Saavedra and Silverman

Question 1

What is the aim of this study?

Answer 1

In the context of a specific phobia, researchers wanted to see if using a type of exposure therapy could reduce disgust and distress associated with buttons

Question 2

What is classical conditioning?

Answer 2

Learning through association. 2 stimuli (neutral and unconditioned) are linked together to produce a new learned response.

Question 3

What is operant conditioning?

Answer 3

• a method of learning that occurs through rewards and punishments for behavior
• a form of learning that occurs when behaviors are encouraged or discouraged through reinforcement and/or punishment.
• basic concept behind operant conditioning is that a stimulus leads to a behavior, which then leads to a consequence.

Question 4

What is evaluative learning?

Answer 4

• A type of classical conditioning in which an individual forms an association between a previously neutral stimulus and a negative emotion.
• Formation of -ve or +ve attitudes towards certain stimuli through experience exposure.
• Associating evaluative responses towards specific stimuli.

Question 5

What is expectancy learning?

Answer 5

Anticipation or belief that a specific event will occur based on past experiences or cues in the environment.

Question 6

List down the features of the sample

Answer 6

• 9 year old
• Hispanic American boy
• Sought support from the Child Anxiety and Phobia Program at Florida International University Miami.
• Showed symptoms 4 years before the start of the study
• Mother provided consent for both participating and publication.

Question 7

Research method?

Answer 7

• Case study
• Data collected using self-reports
• Results of treatment measured using a nine-point scale of disgust also known as “Feelings Thermometer”

Question 8

Sampling method?

Answer 8

• Opportunity sampling

Question 9

How was he diagnosed?

Answer 9

On the basis of child and parent interview data ADIS-C/P, the boy met the DSM-IV criteria for specific phobia of buttons.

Question 10

What difficulties did the boy face as a result of this phobia?

Answer 10

• Unable to dress himself
• Difficulty concentrating in school due to excessive preoccupation with not touching his shirt
• Also excessive preoccupation with not touching anything that his buttoned shirt touched (Objective contaminant)
• avoided wearing buttoned shirts altogether

Question 11

Two things that were ruled out of his diagnosis

Answer 11

• Sexual or physical abuse
• OCD (did not meet the DSM-IV criteria for it)

Question 12

What are the symptoms of Specific Phobia?

Answer 12

Marked and persistent avoidance of the feared object, cued by the presence and anticipating of the object

Question 13

Identify how the boy was treated.

Answer 13

The boy was treated using exposure-based treatment which involved cognitive and behavioral procedures (CBT).
2 interventions were used, positive reinforcement therapy and imagery exposure.

Question 14

Name the two interventions used and what they were used for.

Answer 14

Positive reinforcement therapy to treat fear.
Imagery exposure to treat disgust.

Question 15

Explain the procedure of positive reinforcement therapy.

Answer 15

• A type of behavioural therapy based on operant conditioning.
• In-vivo exposure
• Involved first using contingency management where the mother provided positive reinforcement, contingent upon the child’s successful completion of gradual hierarchical exposures to buttons.
• A hierarchy was devised in the session along with the boy’s subjective ratings of distress on a 9-point scale using the “Feelings Thermometer”
• Treatment lasted 30 mins with the boy alone and 20 mins with the boy and the mother.

Question 16

How many sessions were conducted for positive reinforcement therapy?

Answer 16

4 sessions

Question 17

Name the most difficult and the least difficult buttons, along with the boy’s subjective rating.

Answer 17

Most difficult: small, clear, plastic buttons. Rated them 8/9.
Least difficult: large denim jean buttons. Rated them 2/9.

Question 18

Name the 2nd intervention and its purpose. Explain its procedure as well.

Answer 18

Imagery Exposure - to treat disgust.
- based on classical conditioning
- in vitro method
- involved an interview with the boy which revealed that he found buttons “disgusting” and that they “emitted an unpleasant odor”. the interview formed the basis for disgust imagery exercises.
- the boy was prompted to imagine buttons falling on him, and he was asked to explain how they looked, felt and smelled.
- imagery exposures progressed from images of larger to smaller buttons.
- the most difficult imagery exposure was ‘cognitive restructuring’. this aided the boy to confront his fears so it was a self control strategy

Question 19

What is cognitive restructuring?

Answer 19

A technique used to transform how individuals think. It helps them feel differently about negative thoughts, ultimately influencing their behaviour.
The goal is to replace the phobia-producing thoughts (cognitive distortions) with more balanced thoughts that do not produce phobia anxiety.

Question 20

Explain the results of the 1st intervention.

Answer 20

• successfully completed all in-vivo exposure tasks listed in the table of hierarchical exposure by session 4
• however, his subjective ratings of distress increased dramatically from session 2 to session 3, and continued to rise till session 4.
• in session 4, the boy’s subjective ratings to specific items on the hierarchy were even higher than the ratings he reported when the hierarchy was initially devised.
• this was unusual because generally in CBT, repeated exposures to the feared stimulus is supposed to decrease the ratings of distress over time.
• reported feeling more distressed about handling buttons despite behavioral progress made. (this is consistent with evaluative learning that despite in-vivo exposures to the objects of phobia, evaluative reactions remain unchanged or even increase.

Question 21

Explain the results of the 2nd intervention.

Answer 21

• disgust-related imagery exposures and cognitions appeared to be successful in reducing the boy’s subjective ratings of distress.
• the boy’s rating on the 9 point scale decreased from 8 to 5 to 3 when he was asked to imagine hundreds of buttons falling all over his body.
• the boys ratings also decreased from 7 to 4 to 3 when he was asked to imagine hugging his mother wearing a buttoned shirt.

Question 22

Explain the post treatment

Answer 22

• 6 and 12-month follow-up assessment sessions where ADIS-C/P was done again.
• the boy reported minimal distress about buttons
• no longer met the DSM-IV criteria for a specific phobia of buttons.

Question 23

How many fear and disgust sessions were conducted?

Answer 23

Disgust sessions - 7
Fear sessions - 4
Total sessions - 11