Button phobia

• Fear


  An unpleasant emotion caused by an organism's defensive response to an imminent threat
• Phobia


  A persistent and unreasonable fear of an object. This fear is disproportionate to the danger posed and leads to avoidance of the object
• Disgust


  A feeling of revulsion or disapproval aroused by something unpleasant or offensive (can manifest in physical reactions, such as nausea and facial expressions)
• Baked Beans Phobia
• Expectancy Learning (fear)


  Presentation of a previously neutral/non-threatening object associated with a potentially threatening negative outcome increases individual's expectation of coming into contact with that negative outcome i.e. an object is associated with a negative outcome +, as a result, elicits a fear response
• Evaluative Learning (disgust)


  Individual comes to perceive or 'evaluate' a previously neutral stimulus as negative. This means that object is perceived as itself being negative, rather than it causing a negative event to occur. This is better described as a disgust reaction to an object.
• The sample was a 9 year-old boy who had self-referred to the Child Anxiety and Phobia program at the Florida International University
• The boy had been suffering from an extreme phobia of buttons for the last 4 years
• The boy met the DSM-IV criteria for a specific phobia

  
• Origin of the phobia

  When he was 5 years old, the boy had been in an art class in which they were using buttons. He asked for more buttons and was told to collect some from a bowl on the teacher's desk. When he grabbed the bowl, it fell and all the buttons fell onto him and the floor. He described the experience as distressing and from there, his aversion to buttons steadily increased.
• How the phobia progressed

  1. 1st avoidance of buttons did not present many difficulties, but as time progressed, it became more difficult for him to handle buttons

  2. This meant that boy could no longer dress himself + found it difficult to concentrate in school due to excessive preoccupation with not touching his school uniform or anything that his buttoned shirt touched

  3. His avoidance of buttons was cued by presence + anticipation of buttons.
• Psychology being investigated was Evaluative Learning as a form of classical conditioning
• Evaluative learning does not depend on individual expecting or being aware of association between neutral object + negative outcome
• An individual may negatively evaluate a specific object or event, eliciting a feeling of disgust, rather than fear
• Expectancy Learning


  A previously neutral object is associated with a potentially threatening negative event. In the future, the person is fearful because of the expectation of what will happen.
• Evaluative Learning


  No expectancy (no fear). Instead, the person thinks about and evaluates the object negatively, typically with feelings of disgust towards the object.
• The sample was a 9 year-old boy who met DSM-IV criteria for specific phobia
• The sampling method was Opportunity Sampling as the boy was referred by the Child Anxiety and Phobia program at the Florida International University
• Informed consent was obtained from the mother and the boy
• Quantitative Data = Results from treatment were measured using the 'Feelings Thermometer' – a 9-point scale for disgust

  
• Qualitative Data = Child asked WHY he didn't like buttons
• How did they find out about phobia?

  1. Through careful + deliberate interviews with both child + mother, researchers ruled out possible adverse events in child's life (e.g. abuse, accidents, trauma) that might have contributed to anxiety

  2. Child + parent interviewed using the child-parent anxiety disorders interview schedule (yes or no answers about symptoms - total yes answers determines DSM-IV diagnosis)

  3. Questions asked about social impairment using 9-point 'feelings thermometer'. A rating of 4 or more is considered 'clinically significant'.

  
• Exposure Therapy


  A type of Cognitive-Behavioural Therapy, this involves exposure to feared object in a 'safe' + controlled environment. It usually consists of a 'hierarchy' of 'graded exposures' ranging from mildly arousing to stronger. The idea is, that the 'negative' thoughts surrounding an object are misplaced with positive, or less negative thoughts (it has done you no harm).
• Treatment involved two interventions

  1. Contingency management: form of positive reinforcement therapy. This was a behaviour focused approach which meant the boy was rewarded for showing less fear and for actually handling the buttons. This therapy was given by his mother only after he had completed a gradual exposure to buttons. These treatment sessions lasted between 20-30 minutes.

  2. Imagery exposure: interviews with the boy had revealed that he found touching buttons disgusting and that they smelt bad. These ideas formed the basis for disgust imagery exercises. Unlike in vivo exposure, where the individual actually physically handles or is exposed to fearful stimuli, imagery exposure therapy uses visualisation techniques. This technique incorporates cognitive self-control strategies. The boy was asked to imagine buttons falling on him, and to consider how they looked, felt and smelled. He was also asked to discuss how these imagery exposures made him feel. The images progressed from images of larger to smaller buttons, in line with the boy's fear hierarchy.
• Treatment - Behavioural Exposures

  The boy was exposed to the buttons in vivo (in real life). Treatments lasted 30 minutes with the boy alone, and 20 minutes with the boy and his mother. A successful exposure session was rewarded with positive reinforcement from the mother (to increase the probability of a repeat).
• At 6 and 12 month follow-up, the boy reported minimal distress about buttons and was 'in remission' for the DSM-IV diagnosis. He was now wearing clear plastic buttons on his school uniform every day.
• The treatment used for the button phobia can be used for the treatment of other specific phobias
• The study confirms the link between disgust and phobia - supports the learning approach that phobias are learned, not inherited

  
• Informed Consent


  Participants gave consent to take part in the study
• Deception


  No deception was used in the study
• Debrief


  Participants were debriefed about the purpose and findings of the study
• Right to withdraw


  Participants had the right to withdraw from the study at any time
• Confidentiality


  Participant's personal information was kept confidential
• Protection from harm


  Participants were protected from any physical or psychological harm during the study
• The study supports the view that phobias are learned, rather than inherited/biological (nature vs nurture)
• The study takes a reductionist approach by focusing on specific mechanisms (expectancy and evaluative learning) underlying the phobia
• The study uses children as participants, which raises ethical considerations