## 4 Common/Unifying Theoretical-Conceptual Framework
### qEEG Phenotype and Neurophysiological, Cognitive, and Behavioral Traits
#### 4.2.3 Directedness of the Attention (Internal vs. External Focus)  
Attention is one of the basic human cognitive abilities that allow the discrimination of relevant parts of information and the ignoring of others; it usually refers to a more focused activation of the cerebral cortex that enhances information processing [577]. Attention depends on the vigilance level and, therefore, can be predicted through it; however, _direct-edness_ of attention is independent of vigilance and, thus, should be considered separately.  
It seems that directedness of attention can be conceptualized as _internal_ attention (_self-focus_) and _external_ attention (_environment-focus_). Some healthy individuals are generally well tuned into both internal and external events, which helps them to flexibly reallocate attention '_in_' and '_out_' in order to adapt their behavior to the needs of the current situation. However, others have the propensity to be self-focused or environment-focused. Exaggerated unbalanced attentional focus is typically associated with neuropsychological and is known as _attentional bias_. Attentional biases are characterized by an inability to flexibly reallocate attention to relevant internal or external stimuli, for example, an increase in theorienting of attention towards threat-related stimuli and attentional avoidance/difficulty disengaging attention from irrelevant but negatively valanced stimuli [578].  
When enhanced focus on the external environment prevails (e.g., family, friends, social and work duties, including the distracting effects of environment), the individual is more alert, anxious, or irritable due to the inability to inhibit irrelevant/inappropriate external information. Therefore, there is a predominance of perceptually guided contents over self- and somatically-guided contents; this is usually associated with anxiety, irritability, stress, and mania [579; 580; 581; 582].  
When an individual has excessive self-focus, it elevates volitional control (including both execution monitoring and internal focus) but also interferes with automatic actions, which stems from an inability to inhibit irrelevant/inappropriate internal information [583]. Excessive self-focus occurs at the expense of external environmentally oriented contents and their respective social and psychomotor functions. This shift may be manifested in symptoms such as ruminations, various somatic and vegetative symptoms, social withdrawal, lack of motivation, and psychomotor retardation, usually observed in depression and fatigue [584; 585; 300; 581; 582]. Moreover, because excessive resources are allocated to processing internal mental contents, other outward-oriented aspects such as attention, working memory, and episodic memory are compromised as well, which can lead to various neuropsychological deficits.  
Notice that in both scenarios (excess or deficit of internal attention), perceptually guided contents (environment) are not properly integrated with the somatic- and self-generated contents (self), which results in their disbalance. This disbalance of internal and external contents seems to be abnormally tilted towards either the internal or external content, which, importantly, also goes along with different degrees in the expression of self [300; 305].  
Converging evidence suggests that directedness of attention is reflected in the characteristics of qEEG phenotypes [586; 579; 587; 588; 589; 590; 21; 591; 592; 593].