There is a real published literature on the Attention Training Technique, and it is small, heterogeneous and mixed. A 2016 efficacy review included 10 studies with 295 participants and called the findings preliminary[10]. A 2026 review focused on cognitive and neural mechanisms, included 20 standalone-ATT studies and reported small to large effects across 14 tasks and three neural methodologies — EEG, fNIRS and fMRI[9]. Neither summary turns ATT into a proven treatment or predicts what one person will experience.

What has actually been measured

StudyWhoWhat was measuredReported result
Wells (1990)[1]One patient with panic disorderClinical caseThe first published report of the technique’s effects
Fergus et al. (2014)[7]Laboratory participantsSelf-focused attentionATT produced a greater external focus of attention from pre- to post-manipulation. The comparison arm was a mindfulness-based task, not a neutral control
Rosenbaum et al. (2018)[3]Component study, fNIRSBrain activity and effort, per phaseIncreased blood oxygenation in right inferior frontal gyrus, right dorsolateral prefrontal cortex and superior parietal lobule during the ATT conditions; effort ratings highest in the switching phase
Knowles & Wells (2018)[5]Randomized controlled comparisonResting EEG after a single doseIncreased resting alpha and beta oscillations in frontoparietal networks
Barth et al. (2019)[4]Healthy adults, sham-controlledDichotic listening performanceThe ATT group was significantly faster in correctly responding than the sham training group
Carter & Wells (2018)[6]One patient, schizo-affective disorderAuditory hallucinationsSingle-case report
Schwarz et al. (2025)[8]fMRIAttentional control networkATT versus control conditions activated the frontoparietal network
Stewart et al. (2021)[12]78 adults with probable GADWorry and related processesATT did not outperform the control intervention on any measure
Snuggerud et al. (2026)[13]20 patients with mixed anxiety disordersFeasibility and preliminary clinical outcomesSignificant anxiety improvement versus wait-list; gains were sustained at three- and six-month follow-up

Reading that table honestly

The strongest performance finding is a laboratory one. Barth and colleagues randomized healthy adults against a sham training and found faster correct responding on a dichotic listening task[4]. That is a well-controlled result about an attention task — not about anxiety, mood, or daily life.

The neural findings describe the task, not its benefits. Frontoparietal activity during practice[3][8] and changed resting oscillations after a dose[5] tell you the exercise engages attentional-control systems. They do not, by themselves, establish that anything improves for the person doing it.

One widely repeated framing is wrong. Fergus and colleagues compared ATT against a mindfulness-based task, not against a neutral control[7]. Summaries that describe it as “ATT versus control” overstate what the study did.

Clinical findings point in both directions. Stewart and colleagues found no ATT advantage over control after one week in 78 adults with probable generalized anxiety disorder[12]. A later randomized feasibility trial in 20 patients with mixed anxiety disorders found improvement versus wait-list that was maintained at follow-up[13]. The second study is encouraging, but its sample and wait-list comparison are too weak for a definitive treatment conclusion. A related exploratory study followed 19 young adults four times daily across two weeks before, during and after group ATT, and reported several patterns of reduced symptoms and metacognitive mechanisms[14]. Without a randomized comparison, those time patterns cannot establish that ATT caused the changes.

Reviews are not interchangeable. The 2016 review examined efficacy across clinical and nonclinical samples[10]; the 2018 meta-analysis combined single-case studies of MCT and/or ATT[11]; the 2026 review examined cognitive and neuropsychological correlates and excluded ATT used inside multi-component therapy[9]. Their conclusions answer different questions.

The limits worth stating plainly

  • Small samples. This is a modest literature, not a large one.
  • ATT has been studied both alone and inside larger treatments. Results from full MCT cannot isolate ATT, while the 2026 mechanisms review deliberately included standalone ATT and excluded multi-component treatment[9].
  • Attention tasks are not life outcomes. Faster correct responses on dichotic listening is a measured fact[4]. Whether and how such changes carry over is a further question the current evidence does not close.
  • Healthy volunteers and clinical populations are not interchangeable.

What the exercise itself claims to be

Worth separating from the evidence question. Wells describes ATT as targeting the control of attention — interrupting perseverative, self-focused, worry-based processing and monitoring for threat, and improving flexible executive control[2]. It is explicitly not framed as a relaxation method, a distraction, or a symptom-management strategy[2].

So “does it work?” has to be answered against that aim rather than against a general promise of feeling better.

