This study examined the relative efficacy of rational restructuring and attentional training for the cognitive treatment of test anxiety. Both treatments were ...
Cognitive Therapyand Research, Vol. 7, No. 1, 1983,pp. 69-78
Cognitive Treatment of Test Anxiety: Rational Restructuring versus Attentional Training 1 Erica H. Wise 2 and Stephen N. Haynes
Southern Illinois Universityat Carbondale
This study examined the relative efficacy of rational restructuring and attentional training for the cognitive treatment o f test anxiety. Both treatments were presented in an identical format, which involved imaginal exposure to anxiety-provoking testing situations. In the rational restructuring condition subjects were trained to identify and modify irrational beliefs, and in the attentional training condition subjects were trained to reduce attention to task-relevant variables. The results suggested that both cognitive treatments were superior to the waiting-list control group in reducing test anxiety and improving performance on analogue tasks, and that treatment effects were maintained at an 8-month follow-up. The lack of significant differences between cognitive treatments was discussed in the context of Bandura's self-efficacy theory. In addition, anxiety-reduction scores (derived from the in-session coping exercises) were found to be significant predictors o f treatment outcome. Until the 1970s, desensitization techniques (which were designed to reduce the physiological arousal associated with test anxiety) dominated the reported research (Anton, 1976). However, several recent studies have suggested that the debilitating effects o f physiological arousal may be mediated by cognitive processes (Hollandsworth, Glazeski, Kirkland, Jones, & Van Norman, 1979; Holroyd, Westbrook, Wolf, & Badhorn, 1978). On the basis of these studies, it appears that although high test-anxious subjects
'This article is based on a doctoral dissertation completed by the first author at Southern Illinois University at Carbondale. Portions of this paper were presented at the annual meeting of the Association for the Advancement of Behavior Therapy, New York, 1980. 2Address all correspondenceto Erica H. Wise, Student Health Service (469H), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514. 69 0147-5916/83/0200-0069503.00/0 © 1983 Plenum Publishing Corporation
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tend to report higher levels of subjective arousal, they do not differ significantly from low test-anxious subjects on a variety of objective physiological measures. These findings have important theoretical and treatment implications in that high test-anxious subjects may simply be more aware of and/or concerned with physiological arousal. Treatment approaches designed to modify high test-anxious subjects' cognitive responses to anxiety-provoking situations may therefore be the most effective method for reducing test anxiety. Rational restructuring and attentional training are two cognitive treatments that have received support in the literature. Rational restructuring is based on the notion that irrational beliefs are the determining factors in psychological and behavioral disturbance (Ellis, 1962). The incorporation of this basic premise into systematic treatment procedures has led to positive results in a series of well-controlled outcome studies (e.g., Goldfried, Linehan, & Smith, 1978: Holroyd, 1976; Meichenbaum, 1972). In 1952 Mandler and Sarason proposed the attentional theory of test anxiety in which they suggested that high test-anxious subjects have a repertoire of self-evaluative ruminations that are elicited in testing situations and interfere with performance. Wine (19"71) was the first to clearly articulate the treatment implications of this theory, and reported (Note 1) that training high test-anxious subjects to reduce attention to taskirrelevant variables and increase attention to task-relevant variables resulted in reductions in test anxiety. Although rational restructuring and attentional training are similar in assuming that cognitive processes are the determining factors in the subjective anxiety and performance deficits associated with test anxiety, they differ in terms of actual intervention procedures. Rational restructuring techniques are designed to reduce the extent to which testing situations are perceived as anxiety-provoking, whereas attentional training is designed to provide subjects with an explicit method for dealing with the anxiety that they typically experience in those situations. Therefore, rational restructuring does not directly encourage subjects to reduce task-irrelevant behaviors (e.g., ruminations), and attentional training does not directly intervene in the extent to which academic achievement situations are perceived as anxiety-provoking. The central purpose of this study was to assess the relative efficacy of these two procedures in a structured group setting. In order to minimize nonspecific differences between treatment conditions, they were both presented to subjects in an identical treatment format. The procedures outlined by Goldfried and Davison (1976) appeared to be ideal for this purpose in that the use of imagination-coping exercises made it possible
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to vary only the content of the coping skill between the conditions. A pseudotherapy condition was not included since it has been reliably demonstrated that cognitive treatments are more effective than a variety of theoretically inert procedures (e.g., Goldfried et al., 1978; Holroyd, 1976; Wine, Note 1). A second purpose of this study was to determine the extent to which a measure of the ability to effectively use the coping strategy was related to treatment outcome.
