (Medina Teb, Tehran, Iran) with a blood volume pulse (BVP) sensor and a galvanic skin response sensor from the same manufacturer. Psychophysiological parameters were analyzed using Biosees Evo software, which applies complex algorithms to output these metrics in numerical form.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eChild Behavioral Assessment\\u003c/strong\\u003e\\u003cp\\u003eThe Frankl Behavioral Rating Scale was used to categorize the children\\u0026rsquo;s behavior. This scale is widely employed in both clinical and research settings within pediatric dentistry to rate observed behaviors during dental treatment. The Frankl scale categorizes behavior patterns into four levels, from highly cooperative to extremely uncooperative, providing a structured framework for assessing children\\u0026rsquo;s reactions to dental procedures (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e). (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e) Additionally, the dentist provided an experiential rating based on the child's emotional state (happy or unhappy).\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eBias\\u003c/b\\u003e: The risk of bias for the clinical assessment was limited by the clinician\\u0026rsquo;s judgment using valid and reliable methods to assess children\\u0026rsquo;s psychophysiological parameters, pain and discomfort and behavior patterns during dental setting.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eVariables\\u003c/b\\u003e: The main outcomes of the study were psychophysiological parameters included GSR, HRV (VLF, LF, HF and LF/HF ratio), SDNN and PNN50 which were recorded in pre- and post-treatment (at resting state, cognitive challenge and post-challenge). The secondary outcome of the study was VAS score to pain or discomfort level assessment. Secondary variables included demographic data, previous dental treatment experiences, the type of dental treatment and the local anesthesia used.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eStatistical Analysis\\u003c/strong\\u003e\\u003cp\\u003eData analysis was conducted using Biosees Evo software and SPSS version 28.0. A repeated-measures ANOVA was applied to evaluate within-subject differences pre- and post-treatment. For examining relationships between psychophysiological parameters and patient characteristics, a one-way ANOVA was used. P-values less than 0.05 were considered statistically significant. Levene\\u0026rsquo;s test was employed to assess the homogeneity of variances, ensuring that the assumptions for ANOVA were met.\\u003c/p\\u003e\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e shows data on the demographic, clinical history, and behavioral characteristics of the children. A total of eligible 40 children, aged 8\\u0026ndash;10 years (mean age of 8.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.966 years) were evaluated. Among them, 50% were classified in the \\\"positive\\\" category according to the Frankl Behavior Scale, while none fell into the \\\"definitely negative\\\" category.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eDescriptive, behavioral, and clinical characteristics of children.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eParameter\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eCategory\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eFrequency\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ePercentage (%)\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eAge\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e20.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e30.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eGender\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFemale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e22\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e55.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e18\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e45.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMother's education\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSub-diplomas\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e27.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDiplomas\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e70.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eHigher diploma\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eFather's education\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSub-diplomas\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e14\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e35.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDiplomas\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e60.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eHigher diploma\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e5.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePrevious Treatment History\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNegative\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e40.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePositive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e23\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e60.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eFrankl Behavior Scale\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDefinitely Negative\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNegative\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e32.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePositive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e50.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDefinitely positive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e17.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eemotional state\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eUnhappy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e32.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eHappy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e67.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eType of Anesthesia\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eInfiltration\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e37.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eIAN Block\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e62.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eType of Treatment\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eExtraction\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e30.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFilling\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePulpotomy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e30.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFissure Sealant\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e15.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTotal\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e100\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c4\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eIAN Block: Inferior Alveolar Nerve Block.