Dynamic changes in metacognitive mechanisms and symptoms during the attention training technique: Insights from ecological momentary assessment

Therese Ruud Snuggerud; Esther Ulitzsch; Henrik Nordahl; KariAnne Vrabel; Asle Hoffart; Omid V. Ebrahimi; Oliver Lüdtke; Steffen Nestler; Sverre Urnes Johnson

doi:10.1016/j.janxdis.2026.103136

journal article Apr 01, 2026

Dynamic changes in metacognitive mechanisms and symptoms during the attention training technique: Insights from ecological momentary assessment

Therese Ruud Snuggerud Esther Ulitzsch Henrik Nordahl KariAnne Vrabel Asle Hoffart Omid V. Ebrahimi

Oliver Lüdtke Steffen Nestler

Sverre Urnes Johnson

Journal of Anxiety Disorders Vol. 119 pp. 103136 · Elsevier BV

View at Publisher Save 10.1016/j.janxdis.2026.103136

Topics

No keywords indexed for this article. Browse by subject →

References

78

[1]

Aderka "Sudden gains during psychological treatments of anxiety and depression: A meta-analysis" Journal of Consulting and Clinical Psychology (2012) 10.1037/a0026455

[2]

Baxter "Global prevalence of anxiety disorders: A systematic review and meta-regression" Psychological Medicine (2013) 10.1017/s003329171200147x

[3]

The global burden of anxiety disorders in 2010

A. J. Baxter, T. Vos, K. M. Scott et al.

Psychological Medicine 2014 10.1017/s0033291713003243

[4]

Bean "Ruminative variability predicts increases in depression and social anxiety" Cognitive Therapy and Research (2024) 10.1007/s10608-023-10451-z

[5]

Bosley "Affect dynamics as predictors of symptom severity and treatment response in mood and anxiety disorders: Evidence for specificity" Journal of Person-Oriented Research (2019) 10.17505/jpor.2019.09

[6]

Bringmann "Changing dynamics: Time-varying autoregressive models using generalized additive modeling" Psychological Methods (2017) 10.1037/met0000085

[7]

Brown (1994)

[8]

Callinan "A randomised controlled study of the effects of the attention training technique on traumatic stress symptoms, emotional attention set shifting and flexibility" Cognitive Therapy and Research (2015) 10.1007/s10608-014-9634-8

[9]

Cloos "Accuracy and consistency of visual analog scales in ecological momentary assessment and digital studies" Collabra: Psychology (2025)

[10]

Collins "Analysis of longitudinal data: The integration of theoretical model, temporal design, and statistical model" Annual Review of Psychology (2006) 10.1146/annurev.psych.57.102904.190146

[11]

van Dalen "Applications of the experience sampling method (ESM) in paediatric healthcare: A systematic review" Pediatric Research (2024) 10.1038/s41390-023-02918-2

[12]

Dammen "Attention training technique delivered in groups as treatment for anxiety and depression in patients with coronary heart disease: Study protocol for a waiting-list randomized controlled trial" Frontiers in Psychology (2023)

[13]

Donald "Comparison of attention training and cognitive therapy in the treatment of social phobia: A preliminary investigation" Behavioural and Cognitive Psychotherapy (2014) 10.1017/s1352465812001051

[14]

Ebrahimi "Towards precision in the diagnostic profiling of patients: Leveraging symptom dynamics as a clinical characterisation dimension in the assessment of major depressive disorder" The British Journal of Psychiatry (2024) 10.1192/bjp.2024.19

[15]

Reducing Test Anxiety in School Settings: A Controlled Pilot Study Examining a Group Format Delivery of the Attention Training Technique Among Adolescent Students

Thomas A. Fergus, Christine A. Limbers

Behavior Therapy 2019 10.1016/j.beth.2018.12.001

[16]

Fergus "The attention training technique causally reduces self-focus following worry provocation and reduces cognitive anxiety among self-focused individuals" Journal of Behavior Therapy and Experimental Psychiatry (2018) 10.1016/j.jbtep.2018.06.006

[17]

van Geert "Dynamic systems, process and development" Human Development (2019) 10.1159/000503825

[18]

Inference from Iterative Simulation Using Multiple Sequences

Andrew Gelman, Donald B. Rubin

Statistical Science 1992 10.1214/ss/1177011136

[19]

Gelman "Inference from simulations and monitoring convergence" (2021)

[20]

Gelo "A dynamic systems approach to psychotherapy: A meta-theoretical framework for explaining psychotherapy change processes" Journal of Counseling Psychology (2016) 10.1037/cou0000150

[21]

Guo, J., Gabry, J., & Goodrich, B. (2018). Rstan: R interface to Stan [R package version 2.18.2]. 〈https://CRAN.R-project.org/package=rstan〉.

[22]

Haas "Do early responders to psychotherapy maintain treatment gains" Journal of Clinical Psychology (2002) 10.1002/jclp.10044

[23]

Haslbeck "Comparing Likert and visual analogue scales in ecological momentary assessment" Behavior Research Methods (2025) 10.3758/s13428-025-02706-2

[24]

A complex systems approach to the study of change in psychotherapy

Adele M. Hayes, Leigh A. Andrews

BMC Medicine 2020 10.1186/s12916-020-01662-2

[25]

Change is not always linear: The study of nonlinear and discontinuous patterns of change in psychotherapy

Adele M. Hayes, Jean-Philippe Laurenceau, Greg Feldman et al.

