Saavedra and Silverman

• 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.
• Sample – Single 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