Wells’ published protocol asks for two practice sessions a day, about twelve minutes each[1]. That is the reference dose from the treatment manual; in the research literature the actual amount practiced varies widely, from a single laboratory session to weeks of daily home practice. Those schedules show how ATT has been delivered; they do not establish an optimal frequency or prove that repetition itself produces a benefit.
What the manual says
The 2009 treatment manual is specific: patients are asked to practice twice a day, with practice scheduled for approximately twelve minutes[1]. The session itself is fixed in shape — about five minutes of selective attention, five of rapid switching, and two of divided attention[1] — so frequency, not session design, is the main thing left to the practitioner.
Wells also designed the exercise to stay demanding over time, with sounds and layouts varied between sessions so practice doesn’t make the task easy[1]. Variation is specified to limit familiarity with a particular layout. That design rationale is not, by itself, outcome evidence.
What studies actually did
| Study | Practice amount |
|---|---|
| Rosenbaum et al. 2018[2] | A single session, in the lab |
| Knowles & Wells 2018[3] | A single ~12-minute dose, randomized comparison |
| Barth et al. 2019[4] | Two or four plays of the ATT audio (“doses”) — one ~23-minute session held two, so groups trained on one or two consecutive days |
| Carter & Wells 2018[5] | Asked for two to three practices daily; typical compliance was twice a day |
Two things stand out. Laboratory studies show measurable within-session effects from even a single dose[2] [3] — and clinical use still asks for sustained daily practice[1] [5]. No study has directly compared practice schedules to find an optimal dose; twice daily is the manual’s prescription, not an experimentally derived minimum.
If you practice less
You’d be the norm, not the exception: Wells’ manual itself notes that in reality most patients only manage the practice once a day[1]. The manual explicitly acknowledges once-daily practice. Less frequent schedules have not been compared well enough to say whether a few sessions a week is “enough.” Missing a day does not create a protocol-defined reset or require a longer make-up session.
If you follow the manual, keep the session near its specified length and schedule the next one rather than turning a missed session into a marathon[1].
Does session length matter?
The published session is about twelve minutes[1], and some laboratory studies ran longer variants (about twenty-three minutes)[4]. Much shorter sessions haven’t really been studied, so there’s no evidence-based answer for “is five minutes enough?” — the honest position is that twelve minutes is the tested shape.
For what happens inside those twelve minutes, see the Attention Training Technique explained.
References
- Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. Guilford Press. Chapter 4: Attention Training Techniques.
- Rosenbaum, D., Maier, M. J., Hudak, J., Metzger, F. G., Wells, A., Fallgatter, A. J., & Ehlis, A.-C. (2018). Neurophysiological correlates of the attention training technique: A component study. NeuroImage: Clinical, 19, 1018–1024. https://pmc.ncbi.nlm.nih.gov/articles/PMC6039840/
- Knowles, M. M., & Wells, A. (2018). Single dose of the attention training technique increases resting alpha and beta-oscillations in frontoparietal brain networks: A randomized controlled comparison. Frontiers in Psychology, 9, 1768. https://pmc.ncbi.nlm.nih.gov/articles/PMC6158576/
- Barth, V., Heitland, I., Krüger, T. H. C., Kahl, K. G., Sinke, C., & Winter, L. (2019). Shifting instead of drifting – Improving attentional performance by means of the attention training technique. Frontiers in Psychology, 10, 23. https://pmc.ncbi.nlm.nih.gov/articles/PMC6351493/
- 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/
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.