A few weeks ago, I started answering a question I hear from lots of SLPs: "What do I actually *do* for cognitive therapy?"

So far, I've covered executive function and my simple formula for cognitive therapy.

Today, I'll break down attention.

Let's get into it. 👇

Attention: A Step-by-Step Guide

⚠️ Always start here

Before you do anything else, help your patient identify external distractions (noise, clutter, their phone, the environment) and internal distractions (pain, fatigue, hunger, anxiety).

Notice the distractions, name them, and choose a strategy to manage them.

I know this is easy to skip, but I would encourage you to start with this Every. Single. Session.

Repeated practice helps build the habit. You want your patients doing this when you're not around to set themselves up for success.

🎯 Then...

1️⃣ Figure out which kind of attention is breaking down

2️⃣ Build a hierarchy (start easy, get harder)

3️⃣ Anchor exercises to everyday tasks and strategies

🔄 Layer metacognition on top – predict, plan, self-check, reflect

Here's what that might look like in your session:

Say your patient sits down to pay an online bill. A notification pops up. Then another. Three tabs later, they're ten emails deep and have forgotten why they opened the computer in the first place.

Let's use our steps from above:

1️⃣ Which kind of attention? Selective and alternating. They need to ignore distractions to stay focused on the task, and find their way back if they get interrupted.

2️⃣ Build the hierarchy. Start with zero distractions and a relatively simple attention task. Increase difficulty and add interruptions as they improve.

3️⃣ Anchor it to something real. Choose functional attention tasks that your patient struggles with: entering payment info, reading an email, listening to a voicemail, etc.

🔄 Layer metacognition. Have them predict where they'll have trouble ("If a text pops up, I might lose my place"), plan strategies (finish a section before looking away, double-check answers), and reflect afterward (how did it go, what would help next time).

Attention Treatment Made Easy 🎉

Whew! It can be overwhelming to manually interrupt your patient, track the distraction count, gradually increase difficulty, take data, and coach them through strategies.

That's where the Virtual Rehab Center comes in. 🙌

Interactive Treatment: "Working with Disruptions"

In Working with Disruptions, your patient completes functional digital tasks, like entering credit card info, adding a calendar event, sending a money transfer, and more.

While they work, they are repeatedly disrupted with calls, texts, and emails.

If they accept the disruption, they must decide if it requires follow-up. If they choose to dismiss, it becomes an unread notification they can circle back to later.

The difficulty increases from 0 to 8 distractions, and strategies are built into the task.

More Interactive Treatments:

You've already seen Managing Attention for building awareness and Working with Disruptions for applying strategies under pressure, but you can also use:

💊 Managing Medications: Functional practice sorting pills into a daily, AM/PM, or morning/noon/night organizer by reading instructions that mimic real-life medication labels. This lets your patient safely practice a high-stakes attention task. Strategies are built in, and difficulty increases automatically.

🎧 Everyday Listening Comprehension: Generalize strategies to real life as your patient listens to announcements, news reports, conversations, podcasts, and more. Since audio is fleeting, it's even more important to reduce distractions and use strategies. After each round, your patient is prompted to review the strategies they used and reflect on what worked.

Of course, you can DIY these exercises. (I hope they gave you some good ideas!) But if you want ready-to-go materials, give the Virtual Rehab Center a try. 💜
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The Virtual Rehab Center helps guide your therapy, so you can focus on your patient, not the prep.

🎁 Free for 21 days. Cancel anytime in one click.

All the best,
​-Megan

P.S. Your free trial gives you access to everything! Check out all the treatments, handouts, flashcards, and more. And while you're at it – go ahead and download that PDF on managing distractions. I'm serious about starting there Every. Single. Session.