7/27/2019 Usmle-relat-papers; In Vivo Distraction-coping in the
Rx of Test Anxiety
2/6
In Vivo Distraction-coping 459levels of anxiety tem porarily
induced by extem al stressors (state anxiety) and of more en-during
levels of anxiety (trait anxiety) presumably related to personality
characteristics(Spielberger, Gorsuch. & Lushene, 1970).
Discriminant validit) has been established forboth the TAI and the
STAI with respect to test-anxious individuals vs.
non-test-anxiouspersons (Him le, Thyer, & Papsdorf, 1982; Thyer
& Papsdorf, 1982). Because cogn itiverestructuring procedures
formed a part of the core treatment that all 5s received,
theRational Behavior Inventory (RBI) was administered to provide an
index of therationality of the 5s* personal belief systems (Shorkey
& Whiteman, 1977). The RBI isbased upon Ellis's (1973) system
of rational emotive therapy and is a 37-item question-naire
answered on a 4-point Likert scale with a range of scores from
0-38. Higher scoresare indicative of greater levels of rationality
as defined in the rational emotive therapyliterature. The RBI has
been found to have high levels of convergent (Himle et al..
1^82.Thyer & Papsdorf, 1982; Thyer. Papsdort. & Kilgore,
1983) and discriminan t validity(Thver. Miller, Gordon, &
Papsdorf, 1982).
Each 5 also was administered a standardized anagram solution
task and a psy-chomotor test of manual dexterity pre and post
intervention. The anagram solution taskwas designed to provide a
measure of cognitive performance under high distraction con-ditions
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 thephysiological arousal component of test anxiety, 5s in
both treatment groups receivedidentical instructions in progressive
relaxation training, modified from Bernstein andBorkovec (1973),
and training in biofeedback-assisted hand temperature control
accord-ing to the procedures outlined by Lake. Rainey. and Papsdorf
(1979). To treat thecognitive component of test anxiety, three
distinct cognitive behavioral interventionswere given to both
groups. The first cognitive treatment was based upon
proceduresdeveloped by Meichenbaum (1972) and was designed to give
the 5s an awareness of therole that anxiety-eliciting thoughts have
in the development and maintenance of test anx-iety. This was
followed by training and learning to substitute positive, coping
self-statements 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 theoverall
rationality of the 5's belief systems through the disputation of
irrational beliefsrelated to the importance of test-taking and its
consequen ces. The final compon ent of thecore treatment package
consisted of traditional systematic desensitization. All 5s
weretrained in the procedures outlined by Allen (1972) and
progressed through a standardized12-item hierarchy composed of
test-related stimuli. When an 5 indicated that a par-ticular
hierarchy item e licited an anxiet) response, he or she was
instructed to: (I ) ver-balize 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 mthe Graduate Record Examination. 5s
assigned to the core treatment condition com-pleted these
examinations in a quiet setting and were urged to utilize the
coping skillstaught previously. 5s who had received additional
training in distraction copingprocedures completed identical
examinations while audio tapes of distracting stimuliwere played.
5s in this latter group were trained to practice self-instructions
designed to
7/27/2019 Usmle-relat-papers; In Vivo Distraction-coping in the
Rx of Test Anxiety
3/6
460 Journai of Clinical Psychology. March. 1984. Vol. 40. No.
2As a result of this program, statistically significant reductions
in test anxiety, stateand trait anxiety, increases in rationality,
improvements in anagram solution time, andthe manual dexterity task
all were observed posttreatment. There were no
significantdifferences between the two experimental groups, which
suggested that the distractioncoping procedure added little, if
any, effectiveness to the core treatment. In order toassess the
maintenance of these therapeutic gains, a 12-month follow-up
evaluation wasconducted.
