Panic is where the Attention Training Technique begins. The first published report, in 1990, describes one patient with panic disorder occurring alongside relaxation-induced anxiety, treated with an attentional training approach[1].

That origin explains more about the technique than any later study.

The detail that shaped everything

Read the title again: panic in association with relaxation-induced anxiety. The patient’s difficulty included the fact that the standard calming intervention made things worse.

That rules out building a treatment around relaxation and pushes toward doing something else with attention entirely — which is exactly what the resulting exercise does. Wells specifies that ATT should not be employed as a distraction, avoidance, or symptom-management strategy, and is not intended as an emotion-management strategy[2].

So the technique that came out of a panic case is deliberately not a calming technique. Anyone arriving at ATT hoping it will settle them down is looking for the thing it was designed in opposition to.

What one case does and does not establish

A single case is a starting point. It generates a hypothesis; it does not test one. The literature that followed is set out on does attention training actually work?, and none of it is a controlled trial of ATT for panic disorder.

The technique’s later home is metacognitive therapy, where it functions as the attention-modification strategy inside a larger treatment[2] rather than as a panic intervention in its own right.

Panic does appear once more in the manual, in a different role: the worked case of hypochondriasis is a man with panic attacks as well as health worries[2], and ATT there is one component among several — see attention training and health anxiety.

Why not during an attack

This is the practical point and it needs no hedging.

The protocol places ATT as scheduled practice, done when the person is not in a state of anxiety or acute worry[2]. The chapter has a section on misuse as avoidance or symptom management[2].

There is a specific reason this matters in panic. The pattern the model targets includes attending to bodily events — the manual gives that as an example of the threat-monitoring component[2]. Deploying a technique at the moment your body frightens you keeps attention on your body and adds a rescue ritual. That is the shape of the problem, not a way out of it.

If you are having panic attacks, that is a reason to see a qualified professional. Panic disorder has established treatments, and none of them is a twelve-minute audio exercise practised alone.

What practising it reasonably looks like

The same as for anyone: a regular slot when you are relatively settled, no expectation of feeling calmer afterwards, sessions judged by whether you kept bringing attention back[2], and continued effort, because the exercise is built to stay demanding rather than become comfortable[2].

Wells’ framing for patients is general “mental fitness training”, not a form of avoidance[2] — and in panic, that distinction is the whole thing.

Questions and answers

Was ATT invented for panic?
Its first published use was a single case of panic disorder occurring alongside relaxation-induced anxiety, reported by Wells in 1990. It became a component of metacognitive therapy rather than a panic treatment.
Can I use ATT during a panic attack?
No. The protocol has practice done when you are not in a state of anxiety or acute worry, and using the exercise to manage a symptom in the moment is named in the manual as misuse.
Why does it matter that the original patient reacted badly to relaxation?
Because it shaped the technique. The exercise Wells developed is explicitly not a relaxation method and is specified as not being an emotion-management strategy.

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.

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.