pathways to fear in spider phobic children by harald merckelbach, peter muris and erik schouten...

8/13/2019 Pathways to Fear in Spider Phobic Children by HARALD MERCKELBACH, PETER MURIS and ERIK SCHOUTEN (1996)

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Pergamon Behav. Res. Ther. Vo l. 34, No. 11/12, pp. 935-938, 1996Copyright 1996 Elsevier Science LtdPrinted in Great Britain. All rights reservedS0005-7967 96)00052-6 0005-7967/96 $15.00 + 0 .00

S H O R T E R C O M M U N I C T I O N SPathways to fear in spider phobic children

H A R A L D M E R C K E L B A C H , P E T E R M U R I S a n d E R I K S C H O U T E NDep ar tmen t o f Psycho logy , L imb urg Univers it y , P O Box 616 , 6200 M D, Maa s t r ich t , The Ne ther lands

R e c e i v e d 1 5 M a y 1 9 9 6 )S u m m a r y - - T w e n t y - t w o c h i l d r e n w i t h s p i d e r p h o b i a w e r e i n t e r v i e w e d a b o u t t h e o r i g i n s o f t h e i r f e a r .M o r e s pe ci fi ca ll y, c h i l d r e n w e r e a s k e d a b o u t c o n d i t i o n i n g e v e n t s , m o d e l i n g e x p e r i e n c es , a n d n e g a t i v e i n -f o r m a t i o n t r a n s m i s s i o n . T o e v a l u a t e t h e r e l i a b i l i t y o f t h e i n f o r m a t i o n p r o v i d e d b y t h e c h i l d r e n , p a r e n t sw e r e i n d e p e n d e n t l y in t e r v ie w e d a b o u t t h e o r i g i n s o f t h e i r c h i l d r e n ' s p h o b i a s . W h i l e 4 6 % o f t h e c h i l d r e nc l a i m e d t o h a v e a l w a y s b e e n a f r a i d , 4 1 % a s c r i b e d t h e o n s e t o f t h e i r f e a r t o a v e r s i v e c o n d i t i o n i n ge v e n t s . T h e l a r g e m a j o r i t y o f t h e s e e v e n t s w e re c o n f i r m e d b y p a r e n t s . T h e s e f i n d i n g s c a s t d o u b t s o n as t r o n g v e r s i o n o f t h e n o n - a s s o c i a t i v e a c c o u n t o f s p i d e r p h o b i a , i . e . t h e i d e a t h a t s p i d e r p h o b i a i sa c q u i r e d i n t h e c o m p l e t e a b s e n c e o f l e a r n i n g e x p er i e nc e s . C o p y r i g h t 1 9 9 6 E l s e v ie r S ci en c e L t d

