Enhancing attention through training

Abstract

Attention can be improved by repetition of a specific task that involves an attention network (network training), or by exercise or meditation that changes the brain state (state training). We first review the concept of attention networks that link changes in orienting, alerting and executive control to brain networks. Network training through video games or computer exercises can improve aspects of attention. The extent of transfer beyond the trained task is a controversial issue. Mindfulness is a form of meditation that keeps attention focused on the current moment. Some forms of meditation have been shown to improve executive attention reduce stress and produce specific brain changes. Additional research is needed to understand the limits and mechanisms of these effects.

Full text

Enhancing
attention
through
training
Michael
I
Posner
1
,
Mary
K
Rothbart
1
and
Yi-Yuan
Tang
2
Attention
can
be
improved
by
repetition
of
a
specific
task
that
involves
an
attention
network
(network
training),
or
by
exercise
or
meditation
that
changes
the
brain
state
(state
training).
We
first
review
the
concept
of
attention
networks
that
link
changes
in
orienting,
alerting
and
executive
control
to
brain
networks.
Network
training
through
video
games
or
computer
exercises
can
improve
aspects
of
attention.
The
extent
of
transfer
beyond
the
trained
task
is
a
controversial
issue.
Mindfulness
is
a
form
of
meditation
that
keeps
attention
focused
on
the
current
moment.
Some
forms
of
meditation
have
been
shown
to
improve
executive
attention
reduce
stress
and
produce
specific
brain
changes.
Additional
research
is
needed
to
understand
the
limits
and
mechanisms
of
these
effects.
Addresses
1
University
of
Oregon,
United
States
2
Texas
Tech
University,
United
States
Corresponding
author:
Posner,
Michael
I
(mposner@uoregon.edu)
Current
Opinion
in
Behavioral
Sciences
2015,
4:1–5
This
review
comes
from
a
themed
issue
on
Cognitive
enhancement
Edited
by
Barbara
Sahakian
and
Arthur
Kramer
http://dx.doi.org/10.1016/j.cobeha.2014.12.008
2352-1546/#
2015
Elsevier
Ltd.
All
rights
reserved.
Introduction
We
consider
two
brain
training
strategies
to
improve
attention
and
other
cognitive
functions
[1

].
Network
training
involves
practice
of
a
cognitive
task
thought
to
exercise
specific
brain
networks
related
to
attention.
State
training,
on
the
other
hand,
uses
practice
designed
to
develop
a
brain
state
that
may
influence
attention
and
other
networks
[2–6].
State
training
also
involves
net-
works,
but
it
is
does
not
include
cognitive
tasks
designed
specifically
to
train
a
network.
Both
aerobic
exercise
and
meditation
training
can
establish
a
state
that
appears
to
improve
cognition,
attention
and
mood
[1

].
Training
attention
networks
Since
attention
involves
a
number
of
neural
networks
with
different
functions
[7]
there
are
many
ways
to
improve
one
or
more
of
these
functions
and
thereby
improve
the
efficiency
of
the
network.
Some
of
the
cues
for
dissociations
between
attentional
functions
arise
from
studies
of
brain
injury
using
the
Attention
Network
Test
(ANT)
to
classify
patients.
The
ANT
(see
Fig.
1)
is
a
cognitive
task
built
around
the
flanker
effect
and
designed
to
provide
separate
measurement
of
the
alert-
ing,
orienting
and
executive
networks
[8].
Limitations
in
the
reliability
and
utility
of
the
ANT,
especially
for
applied
research,
have
been
discussed
[9].
While
some
efforts
have
been
made
to
improve
the
test
its
main
goal
is
to
link
behavioral
changes
in
attention
to
the
brain
net-
works
involved.
For
example,
in
one
study
110
stroke
patients
and
62
con-
trol
participants
were
given
the
ANT
[10].
Analysis
of
brain
scans
and
ANT
revealed
three
separate
groups
of
patients:
(i)
those
patients
with
thalamic
damage
showing
deficits
in
alerting,
(ii)
parietal
damage
patients
showing
deficits
in
orienting,
and
(iii)
patients
with
damage
to
white
matter
tracts
connected
to
the
anterior
cingulate
showing
deficits
in
executive
control
[10].
This
classifica-
tion
into
three
categories
fits
with
many
findings
from
imaging
research
summarized
in
Ref.
[7].
Studies
have
used
training
techniques
to
improve
atten-
tion
in
patient
groups
similar
to
those
discussed
above.
Patients
with
thalamic
damage
and
participants
who
are
sleep
deprived
have
trouble
in
obtaining
a
sufficient
level
of
alertness
to
perform
well
in
cognitive
tasks.
The
use
of
auditory
warning
signals
has
been
shown
to
provide
a
temporary
improvement
in
performance
and
training
to
use
the
signals
can
improve
both
alerting
and
orienting
functions
[11].
Patients
with
right
parietal
damage
often
have
problems
orienting
to
signals
that
go
directly
to
the
damaged
hemisphere.
Training
involving
teaching
the
patients
to
instruct
themselves
to
orient
to
the
left
during
visual
search
improved
performance
[12].
Training
in
action
video
games
has
been
shown
to
improve
orienting
network
performance
during
visual
search
and
similar
tasks
[13].
There
is
more
doubt
that
general
improvement
in
all
forms
of
attention
or
learning
occurs
with
videogame
training
[14,15