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe children's VAS scores showed a significant increase post-dental treatment compared to pre-treatment, indicating a higher level of discomfort after the session (P\\u0026thinsp;=\\u0026thinsp;0.003). Most of the psychophysiological parameters related to cardiac autonomic function (including VLF (P\\u0026thinsp;=\\u0026thinsp;0.005), LF (P\\u0026thinsp;=\\u0026thinsp;0.014), HF (P\\u0026thinsp;=\\u0026thinsp;0.024), and LF/HF ratio (P\\u0026thinsp;=\\u0026thinsp;0.022)) also displayed significant differences between the pre- and post-treatment measurements. However, parameters such as PNN, SDNN, HR, and all GSR-related measures across the three conditions (rest, cognitive challenge, and post-challenge) did not exhibit significant changes (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eAnalysis of psychophysiological Parameters in Children Pre- and Post-Treatment.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eParameter\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eCondition\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMean\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eSD\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eVAS\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e2.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.003\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.52\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.51\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMean GSR (Rest)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.38\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.84\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.321\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.22\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.82\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePeak GSR (Rest)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.77\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.690\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.69\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.04\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMean GSR (Cognitive challenge)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.98\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.285\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.62\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.93\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePeak GSR (Cognitive challenge)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.41\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.34\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.299\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.17\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMean GSR (Post-challenge)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.52\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.783\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.601\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.44\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e.962\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePeak GSR (Post-challenge)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.162\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.89\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.28\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eVLF\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e13.97\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e3.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.005\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e15.66\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e3.69\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eLF\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e26.15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e6.55\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.014\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e29.52\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e5.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eHF\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e60.28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e8.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.024\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e57.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e6.18\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eLF/HF Ratio\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.44\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.022\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.51\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.14\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePNN\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e84.45\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e3.66\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.463\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e85.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e4.08\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSDNN\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e234.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e36.59\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.424\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e240.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e31.34\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eHR\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epre-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e72.28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e6.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003e0.656\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003epost-treatment\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e72.78\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e3.77\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eVAS: Visual Analog Scale, GSR: Galvanic\\u0026nbsp;Skin Response, VLF: Very Low Frequency, LF: Low Frequency, HF: High Frequency, LF/HF: Ratio of Low Frequency to High Frequency, PNN: Percentage of Differences Between Normal to Normal Intervals, SDNN: Standard Deviation of Normal to Normal Intervals, HR: Heart Rate.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e shows VAS changes and changes of all GSR variables in the three conditions (rest, cognitive challenge, and post-challenge) were significantly correlated with the children\\u0026rsquo;s behavioral types. Results indicate that changes in VAS were significantly higher in children classified in the negative Frankl category (P\\u0026thinsp;=\\u0026thinsp;0.001), with a non-significant increase in post-treatment VAS scores. Although an increase in VAS following treatment was also observed in the positive Frankl group, it was less than in the negative group. Children in the \\\"definitely positive\\\" Frankl category showed a decrease in VAS scores post-treatment, rather than an increase (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eVAS: Visual Analog Scale.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eAnalysis of psychophysiological changes during treatment based on children's behavioral characteristics (Frankel scale).