The aim of this study was to test the effects of visual and audiovisual distraction on pain, anxiety, and procedure tolerance among patients undergoing colonoscopy. A prospective, randomized, controlled design was used with 180 consecutive patients who underwent colonoscopy. Subjects were randomly allocated into 3 groups: Group A received visual distraction, Group B received audiovisual distraction, Group C with routine care. Outcome variables included pain, anxiety, and willingness to undergo colonoscopy again if the procedure was to be repeated. No significant difference was found on the pain scores of the 3 groups. However, when groups A and B were further divided into groups A1, A2, A3 (low-, middle-, high-involvement groups), and B1, B2, B3 (low-, middle-, high-involvement groups) according to the level of distraction involvement, significant differences in pain scores were found between 7 groups (A1 and A3, A2 and A3, A1 and B3, A2 and B3, A3 and C, B1 and B3, B3 and C). The pain score of Group A3 was significantly lower than those of groups A1, A2, and C, and the pain score of Group B3 was significantly lower than those of groups B1 and C. The reduction of anxiety levels after procedure was insignificant between the 2 intervention groups and control group. The rates of willingness to undergo colonoscopy again if the procedure was to be repeated of the 2 intervention groups were significantly higher than that of the control group. Visual and audiovisual distraction is effective in promoting pain control for patients undergoing colonoscopy and improving their tolerance of the procedure.