Reduction of verbally learned fear in children: A comparison between positive information, imagery, and a control condition

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Abstract

This study explored the effects of positive information and imagery as ways of reducing a verbally installed fear in children. Seventy-two primary school children aged 9–13 years were first exposed to negative information to induce fear of a novel animal, and were then randomly assigned to three interventions: positive information, imagery, or a control condition. Outcome of various interventions was assessed by means of a standardized scale of fear beliefs and an index of confirmation bias (defined as the tendency to search for threat information in relation to the feared stimulus). Results indicated that both positive information and imagery were more effective in reducing fear than the control condition. Some evidence was also obtained showing that positive information was more effective than imagery, which suggests that this intervention represents the most optimal treatment approach when dealing with verbally acquired fears in children.

Research highlights

► Fears can be installed in children via the negative information pathway. ► We examined effects of positive information as an intervention for reducing childhood fear. ► Verbal threat information induces cognitive biases in children. ► Positive information is effective in reducing verbally acquired childhood fears.

Introduction

Specific fears of the dark, animals, blood, and heights are highly prevalent among children (Gullone, 2000). There are good reasons to assume that these childhood fears are normal developmental phenomena, which originate from learning experiences (Muris, 2007). According to Rachman, 1977, Rachman, 1991, three types of learning can be discerned in the acquisition of fear: (1) aversive conditioning (e.g., a child becomes fearful after being stung by a wasp), (2) modeling (e.g., the child observes a parent or peer reacting fearful to a wasp), and (3) negative information transmission (e.g., the child hears that somebody collapsed and was brought to the hospital after a wasp sting). Although the role of these pathways may vary from one type of fear to another (e.g., Ollendick and King, 1991, Muris et al., 1997), it is also true that negative information transmission is considered the dominant route to many of these childhood fears. For example, Rachman (1977) has argued that informational and instructional processes provide the basis for most of the commonly encountered fears in children.

Studies examining the effects of negative information via media exposure (e.g., Van der Molen & Bushman, 2008) or by means of retrospective child- and parent-reports on the origins of fear (e.g., Merckelbach, Muris, & Schouten, 1996) have indeed yielded evidence indicating that this type of learning experience seems to be involved in the etiology of childhood fears. More convincing support for the role of negative information has been obtained after Field, Argyris, and Knowles (2001) introduced an experimental paradigm which has made it possible to study the causal status of this pathway to childhood fear under controlled conditions. The general outline of this paradigm is straightforward: children are confronted with negative information about an unknown stimulus and before and after this experimental manipulation their level of fear for this object is assessed. An initial test of the paradigm showed that children’s fear-related beliefs about a novel monster doll changed as a function of the verbal information. More precisely, it was found that negative information produced a significant increase in children’s self-reported fear ratings (Field et al., 2001). In a recent review, Muris and Field (2010) identified 17 investigations that employed this experimental method. Their conclusion was that this research has clearly demonstrated that negative information enhances children’s fear in various response systems (i.e., cognitive, behavioral, and physiological) and that these effects can last up to six months. As such, Rachman, 1977, Rachman, 1991 original notion that childhood fears can be installed via negative information transmission has been substantiated.

Although it is worthwhile to study the role of informational processes in the development of childhood fears, it would be more interesting from a clinical point-of-view to demonstrate that this learning mechanism can be employed to correct fear. From a theoretical perspective such an intervention would certainly make sense, because associative learning models predict that the provision of positive information may weaken the association between the feared stimulus (the conditioned stimulus) and negative outcomes (the unconditioned stimuli), thereby reducing fear (the conditioned response; Field, 2006). While it is true that information provision is already an integral part of many treatments for childhood fears and phobias (e.g., Ollendick, Davis, & Muris, 2004), there is virtually no research on the specific effects of this type of intervention. An exception is a recent study by Kelly, Barker, Field, Wilson, and Reynolds (2010) who investigated whether a verbally acquired fear can be unlearned by providing children with positive information. One-hundred-and-seven children aged 6–8 years first received negative information to install fear, and were then randomized to receive positive verbal information, modeling, or a control task. Results showed that the negative information produced high levels of fear beliefs and avoidance behavior in all children. Further, the interventions of positive information and modeling both led to clear reductions in fear beliefs and avoidance behavior, which were not evident in the control group. Most importantly, evidence was found to indicate that positive information was more effective than modeling in reducing fear. On the basis of these findings, Kelly et al. (2010) conclude that positive information is a viable strategy to reduce children’s fear and also suggest that this might be particularly true in case fear has been acquired via the verbal information pathway.

