ATT should never be used to avoid or control negative thoughts, feelings, or symptoms. ATT is not a tool to help calm down or stop having negative thoughts. The point of ATT is to learn that you can control attention by yourself instead of using any thought suppression strategies or external help:.

Meanwhile, unwanted inner experiences thoughts, feelings, sensations can be seen as opportunities to improve attentional control by leaving them alone instead of worrying or ruminating about them. You can practice becoming more aware of your attention and strengthen your control over it by following the guideline below.

In order to experience the benefits of the attention training technique, it is recommended to practice daily for four weeks. Ideally, you should practice twice a day. Each session should last 12 minutes 4. Set aside 12 minutes at least once per day. Choose six to nine different sounds around you that you can hear and follow this routine:.

During the training, you will experience thoughts, feelings, and urges come up. Just let these inner experiences be and refocus your attention on the sound you were listening to. The goal with ATT is to show you that controlling your attention is independent of internal thoughts or external sounds events.

Use the scale below to track your progress by marking your attention before and after practicing ATT. If your attention moves two points toward the external part of the scale, you have practiced the technique correctly. On a normal day, your attention typically wanders across the whole scale; from being fully consumed in your own thoughts to being fully focused on something outside of yourself.

Your attention is flexible, and you have complete control over it. For example, you can control whether you focus and dwell on negative thoughts and feelings or on events that are happening right now in the present moment.

Use different situations in your everyday life as opportunities to practice attention control. You can for example focus away from analyzing and worrying about your negative thoughts and instead focus back on work, conversations, and other daily activities.

Allow yourself to be consumed by things you can see and hear in your surroundings regardless of your need of analyzing your problems.

You may find yourself coming up with better solutions when you move your attention away from your thoughts from time to time. Although studies show that ATT practice on its own can be effective 12 13 , further studies are needed to fully evaluate the effects of using ATT alone.

At present, the best effect of ATT is seen when it is used as a part of Metacognitive therapy 11 It is already established as an effective treatment for depression and anxiety disorders.

You can read more about the scientific proof behind Metacognitive therapy here. Emotional disorders like anxiety and depression are, according to Metacognitive therapy, caused by the CAS , which consists of worry, rumination, threat monitoring, and other unhelpful coping strategies.

CAS is regulated by underlying metacognitive beliefs, which is thinking about thinking and about attention. Metacognitive beliefs play an important role in activating worry, rumination, and direct attention to negative thoughts or feelings.

If you believe that you are unable to control rumination and worry, you will not try to stop. Instead, you get locked into extreme self-focus and give your negative thoughts, feelings, and symptoms your full attention.

But, if you learn that you are in full control of your attention, you can easily focus away from intrusive thoughts and instead move your attention to other things that are more important in your life despite how you feel.

According to recent studies, metacognitive beliefs about the uncontrollability of attention e. Examples of unhelpful coping strategies are worry, rumination, thought suppression, alcohol, and distractions.

Photo: Roman Melnychuk What if I have thoughts about harming myself? What if another OCD thought comes up? The thoughts about my thoughts are making everything feel really confusing. Photo: Bermix Studio If you think back to ten of your past worries, how many of them led you to solutions?

Were they good solutions? And did these solutions come from worrying or did you engage in Client version A PDF of the resource plus client-friendly instructions where appropriate.

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Translation Template Are you a qualified therapist who would like to help with our translation project? Select language. By increasing control over attention, ATT can help clients: Be less influenced by metacognitive beliefs.

Interrupt perseverative patterns of thinking e. Increase their ability to engage in disconfirmatory information processing. Reduce self-focused attention. Wells has presented a recommended sequence for facilitating ATT: Psychoeducation: The therapist presents a rationale for using ATT.

Phase one — selective attention: The client focuses their attention on a series of sounds while ignoring all others. Phase two — switching attention: The client moves their attention between the different sounds at a faster pace.

Phase three — divided attention: The client focuses on all the sounds simultaneously. Post-training feedback and homework: The client is asked to practice ATT for homework. Therapist Guidance. 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 can intensify them and make them seem more alarming. Health anxiety: Focusing on the body can exacerbate normal body sensations, increase awareness of them, and trigger health worries.

Social anxiety: Self-focused attention can contribute to distorted inner images of the self and exacerbate negative thoughts and feelings.

Step 2: Check the credibility of ATT. Check whether the client thinks ATT will be helpful e. If the client does not think ATT is credible, explore why and highlight its potential utility e. Step 3: Obtain a self-attention rating.

Before ATT, ask the client to rate the intensity of their self-focus. Step 4: Training. ATT is practiced with the therapist first. The client focuses their gaze on a spot on the wall and keeps their eyes open throughout the exercise. In the first phase selective attention , the client listens to nine sounds in sequence e.

Wells recommends incorporating three sounds within the consulting room and six sounds outside. In the second phase switching attention , the client rapidly shifts the focus of their attention between these sounds.

Finally, in the third phase divided attention , the client focuses on all the sounds simultaneously. Step 5: Feedback. Explore how the client found ATT, including any difficulties.

