Online mindfulness training for older adults during the COVID-19 pandemic: a randomized controlled trial using a multi-method assessment approach.

OBJECTIVES: The COVID-19 pandemic drastically accelerated the need for studies examining the effectiveness of programs to bolster psychological well-being, particularly for at-risk groups, such as older adults (OAs). Mindfulness Training (MT) has been suggested as a well-suited program for this purpose. The present study examined the impact of a 4-week online, trainer-led MT course tailored for OAs during the early months of the COVID-19 pandemic. METHODS: Fifty-three OAs were randomly assigned to either Group A or Group B. Group A received the online MT course during the 4-week interval between the first (T1) and second (T2) testing sessions, while Group B received the same MT course during the interval between T2 and the third testing session (T3). The testing sessions included measures of mindfulness, emotional well-being, psychological health, and cognitive performance. In addition, a very brief survey was sent every week during the T1-T2 and T2-T3 intervals to assess weekly emotional well-being. RESULTS: The findings revealed that MT may improve some, albeit not all, aspects of mindfulness and well-being, while no significant results were noted for outcomes measuring psychological health and cognitive performance. CONCLUSIONS: These findings are discussed in the context of the evolving COVID-19 situation.

Paying attention to attention: a program evaluation of faculty-delivered mindfulness-based attention training to optimize wellness and professionalism in medical students.

BACKGROUND: As physician distress rises, medical schools must provide programs to counter such distress at the earliest stages of training. Mindfulness training (MT) is one intervention that can alleviate stress during medical school. However, framing MT around wellness alone misses the opportunity to connect core cognitive and psychological capacities strengthened by MT to professional goals and skill acquisition inherent to successful medical training. Here, we highlight how the attentional components of MT align with students' goals of becoming attending physicians while promoting academic, psychological, and interpersonal flourishing. MT courses that focus on strengthening attentional capacities can intuitively link academic and professional development with wellness, appealing to a wide array of students. METHODS: We iteratively recontextualized an existing short-form mindfulness training program for high-stress pre-professionals, known as Mindfulness Based Attention Training (MBAT), to the medical school context (MBAT-Rx). MBAT-Rx was offered by physician trainers to first-year medical students at Warren Alpert Medical School of Brown University as a tool for improving study habits and focus in addition to the development of both self-care and patient care strategies. MBAT-Rx consists of weekly, two-hour sessions over four weeks, with 10-15 min of daily mindfulness practice between sessions. At the end of the four weeks, students submitted voluntary program evaluation responses detailing their experience of the program. RESULTS: Optional program evaluation responses (n = 67) highlight that students found the program to be useful for their academic success and ability to pay attention, their interpersonal relationships, and their psychological health. By framing MT as an opportunity to boost core attentional capacities and connecting this to professional and academic goals in addition to wellness, MBAT-Rx appealed to a wide variety of students. CONCLUSIONS: Our ongoing work suggests that framing MT as both a professional development and wellness promotion tool, taught by physicians themselves, and structured around students' time demands, may be a successful model for medical schools looking to increase the impact of their mindfulness offerings. Such programs are needed to equip medical students to navigate the demands of a challenging healthcare training landscape.

Measuring mind wandering with experience sampling during task performance: An item response theory investigation.

The tendency for individuals to mind wander is often measured using experience sampling methods in which probe questions embedded within computerized cognitive tasks attempt to catch episodes of off-task thought at random intervals during task performance. However, mind-wandering probe questions and response options are often chosen ad hoc and vary between studies with extant little guidance as to the psychometric consequences of these methodological decisions. In the present study, we examined the psychometric properties of several common approaches for assessing mind wandering using methods from item response theory (IRT). IRT latent modeling demonstrated that measurement information was generally distributed across the range of trait estimates according to when probes were presented in time. Probes presented earlier in time provided more information about individuals with greater tendency to mind wandering than probes presented later. Furthermore, mind-wandering ratings made on a continuous scale or using multiple categorical rating options provided more information about individuals' latent mind-wandering tendency - across a broader range of the trait continuum - than ratings dichotomized into on-task and off-task categories. In addition, IRT provided evidence that reports of "task-related thoughts" contribute to the task-focused dimension of the construct continuum, providing justification for studies conceptualizing these responses as a kind of task-related focus. Together, we hope these findings will help guide researchers hoping to maximize the measurement precision of their mind wandering assessment procedures.