The short answer

There is enough evidence to take the technique seriously as an attentional-training procedure with measurable cognitive and neural effects[9] and preliminary clinical findings. There is also a credible randomized null result[12], and the positive clinical studies remain small. ATT is neither proven for a particular condition nor baseless; the honest answer is that the evidence is promising, mixed and not yet decisive.

For where the technique came from and what it is for, see the Attention Training Technique explained.

Questions and answers

Is there evidence that ATT works?
Yes, but it is mixed and preliminary. Reviews report promising effects across small clinical, analogue and single-case studies; controlled trials range from positive results to no advantage over an active control. The evidence supports continued study, not a guaranteed personal or clinical outcome.
Has ATT been tested against a placebo?
At least one randomized study used a sham training comparison in healthy adults and reported faster correct responses on a dichotic listening task in the ATT group.
Does ATT change anything in the brain?
Studies using fNIRS, EEG and fMRI report activity in frontoparietal regions during or after the exercise. These describe what the brain does during the task; they are not evidence of clinical benefit.

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. Rosenbaum, D., Maier, M. J., Hudak, J., Metzger, F. G., Wells, A., Fallgatter, A. J., & Ehlis, A.-C. (2018). Neurophysiological correlates of the attention training technique: A component study. NeuroImage: Clinical, 19, 1018–1024. https://pmc.ncbi.nlm.nih.gov/articles/PMC6039840/
  4. Barth, V., Heitland, I., Krüger, T. H. C., Kahl, K. G., Sinke, C., & Winter, L. (2019). Shifting instead of drifting – Improving attentional performance by means of the attention training technique. Frontiers in Psychology, 10, 23. https://pmc.ncbi.nlm.nih.gov/articles/PMC6351493/
  5. Knowles, M. M., & Wells, A. (2018). Single dose of the attention training technique increases resting alpha and beta-oscillations in frontoparietal brain networks: A randomized controlled comparison. Frontiers in Psychology, 9, 1768. https://pmc.ncbi.nlm.nih.gov/articles/PMC6158576/
  6. Carter, K. E. P., & Wells, A. (2018). Effects of the attention training technique on auditory hallucinations in schizo-affective disorder: A single case study. Case Reports in Psychiatry, 2018, 1537237. https://pmc.ncbi.nlm.nih.gov/articles/PMC6106726/
  7. Fergus, T. A., Wheless, N. E., & Wright, L. C. (2014). The attention training technique, self-focused attention, and anxiety: A laboratory-based component study. Behaviour Research and Therapy, 61, 150–155. https://doi.org/10.1016/j.brat.2014.08.007
  8. Schwarz, K., Wells, A., Giller, F., & Endrass, T. (2025). Investigating the neural correlates of the attention training technique using a novel fMRI paradigm for measuring attentional control. Human Brain Mapping, 46(17), e70416. https://pmc.ncbi.nlm.nih.gov/articles/PMC12644246/
  9. Davison, C., Capobianco, L., Carter, K., & Wells, A. (2026). Cognitive and neuropsychological correlates of the attention training technique: A systematic review and evidence synthesis. Frontiers in Psychiatry, 17, 1766748. https://doi.org/10.3389/fpsyt.2026.1766748
  10. 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(10), 999–1025. https://doi.org/10.1002/jclp.22312
  11. Rochat, L., Manolov, R., & Billieux, J. (2018). Efficacy of metacognitive therapy in improving mental health: A meta-analysis of single-case studies. Journal of Clinical Psychology, 74(6), 896–915. https://pubmed.ncbi.nlm.nih.gov/29266265/
  12. Stewart, K. E., Antony, M. M., & Koerner, N. (2021). A randomized experimental analysis of the attention training technique: Effects on worry and relevant processes in individuals with probable generalized anxiety disorder. Behaviour Research and Therapy, 141, 103863. https://pubmed.ncbi.nlm.nih.gov/33872957/
  13. Snuggerud, T. R., Nordahl, H., Vrabel, K. A., Hoffart, A., & Johnson, S. U. (2026). The feasibility and preliminary outcomes of a two-week attention training technique intervention for young adults with mixed anxiety disorders. Cognitive Behaviour Therapy, 55(3), 372–390. https://pubmed.ncbi.nlm.nih.gov/40424353/
  14. Snuggerud, T. R., Ulitzsch, E., Nordahl, H., et al. (2026). Dynamic changes in metacognitive mechanisms and symptoms during the attention training technique: Insights from ecological momentary assessment. Journal of Anxiety Disorders, 119, 103136. https://pubmed.ncbi.nlm.nih.gov/41780315/

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.