Attention Training in Treating Social Anxiety Disorder

Attention training teaches patients how to shift their focus away from unhelpful thoughts and feelings.

It is well-established that cognitive-behavioral therapy (CBT) is effective in treating social anxiety disorder (SAD), and newer research has begun to pinpoint the specific aspects that are most influential. And recent findings confirm the essential role of attention training in reducing SAD symptoms as well.

One of the main factors that is consistently implicated in the maintenance of SAD is self-focused attention. People with SAD tend to disproportionately focus attention on their internal experience during social situations, which in turn “enhances the awareness of a negative mental representation of the self as well as of feelings, thoughts, and physiological symptoms related to anxiety.”1 Self-focused attention may also interfere with one’s ability to process external feedback, have a negative impact on social performance, and reduce the likelihood of corrective experiences because of the lack of attention to details that might counter irrational beliefs that maintain the disorder.1

Cognitive therapies have been shown to decrease self-focused attention,1 and a study just released this year found that such reductions led to improvements in social anxiety within a week,2 suggesting that therapists should make this a priority target in treating SAD. Another study investigated the impact of directly targeting self-focused attention through attention training, expanding on previous case studies showing promise regarding its efficacy.3

In this randomized, controlled trial, researchers at the University of Sydney and the University of New South Wales in Australia assigned participants to six weekly sessions of either attention training or cognitive therapy. While both treatments were found to reduce symptoms of social anxiety among the 30 participants who completed treatment, attention training led to greater improvement in participants’ scores on the Self-Focused Attention questionnaire and the Brief Fear of Negative Evaluation questionnaire. The intervention aimed to teach participants how to focus and shift their attention in order to tune out irrelevant external stimuli and disengage from thoughts and feelings that may be unhelpful.

One type of internally-focused attention that can be problematic for people with SAD pertains to mental imagery.