This case study examined the treatment of a 9-year old boy's specific phobia of buttons using positive reinforcement therapy and imagery exposure therapy over multiple sessions. Positive reinforcement improved the boy's behavior toward buttons but increased his feelings of disgust, fear, and anxiety. Imagery exposure therapy successfully reduced the boy's distress ratings related to buttons as measured by a feelings scale, with reductions maintained at 6- and 12-month follow-ups, indicating resolution of his button phobia. The study concluded that imagery exposure can effectively reduce distress from specific phobias by addressing negative cognitive evaluations.

1. Saavedra and Silverman
(2002)
CASE STUDY: Disgust and a specific phobia of buttons

2. Background: Classical Conditioning
• NEUTRAL STIMULUS:
• Initially does not elicit a response.
• UNCONDITIONED STIMULUS (UCS):
• elicits a predictable response w/o training.
• UNCONDITIONED RESPONSE (UCR):
• automatic or natural reaction to a stimulus w/o training
• CONDITIONED STIMULUS (CS):
• elicits a response due to being paired with an UCS.
• CONDITIONED RESPONSE (CR):
• the learned reaction to a CS

3. Background: Pavlov’s Experiment

4. Background
• In Expectancy learning, the presentation
of a previously neutral/nonthreatening
object or event associated with a
potentially threatening negative outcome
increases the individual’s expectation of
coming into contact with that object or
event: FEAR (exam taking makes you
fearful of the class now)

5. Background
• Evaluative learning, in contrast, does not
depend on the individual’s expecting, or being
aware, of the association between the
neutral/nonthreatening object or event and
the negative outcome. Rather, in evaluative
learning, the individual comes to perceive or
“evaluate” the previously neutral object or
event negatively: DISGUST (You think you are
above such lowly tasks as exam-taking)

6. Background and Research Hypothesis
• The aim of the study was to examine role
of classical conditioning in relation to fear
and avoidance of a particular stimulus.
• In the context of a specific phobia,
researchers wanted to see if using a type
of exposure therapy could reduce the
disgust and distress associated with
buttons.

7. Fun Fact

8. Research Method and Sample
• This was a clinical case study with just one participant. 9
year old Hispanic-American boy.
• Data was collected through self-report at Child Anxiety and
Phobia program at Florida International University.
• Boy and Mother were interviewed about onset of phobia
and subsequent behaviour. Symptoms were present for 4
years.
• Results measured using a nine-point scale known as
‘Feelings Thermometer’.

9. Design and Procedure
• The Boy and the Mother gave consent. They were
interviewed to recall events that may have led to
phobia. Phobia begun at age five.
• Phobia was interfering with normal functioning.
Through discussion a hierarchy of feared stimuli was
created.
• Boy was treated with two interventions:
• First was positive reinforcement (contingency
management) in which he was rewarded for
showing less fear. Mother gave reward only after
successful handling of buttons. Sessions lasted
between 20-30 minutes.

10. Procedure
• The second form of intervention was ‘imagery exposure’.
Visualization techniques used instead of handling real
buttons.
• Disgust related exposures were incorporated with self-
control strategies. Boy was asked to imagine buttons falling
on him and consider how they looked, felt and smelled.
• He was then asked to talk about how these imagery tasks
made him feel. Imagery progressed from larger to smaller
buttons, in line with boy’s fear hierarchy.

11. Results: Positive Reinforcement Therapy
• Successful completion of exposure tasks. Larger
number of buttons handled
• Subjective rating of distress remained high and
increased after sessions two and three.
• Despite behaviour towards fearful stimuli
improving, feelings of disgust fear and anxiety
actually increased.
• Finding is consistent with evaluative learning;
despite behavioural change, evaluative reaction
remain unchanged or even increase.

12. Results: Imagery Exposure
• Appeared successful in reducing boys rating of
distress.
• E.g. In the imagery of hundreds of button falling
over him, score decreased form initial rating of 8
to 5 midway and then 3 at then end of the
intervention
• 6 and 12 month follow-ups were conducted. Boy
reported minimal distress about buttons.
• No longer fell under definition of Phobia.

13. Conclusion
Researchers concluded treatment was successful.
Emotions and cognitions relating to disgust are important
when learning new responses to phobic stimuli.
Imagery exposure can have long term effect on reducing
distress as it tackles negative evaluations of specific phobias.

14. Strengths
Participant studied over time through various data collection
methods, so valid.
Used standardized procedures such as the Feelings scale. Used
quantitative data as well as qualitative.
While the responses were subjective, especially the hierarchy of
fear that was created, the measures are still valid, since it is
studying an individual with a specific phobia.

15. Weaknesses
 Unrepresentative sample: Case study of just one person.
 Risk of bias: As it is a case study, there is a risk of bias
compromising validity.
 Demand characteristics. Boy knows he is undergoing therapy,
which might have affected the ratings.
 Some ethical concerns of using children in trying out new
procedures of therapy. Some distressing exposure to stimuli, though
informed consent was taken from both boy and mother. Anonymity
was also preserved.