The present study examined the effects of attentional focus on anxiety reduction during in vivo exposure. Thirty-nine mildly blood- and injection-fearful subjects were randomly assigned to one of three brief (i.e., 10 minute) exposure conditions. Cognitive attention to the blood-and-injection stimuli was manipulated by engaging participants in either stimulus-relevant conversation (exposure-plus-focusing condition), stimulus-irrelevant conversation (exposure-plus-distraction condition), or no conversation (exposure alone). Attention was successfully manipulated, and while exposure-plus-distraction resulted in a greater decrease in anxiety within-session than both the exposure-plus-focusing and exposure-alone conditions, the three groups showed no difference at postexposure in the behavioral approach task. Implications for the practice of exposure techniques and theories of emotional processing are discussed.