INTRODUCTIONA c c o r d i n g t o R a c h m a n ' s ( 1 9 77 , 1 9 90 ) i n f l u e n ti a l m o d e l o f p h o b i c e t i o l og y , t h e r e a r e t h r e e p a t h w a y s t o p h o b i c f e a r : a v e r -s ive c lass ica l condi t ion ing , model ing ( i . e . v icar ious lea rn ing) , and nega t ive in format ion t ransmiss ion ( i . e . exposure ton e g a t i v e i n f o r m a t i o n a b o u t t h e p h o b i c o b j e c t ) . A n u m b e r o f s t u d i e s h a v e s o u g h t t o e v a l u a t e t h e c o n t r i b u t i o n o f t h e s epa th wa ys to the ac quis i t ion of c l in ica l pho bias (e .g . Os t & H ugd ahl , 1981; Os t , 1987; see, fo r a rev iew, M ercke lb ach , deJ o n g , M u f f s & v a n d e n H o u t , 1 9 9 6 ) . M o s t o f t h e s e s t u d i e s m a d e u s e o f t h e P h o b i c O r i g i n s Q u e s t i o n n a i r e ( P O Q ; O s t &H u g d a h l , 1 9 81 ), a s e l f - re p o r t i n s t r u m e n t t h a t a s k s p a t i e n t s t o g iv e a r e t r o s p e c t iv e j u d g e m e n t a s t o w h e t h e r t h e t h r e ep a t h w a y s p l a y e d a d e c i s iv e r o le i n t h e o n s e t o f t h e i r c o m p l a i n t s .T h e f i n d i n g s o f t h e P O Q s t u d i e s c a n b e s u m m a r i z e d a s f ol lo w s . F i r s t ly , w h i l e a s l ig h t m a j o r i t y o f a l l p h o b i c p a t i e n t sa t t r i b u t e t h e i r s y m p t o m s t o c o n d i t i o n i n g e x p e r i e n c e s , t h i s t y p e o f e x p e r i e n c e s e e m s t o p l a y a m o r e p r o m i n e n t r o l e i ns o m e p h o b i a s ( e. g. c l a u s t r o p h o b i a ) t h a n i n o t h e r p h o b i a s ( e .g . a n i m a l p h o b i a s ; O s t , 1 9 87 , 1 9 91 ). S e c o n d l y , m o d e l i n g e x -p e r i e n c e s a r e m o r e f r e q u e n t l y r e p o r t e d b y a n i m a l p h o b i a s t h a n b y c l a u s t r o p h o b i c s (O s t , 1 9 8 7 ; M e r c k e l b a c h , A r n t z & d eJ o n g , 1 9 9 1 ) , w h e r e a s n e g a t i v e i n f o r m a t i o n p r o c e s s i n g i s t h e l e a s t p r o m i n e n t f a c t o r a c r o s s a l l p h o b i a s ( ( ) s t , 1 9 8 7 ) .T h i r d l y , p a t i e n t s o f t e n i n d i c a t e t h a t m o r e t h a n o n e p a t h w a y c o n t r i b u t e d t o t h e o n s e t o f t h e i r f e a r s a n d t h e r e i s e v i d e n c et o s u g g e s t t h a t t h i s i s a s s o c i a t e d w i t h h i g h e r f e a r l ev el s ( O l l en d i c k & K i n g , 1 9 91 ; M e r c k e l b a c h , d e R u i t e r , v a n d e n H o u t& Hoeks t ra , 1989) .I n g e n e r a l , th e P O Q s t u d i e s s u p p o r t R a c h m a n ' s ( 19 7 7, 1 9 90 ) t h r e e - p a t h w a y s m o d e l o f p h o b i c e t io l o g y . T h a t i s, t h ef i n d i n g s o f t h e s e s t u d i e s u n d e r l i n e t h e r o l e o f c l a s s i c a l c o n d i t i o n i n g , m o d e l i n g , a n d t o a l e s s e r e x t e n t , n e g a t i v e i n f o r -m a t i o n i n t h e a c q u i s i t i o n o f f e a r s a n d p h o b i a s . H o w e v e r , r e c e n t l y s o m e a u t h o r s h a v e c r i t i c i z e d t h e v a l i d i t y o f t h e P O Qs t u d i e s ( e . g . M e n z i e s & C l a r k e , 1 9 9 4 ; W h i t h e r s & D e a n e , 1 9 9 5 ) . T h e s e a u t h o r s a r g u e t h a t t h e P O Q i s a r e t r o s p e c t i v ei n s t r u m e n t t h a t m i g h t b e s u s c e p t i b l e t o m e m o r y b i a s . A n o t h e r c r i t i c a l p o i n t r a i s e d b y t h e s e a u t h o r s i s t h a t P O Q s t u d i e sd o n o t e m p l o y a s t r ic t d e f i n it i o n o f w h a t q u a l i fi e s a s a c o n d i t i o n i n g ex p e r ie n c e . T h i s c o u l d h a v e l e a d t o a n o v e r s t a t e m e n to f t h e r o l e o f c o n d i t i o n i n g i n t h e o r i g i n s o f p h o b i a s . A t h i r d c r i t i c i s m i s t h a t t h e P O