ATTENTION TRAINING TECHNIQUE (ATT) Guidance Notes
Attention Training Technique (ATT) is a specific treatment technique developed by Wells (1990) for use in metacognitive therapy. Whilst this technique was originally developed to be a component of treatment, experimental studies have suggested that it can in some instances have significant beneficial effects on anxiety and depression when practiced in its own right. However, we recommend that ATT is used in the context of a full metacognitive therapy treatment package for optimal effects.
The technique was developed on the basis of the metacognitive theory of psychological disorder. This theory, which is supported by evidence from scientific studies, states that a style of thinking called the Cognitive Attentional Syndrome (CAS) is responsible for psychological disorders. This style is linked to internal metacognitions that control thinking and attention. These are biased in psychological disorder and lock the individual into persistent patterns of negative thinking and attention that are difficult to control and contribute to anxiety and depression.
It follows from this that techniques that disrupt the CAS and help the person strengthen awareness of attentional control should be a beneficial therapeutic tool. This was the goal in developing ATT.
The technique consists of actively listening and focusing attention in the context of simultaneous sounds presented at different loudness and spatial locations. ATT has three phases that are practised at each practice session. The technique lasts approximately 12 minutes. The first phase is called selective attention and requires the participant to focus on individual sounds and spatial locations as instructed, whilst trying to maintain selectivity and reduce distraction. The second phase involves rapid switching of attention between different sounds and spatial locations. The final briefer phase involves dividing attention and trying to attend to as many simultaneous sounds and spatial locations as possible.
In practising the technique the aim is to follow the attention instructions irrespective of what may or may not be noticed in your mind and body. Inner events, should they occur, should simply be treated as additional sources of noise that are not given attentional priority. The aim of the procedure is not to distract from, avoid or suppress thoughts, feelings or emotions. They should be allowed to occupy their own inner space and awareness if they occur as you practice. The focusing of attention as instructed is your top priority and nothing else in your mind or body requires a response.
In order for ATT to work we have found that regular and consistent practice of the technique is necessary. The effects appear to develop with time and we advise that it is practiced twice a day for an initial period of 4 weeks during the course of treatment.
In connection with practicing ATT it is helpful to increase activity levels more generally and to reduce the amount of time spent dwelling and analyzing thoughts and feelings. ATT will help you to accomplish this goal.
MCT-Institute is developing a range of materials you can use in conjunction with ATT. Visit our website regularly for updates and news. You can download ATT notes and a recording to help you practise from this website.
Research on ATT:
Callinan, S., Johnson, D., & Wells, A. (2015). A Randomised Controlled Study of the Effects of the Attention Training Technique on Traumatic Stress Symptoms, Emotional Attention Set Shifting and Flexibility. Cognitive Therapy and Research, 39(1), 4-13.
Cavanagh M & Franklin J (2000). Attention Training and hypochondriasis: Preliminary results of a controlled treatment trial. Paper presented at the World Congress of Cognitive and Behavioral Therapy, Vancouver, Canada.
Fergus, T.A., Bardeen, J.R. (2016). The Attention Training Technique: A Review of a Neurobehavioural Therapy for Emotional Disorders.Cognitive and Behavioral Practice, 23(4), 502-516.
Fergus, T.A., Wheless, N.E., & Wright, L.C. (2014). The attention training technique, self-focused attention, and anxiety: A laboratory-based component study. Behaviour Research and Therapy. 61, 150-155.
Knowles, M. M., Foden, P., El-Deredy, W. and Wells, A. (2016), A Systematic Review of Efficacy of the Attention Training Technique in Clinical and Nonclinical Samples. Journal of Clinical Psychology, 72(10), 999–1025.
Levauz, M.N., Laroi, F., Offerlin-Meyer, I., Danion, J.M., Van der Linden, M. (2011). The Effectiveness of the Attention Training Technique in Reducing Intrusive Thoughts in Schizophrenia: A Case Study. Clinical Case Studies. 10(6), 466-484.
Moritz, S., Wess, N., Treszl, A. Jelinek, L. (2011). The Attention Training Technique as an Attempt to Decrease Intrusive Thoughts in Obsessive–Compulsive Disorder (OCD): From Cognitive Theory to Practice and Back. Journal of Contemporary Psychotherapy. 41(3), 135-143.
Murray, J., Theakston, A., & Wells, A. (2016). Can the attention training technique turn one marshmallow into two? Improving children's ability to delay gratification. Behaviour Research and Therapy, 77, 34-39.
Nassif, Y. & Wells, A. (2014), Attention Training Reduces Intrusive Thoughts Cued by a Narrative of Stressful Life Events: A Controlled Study. J. Clin. Psychol., 70, 510–517.
Papageorgiou C. & Wells A (1998). Effects of attention training on hypochondriasis: a brief case series. Psychological Medicine, 28, 193-200.
Papageorgiou C & Wells, A (2000). Treatment of recurrent major depression with attention training. Cognitive and Behavioral Practice, 7, 407-413.
Sharpe, L., Nicholson Perry, K., Rogers, P., Dear, B.F., Nicholas, M.K., Refshauge, K. (2010). A comparison of the effect of attention training and relaxation on responses to pain. PAIN, 150(3), 469-476.
Siegle, G.J., Ghinassi, F., Thase, M.E. (2008). Neurobehavioral therapies in the 21st century: summary of an emerging field and an extended example of cognitive control training for depression. Cognitive Therapy and Research, 31, 235-262.
Valmaggia, L., Bouman, T.K. & Schuurman, L. (2007). Attention Training with auditory hallucinations: A case study. Cognitive and Behavioral Practice, 14, 127-133.
Wells, A. (1990). Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behavior Therapy, 21, 273-280
Wells, A. (2007). The Attention Training Technique: Theory, effects and a metacognitive hypothesis on auditory hallucinations. Cognitive and Behavioral Practice, 14, 134-138.
Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford Press. (Contains the ATT treatment manual for therapists).
Wells, A. White, J. & Carter, K. (1997). Attention Training: Effects on anxiety and beliefs in panic and social phobia. Clinical Psychology and Psychotherapy, 4, 226-232.