METHOD
Subjects Subjects were 15 male and 23 female college students at Southern Illinois University who responded to advertisements for a clinical/research project designed to reduce test anxiety. O f the 42 subjects who originally began the study, 4 were eliminated from the final data analysis due to a failure to complete treatment.
Overview of Procedure Interested students were instructed to contact the Department of Psychology in order to schedule an individual assessment session. A cutoff score of > 30 on the debilitating scale of the A A T was used in order to ensure that all subjects were at least moderately anxious. A randomized block design (based on sex of subject and scheduling considerations) was used for assigning subjects to the rational restructuring treatment condition (N = 14), the attentional training treatment condition (N = 11), and the waiting-list control condition ( N = 13). There were two sections of each treatment condition and four active treatment groups in all. Identical assessment measures were administered prior to treatment and within 1 week following termination of the treatment groups. The waiting-list control group completed all assessment measures on the same schedule but did not receive any treatment until after the posttreatment assessment session. For ethical reasons, subjects in the waiting-list control group were offered an abbreviated version of the treatment at that time, and were therefore not included in the follow-up. The follow-up was conducted by mail 8 months following termination of treatment and consisted of the questionnaire measures of test anxiety and social-evaluative anxiety.
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Dependent Measures The multimethod assessment procedure consisted of (a) questionnaire measures of test anxiety, (b) subjective anxiety preceding an analogue task, (c) performance scores on the analogue task, and (d) a questionnaire measure of social-evaluative anxiety designed to measure treatment generalization. The test anxiety questionnaire measures consisted of the debilitating and facilitating scales of the Achievement Anxiety Test (AAT) (Alpert & Haber, 1960) and the Suinn Test Anxiety Behavior Scale (STABS) (Suinn, 1969). The "today" form of the Anxiety Adjective Checklist (AACL) (Zuckerman, 1960) was administered prior to the digits forward, digits backward, and digit symbols subscales of the Wechsler Adult Intelligence Scale. The Social Avoidance and Distress (SAD) and Fear of Negative Evaluation (FNE) scales (Watson & Friend, 1969) were administered as a measure of social-evaluative anxiety. Treatment Credibility Ratings. Following the procedures outlined by Goldfried et al. (1978), subjects were asked to rate their estimate of success for the treatment program at the end of the first session on a 5-point scale (from 0 to 100%).
Treatment Groups The treatment groups were run for five 1-hour weekly sessions. Every attempt was made to ensure that the format used in the two treatment conditions was identical, differing only in the presented conceptualization of test anxiety and the associated coping skill. The first session consisted of a didactic presentation of the treatment rationale and a description of the treatment procedures. Each of the following four sessions involved four 1-minute exposures to each of three testing scenes, and overall a total of 12 scenes were presented four times each. During each imaginationcoping trial, subjects were encouraged to vividly imagine the testing scene and to attempt to reduce their anxiety using either rational restructuring or attentional training, depending on group assignment. Following each trial they were asked to record their coping response and estimated level of anxiety (from 0 to 100%) before and after coping (see Goldfried & Davison, 1976). Similar forms were provided for recording coping attempts in three "real-life" academic achievement situations each week.
Therapists Two graduate students in psychology (not one of the authors) served as therapists for the treatment groups. Each therapist ran one group in
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each treatment condition so that group and therapist variables were completely crossed. The therapists received approximately 5 hours of training in the rationale and procedures for each condition and were supervised by the first author. They remained uninformed as to the hypotheses and assessment instruments associated with the study.
RESULTS
Treatm en t Effects Regression analyses revealed that the therapist factor did not account for a significant proportion of the variance in posttreatment scores. Therefore, the data were combined across therapists for all subsequent analyses. Overview of Analyses. Analyses of covariance, using multiple regression techniques, were performed in order to test for overall treatment effects. Two regression models for predicting posttreatment scores were constructed for each dependent measure: (a) a one-variable model including only pretreatment score and (b) a two-variable model including pretreatment score and treatment condition. An F test was conducted in order to compare the predictive efficacy of the two regression models. The results of these analyses are summarized in Table I. Between-groups orthogonal comparisons were performed, using multiple regression techniques, in order to contrast (a) the treatment conTable I. Analysis of Covariance Testing for Treatment Effects ~ R~-difference b
df
F
p
