Saavedra and Silverman (button phobia)

• to examine the role of classical conditioning with relation to fear and avoidance of a particular stimulus
• to see if exposure therapy could reduce feelings of digust and distress correlated with buttons in regard to phobias 

Classical Conditioning: learning process through association. The neutral stimulus (NS) is associated with a stimulus called the unconditioned stilumus (UCS). This creates a response called the unconditoned response (UCR), oftenly an instictive response after once or repeatedly. After conditioning, the newly learnt conditoned response (CR) is associated with the conditoned stimulus (CS), hence completion of classical conditioning.

Phobia: a type of anxiety disorder that creates persistent and irrational fear towards a object or situation that present little danger but creates avoidance in the sufferer. 

Ivan Pavlov first established Classical Conditioning, where learning is associated with a previous neutral stimulus, creating a learnt association. This was done with a dog in an experiment where he associated ringing bells with dog food and in turn the dog salivates. Following the association, the dog would salivate every time the bell is rung due to its association with food. 

Subtypes of Classical Conditioning:

• Expectancy Learning: previously neutral or non threatening object/event associated with a negative experience, hence the individual expects the negative outcome and experiences fear in the presence of a the previous stimuli. 

• Evaluative Learning: forming an association of previous experience with a negative emotion (disgust). The attitudes toward stimuli is a result of complex thought processes and emotions leading an inidivual to perceive previous stilmuli with a negative emotion. Attitudes required from evaluative learning are harder to change. 

This is a case study involving one participant with the life history and treatment studied in depth with data collected from self reports. Both the participant and his mother were interviewed about the onset of his phobia and behaviours associated with it. Results of treatment were measured using a nine-point scale of disgust known as the "Feelings Thermometer".

The boy was a 9 year old Hispanic American boy. With his mother, he sought support from the Child Anxiety and Phobia Program at Florida International Univerity, Miami. He met the criteria of having a phobia of buttons and have been experiencing symptoms for about 4 years prior to the start of study.

Both his mother provided informed consent. Interviews were given to rule out abuse or trauma. The phobia began age 5 when the boy knocked over a bowl of buttons in front of classmates and teacher, causing distress and avoidance of buttons. Whilst interviewed the phobia greatly interferred in his daily life ie. not being able to dress himself and preoccupied with avoiding buttons. 

Researchers created a hierarchy of feared stumili called the nine-points "Feelings Thermometer" with each item on the list provoking increasing fear. Small clear plastic buttons greatly distressed him at a point of 8 on the scale. 

He was treated with Positive Reinforcement (in vivo), where the boy is rewarded for showing less fear and handling buttons (given to his mother after having completed gradual exposure to buttons in 20-30 minute sessions) and Imagery Exposure Therapy (in vitro) involving visualisation where he is asked to imagine buttons falling on him and what is looked, felt and smelt. Disgust related imagery were incorporated with cognitive self control strategies and was asked how this therapy made him feel.

Self Control: form of cognitive behavioural therapy, involving self talk.

Positive Reinforcement : outcomes were successful and all exposure tasks listed were completed in the hierarchy of fears ie. the boy started handling large numbers of buttons in later sessions. Despite this, the boys subjective ratings of distress increased between sessions 2 and 3. By the 4th session, a number of items increased in dislike from original scores. ie. hugging his mother while wearing buttons. This resulted in increase in feelings of disgust, fear, and anxiety as a result, consistent in evaluative learning.

Imagery Exposure Therapy: this is successful in reducing the boys level of distress. Prior to threrapy, the boy rated buttons falling on his body as an 8. This decreased midway to 5 during exposure, and 3 after completion. Following treatment, 6 month and 12 month follow ups were done and during assessment sessions the boy no longer met the criteria for a diagnosed phobia. It no longer imapcted his daily life. 

Treatment was successful. They argue that

• emotions and cognitions relating to disgust are important when learning new respones to phobic stimuli
• Imagery exposures can have long term effect on reducing the distress associated with specific phobias as it tackles negative evaluations

Strengths

• highly valid - different methods and over a long period of time
• used standardised methods - Feelings Thermometer during and after therapy
• Quantitative Data - improvement clearly shown as result of treatment
• Qualitative Data - background of phobia help understand behaviours
• Ethics - informed consent, confidentiality, privacy maintained

Weaknesses

• Case Study - not generalisable
• Subjective - participant had own hierarchy of fears and disgust + personal ratings
• Researcher Bias - can compromise valdity
• Demand Characteristic - boy knew he was undergoing therapy + intentions of improving
• Ethical Issues - Children as participants