Optimal attentional focus during exposure in specific phobia: A meta-analysis |
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| Authors: | Ioana R. Podină Ernst H.W. Koster Pierre Philippot Vincent Dethier Daniel O. David |
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| Affiliation: | 1. Department of Clinical Psychology and Psychotherapy, Babe?-Bolyai University, No. 37, Republicii St., 400015 Cluj-Napoca, Romania;2. Department of Experimental Clinical and Health Psychology, Ghent University, No. 2, Henri Dunantlaan St., B-9000 Ghent, Belgium;3. Department of Psychology, Catholic University of Louvain, No. 10, Place du Cardinal Mercier, 1348 Louvain-la-Neuve, Belgium;4. Department of Oncological Sciences, Mount Sinai School of Medicine, No. 1425, Madison Avenue St., 10029 NY, USA;1. Department of Psychology, University of Oslo, Norway;2. Department of Addiction Treatment, Oslo University Hospital, Norway;3. Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway;4. Department of Health Management and Health Economics, University of Oslo, Norway;1. University of Manitoba, Winnipeg, Manitoba, Canada;2. University of Regina, Regina, Saskatchewan, Canada;1. Developmental Psychology, Utrecht University, Utrecht, The Netherlands;2. Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands;3. Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands;1. University of Arkansas, United States;2. Laureate Institute for Brain Research, United States;3. University of North Texas, United States;4. Virginia Commonwealth University, United States;5. Warren Alpert Medical School, Brown University |
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| Abstract: | Over the last 30 years, researchers have disagreed over the consequences of diverting attention from threat for exposure efficacy, which is an important theoretical and clinical debate. Therefore, the present meta-analysis assessed the efficacy of attentionally focused exposure against distracted and attentionally uninstructed exposure regarding distress, behavioral, and physiological outcomes. We included 15 randomized studies with specific phobia, totaling 444 participants and targeting outcomes at post-exposure and follow-up. Results indicated no difference between the efficacy of distracted exposure as opposed to focused or uninstructed exposure for distress and physiology. For behavior, at post-exposure, results were marginally significant in favor of distracted as opposed to focused exposure, while at follow-up results significantly favored distraction. However, concerning behavior, uninstructed exposure was superior to distraction. Moderation analyses revealed that, regarding distress reduction and approach behavior, distracted exposure significantly outperformed focused exposure when the distracter was interactive (g = 1.010/g = 1.128) and exposure was spread over the course of multiple sessions (g = 1.527/g = 1.606). No moderation analysis was significant for physiological measures. These findings suggest that distraction during exposure could be less counterproductive than previously considered and even beneficial under certain circumstances. Theoretical implications and future directions for research are discussed. |
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