The role of affective interference and mnemonic load in the dynamic adjustment in working memory.

The amount of cognitive control required during a task may fluctuate over the course of performing a task. The dynamic upregulation of cognitive control has been proposed to occur in response to conflict or in response to the need for additional control during demanding cognitive tasks. Specifically, upregulation in cognitive control results in improved performance on trials that follow more demanding trials. Recent work has demonstrated that upregulation occurs during following trials with high (vs. low) mnemonic load and negative (vs. neutral) affective interference during working memory tasks. Although dynamic upregulation appears to be a robust phenomenon, less is known about individual difference factors that may alter the likelihood to engage in upregulation as a result of a signal to increase cognitive control. The current study attempted to replicate prior findings that suggest upregulation may occur following higher load trials or affective interference during a working memory task. Further, the study examined anxiety, depressive symptomatology, working memory capacity, mood, and dispositional mindfulness and possible moderators for upregulation of cognitive control. Participants (N = 150) completed a delayed recognition working memory task with mnemonic load (High vs. Low) and affective interference (Negative vs. Neutral) parametrically manipulated. Participants completed measures of the individual difference factors. The current findings replicate prior work demonstrating an upregulation of cognitive control following high load trials and negative affective interference. Individual difference factors did not moderate the upregulation findings, suggesting that upregulation is a robust phenomenon that can be triggered by both affective interference and mnemonic load.

Self-reported Mind Wandering and Response Time Variability Differentiate Prestimulus Electroencephalogram Microstate Dynamics during a Sustained Attention Task.

Brain activity continuously and spontaneously fluctuates during tasks of sustained attention. This spontaneous activity reflects the intrinsic dynamics of neurocognitive networks, which have been suggested to differentiate moments of externally directed task focus from episodes of mind wandering. However, the contribution of specific electrophysiological brain states and their millisecond dynamics to the experience of mind wandering is still unclear. In this study, we investigated the association between electroencephalogram microstate temporal dynamics and self-reported mind wandering. Thirty-six participants completed a sustained attention to response task in which they were asked to respond to frequently occurring upright faces (nontargets) and withhold responses to rare inverted faces (targets). Intermittently, experience sampling probes assessed whether participants were focused on the task or whether they were mind wandering (i.e., off-task). Broadband electroencephalography was recorded and segmented into a time series of brain electric microstates based on data-driven clustering of topographic voltage patterns. The strength, prevalence, and rate of occurrence of specific microstates differentiated on- versus off-task moments in the prestimulus epochs of trials preceding probes. Similar associations were also evident between microstates and variability in response times. Together, these findings demonstrate that distinct microstates and their millisecond dynamics are sensitive to the experience of mind wandering.

Associations between self-reported spontaneous thought and temporal sequences of EEG microstates.

Thought dynamically evolves from one moment to the next even in the absence of external stimulation. The extent to which patterns of spontaneous thought covary with time-varying fluctuations in intrinsic brain activity is of great interest but remains unknown. We conducted novel analyses of data originally reported by Portnova et al. (2019) to examine associations between the intrinsic dynamics of EEG microstates and self-reported thought measured using the Amsterdam Resting-State Questionnaire (ARSQ). Accordingly, the millisecond fluctuations of microstates were associated with specific dimensions of thought. We evaluated the reliability of these findings by combining our results with those of another study using meta-analysis. Importantly, we extended this investigation using multivariate methods to evaluate multidimensional thought profiles of individuals and their links to sequences of successive microstates. Thought profiles were identified based on hierarchical clustering of ARSQ ratings and were distinguished in terms of the temporal ordering of successive microstates based on sequence analytic methods. These findings demonstrate the relevance of assessing spontaneous thought for understanding intrinsic brain activity and the novel use of sequence analysis for characterizing microstate dynamics. Integrating the phenomenological view from within remains crucial for understanding the functional significance of intrinsic large-scale neurodynamics.

Dynamic brain network configurations during rest and an attention task with frequent occurrence of mind wandering.

