Focus on the process or outcome? It depends on the task goal.

Purpose: The benefit of an external focus over an internal focus has been well-established. Within this literature, several studies have documented a distal effect of attentional focus by comparing the efficacy of a proximal and distal external focus. A potential confound is that most distal focus cues direct the performer’s attention to an outcome occurring after the completion of movement, while the proximal cues direct attention to something that occurs during the movement process. This study aims to disentangle whether the distal effect of attentional focus comes from spatial distance (proximal vs. distal) or temporal distance (during vs. after). Method: To test this, we employed a two-handed underhand medicine ball throw for maximum distance with 38 healthy young adults. This study employed five conditions: baseline, internal-during, internal-after, external-during, and external-after focus. Results: The result indicated that both external-during and -after foci elicited a significantly greater throwing distance than internal-during (p = .006) and internal-after (p < .001), where internal-after even significantly underperformed than baseline (p = .02). Conclusion: Our findings indicate that using an outcome cue unrelated to the intended action does not enhance motor performance. Rather, the most effective approach is to use an external cue that represents the action effect either during or after the movement.

The present study examined the effects of focus instructions on the performance and learning of the standing discus throw and determined the extent of adherence to focus instructions by obtaining post-experimental verbal reports from participants. Twenty-four male college students were randomly assigned to external, internal and control focus conditions. They were given basic instruction on the throwing technique and presented a video model of the correct form. Focus instructions dealt with “trailing the movement with the discus” (external), “leading the movement with the hip” (internal), or “doing your best” (control). Four blocks of ten throws were performed in acquisition and one block of ten throws was performed in a 24hr retention test. The last two throws of each block were videotaped and measured for later analyses. The results indicated no differences between conditions on form or distance scores. However, the interviews indicated that participants in the internal and external focus groups used a combination of internal and external focus cues during acquisition and retention. These findings corroborate those of Maxwell and Masters (2002) and Poolton, Maxwell, Master, and Raab (2006) that showed learners used internal and external attentional focus cues interchangeably.

The superiority of an external focus of attention in motor performance and learning has been confirmed in many studies. However, less research has been done on how well the focus of attention performs under various conditions, such as when performing a dual-task. Recent research also suggests a holistic focus may provide a similar benefit to motor learning and performance. The current study investigates how an internal, external, and holistic focus influences motor learning in single and dual-task conditions. Sixty adolescent girls aged 14–17 without previous experience in the badminton long serve were selected as a sample and participated in the study. Participants were divided randomly into four groups: internal focus (pay attention to the performer's arm), external focus (pay attention to the racket), holistic focus (pay attention to smooth movement), and control group (no attentional focus instructions). Badminton long serves were performed in the acquisition phase (5 sessions), three retention tests (after 48 h, after one week, after one month), transfer and dual-task (with cognitive task) tests were assessed with accuracy as a dependent variable. Both external and holistic focus groups served more accurately in the retention and transfer phase (including dual-task transfer). A holistic focus also enhanced performance throughout acquisition relative to a control group. A holistic and external focus can be used to enhance motor learning. This benefit may be due to enhanced movement automaticity. Practitioners should consider the use of both holistic and external focus cues when giving instructions.

BackgroundMotor skill performance is influenced by attentional focus, and recent studies suggest that external focus, particularly a more distal external focus, may enhance performance more than an internal or a proximal external focus. However, the optimal distance for external focus and the influence of expertise level remain unclear. This systematic review and meta-analysis aimed to evaluate the effect of attentional focus distance on motor performance across various tasks and expertise levels.MethodsThis systematic review and meta-analysis followed established guidelines (PRISMA) and was registered with the International Prospective Register of Systematic Reviews (CRD42024595116). Comprehensive literature searches were performed in PubMed, Web of Science, Embase, and Cochrane Library databases. Data extraction followed the PICOS framework, and analyses were conducted using Stata and Review Manager.ResultsA total of 20 randomized controlled trials with 497 participants were included. The results indicated that a distal external focus significantly improved motor performance compared to both external proximal focus (standardized mean difference, S = 0.3, 95% CI [0.07–0.53], p = 0.01) and internal focus (SMD = 0.59, 95% CI [0.14–1.05], p = 0.01). However, no significant difference was observed between the distal and proximal external focus in novices. Subgroup analyses showed that skill level significantly moderated the effectiveness of attentional focus.ConclusionsA distal external focus improves motor performance in experienced although its effectiveness in novices requires further study. Future research should explore the mechanisms underlying these effects and skill-specific guidelines for optimal attentional focus distance.

