Case Study: A Quantitative Report of Early Attention, Fear, Disgust, and Avoidance in Specific Phobia for Buttons

Kateri McRae, Bethany G. Ciesielski, Sean C. Pereira, James J. Gross

Research output: Contribution to journalArticlepeer-review


Specific phobia is characterized by elevated early attention to the phobic object, negative emotion, and avoidance. Typically, phobic objects are biologically relevant, such as potentially threatening snakes or spiders, or potentially contaminating needles or rodents. It is unclear whether the same early attention, emotion, and avoidance responses can be observed in phobia for uncommon, nonbiologically relevant objects, such as buttons (koumpounophobia). In an experimental case study, we measured early attention (detection rates to briefly presented images before a backward mask), emotion, and avoidance to clothing buttons in a button-phobic participant. We compared these responses to nonphobic objects (zippers), and to well-matched control participants. We observed elevated early attention, fear, and disgust to buttons, which did not generalize to nonphobic emotional stimuli. In addition, we observed elevated avoidance of buttons, which did generalize to normatively fearful and disgusting pictures. If replicated, our results indicate that nonbiologically prepared phobic objects elicit similar elevated early attention, emotion, and avoidance as biologically prepared phobic objects. The finding that avoidance was the only response that generalized to nonphobic objects may have treatment implications—namely, that therapeutic attempts to reduce avoidance might consider including a variety of objects, not just the phobic object.

Original languageEnglish (US)
Pages (from-to)485-493
Number of pages9
JournalCognitive and Behavioral Practice
Issue number2
StatePublished - May 2022


  • backward masking
  • conscious
  • emotion
  • koumpounophobia
  • uncommon phobia

ASJC Scopus subject areas

  • Clinical Psychology


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