Worry is named directly in the pattern ATT was built against. The cognitive attentional syndrome is perseverative, self-focused, worry-based processing together with monitoring for threat[1] — so worry is not a side issue here, it is half the definition.

What follows from that is less obvious than it sounds.

The technique contains nothing about your worries

If worry is the problem, the intuitive intervention works on worries: examine them, test them, decide whether they are realistic. ATT does none of that. It is about twelve minutes of holding, switching and widening attention across sounds[1], with no content to engage at all.

That is the model’s premise made concrete. What makes worry a difficulty, on this account, is not that any particular worry is wrong but that attention is running in a mode — inward, repetitive, scanning — and engaging the content is participating in the mode. Wells describes the technique as interrupting the syndrome and improving flexible executive control[1].

The layer above the worry

The more precise target is meta-worry: worry about worrying. The point at which the fact that you are worrying becomes itself something to be alarmed by — “why can’t I stop”, “this is doing me harm”, “something must be wrong with me”.

That layer is where the metacognitive model does most of its work, and it is what one controlled study chose to measure. Myhr and colleagues followed 46 stressed university students over four weeks and reported that stress appraisals and meta-worry “decreased significantly following ATT with large pre- to post- effect sizes but there were minimal changes in the control group”[2].

Two caveats travel with it: 46 people, and a wait-list control that did nothing, so the comparison does not isolate the exercise from the effect of doing something for four weeks.

Why suppressing worry is ruled out

A reasonable person hearing “attention training for worry” assumes the goal is fewer worries. The protocol rules that out explicitly:

  • The exercise is not intended to lead to a blank mind, and it counteracts the use of active thought suppression[1].
  • Intruding thoughts are treated as additional noise and should not be resisted — the instruction is that you must not try to stop them, and should think of them as passing inner noises[1].
  • The aim is not to remove awareness of inner events but to practise controlling attention in a particular way[1].

There is a reason beyond protocol fidelity. Trying to not-worry is a form of monitoring for worry, which is worrying about worrying — the layer the model says is doing the damage.

The failure mode specific to worriers

The manual lists diverting attention to worry among the counterproductive strategies, and notes the problem of dividing attention between rumination and the sounds[1].

This is the one to watch. Twelve minutes of audio can pass with the worry running underneath it and the session looking, from the outside, like practice. Nothing marks it as a failure except noticing.

When not to use it

When you are worrying. The protocol has practice done when the person is not in a state of anxiety or acute worry[1], and reaching for it to escape a spiral is named in the chapter as misuse as avoidance or symptom management[1].

Practise it on a calm Tuesday. That is the counterintuitive instruction, and it is the whole difference between training and coping.

If worry is persistent enough to be shaping your life, that is worth taking to a qualified professional — the technique was written as one component of a full therapy.

Questions and answers

Does ATT stop worrying?
It is not built to intervene in any particular worry. It trains the control of attention, and the model treats worry as part of an attentional pattern rather than as a content problem to be argued with.
What is meta-worry and why does it matter?
Worry about worrying — the layer where the fact that you are worrying becomes itself alarming. One controlled study measured it as an outcome and found it decreased significantly after four weeks of ATT, against a wait-list control.
Should I use ATT when a worry starts?
No. The protocol has practice done when you are not in a state of anxiety or acute worry, and using the exercise to escape a worry is named in the manual as misuse.

References

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

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.