Mind wandering (MW) has become a prominent topic of neuroscientific investigation due to the importance of understanding attentional processes in our day-to-day experiences. Emerging evidence suggests a critical role for three large-scale brain networks in MW: the default network (DN), the central executive network (CEN), and the salience network (SN). Advances in analytical methods for neuroimaging data (i.e., dynamic functional connectivity, DFC) demonstrate that the interactions between these networks are not static but dynamically fluctuate over time (Chang & Glover, 2010, NeuroImage, 50(1), 81-98). While the bulk of the evidence comes from studies involving resting-state functional MRI, a few studies have investigated DFC during a task. Direct comparison of DFC during rest and task with frequent MW is scarce. The present study applies the DFC method to neuroimaging data collected from 30 participants who completed a resting-state run followed by two runs of sustained attention to response task (SART) with embedded probes indicating a high prevalence of MW. The analysis identified five DFC states. Differences between rest and task were noted in the frequency of three DFC states. One DFC state characterized by negative DN-CEN/SN connectivity along with positive CEN-SN connectivity was more frequently observed during task vs. rest. Two DFC states, one of which was characterized by weaker connectivity between networks, were more frequently observed during rest than task. These findings suggest that the dynamic relationships between brain networks may vary as a function of whether ongoing cognitive activity unfolds in an "unconstrained" manner during rest or is "constrained" by task demands.

Attenuated Face Processing during Mind Wandering.

Mind wandering (MW) has been recently investigated in many studies. It has been suggested that, during MW, processing of perceptual stimuli is attenuated in favor of internal thoughts, a phenomenon referred to as perceptual decoupling. Perceptual decoupling has been investigated in ERP studies, which have used relatively simple perceptual stimuli, yet it remains unclear if MW can impact the perceptual processing of complex stimuli with real-world relevance. Here, we investigated the impact of MW on behavioral and neural responses to faces. Thirty-six participants completed a novel sustained attention to response task with faces. They were asked to respond to upright faces (nontargets) and withhold responses to inverted faces (targets) and to report intermittently if they were "On task" or "Off task." Behavioral analyses revealed greater intraindividual coefficient of variation for nontarget faces preceding Off task versus On task. ERP analyses focused primarily on the N170 component associated with face processing but also included the P1 and P3 components. The results revealed attenuated amplitudes to nontarget faces preceding Off task versus On task for the N170, but not for the P3 or P1. These findings suggest decoupled visual processing of faces during MW, which has implications for social neuroscience research.

Brief exposure to aversive stimuli impairs visual selective attention.

Although it is well established that stress can disrupt complex cognitive functions, relatively little is known about how it influences visual processing, especially in terms of visual selective attention. In the current study, we used highly aversive images, taken from the International Affective Picture System, to induce acute, low-intensity stress while participants performed a visual discrimination task. Consistent with prior research, we found that anticipation of aversive stimuli increased overall amplitude of the N170, suggesting an increase in early sensory gain. More importantly, we found that stress disrupted visual selective attention. While in no-stress blocks, the amplitude of the face-sensitive N170 was higher when participants attended to faces rather than scenes in face-scene overlay images; this effect was absent under stress. This was because of an increase in N170 amplitude in the scene-attend condition under stress. We interpret these findings as suggesting that even low-intensity acute stress can impair participants' ability to filter out task-irrelevant information. We discuss our findings in relation to how even brief exposure to low-intensity stress may adversely impact both healthy and clinical populations.

Mind-wandering increases in frequency over time during task performance: An individual-participant meta-analytic review.

Attention has a seemingly inevitable tendency to turn inward toward our thoughts. Mind-wandering refers to moments when this inward focus diverts attention away from the current task-at-hand. Mind-wandering is thought to be ubiquitous, having been estimated to occur between 30% and 50% of our waking moments. Yet, it is unclear whether this frequency is similar within-task performance contexts and unknown whether mind-wandering systematically increases with time-on-task for a broad range of tasks. We conducted a systematic literature search and individual participant data meta-analysis of rates of occurrence of mind-wandering during task performance. Our search located 68 research reports providing almost a half-million total responses to experience sampling mind-wandering probes from more than 10,000 unique individuals. Latent growth curve models estimated the initial occurrence of mind-wandering and linear change in mind-wandering over sequential probes for each study sample, and effects were summarized using multivariate meta-analysis. Our results confirm that mind-wandering increases in frequency over time during task performance, implicating mind-wandering in characteristic within-task psychological changes, such as increasing boredom and patterns of worsening behavioral performance with time-on-task. The systematic search and meta-analysis provide the most comprehensive assessment of normative rates of mind-wandering during task performance reported to date. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining factors associated with self-reported cognitive functioning in elite military settings: considerations of combat experiences and post-traumatic stress symptomology.