Q i s b i a s e d i n f a v o u r o f R a c h m a n ' s( 1 9 7 7 ) m o d e l . T h a t i s , t h e P O Q i t e m s a r e r e s t r i c t e d t o c o n d i t i o n i n g , m o d e l i n g , a n d n e g a t i v e i n f o r m a t i o n t r a n s m i s s i o na n d c o n s e q u e n t l y , th i s i n s t r u m e n t d o e s n o t i n c l u d e o t h e r o p t i o n s ( e. g. I ' v e a l w a y s b e e n a f ra i d ) . T h i s m i g h t h a v e l e d toa n u n d e r e s t i m a t i o n o f e t i o l o g i c a l s c e n a r i o s t h a t d o n o t i n v o l v e l e a r n i n g e x p e r i e n c e s . F o r e x a m p l e , u s i n g t h e O r i g i n sQ u e s t i o n n a i r e , J o n e s a n d M e n z i e s ( 1 99 5 ) f o u n d t h a t t h e m a j o r i t y o f t h e i r s p i d e r f e a r f u l u n d e r g r a d u a t e s ( i .e . 1 3 o u t o f 1 9S s ) e n d o r s e d t h e h a v e a lw a y s b e e n a f ra i d o f sp i d e r s o p t i o n o f t h i s q u e s t i o n n a i r e , a n o p t i o n t h a t i s n o t a v a i l a b l e i n t h eP O Q . J o n e s a n d M e n z i e s (1 9 9 5 ) a r g u e t h a t t h i s fi n d i n g s u p p o r t s a n o n - a s s o c i a t i v e a c c o u n t o f p h o b i a s ( M e n z i e s &C l a r k e , 1 9 95 ). C e n t r a l t o t h i s a c c o u n t i s t h e a s s u m p t i o n t h a t m o s t s p ec if ic p h o b i a s d e r i v e f r o m d e v e l o p m e n t a l f e a rs t h a ta r e e l i c it e d b y e v o l u t i o n a r y - r e l e v a n t cu e s. A c c o r d i n g l y , t h e a c q u i s i t i o n o f t h e s e p h o b i a s w o u l d n o t d e p e n d o n c r i ti c a ll e a r n i n g e x p e r ie n c e s (i .e . c o n d i t i o n i n g , m o d e l i n g , i n f o r m a t i o n t r a n s m i s s i o n ) . T h e n o n - a s s o c i a t i v e a c c o u n t a n d t h e e m p i r i -c a l f i n d in g s o n w h i c h i t r e s t s a r e d i f fi c u l t t o r e c o n c i l e w i t h r e c e n t fi n d i n g s r e p o r t e d b y K h e f f a t y , K l e i n k n e c h t a n d H y m a n( 19 9 6) . T h e s e r e s e a r c h e r s e m p l o y e d t h e P O Q a n d t h e P h o b i a O r i g i n s S t r u c t u r e d I n t e r v i e w ( P O S I ) t o e v a l u a t e t h e r o l e o fl e a r n i n g e x p e r i e n c es in a s a m p l e o f u n d e r g r a d u a t e s w i t h d o g f e a r o r b l o o d / i n j e c t i o n fe a r . W i t h b o t h m e t h o d s , c o n d i t i o n -i n g - li k e e x p e r i e n c es w e r e f o u n d t o b e t h e m o s t f r e q u e n t l y r e p o r t e d c a u s e o f f e a r o n s e t . M o r e o v e r , i n a m a j o r i t y o f c a se s ,t h e r e p o r t e d o n s e t e x p e r i e n c e s w e r e c o n f i r m e d b y p a r e n t s .W h i l e t h e s t u d y b y K h e r i a t y et al. ( 1 9 9 6 ) a n d t h a t b y J o n e s a n d M e n z i e s ( 1 99 5 ) y i e ld e d c o n f l i c ti n g f i n d in g s , t h e y s h a r et w o i m p o r t a n t l i m i t a t i o n s . T o b e g i n w i t h , th e s e s t u d i e s p r e d o m i n a n t l y r e l ie d o n a n a l o g u e S s , i .e . f e a r fu l r a t h e r t h a n c l in i -c a l ly p h o b i c S s . F u r t h e r m o r e , t h e S s i n t h e s e s t u d i e s w e re a d u l t s t u d e n t s . A s m o s t s p ec if ic p h o b i a s t y p i c a l ly b e g i n b e f o r et h e a g e o f 1 0 , o n e m i g h t q u e s t i o n t h e r e t r o s p e c t iv e a c c o u n t s o f t h e s e S s a b o u t t h e o r i g i n s o f t h e i r c o m p l a i n t s . A f a i l u ret o r e t r ie v e r e le v a n t m e m o r i e s m i g h t l e a d t o a n o v e r e s t i m a t i o n o f t h e ' h a v e a lw a y s b e e n a f r a i d ( i.e . t h e n o n - a s s o c i a t iv e )c a t e g o r y a n d a n u n d e r e s t i m a t i o n o f c o n d i t i o n i n g , m o d e l i n g , a n d / o r n e g a t i v e i n f o r m a t i o n f a c t o r s .

