Date of Award

May 2022

Degree Type


Degree Name

Master of Science



First Advisor

Bonita P Klein-Tasman

Committee Members

Kristin Smith, Matthew Capriotti


children, exposure therapy, play therapy, Williams syndrome


Children with Williams syndrome struggle with fears and phobias that significantly impact their daily lives. Yet there are few psychosocial and no empirically supported behavioral interventions to treat anxiety and phobias in this population of children. This study is part of a larger project examining the effectiveness of an exposure-based play- and humor-infused intervention aimed to provide developmentally appropriate behavioral therapy to reduce fear and anxiety in children aged 4 to 10 with Williams syndrome. This approach was piloted with 9 children (3 females; 6 males) in the context of developing a website to disseminate the approach to university-based and community clinicians. Findings of this study revealed that four of the eight participants showed reductions in fear and anxiety with two of three metrics used to measure treatment response. The current study examines the behavioral coding of patterns of the therapist’s use of play and humor and relations to child behavioral responses within session and across sessions for 2 children with Williams syndrome who were identified as treatment responders in the pilot intervention study based on clinical report and parent ratings. A preliminary behavioral coding scheme has been developed to identify duration of therapist play and humor approaches and subsequent frequency of positive, tolerant and negative child behaviors in the context of an exposure-based therapy. Results showed that tolerance of the feared stimuli increased across therapy sessions for both participants, indicating reduced fear and anxiety as the therapy progressed. Therapist differential use of pure exposure compared to play- and humor-infused exposure revealed that play and humor was used for longer durations across sessions with both participants and was associated with stimulus type as well as child behavior. Findings also showed patterns of therapist attunement to the child’s anxiety level demonstrated through efforts to flexibly adjust the directiveness of exposure. Interestingly, sequential therapist-initiated directed attention behaviors, indicative of the therapist’s use of narration and priming, was associated with subsequent child positive behaviors. This may suggest that the participants were able to begin the formation of new and positive associations with the feared stimuli, progress of which surpasses the expectation of this therapy approach. Limitations of this study include a very small sample size (n=2) and a single-subject research design, which limit the generalizability of findings. Future directions of this research are discussed.

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