M E T H O DSubjects and Procedure
One year after the completion of treatment, 14 of the original
19 5s were contactedby mail for participation in the follow-up
study. The 5s were mailed an evaluation packetthat consisted of the
questionnaires utilized in the original study. It was not feasible
toreadminister the anagram solution task and the psychomotor test
because some of the 5shad moved from the University community. It
was felt that the information from thequestionnaire, which measures
four distinguishable constructs (test anxiety, state andtrait
anxiety, and rationality), would be of value.The percentage (73.6%)
of the 5s assessed at the 1-year follow-up in the presentstudy is
comparable to the return rates from earlier long-term follow-up
studies in thetreatment of test anxiety. For example, DefTenbacher
and Michaels (1981) obtained areturn 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.
RESULTSBecause there were no significant differences between the
core treatment group andthe distraction-coping training group at
posttreatment on the dependent variables in theoriginal study, the
follow-up data are reported for both groups in a combined form.
Theoriginal sample consisted of 10 women and 9 men. of whom
information was obtainedfrom 7 women and 7 men at follow-up. Chi
square analyses showed that the return ratewas not related
significantly to either 5 sex or treatment condition.
Follow-uprespondents did not differ from non-respondents when both
pre- and posttreatmentscores on the various questionnaires were
examined. The mean scores and standarddeviations for all 5s who
completed the pretreatment, posttreatment, and follow-upassessments
are presented in Table 1. Post hoc comparisons for differences in
the 5sscores between time periods are presented in Table 2.The
reductions in test and trait anxiety scores observed at
posttreatment in theoriginal 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 IMeans and Standard Deviations Jor all vS\
Completing the Extended Folloy\-up Evaluationi.\ 141
MeasuresPretreatment\f SD
PosttreatmentM SD
Follow-upM SD
7/27/2019 Usmle-relat-papers; In Vivo Distraction-coping in the
Rx of Test Anxiety
5/6
462 Journal of Clinical Psychology. March, 1984, Vol. 40, N o.
2BIGLAN, A., VILLWOCK, C , & WICK, S . (1979). The feasibility
o f a computer controlled program for thetreatment of lest anxiety.
Journal of Behavior Therapy an d Experimental Psychiatry. 10.
47-49.BRUCH, M. (1978 ). Type of cognitive m odeling, imitation of
modeled tactics, and modification of test anx-iety. Cognitive
Therapy and Research. 2. 147-164.COUNTS, D., HOLLANDSWORTH, J.,
& ALCORN, J. (1978). Uses of EMG biofeedback and cue
controlledrelaxation in the treatment of test anxiety. Journal of
Consulting and C linical Psychology. 2. 147-164.DEFFENBACHER, J.,
& MICHAELS, A. (198 1). Two self-control procedures in the
reduction of targeted andnontargeted anxietiesa year later. Journal
of Counseling Psychology. 28. 525-528.DOCTOR, R., & ALTMAN, R.
(1969). Worry and emotionality as components of test anxiety: R
eplication 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/Con-
sulting 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 Con-sulting 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 managementof
migraine headache. Journal of Applied Beh avior Analysis. 1 2.
127-140.LIEBERT. R.. & MORRIS, L. (1967). Cognitive and
emotional components of test anxiety: A distinction andsome initial
data. Psychological Reports, 20. 975-978.MARLETT, N.. & WATSON.
D. (1968). Test anxiety and immediate or delayed feedback in a
test-likeavoidance task. Journal of Personality and Social
Psychology, 8. 200-203.MATTHEWS. A. (1978) . Fear reduction
research and clinical phobias. Psychological B ulletin. 85.
390-404.MEICHENBAUM. D. (1972). Cognitive modification of test
anxious college sludcnls. Journal of Consulting an
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 distrac-tion, 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
CiinicaiPsychology, 43, 148-153.SARASON, I.. & GANZER. V.
(1961). Anxiety, reinforcement and experimental instructions in a
free verbaliza-tion 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 com ponents 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 intheory and research (Vol. 2). New York: Academic
Press.SPIELBERGER. C. (1980). The Test Anxiety Inventory {TAI).
Palo Alto, CA: Consulting Psychologists Press.SPIELBERGER, C . GO
RSUCH, 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
