Abstract
Distraction is often discouraged in exposure therapy for anxiety disorders, but little is known about how beliefs about distraction may impact treatment outcome (with or without distraction). One barrier to understanding the impact of these beliefs is the lack of an available measure to assess this construct. In addition to proposing a theoretical basis for beliefs about distraction, we created and validated a questionnaire assessing maladaptive beliefs about distraction, the Beliefs about Distraction Inventory. An exploratory factor analysis with an unselected student sample (N = 506, 86 % female) suggested a two-factor solution, conceptualized as “distraction is necessary”, and “distraction is effective”. A confirmatory factor analysis using a contamination-fearful sample (N = 132, 87 % female) demonstrated adequate model fit. In both samples, the measure exhibited strong reliability and validity. Preliminary findings revealed that beliefs that “distraction is necessary” were more strongly associated with anxious psychopathology than beliefs that “distraction is effective”. Results are discussed in terms of cognitive-behavioural theories and therapies for anxiety and related disorders.
Similar content being viewed by others
Notes
The final version of the BADI (including the instructions and distraction techniques checklist) is available free of charge from either author for public use.
References
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181. doi:10.1037/1040-3590.10.2.176.
Antony, M. M., McCabe, R. E., Leeuw, I., Sano, N., & Swinson, R. P. (2001). Effect of distraction and coping style on in vivo exposure for specific phobia of spiders. Behaviour Research and Therapy, 39, 1137–1150. doi:10.1016/S0005-7967(00)00089-9.
Bados, A., Balaguer, G., & Saldaña, C. (2007). The efficacy of cognitive-behavioral therapy and the problem of drop-out. Journal of Clinical Psychology, 63, 585–592. doi:10.1002/jclp.20368.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215. doi:10.1037/0033-295X.84.2.191.
Bandura, A. (1988). Self-efficacy conception of anxiety. Anxiety Research, 1, 77–98. doi:10.1080/10615808808248222.
Beck, A. T., & Steer, R. A. (1990). Beck Anxiety Inventory manual. Toronto: Psychological Corporation.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory-II. San Antonio, TX: Psychological Corporation.
Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238–246. doi:10.1037/0033-2909.107.2.238.
Bentler, P. M., & Chou, C. P. (1987). Practical issues in structural modeling. Sociological Methods & Research, 16, 78–117. doi:10.1177/0049124187016001004.
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Beverly Hills, CA: Sage.
Byrne, B. M. (1989). A primer of LISREL: Basic applications and programming for confirmatory factor analytic models. New York, NY: Springer.
Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4, 92–100. doi:10.1207/s15327558ijbm0401_6.
Creamer, M., Foran, J., & Bell, R. (1995). The Beck Anxiety Inventory in a non-clinical sample. Behaviour Research and Therapy, 33, 477–485. doi:10.1016/0005-7967(94)00082-U.
de Winter, J. C. F., & Dodou, D. (2012). Factor recovery by principal axis factoring and maximum likelihood factor analysis as a function of factor pattern and sample size. Journal of Applied Statistics, 39, 695–710. doi:10.1080/02664763.2011.610445.
Field, A. (2009). Discovering statistics using SPSS (3rd ed.). London: Sage.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35. doi:10.1037/0033-2909.99.1.20.
Gosselin, P., Langlois, F., Freeston, M. H., Ladouceur, R., Dugas, M. J., & Pelletier, O. (2002). Le Questionnaire d’évitement cognitif (QEC): Développement et validation auprès d’adultes et d’adolescents [The Cognitive Avoidance Questionnaire (CAQ): Development and validation among adult and adolescent samples]. Journal de Thérapie Comportementale et Cognitive, 12, 24–37.
Hazlett-Stevens, H., Ullman, J. B., & Craske, M. G. (2004). Factor structure of the Penn State Worry Questionnaire: Examination of a method factor. Assessment, 11, 361–370. doi:10.1177/1073191104269872.
