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Dwelling on potential threat cues: An eye movement marker for combat-related PTSD
Depression and Anxiety
Abstract
Although several studies have documented an attentional bias toward threat in posttraumatic stress disorder (PTSD), the nature of this bias has not been clearly delineated. The present study utilized eye tracking technology to delineate the time course and components of attentional bias for threat cues in combat-related PTSD.
Veterans with PTSD (n = 21), combat-exposed veterans without PTSD (n = 16), and nonveteran controls (n = 21) viewed emotional expressions (fearful, disgusted, happy) paired with neutral expressions for 3 s presentations.
Veterans with PTSD maintained attention longer on the fearful and disgusted expressions relative to the happy expression. This negativity bias was sustained over the course of the 3 s trials, and robustly distinguished veterans with PTSD from both veterans without PTSD and nonveteran controls.
Dwelling on potential threat cues may reflect current PTSD symptoms, or it could reflect a cognitive vulnerability factor for PTSD.
... Symptoms associated with PTSD have been found to alter internal processes that affect SA. These include hypervigilance, an increased arousal, a pattern of behavior involving constantly scanning the environment, and a high responsiveness to stimuli, all of which are often studied with modified dot probe (Fani at al., 2012;Armstrong et al., 2013) or Stroop tasks (Constans et al., 2004). PTSD symptomology is associated with significant memory deficits (DeLaRosa et al., 2020;Nejati et al., 2018) and attentional biases towards negative or threatening cues across a variety of cognitive tasks (Fani et al., 2012;Armstrong et al., 2013;Constans et al., 2004). ...
... These include hypervigilance, an increased arousal, a pattern of behavior involving constantly scanning the environment, and a high responsiveness to stimuli, all of which are often studied with modified dot probe (Fani at al., 2012;Armstrong et al., 2013) or Stroop tasks (Constans et al., 2004). PTSD symptomology is associated with significant memory deficits (DeLaRosa et al., 2020;Nejati et al., 2018) and attentional biases towards negative or threatening cues across a variety of cognitive tasks (Fani et al., 2012;Armstrong et al., 2013;Constans et al., 2004). When presented with ambiguous stimuli, those with PTSD are more likely to interpret it as threatening (Bomyea et al., 2017). ...
... Eye tracking provides a powerful and opportunistic way to unobtrusively measure eye activity and explore the perceptual, attentional, and cognitive processes involved in scene processing and thus SA (Williams & Castelhano, 2019). In accordance with studies that utilize more traditional research paradigms related to PTSD (e.g., Stroop tasks), a majority of PTSD studies that integrate eye tracking have found increased attention towards negative stimuli (Armstrong et al., 2013;Kimble et al., 2010) for those with PTSD. Specifically, those with PTSD have been found to have increased pupil size (Kimble et al., 2010) and fixations (Felmingham et al., 2011) when viewing negative or threatening stimuli. ...
Military deployments often expose personnel to highly threatening and stressful circumstances that put them at greater risk for developing Posttraumatic Stress Disorder (PTSD). PTSD may alter internal processes that affect one’s ability to maintain situational awareness (SA). Military personnel conducting patrols must maintain SA to search for threats, with potentially life-threatening consequences if SA drops. Here an exploratory analyses was conducted to determine whether there were differences in performance and eye gaze behavior between those with and without PTSD during a free-viewing visual search task conducted in a virtual desktop environment. Cognitive workload was increased through an additional auditory Math Task. While performance did not differ significantly between the two Groups, key differences in gaze behavior were found. Results showed that those with PTSD viewed significantly more trail markers, had increased duration of individual fixations overall, and decreased fixation and saccade rates during the Math Task. These results appear consistent with previous findings suggesting those with PTSD may have difficulty disengaging from stimuli.
