Understanding Attention Goals in Music Therapy: Focused Attention (Part 1)
by Madison Michel, MM, MT-BC
Attention is a commonly addressed cognitive skill within music therapy, but how do we define attention within a clinical context? Is it focusing on one stimulus or task for a duration of time? Is it focusing on a task despite distraction? Is it selecting important information out of a larger body? Is it switching focus between two different stimuli or tasks? Is it focusing on multiple things at once?
I could argue that any of the above is an accurate understanding of attention. Indeed, attention is a broad and complex skill set not easily defined, and it can be hard to know where to start when assessing and addressing attention in music therapy.
Defining attention within the context of attentional models could potentially help music therapy clinicians better isolate needs and design interventions to target those needs. While completing my master’s degree at Colorado State University, I studied various models of attention. While it’s always essential to emphasize that our clients do not fit neatly within academic models, for me, these models have taken attention from an abstract cognitive skill to a spectrum of skills that can be isolated.
This blog series, Understanding Attention Skills in Music Therapy, will break down a commonly used attentional model and provide concrete examples of interventions and goal writing for a spectrum of attentional skills.
Clinical 5 Model of Attention
Thaut and Gardiner developed a model for attention that breaks down attention skills into five specific skills that sequentially build on each other (Thaut & Gardiner, 2014). Part 1 of this blog series targets focused attention.
1. Focused Attention: Focusing on a stimulus in light of distraction from other stimuli
2. Sustained Attention: Maintaining attention to a stimulus over time
3. Selective Attention: Selecting salient information from a larger body
4. Alternating Attention: Shifting between focusing on different stimuli
5. Divided Attention: Maintaining focus on two sources of information at the same time
How do focused attention skills present in everyday life?
What is your environment like right now? Is there light coming in through the window? Do you smell dinner cooking? Can you hear your family conversing in the other room? Is your dog curled up next to you? Is your foot asleep? Is your body telling you you’re hungry? You are focusing on reading this blog post despite other visual, auditory, olfactory, tactile, interoceptive, and proprioceptive sensory stimuli you may be perceiving around you.
What does your body and brain need in order to accomplish this?
As an example, while I’m writing this, I note that I am bouncing my foot. I do this because as I sit in my living room, my fiancee is doing yoga, I hear his workout video, and my dog is darting around the room (play time!). Bouncing my foot pulls my attention from these distractions, inward to my body which helps me filter out stimuli to focus on writing. This is an example of an accommodation I do for myself to improve focused attention.
It is pretty remarkable to think about all the things our brains must filter out from our environment in order to focus our attention on what’s in front of us. This is why focused attention is the most basic and essential skill in our model.
When is it appropriate to address focused attention with clients in music therapy?
For a neurodivergent person who perceives their sensory world differently from a neurotypical person, filtering out environmental and internal sensory information to focus attention may be a big need. Since focused attention is foundational to all other cognitive processes, this should be assessed before other attentional or cognitive skills. In fact, focused attention is essential in order to work on all other domain areas: motor, speech/communication, social, and cognitive.
Look for clues from your client and ask them about their experience. Is there a fixation or orientation to other environmental stimuli? Is there a fixation on self/body? Is staying focused on an important everyday task inconsistent in different environments or times of day? Sometimes a simple change of the environment like closing a curtain or having your client take a bathroom break is enough to help a client filter and move attention to the target stimuli. If your client is consistently having difficulty focusing on strong target stimuli, such as a music therapist presenting a music intervention, then focused attention may be your client’s primary need area.
Interventions for Focused Attention
If your client is not focusing their attention, change the stimuli. Music is a multi sensory experience, so it offers a seemingly endless toolbox of ways to change stimuli to pull attention. First, use your music directionally through melody, harmony, rhythm, dynamics, and tambre to redirect your client away from distraction and into a fully engaging musical experience. Dramatic or sudden changes naturally draw attention as well.
If changing the music does not work, note what senses the distractor stimuli seem to engage, and present a musical stimuli that focuses on that same sense. For example, if your client continually turns to pull on the handle of their metal drawer, try facilitating strumming on guitar. Perhaps the texture of the metal and pressure of the metal’s pull on the fingers will satisfy the same tactile/proprioceptive need that the drawer was. So then if the need is met by the guitar, then the environment is more conducive to focus on tasks in music therapy.
Goal Writing for Focused Attention
If focused attention is a primary need area in music therapy, it likely is in other environments. As discussed above, focused attention is foundational in order to address other skills, so objectives should be general enough to be addressed throughout a session even as domain areas vary. If a focused attention goal is written in a way that it is just targeted in a highly preferred activity, then the skills are less likely to generalize. I recommend practicing writing goals to be music therapy specific AND from a multidisciplinary standpoint in order to make sure generalization skills are being addressed outside of specific circumstances.
Goal: Client will improve focused attention in 80% of sessions.
Music Therapy Objective Example:
After attending to distraction stimuli, when the therapist provides a musically embedded attention cue, client will refocus attention on the music therapist in at least 50% of given opportunities throughout the session with no additional verbal/physical prompts per trial.
Multidisciplinary Objective Example:
After attending to distraction stimuli, when the therapist provides an attention cue/directive, client will refocus attention on the therapist in at least 50% of given opportunities throughout the session with no additional verbal/physical prompts per trial.
In summary, focused attention is a foundational skill which must be present in order to address not only cognitive skills, but skills within other domains. By writing focused attention to specific goals in a way that allows a flexible approach throughout the music therapy session, focused attention skills can be targeted within multiple contexts and activities.
In the next post in this series, I focus on sustained attention. Be sure to check it out here!
Thaut, Michael H., & Gardiner, James, C. (2014). Musical attention control training. In Thaut, Michael H., & Hoemberg, Volker (Eds.), Handbook of neurologic music therapy. (1st ed., pp. 257-269). Oxford University Press.