You are on page 1of 6

IN VIVO DISTRACTION-COPING IN THE TREATMENT OF TEST ANXIETY: A 1-YEAR FOLLOW-UP STUDY

DAVID P. HIMLE, BRUCE A. THYER,* JAMES D. PAPSDORF AND SLSAN CALDWELL University of .\^fichigan

Data obtained from 19 clinically test anxious students supported the efficacy of an 8-week treatment program that combined relaxation skill training, cognitive restructuring, and systematic desensitization for the reduction of test anxiety in a previous study by Thyer, Papsdorf, Himie, McCann. Caldwell, and Wickert (1981). Significant reductions in test, state, and trait anxiety, and increases in the rationality of personal belief systems were observed. Cognitive performance on an anagram solution task and behavioral performance on a test of manual dexterity also were improved posttreatment. In this present study, 12-month follow-up data on 14 (73.6%) of the original 5s are reported. The results indicate a maintenance of the significantly decreased levels of test anxiety and continued reductions in trait anxiety and irrationality The significance of these findings is discussed.

Prior research in the field of test anxiety has demonstrated that the disorder is composed of both autonomic arousal and cognitive components (Doctor & Altman, 1969; Goldfried & Sobocinski. 1975; Liebert & Morris, 1967; Spiegler, Morris, & Liebert, 1968). Test anxiety research also has suggested that performance difficulties observed in test anxious students can be attributed to distractions in attentional behavior (Marlett & Watson, 1968; Sarason & Ganzer, 1961; Spielberger, 1972). According to Wine (1971), this distraction may take the form of a preoccupation of worry responses and perceived self-inadequacies. Sarason (1975) further postulates that such distraction may cause impairment in test performance not because of the irrational content of the person's cognitions, but simply due to their distracting quality, which inhibits attentional behavior in evaluative situations. In an earlier report, Thyer, Papsdorf, Himle, McCann, Caldwell, and Wickert (1981) examined the efficacy of an in vivo distraction-coping training procedure explicitly designed to provide test anxious students with attentional skills, when added to a cognitive-behavioral test anxiety reduction program. It vsas hypothesized that the overall treatment would result in significant improvements on a number of outcome measures, but that the experimental group that received additional training in coping with external distraction would demonstrate greater improvements on outcome variables. Participants in the study consisted of 9 male and 10 female 5s recruited from the University community. All of these 5s reported a history of debilitating test anxiety that extended back for several years, which impaired their performance on written and oral examinations. 5s paid a fee of S25 to participate in the 8week treatment program. The 19 5s were assigned randomly to either a core treatment (.V = 9) or to a experimental group (A = 10), which received the core treatment plus in vivo distractioncoping training. 5s had an average age of 24 years with an age range of 14 to 40 and came from a variety of educational levels and academic fields. 5s were assessed psychometrically through three separate self-report instruments administered pre- and posttreatment. The Test Anxiety Inventory (TAI) is a 20-item Likert-type questionnaire with a range of scores from 20 to 80, with higher scores reflective of greater levels of test anxiety (Spielberger, 1980). The State-Trait Anxiety Inventory (STAI) is constructed similarly to the TAI and provides a measure of transient
'Reprint requests should be sent to Bruce A. Thyer. Ph.D.. Department of Psychiatr>. The Universit> of Michigan Hospitals. Ann Arbor. Michigan 4S109.