... In addition to the morphed faces and neuroimaging studies, eye-tracking and attention bias paradigms, including dot-probe studies, have also found a correlation between PTSD and fearful face processing. In a study comparing veterans with PTSD, veterans without PTSD, and healthy nonveteran controls with no diagnoses, Armstrong et al. (2013) observed that veterans with PTSD spent the most time fixating on fearful and disgusted faces. The authors suggested that longer time spent looking at fearful faces (i.e., threat cues) could represent a symptom of PTSD or cognitive vulnerability that might increase the risk for the development of trauma-related psychopathology. ...
... We had two primary hypotheses. First, we predicted that in line with previous research, PTSS severity would be negatively related to performance in the emotional face processing task such that individuals with more severe PTSS would perform worse on an ES task, with poorer performance for each emotion category (i.e., fearful, angry, and happy faces; Armstrong et al., 2013;Badura-Brack et al., 2018;Felmingham et al., 2014). Second, we explored the associations between PTSS and both trauma recency and the level of trauma exposure. ...
... Overall, participants demonstrated the highest scores for recognizing anger, followed by happiness and, finally, fear. The finding that, on average, ES scores were lowest for fear relative to other emotions is closely in line with prior studies showing biases in processing fear in PTSD, including enhanced gaze on fearful faces (Armstrong et al., 2013), structural abnormalities in the medial prefrontal cortex (Phillips et al., 2003), and increased amygdala activation in response to the nonconscious processing of fear stimuli in PTSD (Bryant & Guthrie, 2007). ...
Trauma exposure and posttraumatic stress symptoms (PTSS) are associated with biases in emotional face processing. Existing research has utilized a variety of methodological techniques to demonstrate hyperreactivity to threatening cues in posttraumatic stress disorder (PTSD; i.e., fearful faces), but studies to date have shown conflicting findings, including both increased and decreased time fixating on fearful faces. Moreover, the impact of PTSS severity on emotional face processing in the general population is unknown, as the generalizability of prior work is limited. The current study aimed to examine the associations between PTSS and sensitivity to detecting differences in fearful, angry, and happy faces in a large international sample. Participants were 1,182 visitors (Mage = 31.13 years, SD = 13.57, range: 18–85 years) to TestMyBrain.org who completed three emotion sensitivity tasks and the PTSD Checklist for DSM‐5. The results indicated that higher PTSS scores were associated with poorer performance in detecting happiness, fear, and anger, ps < .001, with the largest effect for fear, f 2 = .06, controlling for age and gender. Participants who experienced more recent and more direct trauma exposure displayed higher levels of PTSS, with a small but significant effect whereby more direct trauma exposure was associated with higher (i.e., better) scores for anger and fear, f2s = .02. Women showed heightened sensitivity to detecting fear compared to men, d = 0.17. The present findings underscore the value of citizen science initiatives that allow researchers to obtain clinical data from diverse samples with a high degree of PTSS variability.
... Although some evidence exist for attentional hypervigilance in subjects with PTSS compared to trauma-controls in terms of initial fixation location to threat cues (Bryant, Harvey, Gordon, & Barry, 1995;Felmingham, Rennie, Manor, & Bryant, 2011) or reduced latencies to threat (Kimble et al., 2010;Matlow, 2013), most investigations found no support for hypervigilant orienting to threat in PTSS (Armstrong, Bilsky, Zhao, & Olatunji, 2013;Bryant et al., 1995;Felmingham et al., 2011;Kimble et al., 2010;Lee & Lee, 2012, 2014Matlow, 2013;Thomas, Goegan, Newman, Arndt, & Sears, 2013). Robust evidence can be reported for attentional maintenance in terms of increased dwell times on threat cues in subjects with PTSS in contrast to healthy controls. ...
... Robust evidence can be reported for attentional maintenance in terms of increased dwell times on threat cues in subjects with PTSS in contrast to healthy controls. Increased maintenance of attention on threat can be found in subjects with PTSD when contrasted with healthy trauma-exposed controls (Armstrong et al., 2013;Kimble et al., 2010;Lazarov et al., 2021;Lee & Lee, 2012, 2014Powers et al., 2019) and with healthy non-traumatized controls (Armstrong et al., 2013;Lazarov et al., 2021;Lee & Lee, 2012, 2014Thomas et al., 2013), and in trauma-exposed healthy subjects when contrasted with non-exposed healthy subjects (Armstrong et al., 2013;Lazarov et al., 2021;Lee & Lee, 2012, 2014Thomas et al., 2013). Lazarov et al. (2019) report in a systematic review strong evidence favoring the maintenance hypothesis, whilst evidence for hypervigilant orienting to threat in PTSD was little. ...
