Looking towards or looking away

What sort of mind-set seems to assist the processing of distressing information? Is it altogether better to distract ones mind from the hurtful event or to think about it? Some studies from experimental psychology compare distraction to attention but often in the context of an existing fear or phobia. For instance, Telch and colleagues (2004) put claustrophobic students in a dark narrow chamber and shut the door. The first group simply had to sweat it out (behavioural exposure). The second group was a 'demanding distraction' group who did a 'seashore rhythm test' in which they had to listen carefully and distinguish tones presented on a headphone. This demanded intellectual concentration and distracted them from the claustrophobic room. A third 'mild distraction' group simply concentrated on neutral thoughts and images whilst in the room. The exposure group showed the greatest reduction in fear over the sessions. The 'demanding distraction' group had substantially less reduction in fear than the 'mild distraction' group. Telch and colleagues concluded 'our findings suggest that it is not distraction per se that interferes with fear reduction but the extent to which the distracted task makes attentional resources less available for cognitive processing during exposure'. Other studies using exposure to tarantulas for spider phobic (Mohlman & Zinbag 2000) and snakes for snake phobic participants (Craske et al 1991) have shown attention to the fear produces better fear reduction than distraction.

How far do these rather simple and tangible phobic objects equate to the complex and rather subtle emotional situations that occur in everyday life? After a lover's quarrel, for instance, will the lovers process the hurtful words and events better if they distract their mind with a crossword puzzle or think over the quarrel?

There is another dimension. There are different ways of thinking over an event. A constructive facing of a painful event might involve thinking it through, trying to puzzle out why it happened or talking to a friend, then moving to other activities. A destructive facing of the event might involve endlessly replaying the scene over in ones mind for weeks with no attempt to understand or resolve it or work it out with a friend. Rime, Philipott, Finkenauer, Ligast, Moorkens & Tornqvist (1995) got subjects to 'over-rehearse' the most emotional event of the previous day, thinking and talking about it every evening for three consecutive weeks. When the topic was discussed sometime later, it was still emotionally disruptive, showing a sort of sensitization effect rather than having aided the processing of the event.

This 'goldilocks and the three bears' account of how much we should attend to emotional hurt - not too much, not too little but just the right amount - may be too simplistic. There may also be a question of timing. The research on bereavement suggests phases of emotional reaction involving numbing, disbelief, anger and later resolution of the loss. Making sense of the bereavement or talking to others may be counterproductive at an early stage but productive at the right stage. Apart from timing, the intensity of the trauma may be a crucial element. For instance, the role of distraction or attending to the emotional event may be entirely different after a rape experience than after a quarrel. It may also vary between emotions, so that distraction after a life threatening terrifying event may be different from distraction after the death of a spouse.

Dorset RDSU
Cornelia House Poole Hospital NHS Trust Longfleet Road Poole Dorset BH15 2JB
Email dawn.stevens@poole.nhs.uk