].
However,
in
a
recent
very
extensive
training
study
with
video
games
and
controls
the
authors
do
find
that
transfer
to
untrained
paradigms
in
some
forms
of
video
games
[15].
A
similar
controversy
regarding
transfer
is
found
when
training
involves
a
specific
but
general
network
such
as
working
memory
[16,17].
Many
studies
of
training
executive
attention
have
been
carried
out
in
children
[18

,19,20]
using
computerized
exercises
designed
to
improve
conflict
resolution
[19,20]
or
more
general
school
curricula
designed
to
exercise
all
aspects
of
executive
functions
[18

].
These
studies
have
often
demonstrated
in
improvement
executive
attention
[18

]
and
some
transfer
[19,20].
While
there
is
evidence
Available
online
at
www.sciencedirect.com
ScienceDirect
www.sciencedirect.com
Current
Opinion
in
Behavioral
Sciences
2015,
4:1–5

that
self
control
score
in
childhood
can
predict
adult
performance
[21]
there
are
no
studies
showing
that
train-
ing
the
executive
network
in
children
can
improve
adult
outcomes.
Although
most
of
the
work
in
video
games
has
been
done
with
adults
and
most
of
the
work
on
school
curricula
with
children
there
is
little
evidence
that
train-
ing
is
limited
to
any
one
age.
There
may
be
ways
to
enhance
the
success
of
network
training.
For
example,
there
is
evidence
that
training
parents
can
greatly
enhance
the
effectiveness
of
child
training,
presumably
by
getting
the
parent
to
support
home
activity
[22].
It
is
also
possible
that
brain
stimula-
tion
through
scalp
electrodes
or
trans-cortical
magnetic
stimulation
(TMS)
may
improve
plasticity
and
enhance
training
[23].
The
safety
of
the
stimulation
methods,
particularly
when
practiced
by
consumers
without
train-
ing,
remains
an
important
concern
[24].
Below
we
con-
sider
some
state
training
methods
that
can
be
used
either
individually
or
in
combination
with
network
training.
Training
brain
states
A
number
of
methods
have
been
proposed
for
training
a
brain
state
that
will
foster
attention
and
self
regulation
[1

].
Exposure
to
nature
has
been
shown
to
be
a
useful
method
to
improve
attention
[1

],
and
aerobic
exercise
has
been
shown
in
many
studies
to
have
broad
effects
on
cognition
including
attention
[6].
Meditation
is
a
mental
method
that
has
the
most
similarities
to
the
network
training
discussed
above.
In
understanding
the
training
of
attention
it
is
important
to
consider
the
way
attention
works
during
cognitive
tasks.
When
involved
in
cognitive
tasks
it
is
common
for
the
human
mind
to
wander
to
thoughts
unrelated
to
the
task
[25]
and
mind
wandering
is
often
directed
to
the
self
[26].
In
some
cases
there
is
awareness
of
the
mind
wandering
and
in
other
cases
one
is
not
aware
until
questioned.
To
determine
the
occurrence
of
such
thinking
it
is
valuable
to
employ
experience
sampling
[27]
where
participants
are
probed
to
report
whether
or
not
their
mind
is
wandering.
In
one
such
study
parti-
cipants
carried
out
a
sustained
attention
task
[28]
while
being
scanned
with
fMRI
and
probed
as
to
whether
their
mind
had
wandered
and
whether
they
had
been
aware
of
that
wandering.
Findings
suggest
that
both
the
default
(a
mostly
midline
network
of
brain
areas
show-
ing
correlated
activity
when
the
person
is
not
engaged
2
Cognitive
enhancement
Figure
1
congruent
no cue
ALERTING = NO CUE RT – DOUBLE CUE RT
ORIENTING = CENTER CUE RT – SPATIAL CUE RT
CONFLICT = INCONGRUENT TARGET RT – CONGRUENT TARGET RT
center cue double cue spatial cue
Cue
Target
incongruent Neutral
+
+
*
+
+
+
D = 400 –
1600 ms
100 ms 400 ms RT < 1700 ms 3000 – RT – D ms
+
+
**
*
–
+
*
*
–
+
*
–
(b) Three target conditions
(c) Time line
(a) Four cue conditions
(d) Three subtractions
Current Opinion in Behavioral Sciences
A
schema
of
the
Attention
Network
Test.
(a)
Cue
conditions,
(b)
target
conditions,
(c)
time
line
of
events.
Adapted
from
Ref.
[8].
Current
Opinion
in
Behavioral
Sciences
2015,
4:1–5
www.sciencedirect.com