... Robust evidence can be reported for attentional maintenance in terms of increased dwell times on threat cues in subjects with PTSS in contrast to healthy controls. Increased maintenance of attention on threat can be found in subjects with PTSD when contrasted with healthy trauma-exposed controls (Armstrong et al., 2013;Kimble et al., 2010;Lazarov et al., 2021;Lee & Lee, 2012, 2014Powers et al., 2019) and with healthy non-traumatized controls (Armstrong et al., 2013;Lazarov et al., 2021;Lee & Lee, 2012, 2014Thomas et al., 2013), and in trauma-exposed healthy subjects when contrasted with non-exposed healthy subjects (Armstrong et al., 2013;Lazarov et al., 2021;Lee & Lee, 2012, 2014Thomas et al., 2013). Lazarov et al. (2019) report in a systematic review strong evidence favoring the maintenance hypothesis, whilst evidence for hypervigilant orienting to threat in PTSD was little. ...
Background and objectives
Most eye tracking based paradigms evidence patterns of sustained attention on threat coupled with low evidence for vigilance to or avoidance of threat in posttraumatic stress symptoms (PTSS). Still, eye tracking data on attention bias is particularly limited for military population. This eye tracking study investigated attentional bias in PTSS in a sample of German Armed Forces veterans.
Methods
Veterans with deployment-related PTSS (N = 24), veterans with deployment-related traumatization without PTSS (N = 28), and never-deployed healthy veterans (N = 18) were presented with pairs of combat and neutral pictures, pairs of general threat and neutral pictures, and pairs of emotional and neutral faces. Their eye gazes were tracked during a free viewing task. 3 x 3 x 2 mixed general linear model analyses were conducted. Internal consistency of attention bias indicators was calculated for the entire sample and within groups.
Results
Veterans with PTSS dwelled longer on general threat AOIs in contrast to non-exposed controls and shorter on general threat and combat associated neutral AOIs in contrast to both control groups. Veterans with PTSS entered faster to general threat AOIs than non-exposed controls. Veterans with PTSS showed circumscribed higher attention fluctuation in contrast to controls. Internal consistency varied across attention bias indicators.
Limitations
Statistical power was reduced due to recruitment difficulties.
Conclusions
Evidence is provided for the maintenance hypothesis in PTSS. No robust evidence is provided for hypervigilant behavior in PTSS. Findings on attention bias variability remain unclear, calling for more investigations in this field.
... A more in-depth examination of findings from extant eye-tracking research (for a systematic review, see Lazarov et al., 2019) shows that increased sustained attention on threat has been consistently shown when comparing PTSD participants with healthy participants with no trauma exposure (Armstrong, Bilsky, Zhao, & Olatunji, 2013;Lee & Lee, 2012Matlow, 2013;Thomas, Goegan, Newman, Arndt, & Sears, 2013), with similar results emerging when comparing PTSD participants to trauma-exposed healthy participants (Armstrong et al., 2013;Kimble, Fleming, Bandy, Kim, & Zambetti, 2010;Lee & Lee, 2012Powers et al., 2019). Comparing trauma-exposed healthy participants with healthy participants who did not experience a traumatic event, aiming to clarify the effects of trauma-exposure per-se on attention allocation, shows elevated threat-related sustained attention in the trauma-exposed group (Lee & Lee, 2012Thomas et al., 2013; cf. ...
