Saavedra and Silverman · button phobia
Use a single-child case study to examine disgust as well as fear in a specific phobia. Keep the reported treatment outcome separate from claims about all children or do-it-yourself treatment advice.
Section Paper 1 · Approaches, Issues and Debates
Exam scope and assessment notes
Original StudyForA teaching mapped to the Cambridge 2028–2030 syllabus. These lessons are independent study support, not Cambridge material, official mark schemes or awarded grades. No lesson reproduces a research article or Cambridge question. Human subject-expert review and full timed-paper grading remain pending. This lesson synthesises the named study from its original article and Cambridge's study outline; it is an original summary, not a reproduction of the paper.
Before you begin
- This is one of the 12 compulsory AS core studies in the 2028–2030 Version 1 syllabus. Check that your exam entry uses this syllabus year.
Work on paper. Try each question before revealing help, and explain why your method works.
Quick readiness check
Which emotions were central to the study?
What you will learn
- Explain the study aim, sample, procedure and findings
- Evaluate the method, ethics and evidence
- Apply the relevant approach and issues/debates without overclaiming
Approach and research focus
Learning approach. The case investigates how disgust and fear may contribute to a child’s button phobia and whether an exposure-based cognitive-behavioural intervention that targets disgust can reduce symptoms.
Background: Research and treatment accounts of childhood phobias have often focused on fear. The authors considered whether disgust could help maintain distress and avoidance in a particular child’s phobia of buttons.
Aim and procedure
The case concerned one 9-year-old Hispanic American boy treated in a specialist child anxiety programme. The case-study method combined interviews, observations and repeated measures/scales of fear, disgust and avoidance. The intervention used exposure-based cognitive-behavioural work and imagery exposures that addressed disgust and negative evaluations of buttons. The study assessed the child after treatment and again at six and twelve months.
Results and conclusion
The authors reported reduced phobic symptoms after treatment, with gains maintained at six- and twelve-month follow-up. The report treats disgust as clinically relevant alongside fear; one case cannot show that the same pattern or intervention will fit every child.
This case suggests that attention to disgust may be useful when describing and treating this child’s button phobia. It cannot isolate which treatment component caused the improvement or establish general effectiveness from one participant.
Evaluate the evidence
Interviews, observations and scales provide several perspectives on one child’s experience; follow-ups assess whether changes lasted beyond the immediate post-treatment point.
A single case gives limited generalisability, and the child was selected from a specialist service rather than sampled from a population.
There was no comparison group and the intervention combined components, so improvement cannot be attributed solely to imagery exposure or disgust work.
Ratings and case interpretation can be affected by self-report, caregiver/clinician perspectives and the treatment relationship.
Ethics and issues/debates
The participant was a child receiving clinical care. Appropriate guardian permission, the child’s assent, confidentiality and qualified clinical oversight are essential.
Do not turn a case report into instructions for exposure therapy; treatment should be planned by a qualified clinician with the child’s wellbeing central.
Classical/evaluative learning can help explain how a stimulus acquires emotional meaning, while treatment combines cognitive and behavioural elements.
The case illustrates the possible interaction of fear and disgust but cannot show that one emotion explains all phobias.
Application to practice is promising as a hypothesis, not a universal treatment rule.
Sources for this lesson
Pause and explain
Why can’t the study identify the active treatment ingredient?
Worked example
A clinic says, ‘This case proves imagery exposure cures button phobia in children.’ Evaluate the claim.
Show the worked solution
- The report describes one 9-year-old boy and one combined treatment programme.
- Improvement was reported after treatment and at six- and twelve-month follow-up.
- No control group or component comparison identifies which treatment element caused the change.
Answer The case reports maintained treatment gains for one child, but it does not prove that imagery exposure alone cures button phobia generally.
Try a topic test
Choose Easy, Normal or Difficult. Save your answers and open worked review after finishing.
Test this topic →From guided practice to a new situation
Write your answer and reasoning first. Use a hint only if you are stuck. The model solution is for self-checking; your written work is not automatically marked.
The child’s treatment gains were maintained at six- and twelve-month follow-up. What does this add, and what does it not prove?
Give me a hint
Follow-up supports duration of reported change, not a general causal claim.
Compare my reasoning
- It indicates that improvement was still reported after treatment ended.
- The result is for this one child and this combined intervention.
- Without a comparison or component test, it cannot show which part caused the gains.
Follow-ups support maintained gains for this child, but not a general cure or a single active treatment ingredient.
Look for these in your work
- Follow-up meaning explained
- Case scope bounded
- Causal limit stated
Evaluate two methodological strengths and two limits of the case study.
Give me a hint
Consider depth, multiple measures, a single participant and combined treatment.
Compare my reasoning
- Interviews, observations and scales allow a detailed account from several sources.
- Follow-up checks whether reported change persisted beyond treatment.
- One selected child and no comparison group restrict generalisation and causal inference.
- The combined intervention prevents isolating the contribution of imagery or disgust-focused work.
The case provides detailed, repeated observations but remains weak for population generalisation and component-level causal claims.
Look for these in your work
- Two evidence strengths identified
- Sample and control limitations identified
- Treatment components evaluated
Propose an ethical way to examine whether disgust is relevant in other phobia cases without prescribing treatment.
Give me a hint
Use qualified oversight, voluntary assent and more than one participant or measure.
Compare my reasoning
- With clinical and ethics oversight, study adults or children only with appropriate consent, assent and safeguarding.
- Use validated, non-invasive measures of fear, disgust and avoidance alongside interviews, without forcing exposure.
- Compare carefully matched case patterns over time and protect identities; do not treat an association as a universal diagnosis or treatment rule.
A safeguarded multi-case study can describe whether disgust appears in different presentations while keeping care decisions with qualified clinicians.
Look for these in your work
- Ethical review and assent specified
- Multiple data sources included
- No treatment prescription or universal claim
Common mistakes
- Generalising from one child to all children
- Attributing change to one component of a combined intervention
- Treating fear and disgust as the same emotion
- Presenting case-study content as personal treatment instructions
What can you explain now?
What does a single case study allow researchers to examine especially closely?
Compare with the explanation
One child’s experience, assessment and change over time
Depth does not compensate for the lack of a comparison group or broad generalisation.
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Make it stick
Name the aim, the best-evidenced result and one methodological limitation of Saavedra and Silverman.
If you needed the solution, close it and solve the problem again from a blank page. A correct answer is stronger when you can explain the reason for each step.