Previous studies have demonstrated that an external focus can enhance motor learning compared to an internal focus. The benefits of adopting an external focus are attributed to the use of less effortful automatic control processes, while an internal focus relies upon more effort-intensive consciously controlled processes. The aim of this study was to compare the effectiveness of a distal external focus with an internal focus in the acquisition of a simulated driving task and subsequent performance in a competitive condition designed to increase state anxiety. To provide further evidence for the automatic nature of externally controlled movements, the study included heart rate variability (HRV) as an index of mental effort. Sixteen participants completed eight blocks of four laps in either a distal external or internal focus condition, followed by two blocks of four laps in the competitive condition. During acquisition, the performance of both groups improved; however, the distal external focus group outperformed the internal focus group. The poorer performance of the internal focus group was accompanied by a larger reduction in HRV, indicating a greater investment of mental effort. In the competition condition, state anxiety increased, and for both groups, performance improved as a function of the increased anxiety. Increased heart rate and self-reported mental effort accompanied the performance improvement. The distal external focus group also outperformed the internal focus group across both neutral and competitive conditions and this more effective performance was again associated with lower levels of HRV. Overall, the results offer support for the suggestion that an external focus promotes a more automatic mode of functioning. In the competitive condition, both foci enhanced performance and while the improved performance may have been achieved at the expense of greater compensatory mental effort, this was not reflected in HRV scores.

This study evaluated the effects of external focus distance for novice soccer players to determine motor skills and enhancing shooting accuracy in soccer. Soccer demands a unique combination of physicality and technical finesse, with precision, accuracy, and ball-handling skills distinguishing great players. This study aims to investigate the impact of different external focus cues on the shooting accuracy of novice male soccer players during a crossbar challenge. It aims to provide insights for coaches and players to optimize training techniques for skill development. The study involved 45 male participants aged 18-25 who were assigned to the distal external focus, proximal external focus, and control group. Participants performed a practice trial followed by five experimental trials with specific focus instructions. Shooting accuracy was measured using the Loughborough Soccer Shooting Test. Statistical analysis was done using SPSS version 20, which included a mixed paired t-test and one-way ANOVA to compare the group performances. Participants with a distal external focus (M=2.4080) group consistently achieved the highest scores, followed by the proximal external focus group (M=1.5573), with the control group (M=1.3467) having the lowest scores. The study shows that, in comparison to a proximal external focus and a control group, a distal external focus significantly increases soccer shooting accuracy. These findings provide valuable insights for optimizing motor skills and enhancing shooting accuracy in soccer.

Attentional focus influences sample entropy in a balancing task.

Dancing is a demanding esthetic activity with dancers having an 85% annual injury incident rate when performing complex dance motor skills. Teachers and clinicians use a combination of external and internal attentional cues when teaching dancers motor skills and when working on rehabilitation programs with injured dancers, respectively. External attentional focus (ie,focusing on movement outcome) reportedly results in superior performance than internal attentional focus (ie,focus on body movements). Interestingly, dancers reportedly often adopt an internal focus when dancing. Still, limited literature exists examining the effects of attentional focus on dancers' performance. How does attentional focus (external or internal) impact performance in dancers? Four original quasi-experimental studies met inclusion criteria. In the current examination, we found mixed results about the impact of attentional focus in dancers. Specifically, using an external attentional focus resulted in better performance in 2 studies, but these findings were limited to lesser experienced dancers. Experienced dancers did not have any physical performance differences when using external or internal focus. Internal focus also did not negatively affect dancers' performance in 2 studies. Some authors noted positive motivational effects (eg,increased perceived competence) when dancers used external focus. Low-quality evidence exists supporting the notion that in less experienced dance students, external focus improves performance. In experienced dancers, the type of attentional focus did not impact performance. External focus provides positive mental effects. Thus, clinicians working with dancers can integrate individualized feedback according to dancer level, with a preference toward external focus due to positive mental effects, to design optimal training and rehabilitation programs. Grade B evidence exists supporting the notion that an external attentional focus improves performance in less experienced dance students and also has positive mental effects. Internal attentional focus does not impede experienced dancers' performance.