in
a
task)
and
executive
networks
are
active
during
mind
wandering
[29].
The
activation
in
both
networks
is
greater
when
the
person
is
not
aware
of
mind
wan-
dering
prior
to
the
probe.
Meditation
is
a
method
that
works
to
resist
mind
wandering
and
produce
an
atten-
tion
focus.
Five
different
styles
of
meditation
have
been
involved
in
over
400
clinical
trials
[30],
but
one
style
of
meditation,
mindfulness
meditation
seems
to
dominant
current
stud-
ies.
Mindfulness
meditation
involves
a
set
of
mental
practices
designed
to
achieve
control
by
the
person
over
the
direction
of
attention.
This
is
done
by
either
focusing
on
a
specific
content
(e.g.
ones
breathing
or
a
word)
or
keeping
a
relaxed
state
in
which
attention
is
not
allowed
to
move
away
from
the
present
state
but
is
not
focused
on
a
particular
content.
Recent
meta-analyses
of
the
behav-
ioral
effects
of
meditation
[31],
functional
brain
systems
involved
[32,33]
and
structural
changes
in
brain
gray
and
white
matter
[34

]
have
been
generally
favorable
to
changes
in
behavior
induced
by
various
forms
of
medita-
tion
training.
The
meditative
state
is
often
accompanied
by
changes
in
measures
related
to
autonomic
activity
often
used
as
a
biomarker
for
monitoring
meditative
states
[31,32].
The
central
nervous
system
also
undergoes
changes
following
meditation
training.
Consistent
structural
changes
found
in
a
metaanalysis
[34

]
are
in
the
ACC
and
insula
parts
of
the
executive
attention
network
[7].
Many
of
the
early
meditation
studies
compared
long
time
practitioners
with
control
participants
selected
to
be
similar
to
the
meditators.
Although
many
findings
were
of
interest,
it
was
hard
to
be
sure
that
differences
were
due
to
meditation
rather
than
to
other
differences
be-
tween
those
devoted
to
the
practice
and
controls.
More
recently
longitudinal
studies
over
periods
of
a
week
to
several
months
have
compared
training
with
various
forms
of
meditation
to
either
waiting
list
or
other
controls.
These
studies
allow
random
assignment
and
can
attri-
bute
cause
to
the
training.
The
studies
have
often
found
important
differences
attributed
to
meditation
[2–
5,32,33,34

,35–37].
However,
meditation
training
is
itself
complex
and
it
remains
unclear
which
aspects
of
the
training
are
most
important
to
obtain
each
of
the
changes
discussed
below.
Longitudinal
studies
A
series
of
meditation
training
studies
have
compared
one
week
of
integrated
body
mind
training
(IBMT),
a
version
of
mindfulness
meditation,
with
an
active
con-
trol
group
given
relaxation
training
[3,37,38]
The
groups
are
randomly
assigned.
IBMT
uses
most
of
the
methods
of
other
mindfulness
training
including
maintaining
attention
in
the
present
without
judgment
and
use
of
instruction
to
promote
a
state
of
high
concentration
on
the
present
with
minimal
mind
wan-
dering.
Relaxation
training
involves
deliberate
relaxa-
tion
of
each
muscle
group
and
has
been
widely
practiced
as
a
part
of
cognitive
behavioral
therapy.
In
comparison
with
the
relaxation
control
group,
one
week
of
IBMT
(30
min
per
day)
produced
better
executive
attention
using
the
Attention
Network
Test,
higher
positive
mood
and
lower
negative
mood
in
self
report,
lower
secretion
of
the
stress
hormone
cortisol
following
meditation
after
a
mental
arithmetic
challenge
and
increased
immuno-reactivity
[3].
A
month
of
IBMT
in
comparison
with
a
relaxation
train-
ing
control
group
showed
reduced
cortisol
at
baseline
(before
any
cognitive
stress)
and
evidence
that
stress
was
reduced
in
a
dose
dependent
manner.
These
changes
do
not
seem
to
be
dependent
upon
specific
aspects
of
IBMT
as
they
have
been
reported
with
other
mindfulness
methods
[39].
However,
one
well
documented
form
of
training,
mindfulness
based
stress
reduction
[40]
has
not
been
found
to
improve
attention
[41].
The
reasons
for
this
difference
are
not
known.
The
IBMT
studies
also
examined
both
central
and
autonomic
nervous
system
activity
in
comparison
to
relaxation
controls.
There
was
clear
evidence
of
changes
in
activity
in
the
ventral
ACC
and
in
its
functional
connectivity
with
the
striatum
[37,38].
These
findings
fit
well
with
meta-analysis
of
meditation
effects
on
func-
tional
and
structural
activation
[4].
In
addition
two
to
four
weeks
of
IBMT
produced
increases
in
fractional
anisot-
ropy
(FA),
an
index
of
white
matter
efficiency
[38].
These
changes
were
found
in
a
band
of
white
matter
tracts
connecting
the
ACC
to
striatal
and
cortical
areas.
After
two
weeks,
the
changes
were
mainly
in
axial
diffu-
sivity
(AD),
often
taken
as
a
measure
of
axonal
density,
while
after
four
weeks
the
study
found
both
improved
AD
and
improved
RD
(radial
diffusivity,
related
to
myelination)
[38].
White
matter
is
usually
regarded
as
changing
in
develop-
ment,
but
relatively
fixed
in
adulthood.
However,
recent
reviews
have
shown
much
more
dynamism
in
adult
white
matter
that
can
be
changed
rapidly
in
response
to
events
such
as
demyelination
in
conjunction
with
multiple
scle-
rosis
[42

