Attention to phobic stimuli during exposure: the effect of distraction on anxiety reduction, self-efficacy and perceived control

To replicate and extend the finding that distraction facilitates between session anxiety reduction (Oliver & Page (2003)), 27 spider phobics underwent three 10-min sessions of in vivo exposure followed by one 10-min exposure session at a 4-week follow-up, while having either stimulus-relevant focused conversation or stimulus-irrelevant distracting conversation with the experimenter. Physiological arousal and subjective anxiety were measured during exposure, and self-efficacy, perceived control and performance on a behavioural task were measured at pre-treatment, post session-3, and follow-up. Monitoring and blunting coping styles were also measured at pre-treatment to assess their impact on treatment outcome. Despite equal physiological activation between the groups, those who underwent distracted exposure showed greater reductions in subjective fear within and between sessions, and showed greater increases in self-efficacy ratings, internal perceived control and performance on a behavioural task. Coping style did not interact with the effect of distraction or focusing during exposure, however blunters had less subjective anxiety reduction overall, particularly when they underwent focused exposure. Results are discussed in terms of the emotional processing model and self-efficacy theory.