Exposure to traumatic events is associated with post-traumatic stress symptomology (PTSS) in a variety of populations. PTSS is also associated with self-reported everyday cognitive failures, which are acknowledged attentional lapses experienced in one's naturalistic everyday environment. While a growing literature suggests that PTSS is associated with both traumatic events and attentional functions, little is known regarding similar associations in elite military cohorts, such as Special Operations Forces (SOF) personnel. Herein, we investigate if prior combat experience is associated with everyday cognitive failures, while considering the possible mediating role of PTSS. SOF personnel (N = 119) completed self-report questionnaires assessing prior combat experience, PTSS, and everyday cognitive failures. Direct and indirect associations between these metrics were examined using structural equation modeling. Mediation analyses revealed that the correspondence between combat experiences and everyday cognitive failures is mediated by the severity of subclinical levels of PTSS. Such findings suggest that greater attention to subclinical PTSS is warranted due to its significant association with everyday cognitive failures that may contribute to deleterious mission-related failures in high-demand tactical professionals, such as SOF.

Mind wandering is associated with worsening attentional vigilance.

The tendency for our minds to wander is a pervasive and disruptive influence on continued task performance. Models of sustained attention have implicated mind wandering, moments when attention has turned inwards toward task-unrelated thought, in characteristic patterns of worsening performance with greater time-on-task, known as the vigilance decrement. Despite their theoretical connection, associations between mind wandering and the vigilance decrement have not been investigated systematically. Across two studies (N = 730), we evaluated covariance between within-task change in rates of probe-caught mind wandering and patterns of worsening behavioral task performance that characterize the vigilance decrement. Bivariate growth curve models characterized patterns of intraindividual linear change in mind wandering alongside concomitant changes in task accuracy, response time (RT), and RT variability. Importantly, models assessing the covariance between intraindividual change in mind wandering and behavioral outcome measures confirmed that increases in mind wandering are associated with patterns of worsening behavioral performance with greater time-on-task. In addition, we investigated the role of several moderating factors associated with patterns of within-task change: self-reported task interest and motivation, and individuals' propensity for mind wandering, and mindfulness in their daily lives. These factors moderated either the overall level or rate of within-task change in mind wandering. Our results provide support for models of sustained attention that directly implicate mind wandering in worsening behavioral performance with greater time-on-task in continuous performance tasks requiring sustained attention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Investigating the protective effects of mindfulness-based attention training on mind wandering in applied settings.

Introduction: Mind wandering, a phenomenon in which attention drifts away from the task-at-hand, is associated with deleterious effects on performance and well-being. As such, efforts to curb mind wandering are warranted. Recently, mindfulness training (MT) has been found to protect against mind wandering. Yet, many MT programs are at risk of falling off the implementation cliff due to challenges implementing these programs in applied settings. To mitigate against this, early-stage research in small convenience samples may be necessary to spur stakeholder engagement and collaboration. Herein, the effects of MT on mind wandering were examined via an internal meta-analysis of early-stage studies of a manualized, context-adaptable short-form MT program, referred to as Mindfulness-Based Attention Training (MBAT). Methods: Five longitudinal studies (N = 304) were conducted in a variety of organizational cohorts. Self-reported mind wandering and meta-awareness, as well as accuracy (A') and response time variability (intra-individual coefficient of variation, ICV) during performance of the sustained attention to response task (SART) were assessed at baseline (T1) and 4 weeks later (T2) in MBAT and no-training participants. Results: Standardized mean change (SMC) from T1 to T2 significantly differed between MBAT and no-training groups for mind wandering (ΔSMC = -0.387, p < 0.001), meta-awareness (ΔSMC = -0.374, p < 0.001), and ICV (ΔSMC = -0.376, p = 0.043), suggesting potential protective effects in self-reported and performance-based metrics of mind wandering. Discussion: These results serve as preliminary proof-of-concept support for MBAT's protective effects on mind wandering. Further, they suggest that MBAT is amenable to implementation across a variety of applied and organizational settings and warrants additional research employing larger sample sizes in randomized controlled designs.

Impact of mindfulness training and yoga on injury and pain-related impairment: a group randomized trial in basic combat training.

