Attention training (brain-training apps)

At a glance

Compared with other treatments

Against a fake version of the task: a small benefit in lab trials, and no benefit when done online or at home.

Does it last

In a study that combined 15 trials, the small benefit after training was gone 4 months later.

What it takes

Short computer sessions, often several times a week for a few weeks.

What it is

People with social anxiety tend to notice signs of threat faster: a frown, a yawn, someone looking away. Attention bias is the name for this habit.

Attention training (also called attention bias modification or cognitive bias modification) is a simple computer task. Two faces flash on the screen, one neutral and one angry or disgusted. Then a dot appears where one face was, and you press a key. In the training version, the dot almost always appears behind the neutral face. The idea is that, after many rounds, your attention learns to move away from threat without you trying.

Why people were excited

The idea is appealing: a few minutes on a computer, no talking to anyone, no facing your fears. Early lab trials reported large effects. Some lab trials reported that up to 72% of people no longer met the criteria for social anxiety disorder after training. That number travelled far.

What the evidence shows

• At home, it did not work better than a fake version. In a Swedish trial of 79 people, the training was done over the internet. The real and the fake training gave the same results. The difference between them was, in the authors’ word, “infinitesimal”.
• The way it was meant to work did not hold up. In a trial of 129 people, symptoms improved in all groups, including the fake training. People’s attention habits did not change. So whatever helped, it was not the training of attention.
• The lab effect was small and short. A study that combined 15 trials with 1,043 people found a small benefit right after training. Four months later, there was no clear benefit. The authors said it was not ready for use outside research.
• Lab and home give different results. A study that combined 36 trials found a small benefit when training was done in a lab, and none when it was done online.

Why would the lab help a little and home not at all? One idea is that in a lab, a researcher is in the room. Sitting in front of a stranger while doing a task is a small social challenge in itself. That may be the active part, not the dots.

What the trials have not answered

Newer versions use eye-tracking or different tasks. Few large trials of these exist for social anxiety. They may do better, but there is no good evidence yet.

Why the idea still matters

The thinking behind attention training is sound. People with social anxiety do pay extra attention to threat, and to themselves. Treatments that work, like cognitive therapy for social anxiety, also target attention. They do it in a different way: they teach you to notice when your focus turns inward or onto threat, and to turn it outwards on purpose, during real conversations.

So the target was right. A computer task with faces and dots was probably too far removed from real social life to move it.

What to do instead

If you want something you can do on a computer, at home, with no therapist in the room, internet CBT and self-help books based on CBT have good trials behind them. They also teach you to face situations step by step, which is what changes social anxiety. Exposure on your own explains how.

Be careful with apps that promise to “rewire” your brain for social anxiety. Ask: was there a trial, against what, and who ran it?

Risks

The task itself is simple and low-risk. The main cost is time spent on something that has not shown a benefit, when other options have.