A groundbreaking qualitative study published in BMC Psychiatry has shed new light on the therapeutic potential of the attention training technique (ATT) when delivered in group settings to patients suffering from coronary heart disease (CHD) complicated by anxiety and depression. This novel research delves deeply into patient experiences, revealing how ATT can serve as a powerful psychological intervention to tackle the often-overlooked mental health symptoms afflicting cardiac patients. The findings are poised to influence the future design of group-based psychological treatments aimed at this vulnerable population.
Coronary heart disease remains one of the leading causes of morbidity and mortality worldwide, and its psychological sequelae are increasingly recognized as crucial factors affecting recovery and quality of life. Anxiety and depression frequently accompany CHD, exacerbating the disease burden and impeding rehabilitation efforts. Traditional treatments generally focus on physical health, leaving a critical gap for effective mental health interventions tailored to the unique needs of CHD patients. This study addresses this gap by exploring the application of ATT—a component of metacognitive therapy—in a group format, an approach that had not previously been qualitatively assessed in this patient demographic.
The attention training technique targets maladaptive thinking patterns by enhancing patients’ ability to control their attentional focus. It works by training individuals to shift their attention deliberately and flexibly, reducing the grip of ruminative and anxious thought processes. ATT’s theoretical foundation lies in modifying metacognitive beliefs—the thoughts about one’s own thinking—which are central in perpetuating psychological distress. Importantly, delivering ATT in a group setting not only offers cost-effectiveness but also leverages social dynamics that may enhance therapeutic outcomes.
The study recruited ten patients with CHD—nine men and one woman—with significant anxiety and/or depression who had previously participated in a randomized controlled trial evaluating group ATT’s effectiveness. Through in-depth, individual interviews conducted three months post-treatment, researchers aimed to capture rich, nuanced accounts of patients’ lived experiences with ATT. This methodological choice allowed for the exploration of both expected and emergent themes surrounding treatment acceptability, perceived benefits, and potential barriers to engagement.
Analysis revealed two overarching thematic categories: non-specific ATT treatment factors and ATT-specific treatment factors. Non-specific factors related to the broader therapeutic context, including interpersonal dynamics and the therapeutic milieu. These encompassed the interactions among group members, the rapport established with the therapist, and the therapist’s delivery style of the intervention. Patients emphasized that these relational aspects played a critical role in fostering a supportive environment conducive to engagement and change.
Within the group, patients reported feeling validated and understood, which counteracted common feelings of isolation often experienced with chronic illness and comorbid psychological symptoms. The group format facilitated shared learning and mutual encouragement, providing not only a platform for the ATT exercises but also social support that reinforced the treatment’s impact. The role of the therapist was equally vital in moderating group interactions, ensuring clarity in technique instruction, and maintaining a constructive therapeutic alliance.
On the more ATT-specific front, patients described evolving understandings of the technique itself and how it influenced their mental processes. Several participants noted a newfound awareness of their attentional capacities and their ability to disengage from negative, automatic thought patterns that previously dominated their mental landscape. This heightened metacognitive insight was associated with reduced anxiety and depressive symptoms, underscoring ATT’s psychological mechanism of action.
Patients articulated that ATT empowered them to reclaim cognitive control, which was instrumental in alleviating distress and improving daily functioning. The cognitive shifts facilitated by ATT were not merely transient; participants conveyed sustained benefits that extended well beyond the formal treatment window. Embracing the group format was seen as an enabling factor, enabling the practice of ATT techniques in a real-world context with peer feedback.
Importantly, the study highlighted how patients’ conceptualizations of ATT aligned well with the therapy’s underlying rationale, suggesting effective communication and understanding fostered by the group delivery model. Patients’ positive perceptions of ATT provide crucial validation for its clinical feasibility and acceptability, which are key determinants for successful translation into routine cardiac care settings.
The research also identified certain barriers and challenges inherent in the group ATT delivery. Variations in individual engagement levels, initial skepticism about the technique, and occasional difficulties in grasping abstract metacognitive concepts were noted. However, these were generally mitigated by skilled therapist guidance and the connective group environment. This insight underscores the critical need for therapist training and adaptive treatment delivery when scaling ATT to diverse cardiac patient populations.
From a technological and methodological standpoint, the utilization of thematic analysis allowed for a comprehensive, data-driven exploration of subjective treatment experiences, providing depth beyond quantitative outcome measures. This qualitative approach enriches the evidence base and advocates for a patient-centered framework in developing future interventions targeting mental health symptoms in CHD.
The study’s implications extend beyond its immediate population, suggesting that group-delivered ATT could be adapted for other chronic illness contexts where psychological distress coexists with physical health challenges. Furthermore, ATT’s emphasis on metacognitive processes aligns with emerging neuroscientific understandings of attention and cognitive control networks, promising exciting avenues for integrative biopsychosocial treatment models.
In conclusion, this pioneering qualitative inquiry affirms that group ATT is not only a feasible and acceptable therapeutic modality for CHD patients experiencing anxiety and depression but also profoundly impactful in enhancing cognitive self-regulation and symptom relief. The preservation of group dynamics and skilled therapist involvement emerged as indispensable elements of success. As cardiovascular and mental health continue to intersect in clinical practice, such innovative, evidence-based psychological interventions offer promising opportunities to improve holistic patient outcomes.
This study, approved by ethics committees and registered with clinicaltrials.gov, invites further research to refine group ATT protocols, explore long-term effectiveness, and integrate digital delivery platforms to increase accessibility. Ultimately, by focusing on patients’ voices and experiences, this work strengthens the case for embedding psychological care as a standard component of comprehensive cardiac rehabilitation.
Subject of Research:
Experiences and perceptions of the attention training technique (ATT) delivered in group therapy as a treatment for anxiety and depression symptoms in patients with coronary heart disease.
Article Title:
Experiences of the attention training technique delivered in groups as treatment for anxiety and depression in patients with coronary heart disease: a qualitative study
Article References:
Tunheim, K., Papageorgiou, C., Lie, H.C. et al. Experiences of the attention training technique delivered in groups as treatment for anxiety and depression in patients with coronary heart disease: a qualitative study. BMC Psychiatry 25, 573 (2025). https://doi.org/10.1186/s12888-025-07027-4
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AI Generated
DOI:
https://doi.org/10.1186/s12888-025-07027-4
