The Science of Phobias & The Famous Case of Button Boy

A phobia is an excessive fear of a seemingly harmless thing. Those affected, go to great lengths to avoid certain situations and if a situation cannot be avoided, they experience severe distress, panic attacks or even fainting. The famous case of Button Boy shows how a single childhood event can create a phobia that is surprisingly complex to treat.

The full story
Intro to Phobia

A phobia is an excessive fear of a seemingly harmless thing and those affected, go to great lengths to avoid certain situations. If a situation cannot be avoided, they experience severe distress, panic attacks or even fainting. Phobias are less prevalent among children and older people, and more common among teenagers, and especially girls. They run in families or can be the result of a traumatic experience early in life. Phobias can be categorized into 3 types.

social phobia
Social Phobia

A social phobia is when we fear others, especially their judgment.

agoraphobia
Agoraphobia

Agoraphobia is the fear of a situation we perceive to be unsafe or difficult to escape.

specific phobias
Specific phobias

Specific phobias include fears of certain things, or situations, such as heights, or injuries and seeing blood. Some phobias are especially complicated — such as the famous case of the Button Boy.

the famous CASE OF button boy
The button boy case

It was a normal day at kindergarten when a 6 year old boy ran out of buttons to paste on his poster board and was asked to come to the front of the class to get some more. When he reached for the bowl, his hand slipped and all the buttons fell on him. For the boy this was a deeply traumatic event. Not long after, he didn’t want to dress himself anymore.

He began to have difficulty concentrating in class due to an excessive preoccupation with not touching his school uniform. And eventually, he started avoiding people just to stay away from their buttons! Life became so difficult that 4 years after the incident the boy and his mother decided to seek professional help.

saavedra and silverman
Saavedra and Silverman

The psychiatrists Lissette Saavedra and Wendy Silverman who studied the case were able to rule out obsessive-compulsive disorder (OCD), which is often confused with a phobia, and concluded that the boy must have developed a specific phobia for buttons. To treat the boy, the doctors invited the mother and son to be part of a research project.

To assess the child’s progress throughout the treatment, they used a Feelings Thermometer, allowing the boy to grade each interaction from 1, feeling happy, to 9, feeling angry. Big, brass jeans buttons hardly bothered the boy, but small, clear, plastic ones horrified him. After the boy’s feelings were better understood, the doctors selected a treatment method.

behavioral exposure therapy
Behavioral exposure therapy

First they tried behavioral exposure therapy, a form of classical conditioning. Whenever the boy touched a button successfully, he was rewarded. They then repeated the process in various forms. After 4 sessions, the boy completed all tasks and he was able to interact with way more buttons than before. However, he felt more distressed about buttons than ever.

When the doctors talked to the boy again he revealed that he found buttons disgusting and that they emitted a bad smell. And so they wondered: did the exposure therapy reduce his fear, but increase his feeling of disgust?

imagery exposure therapy
Imagery expoure therapy

Next, they tried Imagery Exposure Therapy. For the seven sessions that followed, the boy was prompted to just visualize buttons falling on him and imagine how they looked, felt, and smelled.

This time the boy’s self-reported levels of distress reduced dramatically. Even 12-months after the therapy the boy reported minimal fear of buttons. So why did the first treatment fail, while the second one worked?

Expectancy vs evaluating learning
Expectancy vs evaluative learning

The first treatment changed the minds’ expectations of what harmless buttons may trigger —classical conditioning. The second therapy changed the mind’s evaluation of buttons themselves – that they aren’t actually that disgusting. In technical terms, expectancy-learning failed, but evaluative learning, succeeded.

forms of phobia treatment

But treatment of a phobia may take many forms. Social- and agoraphobia are often treated with counseling or even medication. Specific phobias are often treated by systematic desensitization, today often with the help of virtual reality.

Humor is another serious therapy that often works. Activities that elicit humor with the feared situation, can help reduce disgust, anxiety or whatever other uncovered feelings may be the cause of our phobia.

Share your experience of phobia
Share your phobia experience

What’s your experience with phobia? Have you ever had one that you were able to overcome? And if so, how did you do it? Share your thoughts in the comments below.

Sources

Dig deeper!

Classroom exercise

Set up the room in a way that groups of two can sit together.

  • Let the students pick a phobia from this list, or allow them choose one that they experience themselves. 
  • Each student then writes down the main aspects of their phobia in their own words. What phobia do you have? Does it smell and feel like something? Where do you think it comes from?
  • Now they go together in pairs and share with each other what they have written. Together they think about ideas for each other on how to overcome the phobia. 
  • Once they are done, let them present the phobia of their partner. 
  • Finally let the students vote on one phobia which they want to explore deeper and research possible treatment protocols.

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