A Randomised Controlled Study of the Effects of the Attention Training Technique on Traumatic Stress Symptoms, Emotional Attention Set Shifting and Flexibility

Abstract

Attention Training (ATT) is a technique used in metacognitive therapy but it has also been shown to produce stand-alone effects. The present study replicates and extends an earlier study of the effects of ATT on traumatic-stress symptoms. A sample of 60 university students who reported a traumatic life event were randomly assigned to either an ATT group (n = 29) or a control group (n = 31). They were exposed to a recorded narrative of their stressful experience before and after the intervention and the primary outcomes were frequency of intrusions and negative affect reported. Secondary outcomes included self-report and performance-based measures of attention flexibility. ATT significantly reduced intrusions and improved negative affect in individuals who had experienced a stressful life event. The technique also appeared to reduce self-focused attention, increase attention flexibility and modified performance on an emotional attention set shifting task. The results suggest that ATT can be beneficial in reducing specific traumatic stress symptoms.

This is a preview of subscription content, log in to check access.

Fig. 1

Notes

  1. 1.

    This score was sufficient in the pilot study (Nassif and Wells 2014) and was introduced to avoid possible floor effects so that the impact of ATT could be observed on symptoms.

References

  1. Bryant, R. A., & Harvey, A. G. (1997). Attentional bias in posttraumatic stress disorder. Journal of Traumatic Stress, 10, 635–644.

    CAS  PubMed  Google Scholar 

  2. Cavanagh, M. J., & Franklin, J. (2000). Attention training and hypochondriasis: Preliminary results of a controlled treatment trial. Vancouver, Canada: Paper presented at the World Congress of Behavioural and Cognitive Therapies.

    Google Scholar 

  3. Clark, D. A. (2005). Intrusive thoughts in clinical disorders: Theory, research, and treatment. New York: The Guilford Press.

    Google Scholar 

  4. Cohen, J. (1988). Statistical power analysis for the behavioural sciences. Hillsdale, NJ: Erlbaum.

    Google Scholar 

  5. Derryberry, D., & Reed, M. A. (1994). Temperament and attention: Orienting toward and away from positive and negative signals. Journal of Personality Social Psychology, 66, 1128–1139.

    CAS  PubMed  Article  Google Scholar 

  6. Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7, 336–353.

    PubMed  Article  Google Scholar 

  7. Foa, E. B., Molnar, C., & Cashman, L. (1995). Change in rape narratives during exposure therapy for posttraumatic stress disorder. Journal of Traumatic Stress, 8, 675–690.

    CAS  PubMed  Article  Google Scholar 

  8. Gold, S. D., Marx, B. P., Soler-Baillo, J. M., & Sloan, D. M. (2005). Is life stress more traumatic than traumatic stress? Journal of Anxiety Disorders, 19, 687–698.

    PubMed  Article  Google Scholar 

  9. Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of event scale: A measure of subjective stress. Psychosomatic Medicine, 41(3), 209–218.

    CAS  PubMed  Article  Google Scholar 

  10. Johnson, D. (2009). Emotional attention set-shifting and its relationship to anxiety and emotion regulation. Emotion, 9(5), 681–690.

    PubMed  Article  Google Scholar 

  11. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048–1060.

    CAS  PubMed  Article  Google Scholar 

  12. MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95, 15–20.

    CAS  PubMed  Article  Google Scholar 

  13. Matthews, G., & Wells, A. (2000). Attention, automaticity and affective disorder. Behavior Modification, 24, 69–93.

    CAS  PubMed  Article  Google Scholar 

  14. McEvoy, P. M., & Perini, S. J. (2009). Cognitive behavioral group therapy for social phobia with or without attention training: A controlled trial. Journal of Anxiety Disorders, 23, 519–528.

    PubMed  Article  Google Scholar 

  15. Monsell, S. (2003). Task switching. Trends in the Cognitive Sciences, 7, 134–140.

    Article  Google Scholar 

  16. Nassif, Y., & Wells, A. (2007). The detached mindfulness questionnaire. Unpublished self-report scale. UK: University of Manchester.

    Google Scholar 

  17. Nassif, Y. & Wells, A. (2014). Attention training reduces intrusive thoughts cued by a narrative of stressful life events: A controlled study. Journal of Clinical Psychology, Wiley online: DOI; 10.1002/jclp.22047.

  18. Papageorgiou, C., & Wells, A. (1998). Effects of attention training in hypochondriasis: An experimental case series. Psychological Medicine, 28, 193–200.

    CAS  PubMed  Article  Google Scholar 

  19. Papageorgiou, C., & Wells, A. (2000). Treatment of recurrent major depression with attention training. Cognitive and Behavioral Practice, 7, 407–413.

    Article  Google Scholar 

  20. Roberts, A. L., Dohrenwend, B. P., Aiello, A. E., Wright, R. J., Maercker, A., Galea, S., et al. (2012). The stressor criterion for posttraumatic stress disorder: Does it matter? Journal of Clinical Psychiatry, 73, 264–270.

    Article  Google Scholar 

  21. Siegle, G. J., Ghinassi, F., & Thase, M. E. (2007). Neurobehavioural therapies in the 21st century: Summary of an emerging field and an extended example of cognitive training for depression. Cognitive Therapy and Research, 31, 253–262.

    Article  Google Scholar 

  22. Valmaggia, L., Bouman, T. K., & Schuurman, L. (2007). Attention training with auditory hallucinations: A case study. Cognitive and Behavioural Practice, 14, 127–133.

    Article  Google Scholar 

  23. Verbruggen, F., Liefooghe, B., Vandierendonck, A., & Demanet, J. (2007). Short cue presentations encourage advance task preparation: A recipe to diminish the residual switch cost. Journal of Experimental Psychology. Learning, Memory, and Cognition, 33, 342–356.

    PubMed  Article  Google Scholar 

  24. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070.

    CAS  PubMed  Article  Google Scholar 

  25. Wells, A. (1990). Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behaviour Therapy, 21, 273–280.

    Article  Google Scholar 

  26. Wells, A. (2000). Emotional disorders and metacognition. Innovative cognitive therapy. Chichester: Wiley.

    Google Scholar 

  27. Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford press.

    Google Scholar 

  28. Wells, A., & Matthews, G. (1994). Attention and emotion. A clinical perspective. Hove: Erlbaum.

    Google Scholar 

  29. Wells, A., White, J., & Carter, K. (1997). Attention training: Effects on anxiety and beliefs in panic and social phobia. Clinical Psychology and Psychotherapy, 4, 226–232.

    Article  Google Scholar 

  30. Whitmer, A. J., & Banich, M. T. (2007). Inhibition versus switching deficits in different forms of rumination. Psychological Science, 18, 546–553.

    PubMed  Article  Google Scholar 

  31. Williams, J. M. G., Watts, F. N., MacLeod, C., & Mathews, A. (1988). Cognitive psychology and emotional disorders. Chichester, UK: Wiley.

    Google Scholar 

Download references

Conflict of Interest

Sheila Callinan, Dan Johnson and Adrian Wells declare that they have no conflict of interest.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sheila Callinan.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Callinan, S., Johnson, D. & Wells, A. A Randomised Controlled Study of the Effects of the Attention Training Technique on Traumatic Stress Symptoms, Emotional Attention Set Shifting and Flexibility. Cogn Ther Res 39, 4–13 (2015). https://doi.org/10.1007/s10608-014-9634-8

Download citation

Keywords

  • Attention training
  • Traumatic stress symptoms
  • Intrusions
  • Metacognition
  • Attentional control