Don’t worry, get attention training

For those who constantly worry about imagined catastrophes or freak out around others, here’s an attention-grabber. A few brief training sessions offer as much anxiety relief as psychotherapy or medication, at least for four months, two new studies find.

Attention training helps subjects practice how not to focus on threatening words or on photos of threatening faces. Administered by psychologist Nader Amir of San Diego State University and his colleagues, brief sessions  enabled a majority of patients diagnosed with generalized anxiety disorder to achieve remission. The disorder, estimated to affect 6.8 million U.S. adults, involves constant, exaggerated worries about impending disasters regarding health, money or other issues.

A similar form of attention guidance, directed by psychologist Norman Schmidt of Florida State University in Tallahassee, provided marked relief for many patients diagnosed with social anxiety disorder. About 15 million U.S. adults struggle with this condition, which is characterized by a debilitating dread of everyday social situations and a fear of being watched and judged by others.

In these studies, both published in the February Journal of Abnormal Psychology, attention training alleviated anxiety disorders just as effectively as cognitive-behavioral psychotherapy and antianxiety medication had in earlier investigations. Yet attention training requires minimal professional supervision, causes no side effects and could be completed over the Internet.

“I’m somewhat amazed that one to two hours of attention training could have such a dramatic impact on anxiety disorders,” Schmidt says. Several research groups, including Schmidt’s and Amir’s, plan to evaluate whether symptom improvement following attention training lasts beyond four months, the follow-up period for the two studies. Researchers also plan to combine attention training with psychotherapy for anxiety disorders.

“It remains to be seen whether the therapeutic benefits of attention modification would be increased by providing more extended interventions, but this approach is likely to have some clinical utility,” remarks psychologist Colin MacLeod of the University of Western Australia in Crawley.

Amir and Schmidt hypothesize that a habitual focus on potentially threatening events or situations causes the pervasive fear typical of anxiety disorders. Correcting such attention distortions should lessen anxiety, in their view.

Amir’s team randomly assigned 14 patients with generalized anxiety disorder to receive attention-training sessions two times a week for eight weeks. Each session lasted 15 to 20 minutes.

In a series of trials, each participant briefly saw a pair of words on a computer screen — one emotionally neutral and one emotionally threatening. As quickly as possible, volunteers had to identify a letter, either E or F, that had replaced one of the words. On most occasions, the E or F replaced a neutral word. In this way, participants unknowingly practiced diverting their attention away from threatening words.

Another 15 patients completed placebo sessions in which letters replaced neutral words half the time and threatening words half the time. Thus, these volunteers received no training to look away from either threatening or neutral words.

Four months after attention training, seven of 14 patients had recovered from generalized anxiety disorder, compared with only two of 15 patients in the other group.

Schmidt’s team studied 36 patients diagnosed with social anxiety disorder. Half the volunteers completed training that taught them to look away from images of disgusted-looking faces in order to identify letters that replaced neutral-looking faces. For the other half, letters replaced disgusted and neutral faces equally often.

Four months after attention training, 13 of 18 patients had recovered, compared with five of 18 patients in the placebo group.