\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"8\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eParameter\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFrankl Scale\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMean\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eSD\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eMin\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eMax\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eVAS\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNegative\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.54\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.85\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.82\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e4.32\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003e0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePositive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.75\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.21\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e3.24\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDefinitely positive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.72\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.69\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" 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colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDefinitely positive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.72\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.45\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-3.27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.42\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePeak GSR (Rest)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNegative\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" 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morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003e0.011\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePositive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.35\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.68\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.71\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e2.47\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDefinitely positive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" 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rowspan=\\\"3\\\"\\u003e\\u003cp\\u003e0.175\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePositive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.70\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e5.85\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-15.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e7.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDefinitely positive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e4.92\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-9.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e6.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSDNN\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNegative\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e24.30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e56.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-26.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e193.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003e0.141\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePositive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.55\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e31.93\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-57.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e60.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDefinitely positive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-14.14\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e46.03\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-60.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e54.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eHR\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNegative\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.26\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e9.62\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-11.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e24.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e\\u003cp\\u003e0.881\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePositive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e5.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-8.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e19.40\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDefinitely positive\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.31\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e5.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-8.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e5.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c8\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eVAS: Visual Analog Scale, GSR: Galvanic\\u0026nbsp;Skin Response, VLF: Very Low Frequency, LF: Low Frequency, HF: High Frequency, LF/HF: Ratio of Low Frequency to High Frequency, PNN: Percentage of Differences Between Normal to Normal Intervals, SDNN: Standard Deviation of Normal to Normal Intervals, HR: Heart Rate.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eFurthermore, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e illustrates the pre- and post-treatment changes in GSR across various conditions for children grouped according to the Frankl Scale. The analysis revealed that children in the positive Frankl category experienced significant positive changes in GSR across various conditions. Conversely, in the negative and definitely positive groups, GSR changes were negative (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e shows the relationship between psychophysiological parameters and various demographic and clinical variables. VLF showed a significant correlation with the type of dental treatment, with the highest VLF values observed during dental filling procedures and the lowest during fissure sealant treatments (P\\u0026thinsp;=\\u0026thinsp;0.015, r\\u0026thinsp;=\\u0026thinsp;4.36). However, there were no significant differences in psychophysiological parameters based on age, gender, emotional state, and previous dental experience (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eRelationship Between Psychophysiological Changes during Treatment and Demographic Variables.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"12\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" morerows=\\\"1\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003eParameter\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u003cp\\u003eGender\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003eemotional state\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003eType of Anesthesia\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c12\\\" namest=\\\"c9\\\"\\u003e\\u003cp\\u003eType of Treatment\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eFemale\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eUnhappy\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eHappy\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eInfiltration\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003eIAN Block\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003eExtraction\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003eFilling\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003ePulpotomy\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003eFissure Sealant\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMean GSR (Rest)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e22\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e18\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMean\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-0.