Normalize how difficult ATT can be at first, and correct any misunderstandings that may have emerged e. Remind the client that the aim is not to get rid of distracting thoughts or feelings, but to direct attention in a particular way Wells, Step 6: Obtain a self-attention rating. Obtain a second rating of self-focus after ATT.

A 2-point change on the scale mentioned earlier towards being more externally focused is typical. If this has not been the case, explore any difficulties that may have arisen during the exercise and repeat it if necessary. Limited change may indicate the client is attempting to control unwanted internal experiences or dividing their attention with worry or rumination during ATT Wells, These issues should be addressed before attempting ATT again.

Step 7: Homework. Wells suggests practicing ATT twice a day for minutes Wells, Explore what sounds the client might incorporate into their training. References And Further Reading. Fergus, T. The attention training technique: a review of a neurobehavioral therapy for emotional disorders.

Cognitive and Behavioral Practice , 23, DOI: Ingram, R. Self-focused attention in clinical disorders: Review and a conceptual model.

S-REF emphasizes a maladaptive style of thinking called the cognitive-attentional syndrome CAS , wherein individuals engage in excessive conceptual processing of information in the form of worry and rumination Wells, CAS also includes other problematic self-regulatory strategies, such as threat monitoring and thought suppression.

CAS is believed to arise from metacognitive beliefs i. These include beliefs related to coping e. Attentional control also plays a role in CAS in that it enables individuals to disengage from conceptual processing and perseverative self-focused attention Reinholdt-Dunne et al.

In other words, when individuals struggle to control the focus of their attention, they find it much harder to interrupt cycles of worry, rumination, and other forms of self-focused attention. ATT aims to enhance attentional control. By increasing control over attention, ATT can help clients:.

Research indicates that ATT is effective. In a recent systematic review, Knowles and colleagues conclude that ATT is an effective intervention for anxiety and depression, as well as some symptoms of psychosis.

Wells has presented a recommended sequence for facilitating ATT:. One way to address this is attention training, which aims to give you more choice and control over what you pay attention to. Do you think training your attention could be helpful?

This form will guide us through the process. Attention Training Practice Record When people struggle to control the focus of their attention, they find it much harder to interrupt cycles of worry, rumination, and other forms of self-focused attention.

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Select language. By increasing control over attention, ATT can help clients: Be less influenced by metacognitive beliefs. Interrupt perseverative patterns of thinking e. Increase their ability to engage in disconfirmatory information processing. Reduce self-focused attention. Wells has presented a recommended sequence for facilitating ATT: Psychoeducation: The therapist presents a rationale for using ATT.

Phase one — selective attention: The client focuses their attention on a series of sounds while ignoring all others. Phase two — switching attention: The client moves their attention between the different sounds at a faster pace.

Phase three — divided attention: The client focuses on all the sounds simultaneously. Post-training feedback and homework: The client is asked to practice ATT for homework.

Therapist Guidance. 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 can intensify them and make them seem more alarming.

Health anxiety: Focusing on the body can exacerbate normal body sensations, increase awareness of them, and trigger health worries. Social anxiety: Self-focused attention can contribute to distorted inner images of the self and exacerbate negative thoughts and feelings.

Step 2: Check the credibility of ATT. Check whether the client thinks ATT will be helpful e. If the client does not think ATT is credible, explore why and highlight its potential utility e. Step 3: Obtain a self-attention rating. Before ATT, ask the client to rate the intensity of their self-focus.

Step 4: Training. ATT is practiced with the therapist first. The client focuses their gaze on a spot on the wall and keeps their eyes open throughout the exercise. In the first phase selective attention , the client listens to nine sounds in sequence e.

Wells recommends incorporating three sounds within the consulting room and six sounds outside. When your mind wanders away from that sensation to internal mental content or an external distraction, gently return it to the breath-related object.

Gently redirect it every time it darts away. Another focused-attention exercise is mindful walking. Walking can take place either indoors or outdoors. You might find this activity easier than mindful breathing; go with whatever exercise works best for you.

One final focused-attention exercise is the body scan. Remember the idea of your attention being like a flashlight?

Start by focusing your attention on your toes, taking note of whatever sensations might be there. Next, you can move on to the soles of the feet and the heels, then the legs, stomach, and so on, slowly moving your flashlight up your body. After you have a good grounding in focused attention practice and can keep your attention on a particular object or set of sensations for a period of time, you can move on to open monitoring.

This practice is not about paying attention to a particular object or objects. After you name it, let it go.

People generally start to see benefits when they practice for about 15 minutes a day, 5 days a week, for around 4 weeks. Jha urges people not to feel discouraged — as with any new activity or sport, you need to practice. Start small. Your goal might be as simple as vowing to stop every day and take the posture of one of the practices, says Jha.

Whatever your initial goal, commit to that for a month — and congratulate yourself for making it! Finding a mindfulness community, whether virtual or in person, can help you stick to the activity. One thing that struck her is how much the military personnel say it has improved not just their ability to work under pressure but also their home lives.

But after mindfulness training, they found they were better able to be present with their loved ones — which is something most of us would like to do, too.