Learning approach: Saavedra and Silverman (button phobia)

Psychology AS · The core studies. The idea in plain words, the rules to remember, the mistake to avoid and a worked example, written and checked by Mega Lecture.

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The idea

A phobia is a strong, lasting fear of an object or situation. The learning approach says that phobias are learned, for example by classical conditioning, and can be unlearned. Saavedra and Silverman (2002) added evaluative learning: a person can come to judge an object as disgusting, so disgust as well as fear keeps the phobia going.

This case study describes a 9-year-old boy with a phobia of buttons. It began at age 5, when a bowl of buttons fell on him in front of his class. He avoided touching buttons and it affected school and home.

He was treated first with rewarded real-life exposure to buttons, then with imagery exposure aimed at disgust. After treatment, and at 6 and 12 months, he no longer had the phobia.

Rules to remember

Method: case study of one boy, using interviews with the boy and his mother, observation and self-report ratings.
Feelings Thermometer: a 9-point scale from 0 to 8 on which the boy rated his distress.
Hierarchy: buttons ranked from least to most distressing. Large denim jean buttons were rated lowest (2) and small clear plastic buttons highest (8).
Stage 1: real-life (in vivo) exposure with positive reinforcement from his mother. He handled more buttons, but his distress ratings went up.
Stage 2: imagery exposure, in which he imagined how buttons looked, felt and smelled and talked about them. His distress ratings fell.
Result: the phobia was gone at the 6-month and 12-month follow-ups, and he could wear small clear buttons on his school uniform.
Weaknesses: one child, so results may not generalise; no comparison; ratings are subjective.

Common mistake

Students write that the phobia was only about fear. The point of this study is that disgust also played a part, and that the treatment had to target disgust as well as fear.

Worked example

During the rewarded real-life exposure the boy touched more and more buttons, yet his distress ratings rose. What does this suggest about his phobia and its treatment?

Touching more buttons shows that his behaviour changed, because approaching buttons was rewarded.
Rising ratings show that his feelings about buttons did not improve, so the reward changed what he did but not how he felt.
Disgust comes from how an object is judged, so it needs a method that changes the judgement: imagery exposure that works on his thoughts about buttons.

Answer: The phobia was kept going by disgust as well as fear, so reward-based exposure alone was not enough; imagery exposure aimed at disgust was needed.

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