Attention

Attention is a complex primary cognitive function. It provide the ability selectively focus on and prioritize relevant information while ignoring information deemed irrelevant. Attention enables the individual to:

• Achieve and maintain a state of alertness,
 
• Orient toward and select relevant information, and
 
• Regulate thoughts in a willful manner.
 

The fundamental purpose of attention is to direct cognitive resources toward a subset of the available information. This capacity for directing cognitive resources is critically important to one’s ability to learn and purposefully interact with his or her environment, and it is a crucial pre-requisite for higher-level cognitive functions including self-awareness and consciousness.

Neurologically, attention arises from complex interactions between various structures and networks. There is a growing body of research literature detailing the various structures and networks and their specific activities. However, it should be understood that, in practice, an individual’s attentional behavior arises from the simultaneous, integrated activities of these various brain areas. From a therapeutic perspective, we can group and conceptualize these various activities as three “process networks” or overlapping collections of neural structures that together give rise to certain measurable behaviors or functions.

Alerting Network

The alerting network provides the capacity to prepare and sustain vigilance for noticing and processing stimuli. The stimuli may be noted from “bottom-up” or “top-down” channels equally. That is, the stimuli may belong to the external environment and thus be received through the five senses or from memories. Conversely, the stimuli may belong to the internal environment, such as goals, choices, and so forth, and thus be received through willful or effortful cognitive activity. However, as will be discussed in the section on Encoded Memory, this therapeutic model recognizes that all stimuli, regardless of the environment to which it belongs, if it is to receive cognitive processing, must pass through the encoded memory system. To that extent, it is fair to state that the alerting network “notices” or “draws upon” information contained within the memory system which the alerting network deems salient. Non-salient information is overlooked or ignored.

The question as to what determines saliency is non-trivial. Neurochemistry and neural potentiation clearly play a role. It is, however, quite difficult to measure and monitor such activities outside a well-equipped laboratory setting. It’s also fair to presume that signal volume from the bottom-up or top-down channel plays a role – e.g., a light source with higher lumination will likely receive greater notice than a similar hue at lower lumination. Likewise, strongly encoded memories – such as have many dendritic stems – can create more volumous stimuli than weakly encoded memories. Moreover, a growing volume of curated research literature indicates that basic emotions play a critical role in assigning salience to particular stimuli. Specifically, basic emotion – whether concurrently being experienced by the individual or drawn from relational memory – will bias the alerting network to notice memories indexed with similar emotional encoding. The therapist should be aware of both stimuli volume and emotional value when assessing and working with the client’s attentional alerting network.

Targeting the alerting system for development or integration with other cognitive functions requires presenting the client with randomly appearing stimuli over an extended period of time. Stimuli of a visual nature may be the easiest to so present, however the therapist should not be limited to presenting only one type of stimuli. Clients can alert to information coming from one or more physical senses, or to internal sources such as memories and their emotions. Keys to targeting the alerting network include:

• Directing the client to the stimuli field – e.g. a deck of cards, the sounds of the room, or available memories;
 
• Stimulating salience – i.e. by reminding the client to attend to the stimuli field, by praising the client for attending to the stimulus field, and so forth;
 
• Eliciting emotionally feedback loops – e.g. providing client praise upon properly alerting or notice of failure to alert.
 

Orienting Network

The attentional orienting network provides the ability to select relevant information from the plethora of all noticed information, often with an associated selection of sensory input or stimuli location. Whereas the alerting network informs the individual that stimuli requiring attention exists, orienting sorts the noticed stimuli on the basis of its relevance.

Orienting may be considered a transitional attentional behavior in the sense that effective orienting recruits more working memory resources than does alerting, but less than the executive network does. Alerting notices the relevant information; and executive control necessarily requires calculations to be made on the relevant information. In this sense, orienting is the process of selectively filling working memory with relevant information and excluding other information. Thus, as the individual orients on relevant stimuli, it becomes increasingly irrelevant to consider whether the informational channel is “bottom-up” or “top-down” as orienting is done in the internal working memory environment.

As with saliency for the alerting network, the question of what determines relevance for the orienting network is non-trivial. The direction of the information channel is irrelevant; however, directionality for determining relevance matters. Bottom-up relevance may be developed as information is received through the physical senses. For example, a client may alert to a set of colored visual stimuli. Receiving therapist input regarding one color, however, will the client to that specific color. The result will be seemingly to flood the visual field with stimuli of that color. Top-down relevance can be developed similarly. For example, one can easily note the volume of traffic on the road. But thinking about purchasing a given make, model, and color of vehicle will “fill the road” with that same vehicle.

An important internal channel for determining relevance – one which may take either top-down or bottom-up directionality – is emotional tagging. For instance, in a day-to-day experience a client may have a negative emotional proclivity. This, in turn, will bias the orienting system to more readily deem new information that is also emotionally negative as being relevant – a bottom-up process. On the other hand, in a clinical setting the therapist can direct the client to willfully consider more positive emotions. After having done so it can be observed that the client will – at least temporarily – orient more readily toward new information that is emotionally positive – a top-down process.

Moreover, relevance can be biased by client motivation. Consider, for example, a client that is tired of being serious in a therapeutic session. In order to lighten the mood the client may give obviously incorrect or ridiculous responses to questions the therapists intends as straight-forward. Alighting on the ridiculous responses and dismissing the “correct” responses is an expression of the orienting network – in this case, weighted in favor of the goal of producing humor.

