Saavedra & Silverman - Button Phobia

Background: The study highlights how a 9-year-old boy developed a button phobia after an experience with buttons falling on him in school. Saavedra and Silverman were interested in how targeting disgust, rather than fear, could reduce phobia symptoms.

Aim: 

1. Investigate the role of disgust in maintaining a specific phobia.

2. Explore the effectiveness of exposure-based therapy when addressing disgust-related responses.

Method:

Research Method and Design: Single-subject case study with clinical intervention

Variables:

• Independent variable: gradual exposure to buttons

• Dependent variable: level of fear/disgust

Sample: A 9-year-old Hispanic-American boy with a button phobia (he fit the criteria for a specific phobia in the DSM-IV).

Procedure:

1: Baseline Measures

• A Feelings Thermometer was used to assess his level of distress towards different types of buttons (scale of 0 to 8, where 0 = no distress and 8 = extreme distress).

• A hierarchy of feared stimuli was created based on different types of buttons:

1. Small, clear plastic buttons (most distressing, score of 8)

2. Large, plastic buttons (score of 6)

3. Denim buttons (least distressing, score of 2)

2: Treatment Phase 1: Exposure Therapy 

• He underwent gradual exposure therapy, meaning he was exposed to buttons in a structured way from least to most distressing.

• The hierarchy of feared stimuli was followed, and he was encouraged to handle different types of buttons.

• Despite repeated exposure, his distress levels did not decrease significantly, meaning the phobia was resistant to standard exposure therapy.

3: Treatment Phase 2: Imagery Exposure

• Since exposure was not effective, a new treatment phase focused on imagery exposure.

• The boy was asked to imagine buttons falling on him and describe how it felt.

• He was encouraged to explore his emotions and thoughts related to the phobia.

• Cognitive restructuring was used to help him challenge and change irrational thoughts about buttons.

4: Treatment Phase 3: Positive Reinforcement

• The boy was rewarded for showing progress in interacting with buttons.

• This was a form of behavioral reinforcement to encourage engagement with the feared stimulus.

Results:

• Initially, the boy showed high levels of disgust and fear toward buttons

• Fear reduced after multiple sessions, but disgust remained strong for awhile.

• Over time, the disgust response also decreased, and the boy was able to touch and handle buttons with minimal distress.

Conclusion:

This case study demonstrates that disgust can play a significant role in specific phobias and that exposure therapy targeting disgust can be effective. The study suggests that phobia treatments should not only focus on fear reduction but also address disgust-related responses to achieve long-term improvement.

Saavedra, L. M., & Silverman, W. K. (2002). Disgust and a specific phobia: A case study of a child with phobia of buttons. Journal of Anxiety Disorders, 16(1), 69-79. https://doi.org/10.1016/S0887-6185(01)00045-8

McLeod, S. (2024, December 4). Saavedra and Silverman (button phobia). Simply Psychology. https://www.simplypsychology.org/saavedra-and-silverman.html