## 4 Discussion  
Anxious dental patients are arduous to treat, need more time, and have behavioral issues which lead to a stressful and unpleasant experience for them and the treatment provider [12; 41]. The current experiment delivers evidence to support the hypothesis that auditory distraction and brief relaxation therapy are effective in reducing anxiety among patients undergoing dental extractions. However, between the two interventions, brief relaxation therapy had better outcomes when compared to the control group. This is in accordance with a similar study carried out earlier; wherein brief relaxation therapy was shown to be more effective in reducing the anxiety level of patients when compared to musical distraction and control groups [37]. Because the current study presents the findings for patients undergoing tooth extraction, in contrast to tooth restoration in the previous study [37], it is evident that brief relaxation therapy is applicable for simple and complex dental treatments. Most earlier experimental studies assessed the anxiety level of the patients after the dental treatments were performed and compared it to the baseline readings [30; 31; 32; 37]. This type of approach has two issues. First, any treatment provider intends to have a less anxious patient on a dental chair before the dental treatment is provided and therefore the effectiveness of an intervention to reduce the level of anxiety should be measured before the dental treatment and not after. Second, it is obvious that the patient will be less anxious after the dental treatment is completed because the dental treatment is the anxiety-provoking stimulus. Thus, this may have led to biased results in the earlier investigations. In the current study, the level of anxiety was measured before and after the intervention, and before the dental treatment. This design allowed us to measure the effectiveness of auditory distraction and brief relaxation therapy in reducing anxiety more accurately. Moreover, the current study showed that patients in the control group i.e., those not receiving any intervention, had a higher level of anxiety just before dental treatment (mean = 17; SD = 3.21) in comparison to their level at baseline (mean = 16; SD = 3.32). Thus, the current study provides a more accurate measurement of the effectiveness of the interventions compared to the earlier investigations. The finding that brief relaxation therapy is more effective in reducing anxiety in comparison to auditory/musical distraction is confirmed by the current study and an earlier report [37]. This can be attributed to the functional characteristics of the former therapy. It is suggested that '_brief relaxation is a euphemism for hypnosis_' and is a progressive relaxation \begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Group** & **N** & **Mean Rank** & **Mean (SD)** & **Mean Difference (95\% CI)** & \(p\)**-Value** \\ \hline Brief Relaxation & 32 & 35.88 & 22.88 (7.21) & 2.87 (\(-\)0.52, 6.27) & 0.14 \\ Audible distraction & 32 & 29.13 & 20.00 (6.34) & & \\ \hline Brief Relaxation & 32 & 33.13 & 22.88 (7.21) & 5.87 (2.58, 9.17) & 0.001  \\ Control group & 22 & 19.32 & 17.00 (3.21) & & \\ \hline Audible Distraction & 32 & 30.06 & 20.00 (6.34) & & \\ Control group & 22 & 23.77 & 17.00 (3.21) & 3.0 (0.05, 5.95) & 0.15 \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Series of comparisons to demonstrate the effectiveness of brief relaxation therapy and audible distraction in reducing anxiety levels. hypnotic technique [42]. Moreover, it is plausible that the interaction between the treatment provider and the patient during the therapy and the use of sentences such as _'you do not need to worry...'_ (Step 7; see in the Section 2) may have enhanced treatment acceptability in the patients by exhibiting the dentist's compassion for the patient, thereby reducing their anxiety. This, however, should be further established using qualitative analysis.