Saavadrea and Silverman (button phobia)

phobias

the irrational fear of an object or event that posses little to no danger

classical conditioning

a learning process where a neutral stimulus becomes associated with a naturally occurring stimulus, ultimately triggering a conditioned response

evaluative learning

the change in a person's affective evaluation (liking or disliking) of a neutral stimulus after it is associated with a positive or negative stimulus

→ a neutral stimulus becomes negatively evaluated, leading to disgust rather than fear

operant learning

a learning process where voluntary behaviours are modified by their consequences: reinforcement increase the behaviour, punishment decrease the behaviour

expectancy learning

a neutral stimulus becomes associated with a threatening outcome → the individual develops a fear response to the stimulus

background (4)

• phobias are diagnosed by psychiatrists & clinical psychologists using the manual DSM-5

• semi-structured interview were used to diagnose the phobia, including assessing the severity & duration of symptoms

• previous researchs:

  • targeting disgust can help adults with blood-injury phobias

  • fear reduction also lessen disgust in spider-phobic children

aims

To investigate how classical conditioning can be used to treat a child’s phobia by targeting disgust and fear responses

research method

case study

data collection techniques

• interviews

• various scales

• observations

→ data collected before, during & after therapy & at 6 & 12 months follow-ups

feeling’s thermometer

• measures button-related fears on a scale from 0 (minimal distress) to 8 (maximum distress).

• Large denim buttons were the least distressing, while small, clear plastic buttons were the highest distress.

sample (4)

• 9 yo boy

• hispanic-american

• has no other disorders (OCD was ruled out)

• opportunity sample

interview & observation

• semi-structured interview & observation of therapy session

→ notes were made about approach/avoidance of buttons

procedure: assessment of phobia (3)

• the DSM-IV was used to confirm the boy’s phobia diagnosis using a semi-structured interview

• feeling’s thermometer was used to assess symptoms severity

• possible triggers of the phobia were explored to inform treatment

procedure: behavioural exposure (4)

• four 50-min sessions (20-min with mother)

• based on the boy’s hierarchy of distress, starting with less upsetting buttons (large denim) and moving gradually to more distressing ones (small, clear)

• the boy was psoitively reinforced for tolerating/touching the buttons by his mother

• aimed to reduce his avoidance behaviour by making the exposure manageable and gradual.

procedure: imagery exposure (5)

• seven sessions

• the boy were asked to imagined and described the look, smell and feel of buttons

• used cognitive restructuring to challenge his negative thoughts about buttons

• helped him explore why he thought buttons were disgusting and replace these ideas with less negative ones.

• sessions were designed to become gradually more challenging.

procedure: 6 months and 12 months follow ups

distress level and ability to handle buttons were measured by feeling’s thermometer & interviews

ethical issues (5)

• Informed consent was taken from the mother and the boy

• confidentiality of the boy was kept

• protection from harm: the sessions start with least distressing scenario & the boy received positive reinforcement from his mother

• therapeutic context

• follow-ups to check on the boy

results: cause of phobia (4)

• he tipped a bowl of buttons when he was 5 yo; this happened in front of the class

• afterwards, the boy:

  • unable to touch/handle buttons (dress & undress)

  • poor concentration at school due to the buttons on uniform

  • avoid clothes w buttons & ppl w buttons on their clothing

results: exposure therapy (behavioural exposure) [4]

• positive results

  • the boy worked through al the situations in the disgust hierarchy

  • he handled more buttons in each exposure sessions

• negative results

  • feelings thermometer distress reatings increased

  • some situations from disgust hierarchy received higher rating than before

results: imagery exposure [2]

distress rating on the feeling’s thermometer decreased:

• situation: imagine hundreds of buttons falling on him

→ rating went from 8 → 5 → 3

• situation: hugging his mother w a shirt full of buttons

→ rating went from 7 → 4 → 3

results: follow up sessions [2]

• buttons no longer triggered distress

• school uniform w small clear plastic buttons was worn daily w/o issues

conclusions [2]

childhood disgust-based phobias:

→ can be explained using evaluative learning

→ may require imagery exposure + cognitive restructuring + exposure therapy

strengths [4]

• high ecological validity: therapeutic settings

• case study → detailed data collected

• validity: both qualitative & quantitative data collected

• validity: follow up sessions shows the long-term effects of the treatment

weaknesses [3]

• low generalisability: only study one individual

• reliability: sessions was patient focuses → cannot be replicated exactly

• low validity: self-reported data

  • the boy and his mother may overly positive about the long-term benefits due to the relationship w therapist

I&D: application

therapists should be trained in the use of imagery exposure & cognitive restructuring

I&D: nature vs nurture

nurture is supported as learning experiences in therapy helped change the boy’s behavioural & emotional responses