... A more in-depth examination of findings from extant eye-tracking research (for a systematic review, see Lazarov et al., 2019) shows that increased sustained attention on threat has been consistently shown when comparing PTSD participants with healthy participants with no trauma exposure (Armstrong, Bilsky, Zhao, & Olatunji, 2013;Lee & Lee, 2012Matlow, 2013;Thomas, Goegan, Newman, Arndt, & Sears, 2013), with similar results emerging when comparing PTSD participants to trauma-exposed healthy participants (Armstrong et al., 2013;Kimble, Fleming, Bandy, Kim, & Zambetti, 2010;Lee & Lee, 2012Powers et al., 2019). Comparing trauma-exposed healthy participants with healthy participants who did not experience a traumatic event, aiming to clarify the effects of trauma-exposure per-se on attention allocation, shows elevated threat-related sustained attention in the trauma-exposed group (Lee & Lee, 2012Thomas et al., 2013; cf. ...
... Comparing trauma-exposed healthy participants with healthy participants who did not experience a traumatic event, aiming to clarify the effects of trauma-exposure per-se on attention allocation, shows elevated threat-related sustained attention in the trauma-exposed group (Lee & Lee, 2012Thomas et al., 2013; cf. see Armstrong et al., 2013). Taken together, it has been recently suggested that trauma exposure in itself may be sufficient to bias attention toward trauma-relevant stimuli, manifesting in sustained attention on threat cues, with PTSD symptomology further amplifying this bias (Lazarov et al., 2019). ...
Background
Eye-tracking-based attentional research implicates sustained attention to threat in posttraumatic stress disorder (PTSD). However, most of this research employed small stimuli set-sizes, small samples that did not include both trauma-exposed healthy participants and non-trauma-exposed participants, and generally failed to report the reliability of used tasks and attention indices. Here, using an established eye-tracking paradigm, we explore attention processes to different negatively-valenced cues in PTSD while addressing these limitations.
Methods
PTSD patients ( n = 37), trauma-exposed healthy controls (TEHC; n = 34), and healthy controls (HC; n = 30) freely viewed three blocks of 30 different matrices of faces, each presented for 6 s. Each block consisted of matrices depicting eight negatively-valenced faces (anger, fear, or sadness) and eight neutral faces. Gaze patterns on negative and neural areas of interest were compared. Internal consistency and test-retest reliability were evaluated for the entire sample and within groups.
Results
The two trauma-exposed groups dwelled longer on negatively-valenced faces over neutral faces, while HC participants showed the opposite pattern. This attentional bias was more prominent in the PTSD than the TEHC group. Similar results emerged for first-fixation dwell time, but with no differences between the two trauma-exposed groups. No group differences emerged for first-fixation latency or location. Internal consistency and 1-week test-retest reliability were adequate, across and within groups.
Conclusions
Sustained attention on negatively-valenced stimuli emerges as a potential target for therapeutic intervention in PTSD designed to divert attention away from negatively-valenced stimuli and toward neutral ones.
... However, in PTSD, findings from ET studies are not consistent. Using verbal experimental stimuli, two studies found evidence of a vigilance bias (Bryant, Harvey, Gordon, & Barry, 1995;Felmingham, Rennie, Manor, & Bryant, 2011), whereas others, mostly using different kinds of pictorial stimuli, found evidence of a maintenance bias (Armstrong, Bilsky, Zhao, & Olatunji, 2013;Kimble, Fleming, Bandy, Kim, & Zambetti, 2010;Lee & Lee, 2012Thomas, Goegan, Newman, Arndt, & Sears, 2013). Virtually no study found evidence of both biases within one experiment. ...
... The aim of the present study was to fill this gap. We were interested in whether attentional bias toward trauma-related material is specifically related to the occurrence of PTSD, as several previous studies have suggested (e.g., Armstrong et al., 2013;Lee & Lee, 2012Pineles, Shipherd, Mostoufi, Abramovitz, & Yovel, 2009). Therefore, we compared participants with interpersonal childhood trauma with and without a more complex symptom representation of PTSD, including symptoms of emotional instability. ...