Helbig-Lang, S., & Petermann, F. (2010). Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders. Clinical Psychology Science and Practice, 17, 218–233. doi:10.1111/j.1468-2850.2010.01213.x.
Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239. doi:10.1348/014466505X29657.
John, O. P., Donahue, E. M., & Kentle, R. L. (1991). The big five inventory—Versions 4a and 54. Berkeley: University of California, Berkeley, Institute of Personality and Social Research.
Johnstone, K. A., & Page, A. C. (2004). Attention to phobic stimuli during exposure: The effect of distraction on anxiety reduction, self-efficacy and perceived control. Behaviour Research and Therapy, 42, 249–275. doi:10.1016/S0005-7967(03)00137-2.
Kamphuis, J. H., & Telch, M. J. (2000). Effects of distraction and guided threat reappraisal on fear reduction during exposure-based treatments for specific fears. Behaviour Research and Therapy, 38, 1163–1181. doi:10.1016/S0005-7967(99)00147-3.
Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York: Guilford Press.
Loehlin, J. C. (1992). Latent variable models: An introduction to factor, path, and structural analysis (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney: Psychology Foundation of Australia.
Miller, S. M. (1980). When is a little information a dangerous thing? Coping with stressful life-events by monitoring vs. blunting. In S. Levine, & H. Ursin (Eds.), Coping and health, (pp. 145–169). New York: Plenum Press.
Miller, S. M. (1987). Monitoring and blunting: Validation of a questionnaire to assess styles of information seeking under threat. Journal of Personality and Social Psychology, 52, 345–353. doi:10.1037/0022-3514.52.2.345.
Mulaik, S. A., James, L. R., Van Alstine, J., Bennett, N., Lind, S., & Stilwell, C. D. (1989). Evaluation of goodness-of-fit indices for structural equation models. Psychological Bulletin, 105, 430–445. doi:10.1037/0033-2909.105.3.430.
Muris, P., de Jong, P., Merckelbach, H., & van Zuuren, F. J. (1993a). Monitoring coping style and exposure outcome in spider phobics. Behavioural and Cognitive Psychotherapy, 21, 329–333. doi:10.1017/S1352465800011656.
Muris, P., de Jong, P., Merckelbach, H., & van Zuuren, F. J. (1993b). Is exposure therapy outcome affected by a monitoring coping style? Advances in Behaviour Research and Therapy, 15, 291–300. doi:10.1016/0146-6402(93)90014-S.
Muris, P., van Zuuren, F. J., de Jong, P. J., de Beurs, E., & Hanewald, G. (1994). Monitoring and blunting coping styles: The Miller Behavioural Style Scale and its correlates, and the development of an alternative questionnaire. Personality and Individual Differences, 17, 9–19. doi:10.1016/0191-8869(94)90257-7.
Nolen-Hoeksema, S. (1991). Responses to depression questionnaire. Unpublished manuscript, Department of Psychology, Stanford University, Stanford, California.
Oliver, N. S., & Page, A. C. (2008). Effects of internal and external distraction and focus during exposure to blood-injury-injection stimuli. Journal of Anxiety Disorders, 22, 283–291. doi:10.1016/j.janxdis.2007.01.006.
Parrish, C. L., Radomsky, A. S., & Dugas, M. J. (2008). Anxiety-control strategies: Is there room for neutralization in successful exposure treatment? Clinical Psychology Review, 28, 1400–1412. doi:10.1016/j.cpr.2008.07.007.
Radomsky, A. S., Ouimet, A. J., Ashbaugh, A. R., Lavoie, S. L., Parrish, C. L., & O’Connor, K. P. (2006). Psychometric properties of the French and English versions of the Vancouver Obsessional Compulsive Inventory and the Symmetry Ordering and Arranging Questionnaire. Cognitive Behaviour Therapy, 35, 164–173. doi:10.1080/16506070600827198.
Rodebaugh, T. L., Woods, C. M., & Heimberg, R. G. (2007). The reverse of social anxiety is not always the opposite: The reverse-scored items of the social interaction anxiety scale do not belong. Behavior Therapy, 38, 192–206. doi:10.1016/j.beth.2006.08.001.
