Objective: To examine the effectiveness of focused versus unstructured cognitive remediation to address attention deficits following traumatic brain injury (TBI). Based on previous reports on postacute TBI subjects, it was hypothesized that focused intervention would yield superior results. Design: Intervention study with pre- and posttreatment data collection. Setting: Acute rehabilitation hospital. Patients: Sixty-one consecutive patients with severe TBI referred for cognitive remediation were randomly assigned to focused or unstructured remediation of attention deficits. From this sample, 22 pairs were selected, matched for age, education, time postonset of injury, and number of remediation sessions. Interventions: Structured, hierarchical interventions were presented to the focused group. The unstructured group participated in nonsequential, nonhierarchical activities. The average number of sessions was 20. Main Outcome Measures: Digit Span, Mental Control, Simple and Choice Reaction Time, Functional Independence Measure, selected neuropsychological tests. Results: No significant group differences were detected in attentional skills, functional skills, or general cognitive abilities. Conclusions: Progress in attentional skills during acute rehabilitation after TBI is similar with focused and unstructured cognitive remediation.