External focus of attention has been shown to promote more automatic motor control, yielding better performance and more efficient technique, than an internal focus. However, most research has used closed-skill tasks in novices. The extent to which the reported pattern of findings generalises to more complex, time-constrained tasks requires further investigation. In this study, we investigated the effect of attentional focus instructions on performance and technique in an open-skill task in skilled performers. Thirteen skilled cricket batters batted from a ball projector in four conditions, receiving instructions to focus on the movement of their hands (internal focus), the movement of their bat (proximal external focus), the flight of the ball (distal external focus), or no instruction (control). Performance and technique were measured by quality of bat-ball contacts and step length/knee flexion, respectively, whilst playing straight drives. Compared to external focus and control conditions, focusing internally yielded significantly worse batting performance and shorter step lengths, with the largest effects observed between internal and distal external focus conditions. Quality of bat-ball contact data suggested that participants’ ability to protect the wicket (as evidenced by more miss/edge shots) was more negatively affected by focusing internally than their ability to play shots to score runs (as evidenced by fewer good bat-ball contacts). Findings suggest that, for skilled performance of open-skill tasks, a distal external focus yields more effective performance and technique compared with focusing internally. Findings highlight the need for further research on attentional focus effects between different skills within specific sports. Highlights A distal external focus of attention enhances performance and technique of skilled cricket batters compared with an internal focus. Providing skilled batters with no instructions yields similar performance benefits to distal external focus instructions. Focusing internally differentially negatively affects skilled cricket batters depending on the strategic intention of the shot being played (e.g. protecting the wicket vs attempting to score runs).

Attentional focus research consistently suggests that the use of an external focus of attention improves motor learning and performance relative to an internal focus. It appears, however, that external focus cues are not frequently adopted in applied sport settings. One issue that may contribute to this disparity relates to variability in how cues are employed in research and practice. Experimental research tends to use a single-cue approach, while in sports, athletes often sample several cues within the same practice. A limitation of the single-cue approach is that attentional focus effects could be due either to focus direction (internal vs. external) or to the relative effectiveness of a particular cue (e.g. an effective externally focused cue vs. an ineffective internally focused cue). This study tested whether external focus benefits generalize to situations in which participants use multiple cues of the same type throughout acquisition. Volunteers ( N = 22) learned a dart throwing task while using three internally or externally focused cues. Results indicated an external focus led to lower error scores during acquisition and a delayed retention test ( p’s &lt; .05). These results demonstrate that the external focus benefit generalizes to situations where a performer uses multiple cues.

BackgroundThe holistic focus of attention due to promising motor learning and performance benefits constitutes an desired direction for scientific investigations in sports settings. However, the generalizability of its effect on various motor skills in table tennis requires further investigation. The study aimed to determine the impact of holistic focus of attention and proximal and distal external focus on the accuracy of the table tennis forehand stroke in low-skilled players.MethodsEighty undergraduate physical education students were randomly assigned one of four groups: focus on the ball (GPEF, n = 20), focus on targets marked on the tennis table (GDEF, n = 20), focus on feeling smooth and fluid when playing (GHF, n = 20), and control group was subjected to none of the experimental factors (CNTRL, n = 20). The participant’s task was to score as many points as possible by hitting the ball using the forehand technique in table tennis inside the three smallest targets marked on the tennis table. The data were analysed using one-way ANOVA and mixed-ANOVAs with repeated measures on the last factor. Post-hoc pairwise comparisons (Fisher LSD test) were conducted to estimate the statistical significance of the intra-differences between the results. Partial Eta squared and Cohen’s d were calculated to estimate effect size.ResultsThe highest improvement of score results was observed in the group with focus on feeling smooth and fluid when playing, while the lowest was observed in the group with focus on the ball both on the post-test and delayed retention test. Nevertheless, each group significantly improved their score results on the post-test and the delayed retention test, which indicates that holistic focus, proximal and distal external focus, had similar effects on the accuracy of the table tennis forehand stroke in low-skilled players.ConclusionsThe study found that holistic focus and proximal and distal external focus are equally effective in improving the accuracy of the table tennis forehand stroke for players with lower skill levels. We recommend that coaches and practitioners use holistic and external attentional focus cues to enhance motor skill performance in table tennis. For example, when teaching or improving the table tennis strokes, coaches can apply a holistic cue like “focus on smoothing out your wrist movement” or an external cue like “focus on the target area of the table”.

