Most writing about attention in metacognitive therapy is writing about ATT. Wells’ chapter describes a second technique alongside it — situational attentional refocusing, or SAR — and says plainly that the two have different purposes[1]. Knowing that SAR exists is the quickest way to understand what ATT is not for.
What SAR is
SAR is an attentional modification technique used in metacognitive therapy that differs from ATT in its aim and nature. Rather than retraining executive control and interrupting perseverative processing, it is intended to explicitly enhance the processing of information that is incompatible with the patient’s dysfunctional beliefs — for example in treating social phobia — or to counteract external threat monitoring in the later stages of MCT for PTSD[1].
It is applied to stressful or problematic situations as a means of configuring processing in a way that is beneficial for developing adaptive appraisals and beliefs[1].
Crucially, and in the same words the manual uses about ATT: it is not a coping strategy aimed at preventing emotion or removing threat. It is applied as a means of disrupting unhelpful attention patterns that maintain an unrealistic sense of threat, and of increasing the flow of new information into consciousness to modify beliefs[1].
The two techniques side by side
| ATT | SAR | |
|---|---|---|
| Aim | Increase executive control; interrupt perseverative self-focused processing[1] | Increase access to disconfirmatory information; correct counterproductive attentional strategies in situations[1] |
| When | Scheduled practice, done when not anxious or acutely worried[1] | Inside the difficult situation itself[1] |
| What you attend to | Several competing sounds, on instruction[1] | Features of the real environment that carry information about your beliefs[1] |
| Targets which part of the CAS | Perseverative, self-focused processing[1] | Threat-monitoring[1] |
| Delivered | As an exercise, including from a recording[1] | By a clinician, often within behavioural experiments[1] |
How it looks in practice
The manual’s examples are concrete.
Social phobia. In one study, people with social phobia engaged in a session of exposure to a feared social situation while focusing attention externally on features of the social environment — the colour of other people’s hair and eyes. This was compared with a session of exposure alone on a standard habituation rationale; the exposure-plus-SAR condition was more effective at reducing negative beliefs, reducing anxiety, and changing the image patients had of themselves afterwards[1].
The manual also describes using SAR as a belief test: people with social phobia often believe everyone is looking at them, while that awareness comes from self-consciousness rather than from actually looking at others. Patients are asked to enter feared situations and actively look at other people to find out how many are in fact looking — sometimes while deliberately making a mistake, to find out what actually happens then[1].
PTSD. Patients become hypervigilant for threat and focus on aspects of the environment that could be dangerous, which increases their sense of current danger and maintains anxiety. SAR involves noticing threat monitoring and banning it in situations that remind them of the trauma, focusing instead on neutral or safety signals. The manual’s example: a patient who scanned for speeding cars at intersections was asked to look for cars slowing down or stationary instead, and found that looking for danger had led her to ignore the actual features of the situation[1].
Why this clarifies ATT
Two things fall out of the comparison.
ATT is not the in-situation tool, because MCT already has one. The most common misreading of ATT is to use it when things get difficult. The manual’s answer is that in-situation attention work is a different technique, with a different aim, delivered inside treatment — and ATT stays scheduled practice done when you are not in a state of anxiety or acute worry[1].
Neither one is distraction. Wells states that neither strategy is a means of distraction from internal events or a means of managing or avoiding emotion[1].
Can you do SAR yourself?
The manual describes SAR as clinician-delivered, embedded in treatment and often in behavioural experiments built around a specific person’s beliefs[1]. Unlike ATT, which has a fixed script and can be delivered from a recording[1], SAR has no standard procedure to follow on your own — what to look at depends on what belief is being tested.
So this page is here for understanding, not as an instruction. For what MCT is as a whole, see what is metacognitive therapy?.
Questions and answers
- What is situational attentional refocusing?
- An attention technique in metacognitive therapy, applied inside a stressful or problematic situation, intended to increase the processing of information that is incompatible with a person's dysfunctional beliefs, or to counteract external threat monitoring.
- How is SAR different from ATT?
- Different aims and different settings. ATT is scheduled practice that retrains executive control and interrupts perseverative processing; SAR is applied in the situation itself to open access to disconfirming information.
- Can I practise SAR on my own?
- SAR is described in the manual as a clinician-delivered technique, used inside treatment and often as part of behavioural experiments. It is not a self-practice exercise the way a recorded ATT session can be.
References
- 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.