The attention training technique causally reduces self-focus following worry provocation and reduces cognitive anxiety among self-focused individuals.

BACKGROUND AND OBJECTIVES: The attention training technique (ATT) is a component of metacognitive therapy developed to interrupt self-focused, threat-based processing underlying anxiety disorders. Whereas extant research supports the benefits of ATT, including in relation to anxiety reduction, study findings lead to equivocal conclusions as to whether ATT causally interrupts self-focused attention (SFA) as intended. An additional gap in the literature relates to investigating if ATT is especially effective for reducing anxiety among individuals experiencing a heightened self-focused state. The present study sought to address those two gaps in the literature. METHOD: Participants scoring high on a measure of general worry severity completed a worry provocation that increased SFA and then were randomized to ATT (n = 45), a mindfulness task (n = 44), or a distraction task (n = 44). RESULTS: ATT caused large reductions in SFA, whereas there were no changes in focus of attention following the mindfulness or distraction task. Anxiety reduction was found in relation to all three tasks; however, ATT, relative to distraction, was found to cause greater reduction in cognitive anxiety for individuals highly self-focused before the task. LIMITATIONS: The present study used an analogue sample and the design did not allow for an examination of the long-term benefit of ATT. CONCLUSIONS: Results support ATT causally interrupting self-focused states and that ATT is particularly effective in reducing cognitive anxiety among individuals who are self-focused.

The attention training technique, self-focused attention, and anxiety: a laboratory-based component study.

Self-focused attention is an important target of intervention within Wells's (2009) metacognitive therapy and the attention training technique (ATT) is one component of metacognitive therapy that purportedly alters focus of attention. However, we do not yet fully understand whether ATT causes changes in focus of attention, the effectiveness of ATT compared to other techniques in reducing self-focused attention, and how ATT leads to its therapeutic gains. A laboratory-based component study was completed to address these gaps in the literature. Nonclinical participants were randomly assigned to one session of ATT (n = 38) or a mindfulness-based task (n = 38). ATT and the mindfulness-based task differentially changed focus of attention, with ATT causing greater external focus of attention and the mindfulness-based task causing greater self-focused attention from pre-to-post manipulation. ATT and the mindfulness-based task both led to reductions in anxiety. Reductions in self-focused attention were related to less anxiety following ATT, whereas increases in self-focused attention were related to less anxiety following the mindfulness-based task. Conceptual and therapeutic implications are discussed.