Has ATT been used for auditory hallucinations?

Yes, in one published single-case study of a patient with schizo-affective disorder, delivered by clinicians. One case is a hypothesis, not a demonstration.

How was it delivered in that case?

With a larger sound set than usual — three sounds in the room, three outside it and three in the distance, nine in total — in sessions of about twelve to fifteen minutes, with practice two to three times a day.

Should I try this myself?

No. This is the clearest case on the site for working with a clinician rather than self-practice, and nothing here should be read as advice to change or stop any treatment.

Attention Training and Auditory Hallucinations

This page exists because the study exists and people find it. It comes with a caution attached that the others do not.

The study

Carter and Wells published a single case study of the effects of the attention training technique on auditory hallucinations in schizo-affective disorder^[1].

One patient. Clinician-delivered. A case report.

How it was delivered

The delivery differs from the usual description in ways worth noting, because they show the protocol’s dials being used rather than a different technique being applied.

The sound set was at the top of the manual’s range: three individual sounds in the room, three sounds outside the room and three in the distance — nine in total^[1], against the manual’s stated range of between six and nine depending on the level of demand required^[2].

Sessions ran approximately twelve to fifteen minutes^[1], and practice was instructed at two to three times a day^[1] — slightly above the manual’s twice-daily ask^[2].

What a single case can support

Not much, and it should be said plainly rather than hedged.

This was more informative than an ordinary before-and-after case report: it used a repeated A-B-A-B-A-C-B reversal sequence over 80 weeks and included relaxation as a comparison condition^[1]. Repeated reductions associated with ATT make simple passage of time a less satisfactory explanation.

It was still one person, without randomization or a broader comparison group. The design cannot show that the result generalizes to anyone else or rule out every case-specific influence. Its value is hypothesis generation, not a result that supports self-treatment.

The same is true of the technique’s founding paper, which is also a single case^[2]. The wider evidence position is on does attention training actually work?.

Please note the terminology. This study is about auditory hallucinations in schizo-affective disorder. It is not a study of psychosis in general, and describing it that way overstates it.

The caution

This is a context where self-practice is especially inappropriate.

The study was delivered by clinicians to a patient in care. Nothing in it, and nothing on this page, is a reason to change, reduce or stop any treatment, or to substitute an audio exercise for clinical support. If you experience auditory hallucinations, that belongs with a qualified professional.

The broader safety position — that the cited reviews do not provide systematic adverse-event data — is on is ATT safe?. That uncertainty matters especially in a population that needs clinical care.

Why the sound design detail is interesting anyway

One thing this case does illustrate cleanly: the sound count is the protocol’s adjustable dial. The manual ties it to the level of demand required^[2], and here the clinicians used the top of the range across all three distance bands.

That design detail is relevant to how ATT has been configured in published work — see what sounds do you use for ATT?. It does not make the case outcome generalisable.

Questions and answers

Has ATT been used for auditory hallucinations?: Yes, in one published single-case study of a patient with schizo-affective disorder, delivered by clinicians. One case is a hypothesis, not a demonstration.
How was it delivered in that case?: With a larger sound set than usual — three sounds in the room, three outside it and three in the distance, nine in total — in sessions of about twelve to fifteen minutes, with practice two to three times a day.
Should I try this myself?: No. This is the clearest case on the site for working with a clinician rather than self-practice, and nothing here should be read as advice to change or stop any treatment.

References

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

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.