Effectiveness of an abbreviated version of the automated attention training technique (ATT) for stress reduction in a non-clinical sample—A randomized controlled trial

Abstract

Stress is one of the leading risk factors for mental health problems. The attention training technique (ATT), developed in the context of metacognitive therapy, is a method for increasing flexible control of attention and might thus reduce the impact of stressful events on mental health. Developed as a 12-min exercise, ATT is primarily used in a clinical context. To ensure low-threshold implementation by the general population in everyday life, we developed an abbreviated 5-min version of the ATT. The present study examined the effectiveness of this abbreviated ATT in reducing stress in a three-armed randomized controlled trial by comparing the abbreviated version (ATT_abbr; n = 74) with the long version (ATT_long; n = 67) and a waitlist control group (WCG; n = 77) in a non-clinical sample. The primary outcome was change on the Depression, Anxiety, and Stress Scale (DASS-21). In the intention-to-treat analysis of changes from baseline to follow-up, both the abbreviated ATT version and the long ATT version were superior to the WCG in the reduction of stress (d = 0.67 for the abbreviated version and d = 0.44 for the long version). From post to follow-up, reductions in stress were greater for the abbreviated version than the long version (d = 0.37). We also observed effects of both ATT versions on depression and anxiety but no effect on attention control, perseverative thinking, or quality of life. For the abbreviated version, we found preliminary evidence of a dose-response relationship. Participants with access to the abbreviated version conducted the training twice as often compared with those with access to the long version. These results suggest that the abbreviated version of the ATT is associated with greater adherence and possibly greater effects on stress than the long version. If these results are confirmed, the abbreviated version could be used to reduce stress and increase mental well-being in the general population.