Can the Attention Training Technique Reduce Stress in Students? A Controlled Study of Stress Appraisals and Meta-Worry

Neural correlates of the attention training technique as used in metacognitive therapy – A randomized sham-controlled fMRI study in healthy volunteers

Introduction

The Attention Training Technique (ATT) developed as part of metacognitive therapy is a psychotherapeutic treatment method used to enhance top-down attentional flexibility and control. This study investigated potential neurocognitive changes due to ATT and its underlying neural mechanisms using pre-to-post functional magnetic resonance imaging (fMRI).

Materials and methods

Fifty-four healthy participants were subjected to a randomized, sham-controlled attention training and evaluated using a neurocognitive test battery that partly took place in an fMRI environment. Participants received two doses ATT or sham ATT daily for 1 week. On day eight, all subjects completed the neurocognitive test battery again.

Results

After the training, the ATT group showed a significant improvement in reaction times regarding attentional disengagement compared to the sham ATT group. fMRI data showed decreased levels of activation in the anterior cingulate cortex (ACC) when comparing the ATT group to the sham ATT group during attentional disengagement post intervention. No ATT > sham ATT effects were found regarding selective auditory attention, working memory performance and inhibitory control.

Discussion

These findings putatively indicate that ATT facilitates faster attention allocation and increased attentional flexibility in healthy subjects. The fMRI results suggest this ATT-dependent improvement is accompanied by reduced ACC activity, indicating a more flexible attentional state.

The Attention Training Technique Reduces Anxiety and Depression in Patients With Coronary Heart Disease: A Pilot Feasibility Study

Background and Objectives

Depression and anxiety symptoms are highly prevalent in coronary heart disease (CHD) patients and associated with poor outcome. Most psychological treatments have shown limited effectiveness on anxiety and depression in these patients. This study evaluates the feasibility of the attention training technique (ATT) in CHD patients with symptoms of anxiety and/or depression.

Methods

Five consecutive CHD patients with significant depression and anxiety symptoms with Hospital Anxiety and Depression rating scale (HADS) -anxiety or -depression subscale score > 8 received 6 weekly group-sessions of ATT in an open trial. Outcomes included feasibility and symptoms measured by HADS, at baseline, post-treatment and at 6 months follow-up. We also assessed psychiatric diagnoses, type D personality, insomnia, worry, and rumination.

Results

The sample comprised five men with a mean age of 59.9 (SD 4.4) years. Four of the patients attended all six sessions, and one patient attended all but one session. Mean HADS-A scores at baseline, post-treatment, and follow-up were 9.4 (SD 3.0), 4.2 (SD 3.0), and 4.0 (SD 2.5), and for HADS-D 8.6 (SD 3.3), 3.0 (SD 3.7), and 1.6 (SD 1.5), respectively. The results showed clinically significant changes in anxiety, depression, psychiatric disorders, insomnia, worry, and rumination. Statistically significant changes were found from pre- to post-treatment scores for HADS-A and worry, which were maintained at follow-up, and HADS-D scores significantly decreased from pre-treatment to 6-months follow-up.

Conclusions

ATT in a group format appears to be a feasible stand-alone metacognitive treatment for CHD patients. An adequately powered randomized controlled trial is warranted.

A randomized experimental analysis of the attention training technique: Effects on worry and relevant processes in individuals with probable generalized anxiety disorder

CONTEXT

The Attention Training Technique (ATT, Wells, 1990) is an intervention guiding individuals to focus, shift, and divide their attention in response to sounds presented in an audiorecording. The ATT has long been recommended for generalized anxiety disorder (GAD); however, there is insufficient research on its effects on excessive worry and related processes.

OBJECTIVES

This experiment examined whether the ATT is more efficacious than a control intervention at reducing worry and modifying worry-related processes (e.g., attention control, negative metacognitive beliefs, attention bias, mindfulness).

PARTICIPANTS

78 adults with probable GAD.

DESIGN

Participants completed measures of worry and worry-related processes at the lab. They then monitored worry and attention daily for a week. Following this baseline, participants recompleted the lab measures and were randomly assigned to ATT or control. Participants listened to their assigned recording once/day for a week while again monitoring worry and attention daily. Participants then recompleted the lab measures.

RESULTS

The ATT did not perform better than the control condition on any measure. A variety of improvements were seen over the intervention period in both conditions.

CONCLUSIONS

ATT may not have meaningful effects on excessive worry and worry-related processes. Explanations for null findings are offered. CLINICALTRIALS.

GOV REGISTRATION

NCT03216382.

The Relationship Among Trait Mindfulness, Attention, and Working Memory in Junior School Students Under Different Stressful Situations

Attention and working memory are important cognitive functions that affect junior school students’ learning ability and academic performance. This study aimed to explore the relationships among trait mindfulness, attention, and working memory and to explore differences in performance between a high trait mindfulness group and a low one in attention and working memory under different stressful situations. In study 1, 216 junior school students completed the Five Facet Mindfulness Questionnaire (FFMQ), and their attention and working memory were tested in a non-pressure situation. The results showed that attention had a partial mediating effect between mindfulness and working memory. In study 2, the high trait mindfulness group and the low one were tested for attention and working memory under situations with single and multiple pressures. One notable result was that the attention and working memory performances of the high mindfulness group were all significantly higher than those of the low mindfulness group in every stress situation (no stress, single stress, and multiple stresses). Other important results were that trait mindfulness moderates the relationship between stress and attention and between stress and working memory. These results suggest that trait mindfulness has a protective effect in the process by which various stresses affect attention and working memory. These findings indicate that trait mindfulness is an important psychological quality that affects the attention and working memory of junior school students, and it is also an important psychological resource for effectively coping with the impact of stress on attention and working memory. Therefore, it is possible that improving trait mindfulness may help to improve junior school students’ attention and working memory and enable them to cope better with stress, thereby helping to improve academic performance. This research is of great significance for understanding the association between key psychological qualities and cognitive functions in different stressful situations. These findings also provide insight for future studies in educational psychology.