Saavedra and Silverman (button phobia)

Question 1

Aim of this study

Answer 1

To explore the role of disgust and evaluative learning in the treatment of a specific childhood phobia of buttons

Question 2

Psychology being investigated

Answer 2

• The study examines disgust as a critical emotion in the development and maintenance of phobias.
• The concept of evaluative learning (form of classical conditioning) is explored.
• The treatment used includes exposure-based cognitive-behavioral therapy and targets fear and disgust associated with buttons.
• This highlights the importance of addressing disgust in treating specific childhood phobias.

Question 3

Classical conditioning

Answer 3

Expectancy learning:
- associating a neutral stimulus with a negative outcome

Evaluative learning
- associating a neutral stimulus with a negative emotion (eg: disgust)

Question 4

Psychiatric literature

Answer 4

• 1 study targeted disgust beneficial for fear/phobia reduction
• 47 non referred (undiagnosed) adults with symptoms of fear and disgust relating to blood-injury
• ratings of disgust decreased among spider phobic and also fear ratings
• De Jon et al. (1997) did NOT examine the effects of targeting disgust in phobia reduction
• disgust and evaluative learning insufficiently covered in child psychiatric literature

Question 5

Sample

Answer 5

• 9 yr old boy
• Hispanic American
• phobia lasted 4 years (5-9 yrs)
• began at 5 yrs old
• opportunity sampling
• diagnosed with a specific phobia for buttons
• research method: case study

Question 6

Procedure of how the boy developed button phobia

Answer 6

• began when he was 5 yrs
• phobia began during art project that involved buttons where he reached for the bowl of buttons and the bowl fell on him and caused him distressful reaction
• it interfered in his daily life such as not being able to dress in school uniform or wear clothes with buttons on it

Question 7

Informed consent?

Answer 7

• boy & mother provided informed consent to participate in assessment and intervention procedures
• mother provided written consent for write-up of report + publication
• boy met DSM-IV criteria for specific phobia of buttons

Question 8

Diagnostic criteria

Answer 8

A) marked and persistent fear that’s excessive
B) exposure to phobic stimulus creates immediate anxiety response
C) person recognizes fear is excessive/unreasonable
D) phobic situation is avoided or else endured with intense anxiety or distress
E) avoidance, anxious, anticipation, distress in feared situations interferes significantly with person’s normal routine
F) individuals under 18, duration is under 6 months
G) anxiety, panic attacks, phobic avoidance associated with other specific situations aren’t accounted for by another mental disorder:
–> OCD
–> PTSD
–> separation anxiety disorder
–> social phobia
–> agoraphobia

Question 9

Systematic desensitization

Answer 9

This is when a person is gradually exposed to the fear/phobia to desensitize the participant

Question 10

Flooding

Answer 10

It’s to expose the sufferer to the phobic object in a safe, controlled environment for an extended period

Question 11

Diagnosed using

Answer 11

• ADIS/ C/P
• DSM-IV

Question 12

Diagnosis with buttons

Answer 12

• OCD and DSM-IV = X
• physical/sexual abuse = X
• any other significant traumas = X

Question 13

Procedure

Answer 13

1. assessment - DSM-IV (ADIS child and parent versions)
2. behavioral exposure intervention
3. disgust imagery
4. cognitive restructuring

Question 14

Behavioral exposure intervention

Answer 14

• child was treated with cognitive and behavioral procedures
• contingency management: where mother provided positive reinforcement on child’s successful completion of gradual exposure to buttons
• treatment sesh lasted 30 mins with boy and 20 mins with mother
• most difficult buttons: small, clear plastic buttons (rated 8)

Question 15

Evaluation of behavioral exposure intervention

Answer 15

STRENGTHS:
- exposure is gradual (psychological harm is minimized and there is right to withdraw)

• as pp comes into contact with their fear, the ‘reality’ of encounter is valid

WEAKNESSES:
- psychological harm (pp goes through stress/anxiety as they encounter each fear)

• takes a few weeks to complete the intervention process

Question 16

Results

Answer 16

• boy’s rating decreased from 8 (before exposure) to 5 (midway exposure) to 3 (after exposure) when he was asked to imagine 100 buttons falling all over his body
• boy’s rating decreased from 7 (before exposure) to 4 (midway exposure) to 3 (after exposure) when hugging his mother with “shirt full of buttons”

Question 17

What happened to the boy after the treatment?

Answer 17

• posttreatment occurred at 6 months and 12 months
• at 6 and 12 month follow-up assessment sessions, the researchers re-administered the ADIS-C/P and DSM-IV

Question 18

What happened AT the posttreatment assessment session?

Answer 18

• boy reported minimal distress about buttons
• no longer met DSM-IV criteria for specific phobia of buttons
• now was wearing clear plastic buttons on school uniform shirt
• was in remission for this DSM-IV specific phobia diagnosis

Question 19

Conclusions

Answer 19

• targeting ‘disgust’ in treating a specific childhood phobia such as button phobia is useful, when used with evaluative learning

Question 20

What does further research need to be done on?

Answer 20

• specific types of phobias where disgust plays predominant role
• conduct controlled group in manipulating disgust treatment and examine efficacy of these manipulations
• test theoretical mechanisms in relation to evaluative learning processes

Question 21

Evaluation - methodological

Answer 21

STRENGTHS:
- case study (in-depth, detailed, unique as this was the first case to examine disgust as an emotion in a child with specific phobia)

• qualitative data
• quantitative data
• useful/application (clinicians can now target ‘disgust’ in addition to fear when treating pps with button phobia)

WEAKNESSES:
- low generalizability (case study)

• social desirability (positive reinforcement could’ve made him change his behaviors to get the rewards)

Question 22

Evaluation - ethics

Answer 22

STRENGTHS:
- informed consent (mother and son granted permission for assessment and treatment, his mother also gave consent for the article to be written)

• confidentiality (this was retained as the boy’s identity was not revealed)

WEAKNESSES:
- psychological harm (when boy’s distress levels increased from 6 to 8 with behavior exposure interventions)