Silverman & Saavedra

PSYCHOLOGY BEING INVESTIGATED

PHOBIAS 

Intense fear+anxiety of something often harmless, but disrupts daily life. 

CLASSICAL CONDITIONING

Phobias are learnt from CC; if neutral [not scary] stimulus is paired with a scary stimulus, the neutral stimulus also scares the person- this is called expectancy learning. 

EVALUATIVE LEARNING 

A kind of CC; a neutral stimulus being paired with something that causes inexplicable disgust. 

OPERANT CONDITIONING 

Positive reinforcement used to reward behaviours [mother praised the boy for handling buttons] 

BACKGROUND 

DIAGNOSING PHOBIAS 

Manuals are used to see if symptoms are strong enough to require treatment, including duration & severity. S&S used the DSM-5 including 300 disorders & 22 categories. 

DISGUST 

Emotion that helps us avoid harmful situations; S&S used evaluative learning to show how we link NS to harmful things.

PREVIOUS RESEARCH 

S&S’s study is important because no other researcher had tried to reduce disgust to reduce fear. 

AIMS 

• Highlight the role of evaluative learning & disgust in development & treatment of child phobias.
• Test the effectiveness of imagery exposure as a part of exposure-based cognitive-behavioural treatment for a specific button phobia

 HYPOTHESES 

• CC plays a role in fear & avoidance of a stimulus
• Exposure therapy will reduce disgust & avoidance of buttons.

 METHODOLOGY 

Case study; deep analysis of 1 rare case. Qlt & Qnt data collected using a structured interview, observation & psychometric scale of subjective distress. Longitudinal study- studied before, during & after the treatment. 

VARIABLES 

Approach & avoidance observed & recorded during therapy. Approach classified as: touching, holding & manipulating. Feelings thermometer used to score distress: 9 pt scale from 0-8. 

SAMPLE 

9 y/o Hispanic-American from Florida; selected because his mother brought him to the Child Anxiety & Phobia Program at Florida International University in Miami. He had the phobia for 5 years & no other diagnosis. 

PROCEDURE 

INITIAL DIAGNOSIS 

Boy & mom interviewed [semi-structured] using the Anxiety Disorders Interview Schedule for DSM Child & Parent version [ADIS-C/P]. Done to confirm the phobia. Also asked about stressful life events which may trigger phobias, & checked for other disorders. 

BEHAVIOURAL EXPOSURE 

• 
  

  4 50 min treatment sessions: 30 mins alone & 20 w mom.
• Disgust/fear hierarchy: boy & his therapists made a list for 11 stimuli & ranked how distressing they were.
• In vivo exposure: Gradual exposure to buttons in real life. If buttons were tolerated, his mother praised him [contingency management].

DISGUST RELATED IMAGERY EXPOSURE

 7 sessions; the boy described hpw buttons look, feel & smell & how he felt imagining them. Also imagined diff sizes & cognitive restructuring took place. Post treatment follow up ADIS-C/P used right after treatment, 6 months after treatment & 12 months after treatment. 

RESULTS 

WHEN PHOBIA BEGAN 

In nursery, a bowl of buttons fell on him in front of the class so the phobia got worse.

DISRUPTION OF DAILY LIFE 

Unable to touch/handle buttonsà cannot dress himself, school work suffered because couldn’t concentrate, he was afraid to touch anything that touched buttons & so avoided clothes & people with buttons. 

PROGRESS IN THE FIRST 4 SESSIONS 

POSITIVE OUTCOMES

He could tolerate more buttons with each exposure & faced all 11 buttons 

NEGATIVE OUTCOMES 

Distress rating increased significantly between sessions 2&3 & 3&4. He was more distressed by medium coloured button & hugging mom with large plastic bottles than he was at the creation of the hierarchy; expected because of evaluate learning & disgust-based phobias. 

NEXT 7 SESSIONS

It was hard to describe what exactly was unpleasant about the buttons, but they were gross & disgusting. After imagery exposure, ratings of distress decreased. 

POST-TREATMENT FOLLOW-UP. 

At each follow up, the ADIS-C/P showed that he didn’t have the phobia anymore, reported no distress & wore clear plastic buttons. 

CONCLUSIONS 

Evaluative learning is useful understand disgust’s role in childhood specific phobias, exposure therapy --> fear-based phobias, imagery exposure -->disgust-based phobias. These are increasingly effective in targeting emotions linked to stimuli. 

ETHICS 

Informed consent gained from the boy & his mother for: initial diagnosis, treatment, publishing & a write-up. Maintained confidentiality & prevented psychological harm. The detailed explanation of the bowl of buttons & his ethnicity may make him recognisable. 

RELIABILITY: TEST-RETEST 

ADIS-C/P is reliable; children were tested 7 & 14 days after treatment & showed a positive correlation of 0.84.

STANDARDISATION 

Hard to replicate; therapy is spontaneous & depends on the patient’s needs. 

VALIDITY 

Strength: longitudinal design; the boy didn’t have symptoms during the follow up, so the imagery exposure therapy worked. Most therapists don't follow up, so the efficacy is hard to be establish. 

Strength: Case study; provided rich, detailed data. ADIS-C/P used to confirm the diagnosis, & he was observed to see his reactions to buttons. The feelings thermometer [self-report] used to see the change in disgust. The use of triangulation increased validity. 

LINKS TO ASSUMPTIONS 

The boy learned not to fear buttons using operant & CC, showing that we learn from these processes.

OBJECTIVITY & SUBJECTIVITY 

Weakness: The mother may have over reacted about the severity of the symptoms & the boy could have down played them to make the therapist happy, so they cannot be sure about the efficacy of therapy. 

GENERALISATIONS & ECOLOGICAL VALIDITY 

Weakness: Only one Hispanic-American boy was used. Treated at a prestigious university by 2 experts; this may not work for children/therapists of diff backgrounds, so not generalisable. 

ISSUES & DEBATES: KIDS & RESEARCH 

S&S took this case because there is less information on evaluative learning, disgust & childhood phobias. Used the ADIS-C/P & feelings thermometer to increase validity.

APPLICATIONS TO REAL LIFE 

CC based therapy phobias lead to long term improvements of exposure therapy.