Saavedra & Silverman (button phobia)

Classical Conditioning & Evaluative Learning & Phobia

-Classicial Conditioning - learning through association, studied in both humans and animals

-Evaluate Learning - a form of classical conditioning wherein attitudes towards stimuli are considered to be the product of complex thought processes and emotions, which lead an individual to perceive or evaluate a previously neutral stimulus negatively. Attitudes acquired through evaluative learning may be harder to change than more superficial associations

-Phobia - the irrational, persistent fear of an object or event (stimulus) that poses little real danger but creates anxiety and avoidance in the sufferer

Psychology Being Investigated

-This learning process can be applied to any new stimulus, which initially has no effect (the neutral stimulus, NS) when it becomes associated with another stimulus (the unconditioned stimulus, UCS). The UCS already produces a response (the unconditioned response, UCR), which is often an innate (instinctive) reaction

-Stages of classical conditioning - 1) Before conditioning: unconditioned stimulus (food) → unconditioned response (salivation) 2) Before conditioning: neutral stimulus (bell ringing)→ no response 3) During conditioning: unconditioned stimulus (food) + neutral stimulus (bell ringing) → unconditioned response (salivation) 4) After conditioning: conditioned stimulus (bell ringing) → conditioned response (salivation)

Background

-How phobias can be treated using the application of different theories of learning (included operant conditioning to reinforce desirable behaviour)

-The researchers compared this treatment to evaluative learning as a form of classical conditioning to reduce feelings of disgust

-Previous research - From their study of adults with a blood phobia, Hepburn and Page (1999) suggested that treating patients' disgust, as well as their fear, would helped them to make progress. De Jong et al. (1997) worked with children who had a spider phobia. Although no attempt was made to manipulate feelings of disgust, their feelings of disgust declined alongside their reduction in fear

Aim

-examine the role of classical conditioning in relation to fear and avoidance of a particular stimulus

-researchers wanted to see if using a type of exposure therapy could reduce the disgust and distress associated with buttons

Research method and design

-clinical case study as it involved just one participant whose life history and treatment were studied in depth

-Self report measures (data collection)

-Both the boy and his mother were interviewed by the researchers about the onset of his phobia and his subsequent behaviour. The boy was observed throughout the treatment sessions to see if his phobic behaviour showed any improvement

-The results of the treatment were measured using a nine-point scale of distress known as the 'Feelings Thermometer'

Sample

-9 year old Hispanic American boy

-Along with his mother, he had sought support from the Child Anxiety and Phobia Program at Florida International University, Miami

-The boy had button phobia and had been experiencing the symptoms for around 4 years prior to the start of the study

Procedure

-The phobia had begun at age five, when the boy had knocked over a bowl of buttons in front of his class and teacher;this was distressing for him

-The boy and his mother were interviewed in order to determine whether any trauma or abuse could explain the boy's phobia

-He could no longer dress himself and had become preoccupied with avoiding touching buttons or clothing that could have touched buttons

-Through discussion with the participant, they created a hierarchy of feared stimuli, with each item on the list provoking increasing fear (most diffciult item was clear, small buttons which were marked 8 on the nine point Feelings Thermometer)

-Handling or touching the buttoms was the most unpleasant task for him

-The boy was treated with two interventions, one after the other

-Treatment sessions lasted for 20-30 minutes

-First - positive reinforcement therapy; the boy was rewarded for showing less fear and for actually handling the buttons, the positive reinforcement was given to the boy by his mother only after he had completed a gradual exposure to buttons, researchers observed how the boy approached the buttons (c.g. whether the numbers of buttons he handled increased). They also measured his subjective rating of distress (on a 9-point scale) using the Feelings Thermometer

-Second - imagery exposure therapy; Interviews with the boy had revealed that he found buttons touching his body disgusting, and he also believed that buttons smelled unpleasant (disgust imagery exercises with self control stratergies), the boy was asked to imagine buttons falling on him, and to consider how they looked, felt and smelled. He was also asked to talk about how these imagery exposures made him feel, the exposures progressed from images of larger to smaller buttons, in line with the boy's fear hierarchy, self-report measures were taken of the boy's subjective ratings of distress using the Feelings Thermometer

Results (positive reinforcement therapy)

-Successful completion of all the exposure tasks listed in the hierarchy of fear

-The boy was also observed approaching the buttons more positively. One example of this was that he started handling larger numbers of buttons during later sessions

-Subjective ratings of distress increased significantly between sessions two and three, and continued to rise

-By session four, a number of items on the hierarchy such as hugging his mother while she was wearing buttons had increased in dislike from the original scores

-While the participant was showing improved behaviour, the level of fear and disgust he was experiencing from this intervention worsened

Results (Imagery exposure therapy)

-Successful in reducing the boy's rating of distress

-Example - Before imagery therapy, the boy rated this experience the most fearful and disgusting (score of 8 on the Feelings Thermometer). This reduced to 5 midway through the exposure, and just 3 after the exposure was complete

-Six-month and 12-month follow-ups were conducted; reported feeling minimal distress about buttons

-His feelings towards buttons no longer affected his normal functioning; he was also able to wear small, clear plastic buttons on his school uniform on a daily basis

Conclusion

-Emotions and cognitions relating to disgust are important when learning new responses to phobic stimuli

-Imagery exposure can have a long-term effect on reducing the distress associated with specific phobias as it tackles negative evaluations

Ethical Issues

-The boy and his mother gave informed consent to participate in the study. This was importantas the therapy involved deliberate exposure to distressing stimuli, whether real or imagined

-The boy's anonymity was preserved, which allowed him to maintain his privacy

-Aim of the study was to improve the boy's quality of life and minimise psychological distress, which is more ethical than trying to create phobias in participants and then attempting to treat them

Strength

-Validity – triangulation of qualitative and quantitative data-gathering techniques increases credibility (e.g. semi-structured interview, observations of therapy sessions, use of feelings thermometer)

-Validity – follow-up sessions at 6 and 12 months meant long-term efficacy of treatment could be assessed (detailed)

-High ecoclogical validity

Weakness

-Reliability – therapy sessions were patient focused and therefore cannot be replicated exactly. Reliability of findings cannot be checked (low generalisability)

-Subjectivity – self-reported data may be biased. For example, the mother sees child’s behaviour differently from child, and vice versa. Both may be overly positive about the long-term benefits of the therapy due to their relationship with the therapist

-Lacks mundane realism