Determining or directing relevance is crucial to developing the orienting network. Therapists need to carefully consider the client’s internal and external informational sources, emotional biasing, and his or her motivation. Targeting the orienting system for development or integration with other cognitive functions requires presenting the client with mixed relevant and distracting stimuli and requiring the client to attend to the relevant stimuli at the exclusion of the distractions. Stimuli of a visual nature is the easiest to so present, however the therapist should not be limited to presenting only such stimuli. Clients can orient to information coming from one or more physical senses, or to internal sources such as memories and their emotions. Keys to targeting the orienting network include:

• Biasing the client for specific stimuli – e.g. a certain color, sound, or emotional valence (i.e. the “goodness” or “badness” of an emotional experience). The specific stimuli can be as simple as “the most recent card placed on a pile” or more complex stimuli such as a specified sum of two numbers in a rolling sequence of digits separated by three numbers. It should be noted that biasing often induces selection of a sensory modality or stimuli location;
 
• Presenting the client with an information set dominated by “noise” – e.g. information that does not satisfy the biasing criteria;
 
• Stimulating emotionally feedback loops – e.g. providing client praise upon properly orienting or noting the client’s failure to properly orient.
 

Executive Network

The attentional executive network provides the ability to resolve conflicts in prioritizing relevant stimuli. Executive functioning is often a result of top-down processes. Whereas alerting is biased by saliency of the stimuli and orienting by relevance, the executive network is bias by motivation.

Motivation may be either bottom-up processes (such as may occur when feeling a sharp and unexpected pain or other stimulus-driven manner), or top-down processes (i.e. reward-related or goal-seeking processes). Motivation is inseparable from basic emotions. Within the therapeutic model, motivation is regarded as a function of basic emotions, serving both as manifestation of foundational cognition and experienced as the bi-directional feedback loop within the primary and higher cognitive functions. As a consequence of the executive networks close association with motivation, developing the executive network can result in significant modification of client behavior (i.e. reducing drug-seeking behavior for those diagnosed with SUD, etc.). 

It may often be observed that individuals with relatively low executive network functionality will, frequently but not universally, also present with relatively low working memory functionality. Hence, development of either the executive network or working memory will have a positive impact on both functions.

Therapeutically, targeting and developing the executive network requires

• Setting up increasingly challenging conflict resolution scenarios. This can most easily be accomplished through presenting activities requiring the client to logically process information or games involving decision-making with consequential results (i.e. strategic decisions rather than responses to chance);
 
• Guiding the client’s motivation to appropriately prioritize the relevant stimuli. For example, if the client is competitively motivated, choosing activities that can be engaged competitively will motivate the client to resolve conflicting stimuli advantageously; and
 
• Developing self-rewarding emotional feedback loops.
 

Observing and Developing Attention Behavior

The above discussed “cognitive process networks” should be understood as conceptual concepts only. Their utility is seen in allowing us for observe and develop a high-level understanding of the activities of the underlying neural structure and networks. By doing so we can observe and develop desired attentional behaviors, rather than concern ourselves with the activities of specific brain areas:

• Focused Attention – Focused attention describes the ability to respond directly to specific stimuli. It arises from the alerting network and plays a pivotal role in many desirable behaviors, such as problem-solving. An individual’s capacity for focusing is usually assessed through tasks requiring recognition of a given pattern or object. Focused attention is traditionally considered “in development” until the individual reaches young adulthood;
 
• Selective Attention – Selective attention describes the ability to avoid or disengage from irrelevant or distracting stimuli and to inhibit inappropriate responses. It involves the executive network and is usually measured using tasks that require conflicting dimensions of target stimuli. Selective attention typically increases from toddlerhood through the early 20s of a person’s life, with significant increases from age 2 through age 7;
 
• Alternating Attention – Alternating attention describes rapidly switching the object of attention. It is usually engaged automatically by the individual when his or her available cognitive resources are insufficient to process all required stimuli or information simultaneously. It depends upon the orienting network and is typically assessed using multiple-choice tasks or multiple-object tracking tasks. Alternating attention is available from infancy and develops through late childhood;
 
• Divided Attention – Divided attention, sometimes called “distributed attention,” concerns the ability to maintain two or more objects of attention simultaneously. It arises from the interaction of all three attentional process networks, and will usually be assessed through dual-task exercises. Divided attention increases from childhood through young adulthood.
 
• Sustained Attention – Sustained attending, also referred to as vigilance, is called upon when the task at hand requires maintenance over a prolonged period – especially when the task requires detection of rarely or unpredictably occurring target events. Sustained attention is an effortful process. It can be negatively impacted by fatigue, stress, long intervals between target events, random spacial appearance of target events, and infrequent cueing of target events. Sustained attention underlies and determines the efficiency of selective and divided attention. Sustained attention is bi-directional – that is, it can be a “top-down” process driven by internal or goal-activated behavior, or a “bottom-up” process such as may be initiated by sensory inputs. These are overlapping processes that will interact to optimize performance. In the absence of injury, sustained attention increases from early childhood into adulthood, and tends to show a moderate decline as individuals age.