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936 SHORTER COMMUNICATIONSJones and Menzies (1995) argued that studies on etiological pathways in phobias might profit from two strategies:First, parental reports could be used to confirm phobic memories of events in early childhood. Second, child Ss withearly onset phobias could be used to reduce the time between onset and subsequent condition ing (Jones & Menzies,1995; p. 233). The present study combined both strategies. That is, spider phobic children were interviewed about theonset of their fears and independently, parents were asked about the circumstances that surrounded the onset of theirchild's phobia.

METHODSubjects

Children were 22 spider phobic girls with a mean age of 11.6 yr (range: 9-14 yr). They applied for t reatment at theSpider Phobia Project for Children at Limburg University. Children and their parents were invited to participate inongoing research in return for free treatment. All children met DSM-III -R criteria for simple phobia (animal type).This diagnosis was assigned on the basis of the Diagnostic Interview Schedule for Children (DISC; National Institute ofMental Health, 1992); a semi-structured interview that was conducted by a senior psychologist. The mean score of thechildren on the 15-item version of the Spider Phobia Questionnaire for Children (SPQ-C; Kindt, Brosschot & Muffs,1996) was 9.7 (SD = 1.9).rocedureAll children were accompanied by one of their parents (5 fathers; 17 mothers). Before receiving one-session behavioraltreatment, the children and their parents completed spider phobia questionnaires (SPQ or SPQ-C) and an instrumentmeasuring Disgust Sensitivity. The data thus gathered will be described in detail in another article.Next, children were interviewed about the onset o f their spider phobia. This was done with a revised and ex tended ver-sion of the POQ (Ost & Hugdahl, 1981). This version consists of two sections. The first section asks about the onset ageand the course of the fear. This section also contains a have always been afraid option. The second section consists ofquestions about conditioning events (2 items), modeling experiences (2 items), and exposure to negative information (2items). I f a question is answered affirmatively, the S is invited to provide details of the event. If the S is able to describesuch details, he/she is asked whether he/she was already phobic when the event took place.During the interview with the POQ, the accompanying parent was not present. Following the interview, the childreceived treatment. During this time, the paren t was interviewed about the onset and origins of the child's spider phobia.In this interview, the same POQ items were used as in the interview with the child. The parent was not informed aboutthe POQ answers of the child. Child and parent interviews were conducted by a senior psychologist. A child was assignedto conditioning, modeling or negative informa tion pathway if, and only if: (a) she responded positively to the pertinentitem; (b) she could provide details of the event; (c) she felt that the event qualified as an onset event.Agreement between parents' and children's responses to the POQ items were evaluated by means of Cohen's Kappa.Ambiguities in children's or parents ' reports were resolved through a consensus discussion among the researchers.

RESULTSThe mean age of onset reported by the children was 5.1 yr (SD = 3.4). Parents tended to give an earlier age of onsetfor their child's phobia [M = 4.3; SD = 2.8; t(19) = 1.5, P = 0.16, two-tailed]. Most children (i.e. 73%) said that theirphobia had become worse over time, although pa rents did not always confirm this (r = 0.10).Table 1 presents the percentage of children who reported conditioning, modeling, and/or negative information eventsas well as the percentage of children who claimed that their fear had always been present. The distribution of parents'repor ts on phobia onset and resulting r values are also shown. In general, satisfactory r values were found for the agree-ment between parents and children. Children's reports were not evenly distributed over the different options [Cochran's