Rodriguez, B. I., & Craske, M. G. (1993). The effects of distraction during exposure to phobic stimuli. Behaviour Research and Therapy, 31, 549–558. doi:10.1016/0005-7967(93)90106-5.
Rose, M. P., & McGlynn, F. D. (1997). Toward a standard experiment for studying post-treatment return of fear. Journal of Anxiety Disorders, 11, 263–277. doi:10.1016/S0887-6185(97)00010-8.
Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19, 6–19. doi:10.1017/S0141347300011472.
Salkovskis, P. M., Clark, D. M., & Gelder, M. G. (1996). Cognitive-behaviour links in the persistence of panic. Behaviour Research and Therapy, 37, 559–574.
Schmid-Leuz, B., Elsesser, K., Lohrmann, T., Jöhren, P., & Sartory, G. (2007). Attention focusing versus distraction during exposure in dental phobia. Behaviour Research and Therapy, 45, 2691–2703. doi:10.1016/j.brat.2007.07.004.
Sexton, K. A., & Dugas, M. J. (2008). The cognitive avoidance questionnaire: Validation of the English translation. Journal of Anxiety Disorders, 22, 355–370. doi:10.1016/j.janxdis.2007.04.005.
Steketee, G., Bransfield, S., Miller, S. M., & Foa, E. B. (1989). The effect of information and coping style on the reduction of phobic anxiety during exposure. Journal of Anxiety Disorders, 3, 69–85. doi:10.1016/0887-6185(89)90002-9.
Stevens, J. P. (2009). Applied multivariate statistics for the social sciences (5th ed.). New York: Routledge.
Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston, MA: Pearson Education Inc.
Telch, M. J., Valentiner, D. P., Ilai, D., Young, P. R., Powers, M. B., & Smits, J. A. J. (2004). Fear activation and distraction during emotional processing of claustrophobic fear. Journal of Behavior Therapy and Experimental Psychiatry, 35, 219–232. doi:10.1016/j.jbtep.2004.03.004.
Thordarson, D. S., Radomsky, A. S., Rachman, S., Shafran, R., Sawchuk, C. N., & Hakstian, A. R. (2004). The Vancouver Obsessional Compulsive Inventory (VOCI). Behaviour Research and Therapy, 42, 1289–1314. doi:10.1016/j.brat.2003.08.007.
Thwaites, R., & Freeston, M. H. (2005). Safety-seeking behaviours: Fact or fiction? How can we clinically differentiate between safety behaviours and adaptive coping strategies across anxiety disorders? Behavioural and Cognitive Psychotherapy, 33, 177–188.
Tucker, L. R., & Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38, 1–10. doi:10.1007/BF02291170.
Veale, D. (1999). Cognitive therapy in the treatment of obsessive-compulsive disorder. Advances in Psychiatric Treatment, 5, 61–70. doi:10.1192/apt.5.1.61.
Acknowledgments
This research was supported by a doctoral research award from the Canadian Institutes for Health Research which was awarded to the first author, and by a Canadian Institutes of Health Research operating grant awarded to the second author (FRN 119283). We would like to express our gratitude to Michael Lacoursiere, who assisted with data collection. We are also grateful to the anonymous reviewers who provided insightful comments and suggestions on an earlier version of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Senn and Radomsky declare that they have no conflict of interest.
Informed Consent
All procedures performed involving human participants were in accordance with the ethical standards of Human Research Ethics Committee at Concordia University, the Canadian Psychological Association’s Code of Ethics for Psychologists, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Animal Rights
No animal studies were carried out by the authors for this article.
Rights and permissions
About this article
Cite this article
Senn, J.M., Radomsky, A.S. Measuring Beliefs About Distraction: Might the Function of Distraction Matter More than Distraction Itself?. Cogn Ther Res 39, 826–840 (2015). https://doi.org/10.1007/s10608-015-9703-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-015-9703-7