who was the participant, how did he volunteer
9 year old hispanic american boy
he presented with his mother to the child anxiety and phobia program at florida international university miami with an avoidance of buttons
provided informed consent for assessment, intervention, report and its publication
boy met which criteria for phobia
DSM-IV criteria
diagnostic criteria for phobia according to DSM-IV
- marked and persistent fear that is excessive and unbearable, cued by presence or anticipation of specific object or situation
- exposure to the phobic stimulus almost invariably provokes an immediate anxiety response that may take the form of a panic attack
- the person recognises the fear is excessive and unreasonable
- the phobic situation is avoided or endured with intense anxiety or distress
- the avoidance, anxious anticipation or distress interferes significantly in the persons normal routine
- symptoms have to be present for 6 months or more
psychology being investigated
- phobia
intense fear or anxiety that occurs every time a person comes into contact with a certain object or situation - classical conditioning
it can be an explanation for the development of phobias. neutral stimulus associated with scary stimulus, neutral stimulus becomes conditioned stimulus and triggers same level of fear of what it was that scared us in the first place, this is expectancy learning - evaluative learning
special type of classical conditioning. a neutral stimulus paired with some disgusting, neutral stimulus also feels disgusting, the person unlike in expectancy learning does not anticipate threat or danger just experience involuntary disgust and cannot explain why - saavedra and silverman used principles of operant conditioning in their treatment. posit9ive reinforcement.
research methodology
case study with longitudinal design
interview, observation and use of psychometric scale to measure distress used.
aims
- highlight the role of evaluative learning and disgust in the development and treatment of children’s phobias.
- to test the efficacy of imagery exposure as part of an exposure based cognitive-behavioural treatment for a specific phobia of buttons
describe traumatic incident
boy went up to front of his class to retrieve more buttons for his art project, while he reached for the bowl, his hand slipped and all the button in the bowl fell on him. he described the incident as highly stressful
during the 4 year period not other significant stressor or traumatic incident like sexual abuse, or accident took place
describe his distress in daily life
not being able to dress himself, bing too preoccupied in school with not touching buttons or anything that the buttons touch causing difficulty concentrating
first behavioural exposure treatment
first treatment involved using contingency management, mother provided positive reinforcement (praise) contingent of childs successful completion of gradual exposure to buttons. treatment sessions lasted 30 min alone and 20 min with mother.
boy subjectively rated levels of distress on a 9 point scale using feelings thermometer.
by session 4 all in vivo tasks completed
result of in vivo treatment
despite successful completion of in vivo treatment his ratings of distress increased dramatically from session 2 to 3 and 3 to 4. his rating of distress increasing was consistent with evaluative learning, because despite in vivo interactions, his evaluative reaction, disgust, remained unchanged or increased.
further investigation found he found buttons gross and said they emitted unpleasant odour.
second treatment
specific cognitive self control strategies and invitro to imagine buttons falling all over him , imagine how they felt, smelled. imagery exposure progressed from larger buttons to smaller buttons. boys rating of decreased from 8(immediately before exposure) to 5 (midway thru exposure) to 3 (immediately after exposure)
strengths of saavedra and silverman
- case study method, included triangulation. semi structured interview for diagnosis, observation of behaviour during therapy, feelings thermometer as self report data. increases validityof conclusions about efficacy of therapy
- longitudinal design
increased validity as it showed long term effects of imagery based exposure for disgust related phobia in children. - test retest reliability of diagnostic interview schedule
use of anxiety disorders interview schedule for dsm-iv child and parent version.
instrument shown to have excellent reliability.
silverman tested children twice after 7 to 14 days and found 0.84 correlation
weaknesses of saavedra and silverman
- difficult of standardisation and replicability reduces the studies reliability. therapy sessions are spontaneous and cannot be replicated, impossible to test for reliability of findings.
- also no inter observer reliability, only single observer
could have been prone to bias - ethical issue embarrassment
- objectivity
self reported data reduced validity, mother sometimes exaggerate symptoms, child may have downplayed worries especially infront of his mother, may have wished to please his therapists, the efficacy of therapy could be overstated.
issues and debates
use of children
application to everyday life, training therapists to target disgust, highlight that some phobias cannot be treated by exposure alone