Given the potential clinical utility of positive information and the fact that research examining its specific effects is extremely sparse, the present study made an attempt to replicate and extend Kelly et al.’s (2010) study. Seventy-two primary school children were first exposed to negative information to induce fear of a novel animal (i.e., the Cuscus), and were then randomly assigned to three conditions: positive information, imagery, or a control condition. The present research deviated in two ways from Kelly et al.’s study. First, while Kelly et al. (2010) used modeling as the active intervention condition to compare the effects of positive information with, the current study included an imagery condition. During this condition, children were provided with information about another child who successfully dealt with the dreaded animal, and instructed to imagine to behave just like this person. As such the two intervention conditions in the present study were both concerned with the provision of verbal information (and in this respect more comparable to one another than the positive information and modeling interventions as employed by Kelly et al., 2010): in the one condition children were provided with positive information about the novel animal itself (i.e., direct positive information), whereas in the other condition children were given information about another child who successfully coped with the dreaded animal (i.e., indirect positive information). The imagery intervention was based on a therapeutic technique called “emotive imagery”, during which children identify themselves with a personal hero and then imaginarily engage in exposure to the feared stimulus (King, Molloy, Heyne, Murphy, & Ollendick, 1998), and there is good evidence that this type of intervention is effective in reducing fear in children (Cornwall et al., 1996, King et al., 1989). It was predicted that both positive information and imagery would produce reductions in children’s fear of the animal, although one might expect that the former intervention yields somewhat better results as its mechanism more closely mimics and corrects the basic process along which the fear was acquired. Second, as mentioned earlier Kelly et al. (2010) evaluated the effects of various interventions by means of a self-report fear beliefs scale and a behavioral avoidance task. The present study also assessed children’s fear beliefs, but also employed a confirmation bias task as an outcome measure thereby assessing fear in the cognitive domain. Confirmation bias is cognitive distortion referring to the tendency to selectively search for information that validates the view that one holds (Harvey, Watkins, Mansell, & Shafran, 2004). In the context of fear this means that a person will be inclined to predominantly search for threatening information (Smeets, De Jong, & Mayer, 2000). Previous research has demonstrated that children display a confirmation bias in relation to the feared stimulus (Muris et al., 2009, Remmerswaal et al., 2010), and so this cognitive bias seemed an appropriate index for measuring outcome in this experimental intervention study.

Section snippets

Participants

Children were recruited from a regular, public primary school in Zoetermeer, The Netherlands. One-hundred-and-fifty children were invited to participate by sending their parents a letter with information about the study, along with a consent form. Seventy-two parents responded positively to this invitation (only three parents actively declined participation, whereas the other parents did not respond to the mailing at all), which means that the response rate was 48.0%. The participating children

Procedure

After obtaining written informed consent from children’s parents, two female research assistants visited the school to test the children in two sessions. The first session was carried out by one of the research assistants. Children of the same class were tested in groups in the school’s auditory room. Children began with completing the shortened FSSC-R and were then shown a picture of the Cuscus and asked to complete the FBQ for this animal, although they did not really know anything about its

Pre-experimental differences

Table 1 displays the general characteristics of the children in the three experimental groups. One-way analyses of variance (ANOVAs) and chi square tests were performed to examine whether children in the three groups differed in terms of these characteristics. Results revealed no significant between-group differences for age [F(2,71) = 1.96, p = .12], gender [χ2(2) < 1], or ethnic background [χ2(2) = 4.31, p = .12]. The three groups differed significantly in terms of general fearfulness as

Discussion

Fears are fairly common in children (Gullone, 2000) and in most cases seem to reflect developmentally appropriate reactions to stimuli and situations that children do not fully understand (Muris, 2007). It is likely that these fears are often instigated by verbal information of parents or other caregivers who try to warn their child for possible threat and danger (Rachman, 1977). The present study investigated the effects of positive information and imagery as ways of reducing a verbally

Acknowledgement

Children, teachers, and staff of “Openbare Montessorischool Meester Verwers” in Zoetermeer, The Netherlands, are kindly thanked for their participation in this study.

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