The short version: the reviews cited here do not provide systematic adverse-event data for the Attention Training Technique. The published research is small and much of it was built to measure attention and brain activity, not to detect harm — a 2026 systematic review synthesised it across 14 cognitive-attentional tasks and three neural methodologies[2], which is a description of a cognitive evidence base, not a safety one.

That absence is worth stating plainly rather than filling with reassurance. What the manual does document in detail is how the exercise gets misused, and that is the useful part of a safety discussion here.

What the manual names as misuse

Wells devotes attention to this, including a section on misuse as avoidance or symptom management[1]. Three specifics:

Using it to cope in the moment. The technique should not be employed as a distraction, avoidance, or symptom-management strategy, and is not intended as an emotion-management strategy[1]. The protocol has it practised when the person is not in a state of anxiety or acute worry[1].

Turning it into thought suppression. The manual states the exercise is not intended to lead to a blank mind and counteracts the use of active thought suppression[1]; intruding thoughts are to be treated as additional noise and not resisted[1].

Practising it hollow. Thought suppression, daydreaming and diverting attention to worry are listed as counterproductive strategies that can run underneath a session that looks normal[1].

None of these is described as dangerous. They are described as ways of not doing the exercise while believing you are.

Where reasonable caution applies

If you are in treatment. ATT is a component of metacognitive therapy[1] — it was written to be delivered inside a clinical relationship. Adding a self-practice exercise alongside existing treatment is a conversation to have with the clinician providing it, and no self-practice exercise is a reason to change or stop anything.

If a session leaves you distressed. There is no published guidance on this, because the question has not been studied. The ordinary sensible response to any practice that consistently makes you feel worse is to stop and consult someone qualified — that stands independently of what the literature does or does not contain.

If you are hoping it will treat something. This is the misuse the manual is most concerned about, and it is also the expectation most likely to produce disappointment. The exercise trains the control of attention[1]; it does not address the content of any particular problem.

The physical side

Practically, a session is twelve minutes of sitting still, listening, and holding your gaze on a fixed point[1]. If you use headphones, the usual listening-volume common sense applies, and it applies more than usual here because the exercise depends on quiet sounds at the edge of audibility — a session played loud is both worse practice and worse for your ears.

What “safe” can and cannot mean here

The protocol describes sitting, listening and directing attention; the manual’s cautions in this chapter concern efficacy-through-misuse rather than documented physical harms. That is not the same as evidence that every person or circumstance is risk-free.

It cannot mean: this has been checked. A small literature that did not look for adverse effects cannot be cited as evidence there are none. Anyone claiming ATT is proven safe is overstating the record in the same way as anyone claiming it is proven effective — the evidence position on the latter is set out in does attention training actually work?.

Heed is a self-practice tool inspired by ATT research — not therapy, and not a medical device. If you are dealing with something that needs care, it needs a clinician.

Questions and answers

Does ATT have side effects?
The reviews cited here do not provide systematic adverse-event data, so they cannot establish either safety or harm. What the manual does document is misuse — chiefly using the exercise to avoid or manage symptoms.
Can ATT make anxiety worse?
The manual does not report that, but it does specify practising when you are not in a state of anxiety or acute worry, and names using the technique for symptom management as misuse.
Should I stop other treatment to do ATT?
No. ATT is a component of metacognitive therapy, and decisions about treatment belong with a qualified clinician, not with a self-practice exercise.

References

  1. Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. Guilford Press. Chapter 4: Attention Training Techniques.
  2. Davison, C., Capobianco, L., Carter, K., & Wells, A. (2026). Cognitive and neuropsychological correlates of the attention training technique: A systematic review and evidence synthesis. Frontiers in Psychiatry, 17, 1766748. https://doi.org/10.3389/fpsyt.2026.1766748

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.