Habituation during exposure treatment: Distraction vs. Attention-focusing

Department of Psychiatry, Eastern Pennsylvania Psychiatric Institute, Henry Avenue, Philadelphia, PA 19129, U.S.A.
Behaviour Research and Therapy (Impact Factor: 3.85). 02/1982; 20(4):323-8. DOI: 10.1016/0005-7967(82)90091-2
Source: PubMed


To investigate the effects of distraction and attention-focusing during in-vivo exposure to feared stimuli, the responses of 16 obsessive-compulsives with washing rituals were studied. A cross-over design was employed in which 6 of the subjects underwent exposure with attention focusing on the first day followed by exposure with distraction on the second day. The remaining subjects received the reverse order. Habituation of both heart rate and subjective anxiety was observed under both conditions, the rate of habituation tending to remain constant throughout the 90-min exposure. Greater between-session habituation and greater synchrony between the psychophysiological and the subjective measures of anxiety was observed when attention-focusing preceded distraction. Since habituation and synchrony have previously been found to be positively related to treatment outcome, the present results suggest that treatment by exposure to feared stimuli may be more effective if attention-focusing is promoted.

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    • "For example, several recent reviews have suggested that the beneficial effects of mindfulness may be partly explained through exposure (Brown et al. 2007; Shapiro et al. 2006). Exposure interventions are enhanced when individuals attend to rather than distract from the feared stimulus (Grayson et al. 1982). Because mindfulness involves contact with the present moment and allowing it to " just be " , no matter how unpleasant it is, fear responses may be more likely to extinguish in exposure, leading to reduced anxiety. "
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    ABSTRACT: Little is known about the mechanisms through which mindfulness is related to psychological symptoms such as anxiety. One potential mechanism consists of individual differences in emotion-responding variables such as reactivity to aversive stimuli. The current research was designed to examine whether affective reactivity may act as a mechanism of mindfulness. Across two studies, an inverse relation between trait mindfulness (specifically, the Nonjudging of Inner Experience and Acting with Awareness factors of the Five-Facet Mindfulness Questionnaire) and chronic anxiety was partially mediated by affective reactivity, assessed with direct (self-report in study 1) and indirect (lexical decision task in study 2) measures. These results contribute to the understanding of the psychological mechanisms through which mindfulness works.
    Mindfulness 10/2014; DOI:10.1007/s12671-013-0206-x
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    • "without appraising it or reacting upon it. If mindfulness works by enhancing habituation, then a reduction in anxiety should not only be observed within an exposure session but also during a further exposure session (Grayson et al. 1982, 1986). Therefore we chose a delayed time period of renewed exposure after a short break to assess the main effects. "
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    ABSTRACT: In mindful meditation, negative thoughts such as obsessive thoughts are observed simply as mental events that come and go, rather than as accurate reflections of reality. This experimental study tested the efficacy of a mindfulness-based instruction compared to distraction during brief exposure to obsessive thoughts in obsessive–compulsive patients. Thirty patients diagnosed with obsessive–compulsive disorder were asked to listen to their own obsessive thoughts through headphones during three time phases: at baseline, during an experimental condition and during a return to baseline. During the experimental condition, they were instructed to deal with their obsessive thoughts using either a mindfulness-based strategy or a distraction strategy (random allocation). Results showed that a mindfulness-based strategy reduced anxiety and urge to neutralize from first to second baseline, whereas a distraction strategy did not. Data offer initial evidence that using mindfulness-based metaphors during brief exposure with obsessive thoughts may be a useful alternative to distraction.
    Cognitive Therapy and Research 08/2012; 37(4). DOI:10.1007/s10608-012-9503-2 · 1.33 Impact Factor
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    • "Other research has investigated the latter components of emotional processing theory—that reductions in fear within exposures will lead to the incorporation of corrective information and result in decreased activation across presentations of the feared stimuli—with similarly mixed results. Several studies have found that within-session habituation (Beck et al., 1997; Foa, & Chambless, 1978; Grayson et al., 1982) and between-session habituation (Kozak et al., 1988) are both related to outcome, whereas others have not demonstrated a relationship between within-session habituation and outcomes (e.g., Foa, Grayson, & Steketee, 1982; Jaycox, Foa, & Morral, 1998; Kozak et al., 1988; van Minnen & Hagenaars, 2002). "
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    ABSTRACT: Previous exposure therapy research has suggested potential differences in emotional processing at different points in treatment (Hayes, Hope, & Heimberg, 2008). For example, indicators of emotional processing may be more related to outcome during the later exposure sessions than during the initial session. This is consistent with a growing body of psychotherapy research highlighting the importance of timing and change processes across therapy. The current study examined whether the learning-but-not-benefiting hypothesis is observed in a group based intervention for clients with a range of anxiety disorders. It was hypothesized that activation and within session habituation during later, but not the initial exposure session, would be related to outcome, whereas activation and within session habituation during the first session would be related to dropout status. Results revealed that lower activation and less habituation during the first exposure was associated with increased treatment discontinuation. Second, lower peak and, to a lesser extent greater activation and habituation, during exposures were generally associated with better treatment outcomes. These findings highlight the importance of examining the complexities and timing of the exposure process.
    Journal of anxiety disorders 02/2011; 25(5):654-60. DOI:10.1016/j.janxdis.2011.02.006 · 2.68 Impact Factor
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