458

In Vivo Distraction-coping

459

levels of anxiety temporarily induced by extemal stressors (state anxiety) and of more enduring levels of anxiety (trait anxiety) presumably related to personality characteristics (Spielberger, Gorsuch. & Lushene, 1970). Discriminant validit) has been established for both the TAI and the STAI with respect to test-anxious individuals vs. non-test-anxious persons (Himle, Thyer, & Papsdorf, 1982; Thyer & Papsdorf, 1982). Because cognitive restructuring procedures formed a part of the core treatment that all 5s received, the Rational Behavior Inventory (RBI) was administered to provide an index of the rationality of the 5s* personal belief systems (Shorkey & Whiteman, 1977). The RBI is based upon Ellis's (1973) system of rational emotive therapy and is a 37-item questionnaire answered on a 4-point Likert scale with a range of scores from 0-38. Higher scores are indicative of greater levels of rationality as defined in the rational emotive therapy literature. The RBI has been found to have high levels of convergent (Himle et al.. 1^82. Thyer & Papsdorf, 1982; Thyer. Papsdort. & Kilgore, 1983) and discriminant validity (Thver. Miller, Gordon, & Papsdorf, 1982). Each 5 also was administered a standardized anagram solution task and a psychomotor test of manual dexterity pre and post intervention. The anagram solution task was designed to provide a measure of cognitive performance under high distraction conditions and has been sho\Nn to be sensitive to differing levels of test anxiety (Papsdorf, Himle, McCann, & Thyer. 1982). The basic core treatment consisted of a package of procedures. To treat the physiological arousal component of test anxiety, 5s in both treatment groups received identical instructions in progressive relaxation training, modified from Bernstein and Borkovec (1973), and training in biofeedback-assisted hand temperature control according to the procedures outlined by Lake. Rainey. and Papsdorf (1979). To treat the cognitive component of test anxiety, three distinct cognitive behavioral interventions were given to both groups. The first cognitive treatment was based upon procedures developed by Meichenbaum (1972) and was designed to give the 5s an awareness of the role that anxiety-eliciting thoughts have in the development and maintenance of test anxiety. This was followed by training and learning to substitute positive, coping selfstatements and imagery whenever such thoughts related to test anxiety were perceived. This was based upon procedures outlined by Meichenbaum and Turk (1976). Lastly, techniques based upon rational emotive therapy (Ellis. 1973) were used to enhance the overall rationality of the 5's belief systems through the disputation of irrational beliefs related to the importance of test-taking and its consequences. The final component of the core treatment package consisted of traditional systematic desensitization. All 5s were trained in the procedures outlined by Allen (1972) and progressed through a standardized 12-item hierarchy composed of test-related stimuli. When an 5 indicated that a particular hierarchy item elicited an anxiet) response, he or she was instructed to: (I) verbalize positive coping self-statements and to utilize imagery to reduce the anxiety; and (2) then to engage in covert reinforcing self-statements for doing so. All 5s also completed a lO-minute written test at the end of each therapy session, which contained verbal and quantitative questions similar in difficulty to those found m the Graduate Record Examination. 5s assigned to the core treatment condition completed these examinations in a quiet setting and were urged to utilize the coping skills taught previously. 5s who had received additional training in distraction coping procedures completed identical examinations while audio tapes of distracting stimuli were played. 5s in this latter group were trained to practice self-instructions designed to facilitate focusing upon task relevant variables and to ignore external distracting stimuli. This technique is congruent with the recommendation by Wine (1971) to provide attentional training in the treatment of test anxiety and provides for the evaluation of the efficacy of such an approach. Thus, in summary, a total of five treatment procedures were administered to all 5s: Relaxation training, thermal biofeedback training, cognitive-behavioral coping, test-taking practice, and systematic desensitization.

460

Journai of Clinical Psychology. March. 1984. Vol. 40. No. 2

As a result of this program, statistically significant reductions in test anxiety, state and trait anxiety, increases in rationality, improvements in anagram solution time, and the manual dexterity task all were observed posttreatment. There were no significant differences between the two experimental groups, which suggested that the distraction coping procedure added little, if any, effectiveness to the core treatment. In order to assess the maintenance of these therapeutic gains, a 12-month follow-up evaluation was conducted.
METHOD

Subjects and Procedure One year after the completion of treatment, 14 of the original 19 5s were contacted by mail for participation in the follow-up study. The 5s were mailed an evaluation packet that consisted of the questionnaires utilized in the original study. It was not feasible to readminister the anagram solution task and the psychomotor test because some of the 5s had moved from the University community. It was felt that the information from the questionnaire, which measures four distinguishable constructs (test anxiety, state and trait anxiety, and rationality), would be of value. The percentage (73.6%) of the 5s assessed at the 1-year follow-up in the present study is comparable to the return rates from earlier long-term follow-up studies in the treatment of test anxiety. For example, DefTenbacher and Michaels (1981) obtained a return rate of 73.5% in their year-long follow-up study, while Allen and Desaulniers (1974) were able to obtain follow-up information on 64% of their 5s at 2-year follow-up.
RESULTS

