The Attention Training Technique was created by Adrian Wells, professor of clinical and experimental psychopathology at the University of Manchester, founding director of the Metacognitive Therapy Institute, and the originator of metacognitive therapy[3]. The technique first appeared in print in 1990[1] and reached its standard written form in his 2009 treatment manual[2].

The 1990 paper

The first published report is narrow in a way worth knowing about. It describes one patient, with panic disorder occurring alongside relaxation-induced anxiety, treated with an attentional training approach[1].

The clinical situation is telling. Relaxation-induced anxiety is the problem of a patient for whom the standard calming intervention makes things worse — which rules out building the treatment around relaxation and pushes toward doing something else with attention entirely. The exercise that resulted is one that Wells would later specify explicitly as not a relaxation method[2].

A single case is a starting point, not a demonstration. What has been measured since is covered in does attention training actually work?.

From technique to protocol

Between 1990 and 2009 the exercise became a component of a full treatment model. In the 2009 manual, ATT sits inside metacognitive therapy as its attention-modification strategy[2], and the auditory procedure first reported in 1990 remains the basis of the technique[2].

The manual is what turned a described approach into a reproducible one. Chapter 4 fixes:

  • the three phases and their durations — about five minutes selective attention, five attention switching, two divided attention, roughly twelve minutes total[2]
  • the sound layout — between six and nine sounds, in the room, nearby, and in the far distance[2]
  • the switching tempo — around ten seconds, accelerating to five[2]
  • the therapist script, printed verbatim[2]

What Wells built it to do

The target is a processing pattern rather than a set of thoughts. Metacognitive therapy calls it the cognitive attentional syndrome — perseverative, self-focused, worry-based processing together with monitoring for threat[2]. ATT is described as interrupting that pattern and improving flexible executive control[2], with the aim of directly modifying the control of attention[2].

That design goal explains the technique’s most counterintuitive features. It is built to be attentionally demanding and to stay demanding with practice — otherwise, Wells writes, it would not systematically strengthen control processes[2]. And it is ruled out as a distraction, avoidance, or symptom-management strategy, and as an emotion-management strategy[2].

Wells also gives the framing he wants patients to hold: that ATT is a form of general “mental fitness training” rather than a form of avoidance[2].

Why the attribution matters

“Attention training” is a phrase many different programmes use. Wells’ ATT is a specific twelve-minute auditory protocol with a published script and a stated rationale[2] — it is not brain-training games, not concentration exercises for children, and not a meditation practice, though all of those are described with the same two words.

When a source refers to ATT without pointing at the 1990 paper or the 2009 manual, it is worth checking which technique is actually being described.

For the exercise itself, see the Attention Training Technique explained; for the model it was designed against, see the cognitive attentional syndrome.

Questions and answers

Who created the Attention Training Technique?
Adrian Wells, professor of clinical and experimental psychopathology at the University of Manchester and the originator of metacognitive therapy. The technique first appeared in a 1990 paper.
When was ATT first published?
1990, in Behavior Therapy — a single-case report of a patient with panic disorder and relaxation-induced anxiety.
Where is the standard version written down?
In Wells' 2009 book Metacognitive Therapy for Anxiety and Depression, whose fourth chapter sets out the protocol and prints the therapist script.

References

  1. Wells, A. (1990). Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behavior Therapy, 21(3), 273–280. https://doi.org/10.1016/S0005-7894(05)80330-2
  2. Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. Guilford Press. Chapter 4: Attention Training Techniques.
  3. Adrian Wells — research profile, The University of Manchester. https://research.manchester.ac.uk/en/persons/adrian.wells/

Published by the makers of Heed, an app for practicing ATT-style sessions. iPhone · Android. Heed is a self-practice tool inspired by ATT research — not therapy, and not a medical device.