Q(5) = 24. 8, P < 0.001]: the always been afraid option and the conditioning onset were more often mentioned thanthe other options.Table 2 shows the frequency of conditioning, modeling, and negative information reports in the subsample of childrenwho indicated that they had always been afraid of spiders (10 out of 22 children; 45.5%). To construct this table, moreliberal criteria for conditioning, modeling etc. were adopted. That is to say, conditioning, modeling etc. had to bedescribed in some detail, but they were not related to fear onset. Interestingly, high percentages of negative informationand modeling mediated by others and a relatively low percentage of conditioning were found [Cochran's Q(4) = 23.2,P < 0.001].Table 1. Percentage of conditioning modeling and negative information reports and alwaysbeen afraid option of children (N = 22) and parents (N = 22)

% Children % Parents ~cConditioning 40.9 36.4 0.89Modeling mother 13.6 13.6 0.72Modeling father 4.5 4.5 1.O0Modeling others 0.0 0.0 - -Negative informat ion 4.5 0.0 0.44Always been afraid 45.5 54.5 0.84


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938 SHORTERCOMMUNICATIONSMercke lbach , H. , Arn tz , A. , Arr inde l l , W. A. , de Jong , P . J . (1992) . Pa thways to sp ide r phobia . Behaviour Researchand Therapy, 30, 543-546.Me rckelbac h, H., Arn tz, A., de Jong , P. J . (1991). Co nditi onin g experiences in spider phobias. Behaviour Research andTherapy, 29. 333-335.Mercke lbach H. , de Jong , P .J . (1996). Evolu t ionary mode ls o f phobias . In G. C. L . Davey (Ed. ), Phobias: a handbookof descript ions treatme nt , and theory (in press). Chichester: Wiley.Me rckelbac h, H., de Jong , P. J . , Arn tz, A., Schou ten, E. (1993). The role of evalu ative learning and disgust sensitivityin the e t io logy and t rea tment o f sp ide r phobia . Adva nces in Behaviour Research an d Therapy, 15, 243-256.Mercke lbach H. , de Jong , P . J . , Muris , P ., van den Hout , M. A. (1996) . The e t io logy of spec if ic phobias : a rev iew.Clinical Psych ology Review, 16, 337 361.Mercke lbach H. , de Rui te r , C . , van den Hout , M. A. , Hoek s tra , R . (1989) . Cond i t ion ing experiences and phobias.Behaviour Research and Therapy, 27, 657-662.Mu ris , P. , Steerne man , P. , M ercke lbach, H., Meesters, C. (1996). The role of parenta l fearfulness and modelin g inchildren 's fear. Behaviour Research an d Therapy, 34, 265-268.N a t io n a l In s t i t u t e o f Me n ta l H e a l th (N IMH ) (1 9 9 2 ) . Diagnos t ic In terv iew Schedu le fo r Chi ldren DI SC ) (Version 2.3).New Y ork : N ew Y ork S ta te Psych iat r ic Ins t i tu te , Div is ion o f Chi ld and A dolescen t Psych ia t ry .Ollend ick , T . H. , King , N. J . (1991) . Orig ins o f ch i ldhood fea rs : an eva lua t ion o f Rachm an 's theory o f fea r acqu i-sition. Behaviour Research and Therapy, 29, 117 123.Os t , L . G . (1987). Age of onse t in d i f fe ren t phobias . Journa l o f Abnormal Psycho logy , 96 , 223-229.(gst, L. G. (1991). Acquisition of blood and injection phobia and anxiety response patterns in clinical patients . BehaviourResearch and Therapy, 29, 323 332.Ost, L. G., Hu gdah l, K. (1981). Acq uisitio n of phob ias and anxiety response patterns in clinical patients . BehaviourResearch and Therapy, 19, 439~,47.Rachm an, S . (1977) . The con di t ion ing theory o f fea r-acqu is i tion: a c r i t ica l examina t ion . Behaviour Research andTherapy, 15, 375-387.Rachman, S . (1990) . The de te rminan ts and t rea tment o f s imple phobia . Adva nces in Behaviour Research an d Therapy, 12,

1 3 0 .W hithers , R. D., Dea ne, F. P. (1995). Origin s of com m on fears: effects on severity, anxiety responses and me mo ries ofonset. Behaviour Research a nd Therapy, 33, 903-915.

pathways to fear in spider phobic children by harald merckelbach, peter muris and erik schouten...

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