Psychology (9990) | Saavedra and Silverman (button phobia)

Hello Future Psychologist! Your Notes on Saavedra & Silverman (2002)

Welcome to one of the most fascinating case studies in the AS Level curriculum! Saavedra and Silverman's work on button phobia is a brilliant example of how the Learning Approach applies behavioral principles to treat complex psychological problems. Don't worry if phobias seem tricky—by the end of these notes, you'll see exactly how learning theories can explain, and successfully treat, irrational fears.

This study is crucial because it helps us understand the difference between fear (Classical Conditioning) and disgust (Evaluative Learning) when treating phobias.

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Section 1: The Psychology and Context

Psychology Investigated: Learning Theories and Phobias

This study falls under the Learning Approach, which assumes that all behavior (including phobias) is learned from the environment, usually through association or consequences. Specifically, this case study examines three key concepts:

1. Classical Conditioning (Learning by Association)

The standard explanation for phobias (like in Watson and Rayner's 'Little Albert' study). A neutral stimulus (NS, e.g., a button) is paired with an unconditioned stimulus (UCS, e.g., a scary event), leading the neutral stimulus to become a conditioned stimulus (CS) that elicits a conditioned response (CR) of fear.

2. Operant Conditioning (Learning by Consequences)

This explains why phobias persist. When the boy avoids buttons, he successfully reduces his anxiety. This avoidance is a form of negative reinforcement (removing an unpleasant feeling), which encourages him to continue avoiding buttons.

3. Evaluative Learning (Learning by Disgust)

This is the central focus of the study. Sometimes, a phobia is not just about fear, but about feelings of disgust. Evaluative learning occurs when a person learns to associate a neutral stimulus (the button) with a negative emotional response (disgust), which then changes the person's 'evaluation' of that object. This new association is much harder to break than a simple fear response.

Analogy: Imagine you eat your favourite food while watching a very disgusting medical video. Even if you don't feel 'scared' of the food, you might feel revolted by it afterward. That negative "gut feeling" is evaluative learning.

Background to the Study

The boy in this study suffered from a specific phobia—an irrational fear focused on a particular object or situation. His phobia was severe: a fear of buttons. He could not touch buttons, wear clothes with buttons, or even look at them without distress. This phobia significantly impacted his daily life.

Aim(s) of the Study

The primary aims were:

• To investigate the causes of a button phobia in a child.
• To treat the child’s phobia using exposure-based treatment by tackling both his fear and disgust responses.

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Section 2: Procedure and Methodology

Research Method: Case Study

Saavedra and Silverman used a case study, meaning they focused on one individual (the 9-year-old Hispanic American boy) in great detail. This method is common when studying rare or unique conditions.

The Participant (The Boy)

The participant was a 9-year-old boy. His phobia started at age five when he had a traumatic experience with a large bowl of colorful buttons in front of his class. The bowl fell, and he was distressed by the experience, triggering his phobia.

The boy and his mother gave consent to participate in the study, which took place over 5 months.

Data Collection Techniques

As a case study, the researchers gathered rich data using several techniques:

1. Interviews: Used to understand the history of the phobia and the boy's subjective experiences.
2. Observations: Used during therapy sessions to monitor behavior (e.g., avoidance).
3. Rating Scales (Quantitative Data):
   - Feelings Thermometer: A 9-point scale used to measure distress. - The boy rated buttons from 0 (not distressed) to 8 (maximally distressed).

Before treatment, the boy's ratings were very high. For example, small, clear plastic buttons (the ones he found most disgusting) were rated an 8.

The Procedure: Two Forms of Therapy

The therapy focused on addressing the underlying negative associations—both the fear and, crucially, the disgust.

Phase 1: Positive Reinforcement (Operant Conditioning)

This phase was designed to gradually increase the boy's contact with buttons while rewarding him for showing less distress. The key idea here is systematic, positive reward for desired behaviour.

Step-by-step Process:

• The boy was exposed to buttons using a hierarchy of fear/disgust (starting with the least offensive buttons, like large denim buttons, and moving up to small, clear plastic buttons).
• During each session, the boy was rewarded by his mother for successful completion of the gradual exposure.
• The type of reward was subjective—it depended on the boy's motivation (e.g., praise, playing with his toys).

Did You Know? This part of the treatment is closely related to systematic desensitisation (a behavioral therapy), but instead of relying purely on relaxation to overcome fear, it uses direct consequences (rewards).

