The Attention Training Technique has been studied as a treatment technique, but it is not an established standalone treatment for anxiety. Heed is not therapy and makes no treatment claim. Keeping those two statements separate is more accurate than denying the clinical history of ATT.

What follows is what can honestly be said.

Where the technique comes from

The first published report, in 1990, was a single case: a patient with panic disorder occurring alongside relaxation-induced anxiety, treated with an attentional training approach[2]. So the connection to anxiety is real and it is where the technique started.

But note the detail. The patient’s problem included the fact that relaxation made things worse, and the exercise Wells developed is specified as not being a relaxation method — it should not be employed as a distraction, avoidance, or symptom-management strategy, and is not intended as an emotion-management strategy[1]. It was not designed to calm anyone down.

By 2009 it had become a component of metacognitive therapy — the attention-modification strategy inside a larger treatment[1]. It has also been tested as a standalone intervention, so neither context should be erased.

What it actually targets

Its theoretical target is not the feeling of anxiety directly, but a processing pattern: the cognitive attentional syndrome — perseverative, self-focused, worry-based processing with monitoring for threat[1]. Wells describes the technique as interrupting that pattern and improving flexible executive control[1].

The distinction matters practically. A treatment for anxiety would aim at how you feel. ATT aims at where attention goes, which the model proposes is upstream of the pattern — a proposal, not a demonstrated causal chain.

Why you should not reach for it when anxious

This is the most important practical point on the page, and the manual is unambiguous.

The protocol has ATT practised when the person is not in a state of anxiety or acute worry[1]. Using it to manage a symptom in the moment is named in the chapter as misuse — there is a section on misuse as avoidance or symptom management[1].

An exercise used to escape a feeling teaches that the feeling needs escaping, and it puts attention back onto your inner state, which is the pattern the exercise is supposed to interrupt.

If you are in real distress right now, this is not the tool for this moment. Contact a qualified professional, or your local emergency or crisis service if you need immediate support.

What the research does and does not show

The relevant laboratory finding: a single ATT session produced a greater external focus of attention from pre- to post-manipulation, in a component study[3]. The comparison arm was a mindfulness-based task, not a neutral control — summaries describing it as “versus control” overstate it.

The wider picture is mixed. The 2026 systematic review synthesized 20 standalone-ATT studies of cognitive and neural effects across 14 tasks and three neural methodologies[4]. A 2021 randomized study in 78 adults with probable generalized anxiety disorder found that ATT did not outperform its control intervention on any measure[5]. A small 2026 randomized feasibility trial in 20 patients with mixed anxiety disorders found greater anxiety improvement than a wait-list, sustained at three- and six-month follow-up[6]. That is enough to justify more research, not a promise of treatment benefit.

The full evidence position is set out in does attention training actually work?.

If you want to practise anyway

Plenty of people practise attention training without any diagnosis, and Wells’ own framing supports that: he presents it to patients as a form of general “mental fitness training” rather than a form of avoidance[1].

Practised that way it means: a regular slot when you are relatively settled; no expectation of feeling calmer afterwards; sessions judged by whether you kept bringing attention back; and effort that does not go away, because the exercise is built to stay demanding[1].

And if anxiety is something you are managing, please talk to a qualified professional. Heed is a self-practice tool inspired by ATT research — not therapy, and not a medical device.

Questions and answers

Is ATT a treatment for anxiety?
ATT has been studied as a treatment technique, both alone and within metacognitive therapy, but the standalone evidence is still small and mixed. Heed is not therapy and makes no treatment claim. If anxiety is affecting your life, talk to a qualified professional.
Can I use ATT during a panic attack or an anxious moment?
No. The protocol specifies practice when you are not in a state of anxiety or acute worry, and names in-the-moment symptom management as misuse. If you are in real distress, contact a professional or your local crisis service.
Where did ATT come from, if not anxiety treatment?
Its first published use was a 1990 single case involving panic disorder and relaxation-induced anxiety. It later became a component of metacognitive therapy and has also been studied on its own.

References

  1. Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. Guilford Press. Chapter 4: Attention Training Techniques.
  2. 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
  3. 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
  4. 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
  5. 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/
  6. 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/

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.