Saavedra and Silverman (Button-phobia) Flashcards
AIM:
• To examine classical conditioning in regards to fear and stimulus avoidance.
• To find out whether exposure therapy would reduce disgust and avoidance towards buttons in the case of a boy with button phobia.
SAMPLE:
The participant was a 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. He met the criteria for having a specific phobia of buttons and had been experiencing symptoms for around 4 years prior to the start of the study.
BACKGROUND:
Evaluative learning is a form of classical conditioning where a neutral stimulus becomes conditioned as the product of complex thought processes and emotions associated with it.
Pavlov observed classical conditioning in dogs. The dog’s salivation was an unconditioned response to food (an unconditioned stimulus). When dogs learned that the ringing of the bell (a neutral stimulus) meant that they will be fed, the dogs therefore, started associating the food with the bell ring. Now, when the dogs heard the bell (conditioned stimulus) they would start salivating even in the absence of food, therefore salivation would become a conditioned response.
Psychologists proposed the idea of phobias being learned like other behaviours by evaluative learning meaning that the removal of the fear and disgust feelings towards a stimulus would help the individuals unlearn the phobia and would act as a treatment.
PROCEDURE: (1)
The boy and his mother both provided informed consent to participate in the study. They were interviewed in order to determine whether any trauma or abuse could explain the boy’s phobia. The phobia had begun at the age of 5, when the boy had knocked over a bowl of buttons in front of his class and teacher. He found the incident distressing, and from that time onwards his aversion to buttons steadily increased. When he was interviewed, the phobia was interfering significantly with his normal functioning; he could no longer dress himself and had become preoccupied with avoiding touching buttons or clothing that could have touched buttons.
Prior to the treatments, a hierarchy of the boy’s feared stimuli was constructed, consisting of 11 items in increasing severity. The most difficult items for the child were small, clear plastic buttons. These were rated at an “8” on the 9-point Feelings Thermometer. Handling these or touching someone wearing them was the most unpleasant task for the boy.
PROCEDURE: (2)
Two kinds of treatments were carried out.
• The first was contingency management, a form of positive reinforcement therapy, in which the boy was gradually exposed to the 11 stimuli on the hierarchy and was rewarded with his mother’s affection for completing each hierarchy level. The sessions ranged between 20 and 30 minutes. The researchers observed how the boy approached the buttons (eg. Whether the number of buttons he handled increased). They also measured his subjective rating of distress using the Feelings Thermometer.
• The second form of therapy, and the main focus of the study, was known as imagery exposure therapy. It involved visualization techniques in which the boy was asked to imagine the buttons falling on him, and considering 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 large to small buttons, in line with the boy’s fear hierarchy. Throughout the session the boy had to perform cognitive self-control strategies - self-talk in which the individual considers positive thoughts when troubling ones occur. At each session, they also measured his subjective rating of distress using the Feelings Thermometer.
RESEARCH METHOD:
This was a clinical case study as it involved just one participant whose life history and treatment were studied in depth. Data was collected using self-report measures. Both the boy and his mother were interviewed by the researchers about the onset of his phobia and his subsequent behaviour.
VARIABLES:
The Independent variables were contingency management (a kind of Behavioural therapy) and image exposure therapy (a kind of cognitive therapy) and their affect on the distress levels of the boy recorded in the Feelings Thermometer and his avoidance behaviour were dependent variables.
RESULTS: (Contingency Management)
• Results for Contingency Management:
All items on the hierarchy list were successfully completed. The boy was also observed handling the buttons more positively. One example of this was that he started handling larger numbers of buttons during later sessions. However, his subjective rating of distress improved between sessions 2 and 3, and continued to rise. By session 4, 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. So, despite his behaviour towards the fearful stimuli improving, his feelings of disgust, fear and anxiety actually increased as a result of the positive reinforcement therapy.
RESULTS: (Image Exposure Therapy)
• Results from Image Exposure Therapy:
Successful in minimizing the ratings of distress. Before the therapy, the most fearful experience rated with 8 was “hundreds of buttons falling all over his body”. This reduced to 5 midway through the exposure, and just 3 after the exposure was complete.
Following his treatment, 6-month and 12-month follow ups were conducted. At these assessment sessions, the boy reported feeling minimal distress about buttons. He also no longer met the diagnostic criteria for button phobia. His feelings towards buttons no longer affected his normal functioning; he was able to wear small, clear plastic buttons on his school uniform on a daily basis.
CONCLUSION:
The treatment was successful. The researchers concluded that contingency management was successful in changing observable behaviour, and the imagery exposure therapy was successful in reducing feelings of fear and disgust.
In particular they argue that:
• Imagery exposure therapy can give long term results for the reduction of fear, disgust and distress that come with specific phobias by altering negative evaluations.
• It may be argued that emotions and cognitions are the crucial items in a person’s learning of phobic stimuli response.
EVALUATION: (Strengths and weaknesses)
• not generalizable
• highly valid
ExtrAs
• Demand characteristics
The boy was fully aware that he was undergoing therapy with the intention of improving his phobic symptoms. This might have affected the ratings he gave to the different levels of exposure therapy.
• Bias may affect validity
Working on a case study involves building rapport with the participant. There is less room for objectivity. This means there is a higher risk of bias, which may compromise the validity of the study. There may also be Researcher bias (reporting on a particular participant who may be more likely to have a positive outcome).
• IMPORTANT:
This piece of research involved a case study, which means the sample is small (in this case, one person). Using a small sample in a psychological study can make it difficult to generalize the results to a larger population. As the participant was diagnosed with a specific phobia of buttons, it makes the case even less likely to be representative of the general population. However, the case study is highly valid; the participant was studied over a period of time using several different methods of data collection. The researchers used standardized measures such as the Feelings Thermometer before, during and after therapy. Collecting and analysing quantitative data means the researchers could compare the phobic reactions of the boy at the start and end of his treatment to assess any improvement.
EVALUATION: (Ethical Issues)
When using children as participants, ethical issues can be a major concern. In this instance, the boy and his mother gave informed consent to participate in the study which was important as the therapy involved deliberate exposure to distressing stimuli, whether real or imagined. Overall, the aim of the study was to improve the boy’s quality of life and minimize psychological distress, which is more ethical than trying to create phobias in participants and then attempting to cure them. In addition, the boy’s anonymity was preserved, which allowed him to maintain his privacy.