Clinical Psychology Review 2007 10.1016/j.cpr.2007.01.008

[26]

Hoffart "Latent trait, latent-trait state, and a network approach to mental problems and their mechanisms of change" Clinical Psychological Science (2020) 10.1177/2167702620901744

[27]

Hoffart "Mechanisms of change in metacognitive and cognitive behavioral therapy for treatment-resistant anxiety: The role of metacognitive beliefs and coping strategies" Journal of Experimental Psychopathology (2018) 10.1177/2043808718787414

[28]

Hoffart "Mapping the dynamics of generalized anxiety symptoms and actionable transdiagnostic mechanisms: A panel study" Depression and Anxiety (2025) 10.1155/da/1885004

[29]

The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses

Stefan G. Hofmann, Anu Asnaani, Imke J. J. Vonk et al.

Cognitive Therapy and Research 2012 10.1007/s10608-012-9476-1

[30]

Hoover "Nonparametric smoothing estimates of time-varying coefficient models with longitudinal data" Biometrika (1998) 10.1093/biomet/85.4.809

[31]

Houben "The relation between short-term emotion dynamics and psychological well-being: A meta-analysis" Psychological Bulletin (2015) 10.1037/a0038822

[32]

Johnson "Psychometric Properties of the General Anxiety Disorder 7-Item (GAD-7) Scale in a Heterogeneous Psychiatric Sample" Frontiers in Psychology (2019) 10.3389/fpsyg.2019.01713

[33]

Karp "Relationship of variability in residual symptoms with recurrence of major depressive disorder during maintenance treatment" Focus (2005) 10.1176/foc.3.1.161

[34]

Kazdin "Understanding how and why psychotherapy leads to change" Psychotherapy Research (2009) 10.1080/10503300802448899

[35]

Kowalski "Cognitive-attentional syndrome – The psychometric properties of the CAS-1 and multi-measure CAS-based clinical diagnosis" Comprehensive Psychiatry (2019) 10.1016/j.comppsych.2019.02.007

[36]

Lanza (2021)

[37]

Loerinc "Response rates for CBT for anxiety disorders: Need for standardized criteria" Clinical Psychology Review (2015) 10.1016/j.cpr.2015.08.004

[38]

Patterns of early change and their relationship to outcome and follow-up among patients with major depressive disorders

Wolfgang Lutz, Niklaus Stulz, Katharina Köck

Journal of Affective Disorders 2009 10.1016/j.jad.2009.01.019

[39]

McEvoy "Mechanisms of change during attention training and mindfulness in high trait-anxious individuals: A randomized controlled study" Behavior Therapy (2017) 10.1016/j.beth.2017.04.001

[40]

Meine "Network analyses of ecological momentary emotion and avoidance assessments before and after cognitive behavioral therapy for anxiety disorders" Journal of Anxiety Disorders (2024) 10.1016/j.janxdis.2024.102914

[41]

Murray "The attention training technique improves children’s ability to delay gratification: A controlled comparison with progressive relaxation" Behaviour Research and Therapy (2018) 10.1016/j.brat.2018.02.003

[42]

Myhr "Can the attention training technique reduce stress in students? A controlled study of stress appraisals and meta-worry" Frontiers in Psychology (2019) 10.3389/fpsyg.2019.01532

[43]

Myin-Germeys "Experience sampling methodology in mental health research: New insights and technical developments" World Psychiatry (2018) 10.1002/wps.20513

[44]

Nelson "Moving from static to dynamic models of the onset of mental disorder: A review" JAMA Psychiatry (2017) 10.1001/jamapsychiatry.2017.0001

[45]

Neubauer "Studying within-person variation and within-person couplings in intensive longitudinal data: Lessons learned and to be learned" Gerontology (2020) 10.1159/000507993

[46]

Newman "Time-varying moderation of treatment outcomes by illness duration and comorbid depression in generalized anxiety disorder" Journal of Consulting and Clinical Psychology (2019) 10.1037/ccp0000385

[47]

Normann "The efficacy of metacognitive therapy: A systematic review and meta-analysis" Frontiers in Psychology (2018) 10.3389/fpsyg.2018.02211

[48]

Pålerud "Sudden gains in cognitive behavioural therapy and metacognitive therapy for complex anxiety disorders" Clinical Psychology Psychotherapy (2025) 10.1002/cpp.70111

[49]

Papageorgiou "Effects of attention training on hypochondriasis: A brief case series" Psychological Medicine (1998) 10.1017/s0033291797005825

[50]

Papageorgiou "Treatment of recurrent major depression with attention training" Cognitive and Behavioral Practice (2000) 10.1016/s1077-7229(00)80051-6

Showing 50 of 78 references

Metrics

0

Citations

78

References

Details

Published: Apr 01, 2026
Vol/Issue: 119
Pages: 103136
License: View

Authors

T

Therese Ruud Snuggerud

Institute of Psychology, Humboldt University Berlin

Cite This Article

Therese Ruud Snuggerud, Esther Ulitzsch, Henrik Nordahl, et al. (2026). Dynamic changes in metacognitive mechanisms and symptoms during the attention training technique: Insights from ecological momentary assessment. Journal of Anxiety Disorders, 119, 103136. https://doi.org/10.1016/j.janxdis.2026.103136

Dynamic changes in metacognitive mechanisms and symptoms during the attention training technique: Insights from ecological momentary assessment

You May Also Like