saavedra and silverman et al button phobia

Question 1

who was the participant, how did he volunteer

Answer 1

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

Question 2

boy met which criteria for phobia

Answer 2

DSM-IV criteria

Question 3

diagnostic criteria for phobia according to DSM-IV

Answer 3

1. marked and persistent fear that is excessive and unbearable, cued by presence or anticipation of specific object or situation
2. exposure to the phobic stimulus almost invariably provokes an immediate anxiety response that may take the form of a panic attack
3. the person recognises the fear is excessive and unreasonable
4. the phobic situation is avoided or endured with intense anxiety or distress
5. the avoidance, anxious anticipation or distress interferes significantly in the persons normal routine
6. symptoms have to be present for 6 months or more

Question 4

psychology being investigated

Answer 4

1. phobia
   intense fear or anxiety that occurs every time a person comes into contact with a certain object or situation
2. 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
3. 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
4. saavedra and silverman used principles of operant conditioning in their treatment. posit9ive reinforcement.

Question 5

research methodology

Answer 5

case study with longitudinal design

interview, observation and use of psychometric scale to measure distress used.

Question 6

aims

Answer 6

1. highlight the role of evaluative learning and disgust in the development and treatment of children’s phobias.
2. to test the efficacy of imagery exposure as part of an exposure based cognitive-behavioural treatment for a specific phobia of buttons

Question 7

describe traumatic incident

Answer 7

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

Question 8

describe his distress in daily life

Answer 8

not being able to dress himself, bing too preoccupied in school with not touching buttons or anything that the buttons touch causing difficulty concentrating

Question 9

first behavioural exposure treatment

Answer 9

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

Question 10

result of in vivo treatment

Answer 10

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.

Question 11

second treatment

Answer 11

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)

Question 12

strengths of saavedra and silverman

Answer 12

1. 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
2. longitudinal design
   increased validity as it showed long term effects of imagery based exposure for disgust related phobia in children.
3. 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

Question 13

weaknesses of saavedra and silverman

Answer 13

1. difficult of standardisation and replicability reduces the studies reliability. therapy sessions are spontaneous and cannot be replicated, impossible to test for reliability of findings.
2. also no inter observer reliability, only single observer
   could have been prone to bias
3. ethical issue embarrassment
4. 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.

Question 14

issues and debates

Answer 14

use of children

application to everyday life, training therapists to target disgust, highlight that some phobias cannot be treated by exposure alone