(saavedra) button phobia - Disgust and Specific Phobias in Children: A Comprehensive Study

Introduction to Disgust in Psychiatry

  • Disgust as “the forgotten emotion of psychiatry” (Phillips et al., 1998)
    • Significant role in the genesis (Rozin and Fallon, 1987) and treatment (Woody and Teachman, 2000) of phobias.
  • Interaction of disgust with fear can lead to increased avoidance behavior (Phillips et al., 1998).

Evaluative Learning

  • Coined as “the forgotten learning process of psychiatry”
  • Evaluative Learning
    • A form of classical conditioning distinct from expectancy learning.
    • Definition: A process where an individual negatively evaluates a previously neutral or nonthreatening object/event without anticipating any threat.
    • Contrast with Expectancy Learning:
      • Definition: Involves the association of a neutral object with a potential negative outcome, leading to an expectation of encountering that threat (Field and Davies, 2001).
      • Result: Individual reacts with fear.
    • Evaluative learning focuses on the perception or evaluation rather than anticipation of any negative outcome (Hermans et al., 2002).
    • Example: An individual may find buttons disgusting (evaluative learning) without foreseeing any objective danger related to them (expectancy learning).

Treatment Implications

  • Importance of addressing both fear and disgust in treatment strategies (Woody and Teachman, 2000).
  • Only one prior study targeted disgust for fear/phobia reduction, finding it beneficial (Hepburn and Page, 1999).
  • In children, De Jong et al. (1997) indicated a decrease in disgust ratings among spider phobics alongside fear rating decreases, establishing a functional relation.

Case Study Introduction: Specific Phobia of Buttons

  • Article goal: Highlighting the interaction of disgust and evaluative learning in a specific phobia case.
  • Case Study Details:
    • Focus on a 9-year-old Hispanic American boy with a phobia of buttons.
    • Case oversight by Lisette M. Saavedra, M.S., and Wendy K. Silverman, Ph.D.
    • Study funded by NIMH grant 54690.

Case Report: Participant Details

  • Participant Profile:
    • 9-Year-Old Hispanic Male
    • Presenting with his mother to the Child Anxiety and Phobia Program at Florida International University.
    • Consent was obtained for assessment and intervention.
  • Diagnosis:
    • DSM-IV criteria for specific phobia of buttons established through interviews (ADIS-C/P) (Silverman and Albano, 1996; Silverman et al., 2001).
    • Phobia onset at 5 years old linked to distress from an art project incident (buttons fell on him).
  • Avoidance Behavior:
    • Progressive avoidance of buttons leading to daily life challenges like dressing and concentrating in class.
    • Duration of phobia: 4 years, with no significant stressors related to the onset identified.

Intervention Procedure and Results

  • Behavioral Treatment:
    • Exposure-based intervention integrated cognitive and behavioral strategies (Silverman and Kurtines, 1996).
    • Use of Contingency Management where positive reinforcement was provided during gradual exposure to buttons.
    • Exposure Hierarchy:
    • Developed with varying distress ratings on a 9-point scale (ratings found in Table 1).
  • Behavioral Progress:
    • By session 4, all in vivo exposure tasks completed.
    • Observed increase in distress ratings during sessions, contradicting typical treatment outcomes (Silverman et al., 1999).

Disgust Imagery and Cognitions

  • Exploration of disgust-related imagery started after initial exposure sessions; focus on how buttons were perceived (e.g., disgusting, gross).
  • Imagery exposures:
    • Progressed from larger to smaller buttons incorporating cognitive restructure strategies (Silverman and Kurtines, 1996).
    • Distress ratings showed successful reductions post-imagery exposure, illustrating the effectiveness of targeting disgust emotions.

Follow-up Assessments

  • Posttreatment and Follow-up Outcomes:
    • Minimal distress reported about buttons; no longer met the criteria for specific phobia of buttons.
    • Continuous wearing of previously dreaded clear plastic buttons noted at 6 and 12 months post-treatment, indicating remission of DSM-IV diagnosis.

Conclusion and Discussion

  • This case study is pioneering in discussing the role of disgust in childhood phobias in psychiatric literature.
  • Introduction of evaluative learning as a conceptual framework for phobias incorporating disgust is significant.
  • Transition from fear-based interventions to disgust-targeted strategies proved more effective in treating the phobia, reinforcing the importance of addressing disgust alongside fear.

Future Directions for Research

  • Investigate types of phobias prominently influenced by disgust.
  • Conduct controlled studies to manipulate disgust in treatment protocols and evaluate efficacy, focusing on evaluative learning processes.

References

  • A detailed list of references cited throughout the notes, including primary studies, authors, and publications relevant to the research and findings discussed, such as:
    • Baeyens et al. (1996), De Jong et al. (1997), Field and Davies (2001), Hepburn and Page (1999), Hermans et al. (2002), Merckelbach et al. (1993), Phillips et al. (1998), Rozin and Fallon (1987) related to disgust studies, clinical psychology, and phobia treatment methodologies.