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.23\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.62\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-0.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-0.10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-0.29\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.02\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e-0.03\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-0.47\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.86\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.71\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.61\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.84\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0.92\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e1.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e1.15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e0.94\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u003cp\\u003e0.690\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e0.642\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e0.654\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c12\\\" namest=\\\"c9\\\"\\u003e\\u003cp\\u003e0.745\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePeak GSR (Rest)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e22\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e18\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMean\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-0.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.77\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-0.21\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-0.01\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-0.19\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-0.02\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-0.63\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.39\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.93\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.37\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e1.09\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.62\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1.24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e1.41\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e1.29\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e1.55\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u003cp\\u003e0.865\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e0.604\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e0.639\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c12\\\" namest=\\\"c9\\\"\\u003e\\u003cp\\u003e0.627\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMean GSR (Cognitive challenge)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e22\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e18\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMean\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-0.03\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.39\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.74\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.08\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-0.40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-0.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-0.40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e0.03\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.01\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-0.53\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.37\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.96\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e1.19\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e1.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1.36\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e1.03\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.72\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e1.36\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u003cp\\u003e0.310\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e0.828\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e0.355\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c12\\\" namest=\\\"c9\\\"\\u003e\\u003cp\\u003e0.638\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePeak GSR (Cognitive challenge)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e22\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e18\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMean\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-0.18\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.33\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-1.08\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-0.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-0.09\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e-0.43\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-0.11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.06\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-0.72\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.01\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.92\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.64\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.21\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0.95\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.69\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1.93\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e1.42\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.88\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e1.63\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u003cp\\u003e0.751\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e0.499\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e0.401\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c12\\\" namest=\\\"c9\\\"\\u003e\\u003cp\\u003e0.717\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMean GSR (Post-challenge)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eN\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e22\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" 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colname=\\\"c3\\\"\\u003e\\u003cp\\u003e22\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e18\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMean\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.71\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.66\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e2.45\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.32\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e1.79\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e1.63\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e2.01\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e4.36\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.02\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-0.