Extinction of a phobia of physical examination in a seven-year-old mentally retarded boy—A case study

Counterconditioning is a process in which aversive stimuli that ordinarily evoke emotional or avoidance responses are paired with positive stimuli which evoke incompatible activities. Several sets of operations have been employed to induce these incompatible activities (e.g. food, Jones, 1924; relaxation. Grossberg, 1964; positive imagery, Lazarus and Abramowitz, 1962; pharmacological agents, Friedman, 1966; laughter, Ventis, 1973).Although the Counterconditioning process has been successfully applied to a wide variety of emotional disorders, special problems arise when the procedure is applied to the mentally retarded. First, because of the limitations in cognitive abilities, it is generally impossible to train the subject in either relaxation or positive imagery processes. Consequently, it is necessary to place the child in direct contact with the anxiety-inducing situation. Secondly, it is often difficult to find an anxiety-free situation which is incompatible with the anxiety-arousing situation and which can be practically implemented, particularly when the phobia involved is complex.The purpose of this paper is to describe a case whereby a phobic response of physical examination by male doctors in a 7–yr-old mentally retarded boy was extinguished by pairing the examination with an anxiety-free situation, i.e. an extremely comfortable relationship between the patient and a nurse on the ward. Previous research had indicated that parents and people who have positive relationships with a person might possibly serve as effective anxiety reducers in fear-provoking situations (Jersild and Holmes, 1935).