Phase 2: Imagery Exposure and Disgust Therapy (Evaluative Learning)

Although Phase 1 reduced his ratings of fear, the boy’s distress over certain buttons (small, clear ones) remained high because he still felt intense disgust. Therefore, the therapist shifted strategy to tackle this evaluative component.

Step-by-step Process:

1. The boy was asked to imagine buttons falling on him and to think about how they looked and smelled.
2. The therapist used cognitive restructuring to help the boy change his thinking about the disgusting nature of buttons (e.g., he was asked why buttons might be "dirty").
3. They paired the imagery of the buttons with thoughts designed to change the negative evaluation (e.g., imagining pleasant smells instead of dirty ones).
4. This imagery exposure sessions lasted 60–90 minutes.

Don't worry if this seems tricky at first—the key difference is that Phase 1 tackled the fear through reward, and Phase 2 tackled the disgust through visualization and cognitive work.

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Section 3: Results and Conclusion

Key Findings (Quantitative Data)

• After the Positive Reinforcement treatment (Phase 1), the boy’s subjective ratings of distress decreased significantly for buttons on the visual hierarchy.
• However, his ratings for the most disgusting buttons (small, clear plastic ones) remained high (rated 8/9). This showed that Operant Conditioning alone was not enough because the core problem was disgust, not just fear.
• After the Imagery Exposure therapy (Phase 2), the boy’s rating of disgust dropped from 8 to 3.
• One month after the therapy, the boy was able to wear clothes with buttons.
• Six months after the therapy, the boy’s phobia was completely gone; he could handle buttons and was wearing uniform shirts to school.

Qualitative Findings

The qualitative data gathered through interviews and observations confirmed that the boy's perception of buttons had fundamentally changed, proving the success of the Evaluative Learning intervention. The boy’s distress disappeared when he no longer associated buttons with feeling "dirty" or "disgusting."

Conclusions

Saavedra and Silverman concluded that:

1. Phobias based on disgust (evaluative learning) must be treated differently from phobias based purely on fear (classical conditioning).
2. The treatment successfully used positive reinforcement and imagery exposure to treat the boy's specific button phobia by addressing the underlying cause: the association between buttons and disgust.

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Section 4: Evaluation and Debates

Strengths of the Study

• In-Depth Data (Case Study): Because it was a case study, the researchers gathered incredibly detailed, rich qualitative data over five months, providing a unique insight into the boy’s experiences and the nature of his phobia.
• High Validity: The use of multiple methods (interviews, scales, observations) allowed for triangulation, increasing the validity of the findings (we can be more confident the phobia was truly gone).
• Application to Everyday Life: The findings have high practical use. They demonstrated an effective treatment for specific phobias, especially those maintained by disgust rather than fear.
• Standardised Measures: The use of the Feelings Thermometer provided quantifiable data, allowing for objective measurement of distress levels both before and after treatment.

Weaknesses of the Study

• Low Generalisability: As a case study involving only one child with a specific, rare phobia, the findings may not apply to other people or other types of phobias. The boy was also unique due to his high motivation for recovery.
• Researcher Bias: Given the intense interaction between the boy, his mother, and the therapist, the data may be subjective. The therapist might have selectively recorded data that confirmed the success of the treatment.
• Demand Characteristics: Since the boy knew he was in therapy to overcome his fear (and was being rewarded), he may have deliberately reported lower distress scores (especially in Phase 1) to please the researchers or receive rewards.

Ethical Issues

Since the boy was only 9 years old, the issue of consent is crucial. While the mother provided valid consent, the boy’s assent (agreement to participate) was still needed. The use of **children in research** always requires careful consideration of potential distress.

• Harm: The boy experienced distress during the exposure stages of the therapy, although the treatment was designed to minimise this harm through gradual steps.
• Confidentiality: Although the child's identity was protected (known only as 'the boy'), in a case study, it can be harder to fully anonymise the individual's specific background details.

Issues and Debates

Application to Everyday Life (High)

This is the most important debate link. This study provides a successful, tailored therapy that can be used by clinical psychologists to treat specific phobias, especially those rooted in disgust (e.g., phobias of mould, dirt, or certain textures).

Individual vs. Situational Explanations

• Situational: The phobia was clearly learned due to a specific event (the button bowl incident) and maintained by the environmental consequence of avoidance (learning approach).
• Individual: The boy's unique pre-existing sensitivity to disgust and his strong motivation played a large role in both the phobia's development and the eventual successful outcome.

You’ve mastered Saavedra and Silverman! Remember that the key lesson here is the difference between fear (easy to treat) and disgust (harder, requires deeper evaluative work).