Attentional focus during exposure in spider phobia: The role of schematic versus non-schematic imagery

• We manipulated the nature of the concepts activated during exposure therapy.
• Concepts unlinked to spiders led to a return of distress at follow-up.
• Concepts linked to spiders led to decreased emotional responses between sessions.
• Activated concepts may have a major role in the maintenance of distress reduction.

Research has provided controversial results regarding the role of distraction (vs. attentional focus) during exposure therapy. In the present study, we manipulated the nature of the concepts activated during exposure. Sixty-six spider phobics were exposed to pictures of spiders and asked, or not, to form mental images of concepts that were either related or unrelated to spiders. At pre-exposure, mid-exposure, post-exposure, and follow-up, subjective distress, heart rate variability, and skin conductance responses were measured and the Fear of Spiders Questionnaire and a Behavioural Avoidance Test were performed. Results showed that the activation of concepts unrelated to spiders led to return of distress at follow-up. Moreover, the activation of concepts related to spiders decreased emotional and avoidance responses between sessions. This pattern of results suggests that the nature of the activated concepts does not influence subjective distress during exposure, but plays an important role in the maintenance of distress reduction between sessions.