Saavedra and Silverman

Cards (57)

  • To explore the role of disgust and evaluative learning in the treatment of a specific childhood phobia, in this case, a phobia of buttons (koumpounophobia).
  • Research Method – Case study approach.
  • SampleSingle participant, a 9-year-old Hispanic American boy.
  • Question Types and Research Technique for Data Collection – Data were collected through clinical interviews and subjective ratings of distress by the participant, using the Anxiety Disorders Interview Schedule for DSM-IV–Child and Parent versions (ADIS-C/P).
  • Measured and Manipulated Variables – The primary measured variable was the boy’s subjective distress related to buttons, assessed on a 9-point scale. The manipulated variables were the interventions (behavioral exposures and disgust-related imagery exposures).
    1. Initial Assessment – The boy met DSM-IV criteria for a specific phobia of buttons, which began at 5 years of age.
    1. Treatment Approach – The intervention included:
    • Contingency management with positive reinforcement by the mother for the child’s successful completion of gradual exposures to buttons.
    • Behavioral exposures: Treatment sessions lasted about 30 minutes with the boy and 20 minutes with the boy and his mother​​.
    • Imagery exposures: This involved the boy imagining scenarios involving buttons and included cognitive restructuring. The exposures progressed from images of larger to smaller buttons​​.
    • Informed Consent – The boy’s mother provided informed consent for both participation in the assessment and intervention procedures and for the publication of the case study​​.
    • Participant’s Well-being – Care was taken to ensure the participant’s comfort and to address his phobia effectively.
    • Confidentiality – The study maintained the confidentiality and anonymity of the participant.
    • Imagery Exposure Sessions – There was a notable reduction in the boy’s distress ratings during these sessions. For example, his distress rating decreased from 8 to 5 to 3 during an imagery exposure session where he imagined hundreds of buttons falling over his body​​.
    • Increased Distress Initially – During the early sessions, there was an increase in distress ratings, especially when the number of buttons was manipulated. This was observed from session 2 to session 4, indicating an initial intensification of the phobia​​.
    • Posttreatment Follow-up – At the 6-month and 12-month follow-ups, the boy reported minimal distress about buttons and no longer met the DSM-IV criteria for a specific phobia of buttons. He was able to wear clear plastic buttons, which he had previously rated as most distressful​​.
    • Improvement in Daily Life: The boy’s ability to wear buttons on a daily basis, such as on his school uniform, indicated a substantial improvement in his daily life.
    • Reduction in Phobia – The remission of the DSM-IV-specific phobia diagnosis at the follow-up sessions highlights the effectiveness of the treatment.
    • Successful Intervention – The gradual reduction in distress ratings and the eventual remission of the phobia suggest that the cognitive-behavioral interventions, focusing on both disgust and fear, were effective.
    • Importance of Addressing Disgust in Phobias – The study underscores the significance of targeting disgust in phobias, not just fear.
  • classical conditioning: learning through association, studied in both humans and animals
  • evaluative learning: a form of classical conditioning wherein attitudes towards stimuli are considered to be the product of complex thought processes and emotions which lead an individual to perceive a previously neutral stimulus negatively
  • phobia: the irrational persistent fear of an object or stimulus that poses little real danger but creates anxiety and avoidance in the sufferer
  • the aim was to examine the role of classical conditioning in relation to fear and avoidance of a particular stimulus.
  • aim: to investigate is using a type of exposure theray could reduce the disgust and distress associated with butttons
  • data was collected using self report methods
  • results were measured on nine point scale named as feelings thermometer
  • he had sought support from shild anxiety and phobia program at florida international university, miami
  • he had been experiencing symptoms for around 4 years prior to study
  • boy and mom provided informed consent
  • they were interviewed in order to order to determine whether any trauma or abuse could explain the phobia
  • phobia began at age 5
  • boy had knocked a bowl of buttons on him in front of class and teacher . he found it distressing and from then on his aversion to buttons increased.
  • he could no longer dress himself and become preoccupied with avoiding touching buttons or clothes that could have touched buttons
  • they created a hierarchy of feared stimulus with each item provoking increasing fear
  • most difficult item (highest on hierarch of feared stimulus) was small clear plastic buttons rated at 8 on the 9 point feelings thermometer
  • large denim jean buttons was the lowest rated at 2 on feelings thermometer
  • first intervention was contingency management, a form of positive reinforcement therapy
  • this was a behavior exposure therapy so boy was rewarded for showing less fear and handling the buttons
  • these behavior exposure sessions lasted between 20- 30 mins
  • researchers observed whether the number of buttons he handled increased and his subjective ratings of distress on feelings thermometer - behavior exposure therapy
  • the second inetervention was imagery exposure therapy
  • imagery exposure therapy`; therapy in which the person is asked to vividly imagine their feared object, situation or activity