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3.01\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e4.28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e3.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e3.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e2.90\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" 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colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.44\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e1.27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e-2.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e3.00\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-1.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" 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colname=\\\"c8\\\"\\u003e\\u003cp\\u003e28.60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e58.53\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e39.11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e27.05\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e40.88\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u003cp\\u003e0.526\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e0.678\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" 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colname=\\\"c7\\\"\\u003e\\u003cp\\u003e15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMean\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-1.40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.81\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.26\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e1.89\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e-0.34\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1.40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e2.54\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e0.18\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e-4.07\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5.63\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e7.96\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e9.62\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e5.54\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e4.28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e5.12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e9.38\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cp\\u003e7.90\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u003cp\\u003e3.91\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cp\\u003e2.93\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eP value\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e\\u003cp\\u003e0.058\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cp\\u003e0.066\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e0.339\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c12\\\" namest=\\\"c9\\\"\\u003e\\u003cp\\u003e0.315\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"12\\\" nameend=\\\"c12\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eVAS: Visual Analog Scale, GSR: Galvanic\\u0026nbsp;Skin Response, VLF: Very Low Frequency, LF: Low Frequency, HF: High Frequency, LF/HF: Ratio of Low Frequency to High Frequency, PNN: Percentage of Differences Between Normal to Normal Intervals, SDNN: Standard Deviation of Normal to Normal Intervals, HR: Heart Rate, IAN Block: Inferior Alveolar Nerve Block.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eDental anxiety and fear are common among patients, often causing stress during dental procedures. Psychophysiological parameters provide valuable insights into anxiety, pain, and stress levels, enabling dentists to optimize treatment approaches and improve patient experiences. VAS is a simple and reliable tool for assessing pain and anxiety in children during dental treatments, where higher scores indicate greater discomfort and pain (\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). In the present study, VAS scores significantly increased during dental treatment. Additionally, there was a significant difference in VAS score changes during treatment across different behavioral categories based on the Frankl Scale. Children in the \\\"Definitely Positive\\\" group exhibited a reduction in VAS scores during dental treatment, suggesting a decrease in their stress levels. Conversely, children in the \\\"Negative\\\" group showed the greatest increase in VAS scores, indicating a higher level of discomfort during treatment. VAS scores also increased in the \\\"Positive\\\" behavioral group. Findings from Alshatrat et al. (2022) similarly indicated that VAS scores increase in children undergoing painful dental procedures requiring local anesthesia, but the use of virtual reality distraction techniques can significantly reduce pain intensity during treatment. However, children who underwent non-painful procedures, such as fluoride therapy, showed no significant change in VAS scores (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e). In a study by Dogan et al. (2013) comparing VAS scores in children with hemophilia and healthy children, both groups showed an increase in VAS scores during treatment, however, there was no significant difference between them (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e). Additionally, Yee et al. (2017) explored the use of the electronic Self-Assessment of Anxiety and Information for Dentists (eSAID) system, which allows children to communicate their feelings and preferences to dentists. Their findings demonstrated a significant reduction in VAS scores among children using eSAID during treatment, while VAS scores increased in the control group (\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). In contrast, Jalili et al. (2019) observed no significant difference in children's perceived pain during local anesthesia between the first and second sessions, as measured by VAS scores (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003ePsychophysiological data collection methods offer the capability for quantitative assessment of anxiety levels, providing an objective metric for patient arousal and stress during dental treatment. GSR, as a key psychophysiological parameter, indirectly reflects ANS activity and is thus widely used to evaluate arousal and stress. GSR is primarily influenced by sweat gland activity, which involves both eccrine and apocrine glands. Eccrine glands, dispersed across the body, are controlled by the sympathetic nervous system. Under stress, the sympathetic system activates, releasing norepinephrine and epinephrine, which stimulate the sweat glands. This triggers ion channels in the glands, allowing sodium and chloride ions to be released, attracting water and producing sweat, which in turn increases GSR in stressful or painful situations (\\u003cspan additionalcitationids=\\\"CR33\\\" citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e). The present study found no significant difference in GSR parameters pre- and post-treatment; however, significant differences were observed