Exposure in vivo of obsessive—compulsives under distracting and attention-focusing conditions: replication and extension

Exposure to feared situations has been found to result in decrement in subjective anxiety and heart rate (HR) for anxiety-disordered patients. In a preliminary study using a crossover design, obsessive-compulsives experienced less return of fear during in vivo exposure when attention was focused on their feared obsessional stimuli than when it was distracted from them. Thus, attention seemed to facilitate between-session but not within-session habituation. The present study was conducted to replicate and extend the previous investigation using a between-groups design. Seventeen obsessive-compulsives with washing rituals were exposed to their most feared contaminant for two consecutive 90-min sessions under either distracting (playing a video game) or attention-focusing (observing and discussing the contaminant) conditions. Consistent with our earlier findings, HR response reduced substantially during attention-focusing but remained elevated during distraction. However, on subjective anxiety greater reduction was observed in the distraction condition, particularly during the first exposure session. Results are discussed in light of findings by other investigators regarding procedural manipulations during exposure.