This page has to keep two things apart that are constantly run together: evidence about metacognitive therapy for depression, which is reasonably encouraging, and evidence about the attention training exercise on its own, which is thin. They are not the same claim, and the difference decides what you should do with them.

What was found with ATT itself

Haukaas and colleagues randomized 81 Norwegian university students with self-reported symptoms of depression, anxiety or stress into either ATT or Mindful Self-Compassion — three group sessions over three weeks, with six-month follow-up[1].

Both groups showed significant reductions in anxiety and depression, with no significant difference between the conditions[1].

That is the honest headline. ATT was associated with improvement, and so was the alternative, and the study cannot tell you the improvement came from ATT specifically rather than from three weeks of structured group practice of something.

The study’s more interesting result is about mechanism: improvement in attention flexibility was the only significant unique predictor of treatment response[1] — regardless of which practice someone had been assigned.

What was found with the full therapy

Different literature, different weight. A parallel single-blind randomized trial in Danish primary care randomized 174 adults with major depression to metacognitive therapy or CBT. On the Beck Depression Inventory-II the adjusted difference was −5.49 points (95% CI −8.90 to −2.08, p = 0.002) favouring MCT, with recovery rates of 74% versus 52% at post-treatment; on the Hamilton Depression Rating Scale no significant difference emerged. The authors conclude that the evidence “suggests that MCT had considerable beneficial effects in treating depression that may exceed CBT”[2].

That trial did not test ATT. It tested a full course of clinician-delivered therapy of which ATT is one component[3] — alongside formulation, belief work, worry postponement and the rest. Citing it as evidence for an attention exercise would be a straightforward overreach, and it is the most common one made about this technique.

Why rumination is the connecting thread

The reason depression appears in this literature at all is the model, not the exercise. The cognitive attentional syndrome is perseverative, self-focused, worry-based processing with threat monitoring[3] — and depressive rumination is a clear instance of the perseverative part.

ATT is described as interrupting that pattern and improving flexible executive control[3]. That is a claim about the mechanism the therapy targets. It is not a claim that twelve minutes of audio treats depression, and the manual does not make one.

More on the pattern: the cognitive attentional syndrome.

The practical position

If you are dealing with depression, the reasonable reading of all of the above is: the therapy is worth asking a clinician about; the exercise is not a substitute for it.

If you practise ATT alongside proper care, the standing rules apply — scheduled practice when you are not in acute distress[3], no expectation of feeling better afterwards, since it is specified as not being an emotion-management strategy[3], and no use of it to escape a low mood in the moment[3].

And if things are bad, that is a conversation for a qualified professional today, not an app. Heed is a self-practice tool inspired by ATT research — not therapy, and not a medical device.

Questions and answers

Does ATT help with depression?
One randomized trial in students with symptoms of depression and anxiety found reductions after ATT — and equally after Mindful Self-Compassion, with no significant difference between them. That is not evidence that ATT specifically treats depression.
What about metacognitive therapy for depression?
That is a different and stronger literature: a trial of 174 adults found MCT outperformed CBT on one primary measure. But it tested a full course of clinician-delivered therapy, of which ATT is one component.
Can I use an ATT app instead of treatment for depression?
No. Nothing in this literature supports that, and depression is something to take to a qualified professional.

References

  1. Haukaas, R. B., Gjerde, I. B., Varting, G., Hallan, H. E., & Solem, S. (2018). A randomized controlled trial comparing the attention training technique and mindful self-compassion for students with symptoms of depression and anxiety. Frontiers in Psychology, 9, 827. https://pmc.ncbi.nlm.nih.gov/articles/PMC5982936/
  2. Callesen, P., Reeves, D., Heal, C., & Wells, A. (2020). Metacognitive Therapy versus Cognitive Behaviour Therapy in Adults with Major Depression: A Parallel Single-Blind Randomised Trial. Scientific Reports, 10, 7878. https://pmc.ncbi.nlm.nih.gov/articles/PMC7217821/
  3. 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.