among different behavioral groups based on the Frankl Scale. Notably, the GSR changes in the \\\"Definitely Positive\\\" group showed a decrease, aligning with a decrease in VAS scores, indicating lower discomfort and stress during treatment. Interestingly, the \\\"Negative\\\" group also showed a decrease in GSR, despite their high VAS scores and visibly negative behavior during treatment. This unexpected finding suggests that, although these children display behaviors associated with fear and stress, they may require a different intervention approach than anticipated. Barlow's research indicates that decreased GSR can have two interpretations: a slight reduction below normal levels reflects lower stress, while a significant drop may indicate either reduced stress or extreme stress leading to sympathetic system shutdown. The clinical context determines the explanation (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). In the \\\"Positive\\\" group, GSR increased, corresponding to their elevated VAS scores. In this study, no significant associations were found between GSR parameters and other demographic or clinical characteristics. Şimşek et al. (2021) reported that increases in GSR and HR correlated with heightened anxiety levels as dental procedures progressed, particularly during tooth extraction. They also found a significant relationship between GSR and age, although there was no significant correlation with other demographic factors such as education level or gender (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e). Najafpour et al. (2017) similarly found that GSR was significantly correlated with dental anxiety levels in children aged 5 to 7, supporting its reliability as a clinical measure of dental anxiety in pediatric patients (\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e). Ram\\u0026iacute;rez-Carrasco et al. (2017) explored the use of hypnosis combined with behavioral management techniques to reduce anxiety during infiltration injections in children. They measured anxiety using the FLACC scale and recorded both HR and GSR before and after anesthesia. While HR slightly decreased during hypnosis, GSR remained unchanged (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). Lueken et al. (2011) concluded that GSR only changed in response to dental-specific stimuli and not to non-dental video stimuli, highlighting GSR's sensitivity to treatment-specific stressors (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e). Finally, Caprara et al. (2003) demonstrated a significant relationship between dental stress and GSR, showing an increase in GSR during treatment, particularly with anxiety related to injections, which was reported as the most stress-inducing aspect of dental procedures (\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eAnother essential category of psychophysiological parameters is related to cardiac function, which is influenced by both branches of the ANS: the sympathetic and parasympathetic systems. These systems affect the heart via the sinoatrial (SA) node, where they exert opposing effects. During stress, the sympathetic nervous system releases neurotransmitters norepinephrine and epinephrine, increasing the automatic depolarization rate of SA node cells, which raises HR, contractility, and conduction. In contrast, the parasympathetic nervous system, dominant during rest, releases acetylcholine, which counteracts sympathetic effects on the heart (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e). Specific cardiac measures are tied to the different branches of the ANS: VLF and LF components are typically associated with sympathetic activity and increase under stress, whereas HF is linked to parasympathetic activity and tends to be decreased with stress and pain. The LF/HF ratio reflects the balance between sympathetic and parasympathetic activity, with an increased ratio indicating sympathetic dominance and elevated stress levels (\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e). In the current study, we observed significant differences in VLF, LF, HF, and the LF/HF ratio before and after dental treatment. Specifically, during treatment, there was an increase in VLF, LF, and the LF/HF ratio, alongside a decrease in HF, all indicative of heightened stress and discomfort in children undergoing dental procedures. However, no significant pre- and post-treatment differences were found in other cardiac parameters, such as PNN, SDNN, and HR, nor were there any significant differences across different behavioral groups categorized by the Frankl Scale. Additionally, among demographic and clinical variables, only the type of treatment correlated significantly with VLF changes. Tooth filling induced the greatest VLF changes, suggesting that it was the most stress-inducing for children, followed by extraction and pulpectomy.\\u003c/p\\u003e\\u003cp\\u003eResearch by Dragunova et al. (2023) on rats demonstrated that dental procedures involving implants and sinus lifts induced significant activation of the sympathetic branch of the ANS, as shown by an increase in the LF component two days post-operation, reflecting heightened stress response (\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e). Košir et al. (2021) found that dental-related stimuli resulted in increased HR. However, GSR levels varied depending on the type of stimulus, with auditory stimuli and dental examinations producing more pronounced changes than visual stimuli alone (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e). Veerabhadrappa et al. (2016) observed that anxiety associated with local anesthesia injections during dental treatments led to an increase in the LF and LF/HF ratio and a decrease in other HRV parameters, such as HF, reflecting increased sympathetic activity and reduced parasympathetic activity during high-stress dental procedures (\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e). Santana et al. (2014) assessed HRV across time (SDNN, RMSSD, pNN50) and frequency domains (LF, HF, and LF/HF ratio) during four intervals of root canal treatment: T1 (10 minutes before), T2 (10 minutes post-anesthesia), T3 (during treatment), and T4 (30 minutes post-treatment). Results showed increased SDNN, RMSSD, and pNN50 in T2 relative to T1. Additionally, LF increased in T4 compared to T2, while HF decreased, and the LF/HF ratio in T4 was significantly higher than in T2, indicating elevated sympathetic activation post-treatment (\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e). Casap et al. (2008) found that detailed informed consent for third molar extractions led to increased electrodermal activity (EDA) and HR, suggesting that extensive preoperative disclosure can heighten patient stress levels (\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e). In another study, Shapiro et al. (2007) reported significant improvement in both behavioral and psychophysiological relaxation measures when patients were treated in a sensory-adapted dental environment (SDE) compared to a standard dental setting, indicating that modifications in the treatment environment can play a crucial role in stress reduction (\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eOur findings were based on a relatively small number of participants due to the ethical considerations and lack of cooperation of children in the use of measuring instruments. Further elucidation about psychophysiological parameters in children during dental procedure needs to be investigated.