Does ATT reduce stress?

In one controlled study of 46 stressed university students, stress appraisals and meta-worry decreased significantly after four weeks of ATT with large pre-to-post effect sizes, with minimal change in a wait-list control. That is a single small study against a passive comparison.

Can I use it when I'm stressed?

Not in the moment. The protocol has practice done when you are not in a state of anxiety or acute worry, and using it to manage a feeling is named in the manual as misuse.

Worry about worrying — the second layer, where the fact that you are worrying becomes itself a thing to be alarmed about. It is a central target of the metacognitive model.

Attention Training and Stress

There is exactly one study in this literature aimed at stress, and it is worth reading closely rather than citing as a headline.

The study

Myhr and colleagues took 46 university students who identified as currently stressed and randomized them: 23 practised ATT over four weeks, 23 waited. The outcomes were stress appraisals and meta-worry — worry about worrying^[1].

The finding, in the authors’ words: both measures “decreased significantly following ATT with large pre- to post- effect sizes but there were minimal changes in the control group”^[1].

How much weight that carries

Real, and limited, for two reasons worth being explicit about.

Forty-six people. A small study.

The control group did nothing. A wait-list is a passive comparison, so the difference includes everything that comes with doing something for four weeks — expecting it to help, having a structure, being in a study. It does not isolate the exercise. That is the standard caveat for wait-list designs and it applies here.

Compare that with the other student trial, where ATT was measured against an active alternative and the two came out level — covered on attention training for students.

Why meta-worry rather than stress itself

The choice of outcome is not arbitrary, and it explains what the technique is actually aimed at.

The metacognitive model’s target is a processing style: perseverative, self-focused, worry-based processing together with monitoring for threat^[2]. Meta-worry — the layer where worrying becomes itself alarming — sits squarely inside that. Measuring it is measuring the thing the model says ATT should move, rather than a general mood score.

Wells describes the technique as interrupting that pattern and improving flexible executive control^[2], with the aim of directly modifying the control of attention^[2].

The part people get wrong

Stress is precisely the state in which you would reach for something, and precisely when the protocol says not to.

The manual has ATT practised when the person is not in a state of anxiety or acute worry^[2]. It should not be employed as a distraction, avoidance, or symptom-management strategy, and is not intended as an emotion-management strategy^[2] — with misuse as avoidance or symptom management given its own section in the chapter^[2].

Note what the study did: four weeks of practice, and stress measured before and after. Not sessions deployed at stressful moments.

It is also not relaxation, and will not feel like it. The exercise is designed to be attentionally demanding and to stay that way with practice^[2].

A reasonable expectation

Practise on a schedule, in ordinary moments, over weeks — the shape the study used, and the shape the manual asks for at twice a day for about twelve minutes, while noting most people manage once^[2]. Do not judge it by how any single session leaves you feeling.

And if the stress is situational — a deadline, a job, a person — attention training does not change the situation, and no reading of that study suggests it does.

Questions and answers

Does ATT reduce stress?: In one controlled study of 46 stressed university students, stress appraisals and meta-worry decreased significantly after four weeks of ATT with large pre-to-post effect sizes, with minimal change in a wait-list control. That is a single small study against a passive comparison.
Can I use it when I'm stressed?: Not in the moment. The protocol has practice done when you are not in a state of anxiety or acute worry, and using it to manage a feeling is named in the manual as misuse.
What is meta-worry?: Worry about worrying — the second layer, where the fact that you are worrying becomes itself a thing to be alarmed about. It is a central target of the metacognitive model.

References

Myhr, P., Hursti, T., Emanuelsson, K., Löfgren, E., & Hjemdal, O. (2019). Can the attention training technique reduce stress in students? A controlled study of stress appraisals and meta-worry. Frontiers in Psychology, 10, 1532. https://pmc.ncbi.nlm.nih.gov/articles/PMC6635479/
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.