The effects of distraction during exposure to phobic stimuli

Theoretical conceptualizations regarding the role of attentional focus during exposure-based treatments for fear and anxiety suggest that distraction interferes with the mechanisms required for fear reduction, typically by preventing emotional and/or cognitive processing of the phobic stimulus and response. The present discussion reviews the current literature and demonstrates the paucity of empirical evidence supporting such notions. Seemingly conflicting findings are integrated upon close examination of the various qualitative dimensions of the distracters employed. These characteristics, which differed substantially across studies, include the nature of the attentional demand posed by the distracter (e.g. cognitive vs sensory demand) as well as the distracter's affective quality (e.g. neutral vs relaxing). The effects of differing dimensions of distraction on fear reduction, in addition to interaction with aspects of the exposure situation, are discussed. The need for further investigation of the qualitative dimensions of distraction, including their operational specification, is recognized. Finally, recommendations for future research are made.