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThis study showed that children\\u0026rsquo;s behaviors during dental treatment are closely associated with some psychophysiological parameters, with the strongest correlation observed in GSR as a primary indicator of sympathetic nervous system activity. These findings highlight GSR as a probable valuable measure for assessing and managing anxiety in pediatric dentistry. Additionally, this study reveals the sensitivity of cardiac parameters to dental treatment. Further research in clinical neuroscience and behavioral prediction could enhance our understanding of pediatric dental anxiety, supporting the development of improved treatment protocols and fostering a more positive dental experience.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthical Considerations: \\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was conducted in accordance with the principles outlined in the Declaration of Helsinki and received ethical approval from the Qom University of Medical Sciences (IR.MUQ.REC.1402.242). Participation was entirely voluntary, with no costs or penalties for withdrawal. Informed consent was obtained from both the children (verbally) and their parents (written consent), ensuring awareness and understanding of the study\\u0026rsquo;s purpose and procedures.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for Publication:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor Contributions:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cul\\u003e\\n\\u003cli\\u003e\\u003cstrong\\u003eA.M.\\u0026nbsp;\\u003c/strong\\u003econceived the idea.\\u003c/li\\u003e\\n\\u003cli\\u003e\\u003cstrong\\u003eA.M.,\\u0026nbsp;A.A., \\u003c/strong\\u003eand\\u003cstrong\\u003e\\u0026nbsp;M.Z.\\u0026nbsp;\\u003c/strong\\u003edesigned the study.\\u003c/li\\u003e\\n\\u003cli\\u003e\\u003cstrong\\u003eA.M.,\\u0026nbsp;M.H.K.N.,\\u0026nbsp;M.Z., \\u003c/strong\\u003eand\\u003cstrong\\u003e\\u0026nbsp;M.A.\\u0026nbsp;\\u003c/strong\\u003ecollected the data.\\u003c/li\\u003e\\n\\u003cli\\u003e\\u003cstrong\\u003eA.M.,\\u0026nbsp;M.H.K.N.,\\u0026nbsp;M.A., \\u003c/strong\\u003eand\\u003cstrong\\u003e\\u0026nbsp;M.Z.\\u0026nbsp;\\u003c/strong\\u003eanalyzed the data.\\u003c/li\\u003e\\n\\u003cli\\u003e\\u003cstrong\\u003eA.M.,\\u0026nbsp;M.H.K.N.,\\u0026nbsp;M.Z.,\\u0026nbsp;M.H.N., \\u003c/strong\\u003eand\\u003cstrong\\u003e\\u0026nbsp;A.A.\\u0026nbsp;\\u003c/strong\\u003eprepared the manuscript.\\u003c/li\\u003e\\n\\u003cli\\u003e\\u003cstrong\\u003eA.M.,\\u0026nbsp;M.H.K.N.,\\u0026nbsp;M.Z.,\\u0026nbsp;M.A.,\\u0026nbsp;A.S.,\\u0026nbsp;M.H.N., \\u003c/strong\\u003eand\\u003cstrong\\u003e\\u0026nbsp;A.A.\\u0026nbsp;\\u003c/strong\\u003ereviewed the manuscript.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of Data and Materials: \\u003c/strong\\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting Interests: \\u003c/strong\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding: \\u003c/strong\\u003eThis research received no specific grant from any funding agency.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments: \\u003c/strong\\u003eNone.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical trial number:\\u003c/strong\\u003e not applicable\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eBarlow DH, Durand VM, Hofmann SG. 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Clin Child Fam Psychol Rev. 2020;23(2):205\\u0026ndash;28.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eGarrett-Ruffin S, Hindash AC, Kaczkurkin AN, Mears RP, Morales S, Paul K, et al. Open science in psychophysiology: An overview of challenges and emerging solutions. Int J Psychophysiol. 2021;162:69\\u0026ndash;78.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKhazan I. Mindfulness-and acceptance-based biofeedback. Biofeedback. 2015;43(3):104\\u0026ndash;10.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003ePeifer C, Tan J. The psychophysiology of flow experience. Advances in flow research. Springer; 2021. pp. 191\\u0026ndash;230.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLundgren J, Berggren U, Carlsson SG. Psychophysiological reactions in dental phobic patients with direct vs. indirect fear acquisition. J Behav Ther Exp Psychiatry. 2004;35(1):3\\u0026ndash;12.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMehdipour A, Fateh R, Fuladvand F, Aghaali M, Keykha E, Hadilou M. Association between sleep pattern, salivary cariogenic bacteria and fungi populations, pH and buffering capacity in children: A comparative study. Dent Med Probl. 2024;61(2):217\\u0026ndash;24.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKalra N, Sabherwal P, Tyagi R, Khatri A, Srivastava S. Relationship between subjective and objective measures of anticipatory anxiety prior to extraction procedures in 8- to 12-year-old children. J Dent Anesth Pain Med. 2021;21(2):119\\u0026ndash;28.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eJimeno F, Bielsa S, Ndez C, Rodr\\u0026iacute;guez A, Mercad\\u0026eacute; M. Objective and subjective measures for assessing anxiety in paediatric dental patients. Eur J Pediatr dentistry: official J Eur Acad Pediatr Dentistry. 2011;12:239\\u0026ndash;44.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRam\\u0026iacute;rez-Carrasco A, Butr\\u0026oacute;n-T\\u0026eacute;llez Gir\\u0026oacute;n C, Sanchez-Armass O, Pierdant-P\\u0026eacute;rez M. Effectiveness of Hypnosis in Combination with Conventional Techniques of Behavior Management in Anxiety/Pain Reduction during Dental Anesthetic Infiltration. Pain Res Manag. 2017;2017:1434015.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eŞimşek HO, Aytekin BA. Can Dental Anxiety During Impacted Third Molar Surgery Be Measured Biometrically? Clinical Study with the Galvanic Skin Response Technique. Meandros Med Dent J. 2021;22(1):18.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKošir T, Sajovic J, Grošelj M, Fidler A, Drevenšek G, Selič-Zupančič P. Real-life dental examination elicits physiological responses different to visual and auditory dental-related stimuli. PLoS ONE. 2021;16(6):e0252128.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eNanjundeswaraswamy T, Divakar S. Determination of sample size and sampling methods in applied research. Proceedings on engineering sciences. 2021;3(1):25\\u0026ndash;32.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLueken U, Hoyer J, Siegert J, Gloster AT, Wittchen HU. Symptom provocation in dental anxiety using cross-phobic video stimulation. Eur J Oral Sci. 2011;119(1):61\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLuyk NH, Beck FM, Weaver JM. A visual analogue scale in the assessment of dental anxiety. Anesth Prog. 1988;35(3):121\\u0026ndash;3.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMindfulness. and Acceptance Approach to Biofeedback. The Clinical Handbook of Biofeedback2013. pp. 1\\u0026ndash;23.