Because there were no significant differences between the core treatment group and the distraction-coping training group at posttreatment on the dependent variables in the original study, the follow-up data are reported for both groups in a combined form. The original sample consisted of 10 women and 9 men. of whom information was obtained from 7 women and 7 men at follow-up. Chi square analyses showed that the return rate was not related significantly to either 5 sex or treatment condition. Follow-up respondents did not differ from non-respondents when both pre- and posttreatment scores on the various questionnaires were examined. The mean scores and standard deviations for all 5s who completed the pretreatment, posttreatment, and follow-up assessments are presented in Table 1. Post hoc comparisons for differences in the 5s' scores between time periods are presented in Table 2. The reductions in test and trait anxiety scores observed at posttreatment in the original study were found to persist 1 year after the 8-week treatment program. Test anxiety scores at follow-up were significantly lower than at posttreatment as well. The data
TABLL I
Means and Standard Deviations Jor all vS\ Completing the Extended Folloy\-up Evaluation i.\ 141 Pretreatment Measures Test Anxiety State Anxiet\ Trait Anxiety Rational Beliefs \f 60.92 39.92 44.35 23.07 SD 10.65 8.53 7.73 5 3S Posttreatment M 43.42 36.92 38 35 27 50 SD 13.64 12.96 7.29 3 97 M 34.57 35.85 35.35 2X71 Follow-up SD 9.47 12.03 5.77 3.02

In Vivo Distraction-coping

461

for slate and trail anxiety, as well as for rationality, clearly are in the direction of greater improvements.
TABLE 2 Post Hoc Comparisons Between Time Periods^ Measures Test Anxiety State Anxiety Trait Anxiety Rational Beliefs Pre vs. Post /)<.OOI ns /><.O5 ns Pre vs. Follow-up p <.OO1 ns p <.OOI ns Post vs Follow-up

p<.05
ns ns ns

*r-tests for independent measures

DISCUSSION

The continued improved level of test and trait anxiety supports the efficacy of the procedures employed in the original study. This finding is of special significance because this study represents one of the few experiments in which the 5s reported a history of debilitating test anxiety. Most reports in the literature that do contain follow-up information have been based upon results obtained by following procedures typically found in analogue fear reduction research (Matthews, 1978), in that a large number of undergraduates are administered a self-report measure of test anxiety, and individuals who score in the extreme upper range of test anxiety are invited to participate in the research study in return for free treatment or academic credit. Barios (1979) has stated that 5 recruitment procedures of this nature ensure the participation of minimally anxious students and limits the external validity or generalizability of the findings to seriously test anxious populations. The use of such 5s in test anxiety research is quite prevalent and probably represents the majority of studies in the field (e.g., Biglan, Villwock, & Wick, 1979; Bruch, 1978; Counts, Hollandsworth, & Alcorn, 1978; Deffenbacher 8L Michaels, 1981; Holroyd, 1976; Hussian & Lawrence, 1978; Wisocki, 1973). In the original report of this project (Thyer et al., 1981), the 19 5s' posttreatment rationality scores were improved significantly, relative to their pretreatment values. One result of the reduced number of 5s in the follow-up study (A' = 14) is that the changes in RBI scores failed to exceed chance expectations. The continued trend toward more rational belief systems at follow-up, however, is suggestive of the enduring efficacy of the cognitive behavioral treatment program. An alternative hypothesis not excluded in the present experimental design is that graduation from college by some 5s accounted for the continued decrease in test anxiety observed at 12-month follow-up. To control for this potential confound, a no-treaiment control group would be required. This was not feasible with our sample of 5s, all of whom actively sought and paid for effective treatment. Further research that employed analogue 5s could investigate this possibility.
REFERENCES
(1972). The behavioral treatment of test anxiety: Recent research and future trends. Behavior Therapy. 3. 253-262. ALLEN, G . J., & DBSAULNIEM, G . J. (1974). Effectiveness of study counseling and desensitization in alleviating test anxiety: A two-year Tollow-up. Journal of Abnormal Psychology. 83. 186-191. BARIOS, B. (1979). Publication trends on behavior analogue research on phobias. Journal of Behavior Therapy and Experimental Psychiatry. 10. 203-205. BERNSTEIN, D . , & BORKOVEC, T . (1973). Progression relaxation training Champaign. IL- Research Press.
ALLEN, G.