].
A
number
of
studies
of
network
training
have
also
found
changes
in
white
matter
with
practice
[43–45,46

].
The
finding
of
an
early
change
in
AD
followed
later
by
RD
is
similar
to
the
order
of
changes
found
in
early
develop-
ment
and
raises
the
question
of
whether
examination
of
behavioral
changes
that
occur
with
learning
in
adults
may
provide
added
insight
into
the
slower
changes
manifest
during
child
development
[38].
It
is
only
possible
to
speculate
on
exactly
how
meditation
and
other
forms
of
learning
might
work
to
alter
white
matter,
but
a
recent
Enhancing
attention
Posner,
Rothbart
and
Tang
3
www.sciencedirect.com
Current
Opinion
in
Behavioral
Sciences
2015,
4:1–5

paper
points
to
frontal
theta
as
a
possible
important
cause
of
these
effects
[47].
Clinical
studies
Many
physical
and
mental
disorders
involve
deficits
of
attention
[48],
so
an
important
goal
of
training
attention
is
to
treat
disorders.
There
are
correlations
between
the
executive
attention
network
and
self
control
or
self
regu-
lation
in
children
and
adults
[49

].
Since
addictions
have
been
related
to
deficits
in
self
regulation
[50]
they
are
a
natural
target
for
such
studies.
One
such
study
has
involved
smoking
addiction
[51

],
but
unlike
most
such
studies
participants
were
not
com-
mitted
to
quit
smoking,
but
were
recruited
for
stress
reduction.
Smokers
and
non
smokers
were
randomly
assigned
to
two
weeks
of
IBMT
or
two
weeks
of
relaxa-
tion
training.
The
IBMT
group
showed
a
60%
reduction
in
smoking
as
measured
by
a
carbon
monoxide
meter,
while
the
control
group
showed
no
significant
reduction.
Prior
to
training
smokers
showed
lower
activity
in
the
anterior
cingulate
than
non
smokers,
but
the
training
produced
an
increase
in
ACC
activation.
The
authors
suggest
that
self
regulation
was
reduced
in
smokers
prior
to
training,
but
increased
after
IBMT
training.
Although
there
is
increased
interest
in
using
training
methods
to
improve
several
clinical
conditions
[48,49

],
research
will
be
needed
to
understand
more
fully
how
this
can
best
be
brought
about.
Future
issues
Training
brain
networks
and
changing
brain
states
have
both
proven
effective
in
some
studies
as
a
means
of
improving
attention.
For
network
training,
the
degree
of
transfer
to
remote
tasks
remains
an
important
issue.
The
claims
that
training
in
a
single
task
improves
vast
areas
of
cognition
seems
to
be
unjustified.
However,
effort
to
train
a
set
of
tasks
that
might
together
make
a
more
general
improvement
in
attention
and
cognition
remains
a
possibility.
State
training
does
not
involve
a
single
task
so
the
issue
of
how
general
the
effects
are
is
rather
different
than
for
network
training.
Some
forms
of
meditation
have
been
shown
to
improve
attention
[3,37],
but
others
may
not.
For
state
training
there
are
remaining
issues
about
which
methods
are
most
effective,
their
mechanisms
and
how
long
they
last
following
training.
Executive
attention
appears
to
be
important
in
achieving
ability
for
self
control.
State
training
through
meditation
has
been
used
to
reduce
addiction
by
increasing
self
regu-
lation.
Other
disorders
involving
attention
may
also
be
improved
by
training,
but
more
research
on
this
is
needed.
Conflict
of
interest
statement
Nothing
declared.
Acknowledgements
This
research
was
supported
by
the
Office
of
Naval
Research
grant
to
the
University
of
Oregon
and
by
the
National
Institute
of
Health
grant
HD060563
to
Georgia
State
University.
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