Investigating the Neural Correlates of the Attention Training Technique Using a Novel <scp>fMRI</scp> Paradigm for Measuring Attentional Control

Attentional control (AC) plays a causal role in various mental disorders and, within the metacognitive model, contributes to maladaptive repetitive cognitive processes such as rumination and worry. The Attention Training Technique (ATT), an auditory psychotherapeutic intervention, improves AC and is associated with the efficiency of large-scale fronto-parietal control networks (FPN). This study investigates the neural correlates of ATT by applying a newly tailored fMRI paradigm, focusing on FPN engagement and its relationship with AC. We adapted ATT to examine neural responses during ATT compared to passive listening in ATT-naïve participants (N = 43) and ensured the robustness of results by validating the findings in a second independent sample (N = 28). To optimize the paradigm, we compared two ATT conditions, rapidly switching (ATT_switch) and selectively focusing (ATT_focus) attention, against multiple passive-listening control conditions, to probe ATT-related FPN activation. We also tested whether trial-wise subjective effort and self/external focus ratings differentiated ATT from control trials, parametrically modulated FPN activation, and whether ATT-related FPN activation correlated with trait AC. ATT versus control conditions activated the FPN (p_FWE < 0.05). This effect was present in both ATT conditions, with stronger activation in the ATT_switch versus ATT_focus condition, and independent of the specific control condition. Ratings of self/external focus and effort significantly differentiated ATT from control conditions (all p < 0.001) and parametrically modulated FPN activation (p_FWE < 0.05). All effects were replicated in the second sample. Across both samples, FPN activation in ATT versus control conditions and trial-wise ratings related to trait AC. Using a novel fMRI paradigm in two independent samples, we demonstrate that the ATT is associated with activation of the FPN, a key network for AC and mental health. The relationship between FPN activation and self-report measures supports the relevance of the data for understanding ATT and its links to clinical phenotypes.