Introduction: Service members are at risk for pain-related difficulties in functioning and physical injury. Previous studies suggest that mindfulness training (MT) and yoga may prevent these outcomes. The present study was designed to determine the impact of MT and yoga on the health, pain, and injury of Army trainees completing 10 weeks of basic combat training (BCT). Methods: Platoons (≈40 trainees per platoon) were randomized to MT and yoga or training-as-usual in October to December 2020 at a large installation in the US. Self-reported outcomes were health, pain level, and pain impact on training, sleep, mood, and stress. Objective outcomes were injury-related medical encounters and number of diagnoses. The trial was registered at ClinicalTrials. Gov (NCT05550610). Results: Intervention trainees reported significantly better health (OR = 1.05, 95% CI [1.00, 1.10]) and less impact of pain on training (OR = 0.81, 95% CI [0.74, 0.90]), sleep (OR = 0.88, 95% CI [0.81, 0.95]), mood (OR = 0.86, 95% CI [0.78, 0.96]), and stress (OR = 0.88, 95% CI [0.79, 0.98]). There was no significant difference in injury-related medical encounters (AOR = 0.70, 95% CI [0.48, 1.03]), but intervention trainees had fewer diagnoses (OR = 0.67, 95% CI [0.47, 0.95]) and were 30% less likely to have a first medical encounter at any time during BCT. This difference emerged 3 weeks into BCT. Discussion: A combined MT and yoga intervention resulted in better trainee health. The US Army and other organizations requiring resilience under extreme stress should consider implementing MT and yoga to offset risks to employee health.

Optimizing Performance and Mental Skills With Mindfulness-Based Attention Training: Two Field Studies With Operational Units.

INTRODUCTION: Mental skills such as focusing attention and managing emotions are essential for optimal performance in high-stress occupations. Studies with military samples have demonstrated that mindfulness training (MT) led to improved computer-based cognitive performance. MATERIALS AND METHODS: To examine the impact of MT on operational performance, mental skills, and psychological health, a short-form program, Mindfulness-Based Attention Training (MBAT), was delivered to active duty soldiers as part of two randomized trials. Participants in study 1 (n = 121) and study 2 (n = 77) were randomized to one of three conditions: MT with proctored practice, MT with unproctored practice, or a waitlist control. Weekly 2-hour MBAT sessions were offered to participants in both MT conditions for 4 weeks. Beyond these sessions, participants also engaged in mindfulness practice that was proctored (within the occupational context) or unproctored (left up to the individual) for four subsequent weeks. RESULTS: Overall, the frequency of mindfulness practice was generally associated with better performance and improvements in mental skills. In study 1, those who practiced 3 or more days per week performed better on marksmanship under physical stress and reported fewer attentional lapses, less emotion regulation difficulties, greater mental toughness, and higher self-reported mindfulness compared to those who did not practice. In study 2, the frequency of mindfulness practice was associated with fewer attentional lapses and emotion regulation difficulties. CONCLUSIONS: Consistent with prior findings, results suggest that regular engagement in MT practice may help to optimize operational performance and improve mental skills in military cohorts.

Working memory templates are maintained as feature-specific perceptual codes.

Working memory (WM) representations serve as templates that guide behavior, but the neural basis of these templates remains elusive. We tested the hypothesis that WM templates are maintained by biasing activity in sensoriperceptual neurons that code for features of items being held in memory. Neural activity was recorded using event-related potentials (ERPs) as participants viewed a series of faces and responded when a face matched a target face held in WM. Our prediction was that if activity in neurons coding for the features of the target is preferentially weighted during maintenance of the target, then ERP activity evoked by a nontarget probe face should be commensurate with the visual similarity between target and probe. Visual similarity was operationalized as the degree of overlap in visual features between target and probe. A face-sensitive ERP response was modulated by target-probe similarity. Amplitude was largest for probes that were similar to the target, and decreased monotonically as a function of decreasing target-probe similarity. These results indicate that neural activity is weighted in favor of visual features that comprise an actively held memory representation. As such, our findings support the notion that WM templates rely on neural populations involved in forming percepts of memory items.

Investigating the impact of mindfulness meditation training on working memory: a mathematical modeling approach.