462
BIGLAN,

Journal of Clinical Psychology. March, 1984, Vol. 40, No. 2

A., VILLWOCK, C , & WICK, S. (1979). The feasibility of a computer controlled program for the treatment of lest anxiety. Journal of Behavior Therapy and Experimental Psychiatry. 10. 47-49. BRUCH, M. (1978). Type of cognitive modeling, imitation of modeled tactics, and modification of test anxiety. Cognitive Therapy and Research. 2. 147-164. COUNTS, D., HOLLANDSWORTH, J., & ALCORN, J. (1978). Uses of EMG biofeedback and cue controlled relaxation in the treatment of test anxiety. Journal of Consulting and Clinical Psychology. 2. 147-164. DEFFENBACHER, J., & MICHAELS, A. (1981). Two self-control procedures in the reduction of targeted and nontargeted anxietiesa year later. Journal of Counseling Psychology. 28. 525-528. DOCTOR, R., & ALTMAN, R. (1969). Worry and emotionality as components of test anxiety: Replication and further data. Psychological Reports, 24. 563-568. ELLIS, A. (1973). Humanistic psychotherapy: The rational emotive approach. New York: Julian Press. GOLDFRIED, M., & SOBOCINSKI, D. (1975). Effects of irrational beliefs on emotional arousal. yourna/o/Consulting and Clinical Psychology. 43, 504-510. HIMLE, D., THYER, B., & PAPSDORF, J. (1982). Relationships between rational beliefs and anxiety. Cognitive Therapy and Research. 6. 219-223. HOLROYD, K. (1976). Cognition and desensitization in the group treatment of test anxiety. Journal of Consulting and Clinical Psychology. 44, 991-1001. HUSSIAN, R., & LAWRENCE, P. (1978). The reduction of test, state and trait anxiety by test specific and generalized stress innoculation training. Cognitive Therapy and Research. 2. 25-37. LAKE, A., RAINEY, J.. & PAPSDORF, J. (1979). Biofeedback and rational emotive-therapy in the management of migraine headache. Journal of Applied Behavior Analysis. 12. 127-140. LIEBERT. R.. & MORRIS, L. (1967). Cognitive and emotional components of test anxiety: A distinction and some initial data. Psychological Reports, 20. 975-978. MARLETT, N . . & WATSON. D. (1968). Test anxiety and immediate or delayed feedback in a test-like avoidance task. Journal of Personality and Social Psychology, 8. 200-203. MATTHEWS. A. (1978). Fear reduction research and clinical phobias. Psychological Bulletin. 85. 390-404. MEICHENBAUM. D. (1972). Cognitive modification of test anxious college sludcnls. Journal of Consulting and Clinical Psychology, 39. 370-380. MEICHENBAUM. D.. & TURK. D. (1976). The cognitive-behavioral management of anxiety, anger, and pain. In P. Davidson (Ed.). Behavioral management of anxiety, depression and pain. New York: Brunner/Mazel. PAPSDORF, J.. HIMLE, D.. MCCANN, B., & THYER, B. (1982). Anagram solution time and effects of distraction, sex differences, and anxiety. Perceptual and Motor Skills. 55. 215-222. SARASON. 1. (1975). Test anxiety and the self-disclosing coping model. Journal of Consulting and Ciinicai Psychology, 43, 148-153. SARASON, I.. & GANZER. V. (1961). Anxiety, reinforcement and experimental instructions in a free verbalization situation. Journal of Abnormal and Social Psychology. 65. 300-307. SHORKEY. C . & WHITEMAN. V. (1977). Development of the Rational Behavior Inventory: Initial validity and reliability. Educational and Psychological Measurement, 37, 527-532. SPIEOLER. M.. MORRIS, L.. & LIEBERT, R. (1968). Cognitive and emotional components of test anxiety: Temporal factors. Psychological Reports. 22. 451-456. SPIELBERGER, C. (1972). Anxiety as an emotional state. In C. Spielberger (Ed.), Anxiety: Current trends in theory and research (Vol. 2). New York: Academic Press. SPIELBERGER. C. (1980). The Test Anxiety Inventory {TAI). Palo Alto, CA: Consulting Psychologists Press. SPIELBERGER, C . GORSUCH, R.. & LUSHENE, R. (t970). Manual for the State-Trait Anxiety Inventory. Palo Alto. CA: Consulting Psychologists Press. THYER, B.. MILLER. E., GORDON, A., & PAPSDORF. J. (1982). Discriminant validity of the Rational Behavior Inventory with respect to social desirability. Psychological Reports. 51, 370. THYER, B.. & PAPSDORF, J. (1982). Discriminant and concurrent validity of two commonly used measures of test anxiety. Educational and Psychological Measurement. 42. 1197-1204. THYER, B.. PAPSDORF. J.. HIMLE. D., MCCANN, B.. CALDWELU S., 8L WICKERT. M. (1981). In vivo distraction-coping in the treatment of test anxiety. Journal of Clinical Psychology. 37. 754-764. THYER, B.. PAPSDORF. J., & KILGORE, S. (1983). Relationship between irrational thinking and psychiatric symptomatology. Journal of Psychology. 113. 31-34. WINE. J. (1971). Test anxiety and direction of attention. Psychological Bulletin. 76. 92-104. WISOCKI, P. A. (1973). A covert reinforcement program for the treatment of test anxiety. Behavior Therapy. 4, 55-61.

You might also like