A Systematic Review of Efficacy of the Attention Training Technique in Clinical and Nonclinical Samples.

ABSTRACT

OBJECTIVE: The Attention Training Technique (ATT; Wells, 1990) is a brief metacognitive treatment strategy aimed at remediating self-focused processing and increasing attention flexibility in psychological disorder. METHOD: We systematically reviewed and examined the efficacy of ATT in clinical and nonclinical samples. Scientific databases were searched from 1990 to 2014 and 10 studies (total N = 295) met inclusion criteria. Single-case data were meta-analyzed using the improvement rate difference, and standardized between and within-group effect sizes (ESs) were examined across 4 analogue randomized controlled trials (RCTs). RESULTS: Single-case outcomes indicated that ATT yields large ES estimates (pooled ES range 0.74-1.00) for anxiety and depressive disorders. Standardized ESs across the RCTs indicated that ATT yields greater treatment gains than reference groups across majority outcomes (adjusted Cohen's d range 0.40-1.23). CONCLUSIONS: These preliminary results suggest ATT may be effective in treating anxiety and depressive disorders and help remediate some symptoms of schizophrenia. Although a limited number of studies with small sample sizes warrants caution of interpretation, ATT appears promising and future studies will benefit from adequately powered RCTs.