We investigated whether mindfulness training (MT) influences information processing in a working memory task with complex visual stimuli. Participants were tested before (T1) and after (T2) participation in an intensive one-month MT retreat, and their performance was compared with that of an age- and education-matched control group. Accuracy did not differ across groups at either time point. Response times were faster and significantly less variable in the MT versus the control group at T2. Since these results could be due to changes in mnemonic processes, speed-accuracy trade-off, or nondecisional factors (e.g., motor execution), we used a mathematical modeling approach to disentangle these factors. The EZ-diffusion model (Wagenmakers, van der Maas, & Grasman, Psychonomic Bulletin & Review 14:(1), 3-22, 2007) suggested that MT leads to improved information quality and reduced response conservativeness, with no changes in nondecisional factors. The noisy exemplar model further suggested that the increase in information quality reflected a decrease in encoding noise and not an increase in forgetting. Thus, mathematical modeling may help clarify the mechanisms by which MT produces salutary effects on performance.

Higher self-reported posttraumatic stress symptoms are associated with poorer working memory in active-duty service members.

OBJECTIVE: Posttraumatic stress is a significant issue facing military service members and can negatively impact working memory (WM), which is critical for performance success. Yet, few studies have examined the link between self-reported posttraumatic stress symptoms (PTSS) and WM performance in active-duty military cohorts. The present study utilized hierarchical linear modeling to examine this relationship by considering PTSS and underlying symptom clusters as well as WM demands related to load and affective interference in an active-duty military cohort (N = 515). METHOD: PTSS severity was assessed via the posttraumatic stress disorder checklist-military version (PCL-M), and behavioral performance was measured on a delayed-recognition WM task that manipulated mnemonic load (low vs. high load) and affective interference (negative combat-related vs. neutral civilian images presented during the delay interval). RESULTS: Examination of the relationship between PCL-M and WM performance demonstrated that higher total PCL-M scores (especially higher numbing and hyperarousal symptoms) were associated with poorer WM task performance, b = -0.083, p = .003, 95% CI [-0.137, -0.029], even after controlling for combat experiences and previous deployment status. This relationship was stronger on trials with negative, b = -0.114, p < .001, 95% CI [-0.175, -0.054], compared to neutral distracters, b = -0.052, p = .093, 95% CI [-0.112, 0.009]. CONCLUSIONS: These results suggest that PTSS are associated with performance costs on a WM task with combat-related negative distracters. Broadly, these findings highlight the need to address PTSS in active-duty cohorts and further investigate vulnerabilities related to cognitive demands and psychological health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Is resilience trainable? An initial study comparing mindfulness and relaxation training in firefighters.

Motivated by the growing interest in promoting resilience in first responders and other professionals who face threatening professional circumstances, the current study investigated the effectiveness of offering a short-form mindfulness training (MT) program to firefighters. The overarching question was to determine if psychological and cognitive markers of resilience are bolstered via MT. Firefighters (n = 121) were assigned to an MT program (n = 42), an active-comparison relaxation training program (RT, n = 31), or served as no-training controls (NTC, n = 48). Both the MT and RT programs were contextualized for firefighters and consisted of 4, 2-h training sessions delivered over 4 weeks by the same expert trainer, as well as 10-15 min of daily out-of-class practice. Intent-to-treat analyses revealed a significantly greater increase in psychological resilience from baseline (T1) to post-training (T2) in firefighters who received MT vs. RT or no training. In addition, positive affect and objective attentional task performance demonstrated a greater increase over time (from T1 to T2) with more days per week of out-of-class practice for the MT group but not for the RT group. These results suggest that MT moreso than RT bolsters markers of resilience in firefighters.

Experience sampling of the degree of mind wandering distinguishes hidden attentional states.

Experience sampling of attentional states has consistently demonstrated that mind wandering is a frequent and disruptive obstacle when one must sustain attention during continuous task performance. Yet, methods commonly used to assess the subjective experience of mind wandering may conflate several potential sources of meaningful variation in individuals' degree of task engagement. In the present study, we examined evidence for distinct and identifiable patterns in subjective reports of the degree of task-related attentional focus during a sustained attention task in a large sample of adults (N = 537). Experience sampling probes embedded in the task assessed task-related focus using a continuum of response ratings ranging from 1 (on-task) to 6 (off-task). Participants used a range of probe response options in categorizing their current attentional state, and the continuum of probe ratings differentiated patterns of behavioral performance in the moments preceding probes. Markov-chain modeling of the categorical time series sequence of probe ratings further revealed distinct and behaviorally relevant hidden states underlying probe rating behavior. We replicated these findings in two additional independent data sets. Collectively, these findings suggest that three or more hidden attentional states best account for subjective ratings of task-related focus. The implications of these findings for models of sustained attention and mind wandering are discussed.