PK

Saavedra & Silverman - Button Phobia Case Study

Psychology being Investigated

  • Classical conditioning (associative learning → Pavlov’s dogs)

    • Unconditioned stimulus: dog food

    • Unconditioned response: salivation (doesn’t need training, natural response)

    • Neutral stimulus: bell (not related to unconditioned stimulus, but connected by association)

    • Conditioned stimulus: bell (when played with the food)

    • Conditioned response: salivation at the sound of the bell (when played without the food)

  • Evaluative vs. Expectancy learning

    • Evaluative: occurs without the individual's awareness of the association, resulting in a negative evaluation of the object, often eliciting disgust rather than fear. 

    • Expectancy: a neutral object becomes associated with a negative outcome, leading to fear.

    • Shows that treatment for phobias should address both fear and disgust.

  • Operant Conditioning

    • Learning based on reinforcement and punishment

    • Reinforcement  → increases frequency of behaviour

      • Negative: remove something negative

      • Positive: add something positive (reward system)

    • Punishment → decreases frequency of behaviour

      • Negative: remove something positive

      • Positive: add something negative

  • Phobia

    • When disgust and fear combine to create ‘avoidance behaviour’ → basically when fear and disgust for something disrupts everyday life.

    • The object poses little real danger but creates anxiety and avoidance in the person.

Aim of the Study

  • To examine the role of classical conditioning in relation to fear and avoidance of a particular stimulus by using a type of exposure therapy and reducing the disgust and distress associated with buttons.

  • in simple terms: The study aimed to look at how classical conditioning is connected to fear and avoidance of buttons. It used a type of therapy called exposure therapy to help reduce the fear and unpleasant feelings about buttons.

Sample & Background of Participant’s Phobia

  • Participant was a 9 year old Hispanic American boy with a phobia of buttons.

  • The boy's phobia began at age 5 during a distressing incident involving buttons in school. 

  • Over four years, his avoidance of buttons escalated, impacting his daily life, including difficulties dressing and concentrating in school. 

  • The phobia did not stem from significant stressors or traumas, and his symptoms did not align with obsessive-compulsive disorder.

Research Method and Design

  • Case study → involved just one participant whose life history & treatment were studied in depth.

  • Data collection → through self-reports, interviews and observations.

  • Results → measured through a nine-point scale of distress called the ‘Feelings Thermometer.’

Procedure of the Study

  • Treatment done through two interventions → behavioral exposures, and imagery exposures.

  • Behavioral Exposures

    • First used contingency management in which the mother provided positive reinforcement contingent on the child’s successful completion of gradual exposure to buttons.

    • Treatment sessions lasted about 30 mins with the boy and 20 mins with the boy and his mother. 

    • Table below shows the disgust/fear hierarchy with child’s rating on the feelings thermometer.

Stimuli

Distress Ratings (0-8)

1

Large denim jean buttons

2

2

Small denim jean buttons

3

3

Clip-on denim jean buttons

3

4

Large plastic buttons (coloured)

4

5

Large plastic buttons (clear)

4

6

Hugging mom when she wears large plastic buttons

5

7

Medium plastic buttons (coloured)

5

8

Medium plastic buttons (clear)

6

9

Hugging mom when she wears regular medium plastic buttons

7

10

Small plastic buttons (coloured)

8

11

Small plastic buttons (clear)

8

    • Most easy task (rating 2) → large, denim jean buttons

    • Most difficult task (rating 8) → small, clear, plastic buttons

    • By session 4, the boy was able to handle all the buttons and completed the exposure tasks fully. But, his distress rating increased dramatically between each session, and by the end, his ratings were even higher than they were before, which was unusual.

  • Imagery Exposures

    • Boy found buttons disgusting upon contact with his body, and he even said that buttons emitted unpleasant odors.

    • So, the next 7 sessions incorporated disgust-related exposures and cognitions. 

    • Involved exploring with the boy what he found disgusting about the buttons and using specific self control/cognitive strategies to overcome this.

    • He was prompted to imagine buttons falling on him → with details like how they looked, felt, and smelled. 

    • These exposures went from smaller to larger buttons.

    • Boy found difficulty in cognitive restructuring → even though he could say that buttons made him feel “gross” or “disgusted,” he was unable to describe what exactly he found disgusting about them.

Results of the Study

  • These ‘disgust related imagery exposures & cognitions’ were successful (yay!) in reducing the boy’s subjective ratings of distress. 

  • Decreased from 8 (immediately before the exposure) to 5 (midway through the exposure) to 3 (immediately after the exposure) → asked to imagine buttons falling on him.

  • Postreatment → 6 & 12 month follow up assessment sessions → readministered ADIS-C/P and the boy reported minimal distress abt buttons and he no longer met the DSM-IV criteria for specific phobia of buttons.

[this was done to ensure there was no relapse, no symptoms after treatment]

Conclusion

  • Disgust plays a key role in the development and maintenance of a phobia but a mixture of behavioural exposure and cognitive restructuring helped to eliminate the feelings of disgust.

Ethical Issues

  • The participant was severely distressed, and protection was provided.

  • Informed consent was taken from the mother and the boy.

Evaluation of the Study

  • Strengths

    • High internal validity – The participant was studied over time, ensuring a thorough assessment of changes.

    • High reliability – standardized measures – The use of the Feelings Thermometer enhances reliability by ensuring consistency in how anxiety levels were recorded.

  • Weaknesses

    • Population validity - low generalizability – The study focused on a single participant, making it difficult to apply findings to the broader population.

    • Low ecological validity – The therapy took place in a controlled environment, which may not fully reflect real-world settings where phobias are triggered.

Issues & Debates (Discussion)

  • Application to Everyday Life: For treating other phobias

  • Nature versus Nurture: The process of acquiring the phobia relates to nurture.