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eShinohara S, Nomura Y, Shingyouchi K, Takase A, Ide M, Moriyasu K, et al. Structural relationship of child behavior and its evaluation during dental treatment. J Oral Sci. 2005;47(2):91\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eFacco E, Zanette G, Favero L, Bacci C, Sivolella S, Cavallin F, et al. Toward the validation of visual analogue scale for anxiety. Anesth Prog. 2011;58(1):8\\u0026ndash;13.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAlshatrat SM, Sabarini JM, Hammouri HM, Al-Bakri IA, Al‐Omari WM. Effect of immersive virtual reality on pain in different dental procedures in children: A pilot study. Int J Pediatr Dent. 2022;32(2):264\\u0026ndash;72.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDogan M, Yazicioglu I, Antmen B. Anxiety and pain during dental treatment among children with haemophilia. Eur J Paediatr Dent. 2013;14(4):284\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eYee R, Jones L, Hosey M. What the child SAID to the dentist: A UK randomized controlled trial. Child Care Health Dev. 2017;43(6):926\\u0026ndash;32.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eJalali F, Shojaeepour S, Shojaiepour R. Comparison of Two Standard Scales for Pain Perception during Local Anesthetic Injection in Children. J Iran Dent Association. 2020;32(1):37\\u0026ndash;42.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMackersie CL, Calderon-Moultrie N. Autonomic nervous system reactivity during speech repetition tasks: Heart rate variability and skin conductance. Ear Hear. 2016;37:S118\\u0026ndash;25.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAndrianome S, Gobert J, Hugueville L, St\\u0026eacute;phan-Blanchard E, Telliez F, Selmaoui B. An assessment of the autonomic nervous system in the electrohypersensitive population: a heart rate variability and skin conductance study. J Appl Physiol. 2017;123(5):1055\\u0026ndash;62.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eNovak P. Electrochemical skin conductance: a systematic review. Clin Auton Res. 2019;29:17\\u0026ndash;29.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eNajafpour E, Asl-Aminabadi N, Nuroloyuni S, Jamali Z, Shirazi S. Can galvanic skin conductance be used as an objective indicator of children\\u0026rsquo;s anxiety in the dental setting? J Clin experimental dentistry. 2017;9(3):e377.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCaprara HJ, Eleazer PD, Barfield RD, Chavers S. Objective Measurement of Patient\\u0026rsquo;s Dental Anxiety by Galvanic Skin Reaction. J Endod. 2003;29(8):493\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eShen MJ. The cardiac autonomic nervous system: an introduction. Herzschrittmachertherapie + Elektrophysiologie. 2021;32(3):295\\u0026ndash;301.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKim H-G, Cheon E-J, Bai D-S, Lee YH, Koo B-H. Stress and heart rate variability: a meta-analysis and review of the literature. Psychiatry Invest. 2018;15(3):235.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDragunova S, Samoilova M, Ezhova E. Heart Rate Variability in the Simulation of Sinus Lifting and Dental Implantation in Rats. OTORHINOLARYNGOLOGY, HEAD and NECK PATHOLOGY (ORLHNP).4:30.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eVeerabhadrappa ST, Vyas AL, Anand S, Das N, editors. Analysis of cardiac dynamics due to local anesthesia during third molar tooth extraction using heart rate variability. 2016 International Conference on Electrical, Electronics, and Optimization Techniques (ICEEOT); 2016 3\\u0026ndash;5 March 2016.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSantana MD, Sousa ACAD, Assis EVd A, LCd, Valenti VE. Changes in heart period during endodontic treatment. Experimental Clin Cardiol. 2014:1\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCasap N, Alterman M, Sharon G, Samuni Y. The Effect of Informed Consent on Stress Levels Associated With Extraction of Impacted Mandibular Third Molars. J Oral Maxillofac Surg. 2008;66(5):878\\u0026ndash;81.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eShapiro M, Melmed RN, Sgan-Cohen HD, Eli I, Parush S. Behavioural and physiological effect of dental environment sensory adaptation on children\\u0026rsquo;s dental anxiety. Eur J Oral Sci. 2007;115(6):479\\u0026ndash;83.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Behavioral Symptoms, Dental Anxiety, Psychophysiology, Galvanic Skin Response, Pediatric Dentistry\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6943745/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6943745/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003eDental procedures elicit anxiety which can hinder treatment quality. Psychophysiology science provides insights into anxiety in behavior management by measuring autonomic indicators. This study examined the relationship between psychophysiological parameters and behavioral patterns in children during dental treatments.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eThis cross-sectional descriptive analytical study was conducted on 40 eligible children receiving dental treatment. Demographic information, clinical history, Visual Analog Scale (VAS), dental treatment type and local anesthesia were recorded. Galvanic Skin Response (GSR) and heart rate variability (HRV) metrics were assessed. Child behaviors were measured using the Frankl Scale. Data were analyzed using repeated-measures ANOVA and one-way ANOVA. The significance threshold was set at a p-value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003ePost-treatment VAS scores were significantly higher (P\\u0026thinsp;=\\u0026thinsp;0.003). HRV metrics, including Very Low Frequency (VLF) (P\\u0026thinsp;=\\u0026thinsp;0.005), Low Frequency (LF) (P\\u0026thinsp;=\\u0026thinsp;0.014), High Frequency (HF) (P\\u0026thinsp;=\\u0026thinsp;0.024), and LF/HF ratio (P\\u0026thinsp;=\\u0026thinsp;0.022) exhibited significant changes after treatment. The Frankl 2 group demonstrated the largest increases in VAS scores (P\\u0026thinsp;=\\u0026thinsp;0.001). The Frankl 3 group exhibited a significant positive GSR shift, while the Frankl 2 group showed a significant negative GSR shift (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Among clinical factors, VLF was significantly correlated with treatment type, particularly in cases involving dental fillings (P\\u0026thinsp;=\\u0026thinsp;0.015, r\\u0026thinsp;=\\u0026thinsp;4.36).\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e\\u003cp\\u003eGSR are associated with child behavior during dental setting.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Investigating the Relationship Between Psychophysiological Parameters and Behavioral Patterns in Children aged 7-10 years During Dental Treatment\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-07-22 08:13:07\",\"doi\":\"10.21203/rs.3.rs-6943745/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"0dd99fe8-b025-4f2c-babb-c4aa6019060f\",\"owner\":[],\"postedDate\":\"July 22nd, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-01-30T07:53:04+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-07-22 08:13:07\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6943745\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6943745\",\"identity\":\"rs-6943745\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}