Practice variability promotes an external focus of attention and enhances motor skill learning

The Optimizing Performance Through Intrinsic Motivation and Attention for Learning (OPTIMAL) theory postulates that directing attention to the intended movement effect or outcome (external focus) is more effective than directing attention to the internal body motion or body part (internal focus). This study compared external versus internal focus of attention as novice students learned ultrasound-guided peripheral cannulation. The authors hypothesized that conditions promoting an external (vs internal) focus of attention would result in better performance on immediate and delayed (retention) testing. The authors conducted a randomized, experimental study from October 2022 to February 2023 comparing external and internal focus using ultrasound-guided peripheral venous cannulation followed by practice using an ultrasound training block. Undergraduate health science students performed 4 practice trials with instructions to focus on the needle tip (external focus) or their hands (internal focus), followed by immediate and delayed (retention) assessment 2 weeks later. The primary outcome was time to successful cannulation. Results were compared using Kaplan-Meier curves and parametric survival analysis regression (accelerated failure time) models. Seventy participants completed the immediate assessment. The external focus group completed successful cannulation a mean of 2.33 times faster (95% confidence interval [CI], 1.47-3.67; P < .001) than those in the internal focus group (median time, 12.0 vs 29.5 seconds). Results also favored the external focus group during practice, with the external focus group successfully completing the task a mean of 1.83 times faster (95% CI, 1.04-3.21; P = .04) than the internal focus group. In the retention assessment, the external focus group successfully completed the task a mean of 2.37 times faster (95% CI, 1.19-4.74; P = .02) than the internal focus group. External focus of attention compared with internal focus of attention improves medical motor skill learning in novice learners.

Many studies have shown that focusing on an intended movement effect that is farther away from the body (distal external focus) results in performance benefits relative to focusing on an effect that is closer to the body (proximal external focus) or focusing on the body itself (internal focus) (see, Chua, Jimenez-Diaz, Lewthwaite, Kim & Wulf, 2021). Furthermore, the advantages of a distal external focus seem to be particularly pronounced in skilled performers (Singh & Wulf, 2020). The present study examined whether such benefits of more distal attentional focus may be associated with enhanced functional variability. Volleyball players (n = 20) performed 60 overhand volleyball serves to a target. Using a within-participants design, the effects of a distal external focus (bullseye), proximal external focus (ball) and an internal focus (hand) were compared. The distal focus condition resulted in significantly higher accuracy scores than did the proximal and internal focus conditions. In addition, uncontrolled manifold analysis showed that functional variability (as measured by the index of synergy) was greatest in the distal focus condition. These findings suggest that a distal external focus on the task goal may enhance movement outcomes by optimising compensatory coordination of body parts.

Maintaining an external direction of focus during practice is reported to facilitate acquisition of non-speech motor skills, but it is not known whether these findings also apply to treatment for speech errors. This question has particular relevance for treatment incorporating visual biofeedback, where clinician cueing can direct the learner's attention either internally (i.e., to the movements of the articulators) or externally (i.e., to the visual biofeedback display). This study addressed two objectives. First, it aimed to use single-subject experimental methods to collect additional evidence regarding the efficacy of visual-acoustic biofeedback treatment for children with /r/ misarticulation. Second, it compared the efficacy of this biofeedback intervention under two cueing conditions. In the external focus (EF) condition, participants' attention was directed exclusively to the external biofeedback display. In the internal focus (IF) condition, participants viewed a biofeedback display, but they also received articulatory cues encouraging an internal direction of attentional focus. Nine school-aged children were pseudo-randomly assigned to receive either IF or EF cues during 8 weeks of visual-acoustic biofeedback intervention. Accuracy in /r/ production at the word level was probed in three to five pre-treatment baseline sessions and in three post-treatment maintenance sessions. Outcomes were assessed using visual inspection and calculation of effect sizes for individual treatment trajectories. In addition, a mixed logistic model was used to examine across-subjects effects including phase (pre/post-treatment), /r/ variant (treated/untreated), and focus cue condition (internal/external). Six out of nine participants showed sustained improvement on at least one treated /r/ variant; these six participants were evenly divided across EF and IF treatment groups. Regression results indicated that /r/ productions were significantly more likely to be rated accurate post- than pre-treatment. Internal versus external direction of focus cues was not a significant predictor of accuracy, nor did it interact significantly with other predictors. The results are consistent with previous literature reporting that visual-acoustic biofeedback can produce measurable treatment gains in children who have not responded to previous intervention. These findings are also in keeping with previous research suggesting that biofeedback may be sufficient to establish an external attentional focus, independent of verbal cues provided. The finding that explicit articulator placement cues were not necessary for progress in treatment has implications for intervention practices for speech-sound disorders in children.