Attention Training Practice Record

Self-focused attention (SFA) is a transdiagnostic cognitive process that has been associated with multiple disorders (Woodruff-Borden et al., 2001). SFA involves selective (and often automatic) attention to self-referent information – bodily sensations, thoughts, emotions, beliefs, or memories – rather than external information (Ingram, 1990). While it is not always maladaptive, Ingram (1990) suggests SFA becomes problematic when it results in ‘self-absorption’: an excessive, sustained, and inflexible attention to internal states.

The attention training technique (ATT) aims to reduce SFA (Wells, 1990). It is a key component of metacognitive therapy (Wells, 2009) and is sometimes used as a standalone technique (e.g., Papageorgiou & Wells, 2000).

“Attention training… is based on the principle that intense and adhesive self attention contributes to maintenance of anxiety and other disorders and represents an emotional vulnerability factor.” (Wells, 2000).

ATT and metacognitive therapy are grounded in the self-regulatory executive function (S-REF) model, also developed by Wells (Wells & Matthews,

“When people focus on their thoughts, feelings, physical sensations, or performance too much or too often, it can make them more distressed. Do you ever become very self-focused or self-conscious, or notice your attention gets ‘stuck’ on upsetting internal experiences? One way to address this is attention training, which aims to give you more choice and control over what you pay attention to. You could think of it as strengthening your attention ‘muscles’, but like any kind of training, it requires practice. Do you think training your attention could be helpful? This form will guide us through the process. You can also use it to record training you do on your own”.

• Step 1: Present a rationale. Discuss the ways self-focused attention can intensify and increase the detection of internal reactions, which contribute to negative beliefs and emotions. Disorder-specific rationales can also be provided. For example:
  • Panic disorder: Focusing on physical symptoms

• Fergus, T. A., & Bardeen, J. R. (2016). The attention training technique: a review of a neurobehavioral therapy for emotional disorders. Cognitive and Behavioral Practice, 23, 502-516. DOI: 10.1016/j.cbpra.2015.11.001.
• Ingram, R. E. (1990). Self-focused attention in clinical disorders: Review and a conceptual model. Psychological Bulletin, 107, 156–176. DOI: 10.1037/0033-2909.107.2.156.
• Knowles, M. M., Foden, P., El-Deredy, W., & Wells, A. (2016). A systematic review of efficacy of the attention training technique in clinical and nonclinical samples. Journal of Clinical Psychology, 72, 999-1025. DOI: 10.1002/jclp.22312.
• Papageorgiou, C., & Wells, A. (2000). Treatment of recurrent major depression with attention training. Cognitive and Behavioral Practice, 7, 407-413. DOI: 10.1016/S1077-7229(00)80051-6.
• Reinholdt-Dunne, M. L., Blicher, A., Nordahl, H., Normann, N., Esbjørn, B. H., & Wells, A. (2019). Modeling the relationships between metacognitive beliefs, attention control and symptoms in children with and without anxiety disorders: A test of the S-REF model. Frontiers in Psychology, 10, 1205. DOI: 10.3389/fpsyg.2019.01205.
• Veale, D., Willson, R.,