... Eye-tracking data were reduced using the Eye Link Data Viewer (SR Research, Ottawa, Ontario, Canada). As with the majority of ET studies, a fixation was defined as stable gaze within a circular area of 1°of visual angle for at least 100 ms (see, e.g., Armstrong et al., 2013;Waechter et al., 2014). To analyze the vigilance bias, we calculated the number of trials with an initial fixation on the target stimulus relative to the total number of valid trials separately for each emotional category (see Armstrong et al., 2013;Felmingham et al., 2011). ...
Objective:
Previous studies have found evidence of an attentional bias for trauma-related stimuli in posttraumatic stress disorder (PTSD) using eye-tracking (ET) technlogy. However, it is unclear whether findings for PTSD after traumatic events in adulthood can be transferred to PTSD after interpersonal trauma in childhood. The latter is often accompanied by more complex symptom features, including, for example, affective dysregulation and has not yet been studied using ET. The aim of this study was to explore which components of attention are biased in adult victims of childhood trauma with PTSD compared to those without PTSD.
Method:
Female participants with (n = 27) or without (n = 27) PTSD who had experienced interpersonal violence in childhood or adolescence watched different trauma-related stimuli (Experiment 1: words, Experiment 2: facial expressions). We analyzed whether trauma-related stimuli were primarily detected (vigilance bias) and/or dwelled on longer (maintenance bias) compared to stimuli of other emotional qualities.
Results:
For trauma-related words, there was evidence of a maintenance bias but not of a vigilance bias. For trauma-related facial expressions, there was no evidence of any bias.
Conclusions:
At present, an attentional bias to trauma-related stimuli cannot be considered as robust in PTSD following trauma in childhood compared to that of PTSD following trauma in adulthood. The findings are discussed with respect to difficulties attributing effects specifically to PTSD in this highly comorbid though understudied population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
... The first disadvantage of RT-based tasks is their limited ability to capture the complexity of attention processes and to easily distinguish between the different aspects of attention (Weierich et al., 2008;Felmingham et al., 2011;Armstrong et al., 2013), such as facilitated threat detection, difficulty disengaging attention from threat, and attentional threat avoidance (Weierich et al., 2008;Cisler and Koster, 2010). Facilitated threat detection, or threat vigilance, is defined as the ease or speed in which threat is detected, as attention is preferentially drawn to threatening stimuli in the environment. ...
... Facilitated/ biased threat detection can be determined by examining the location and the latency of initial eye movements occurring immediately after stimulus onset, namely, first fixations. A greater proportion of first fixations on threat compared with neutral stimuli, or shorter latencies to first fixate on threat compared with neutral stimuli, are considered evidence of facilitated threat detection (Felmingham et al., 2011;Armstrong et al., 2013). Likewise, while less common, scan-path variables are sometimes used to reflect hypervigilance behavior occurring when scanning different stimuli, which might enhance threat detection (Stewart, 2012;Kimble et al., 2014). ...
... When computed for initial fixations, increased dwell time on threat compared with neutral stimuli signals difficulty in initial attention disengagement. When accumulating the durations of all fixations made on threat compared with neutral stimuli during stimulus presentation (i.e. total dwell time), increased dwell time usually reflects sustained attention or maintenance of attention on threat (Armstrong and Olatunji, 2012;Armstrong et al., 2013). Alternatively, though less common, total fixation count may be also used to indicate sustained attention, although total fixation count and dwell time are usually highly correlated (Waechter et al., 2014). ...
Background
Cognitive models of posttraumatic stress disorder (PTSD) implicate threat-related attentional biases in the etiology and phenomenology of the disorder. However, extant attentional research using reaction time (RT)-based paradigms and measures has yielded mixed results. Eye-tracking methodology has emerged in recent years to overcome several inherent drawbacks of RT-based tasks, striving to better delineate attentional processes.
Methods
A systematic review of experimental studies examining threat-related attention biases in PTSD, using eye-tracking methodology and group-comparison designs, was conducted conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were selected following a systematic search for publications between 1980 and December 2017 in PsycINFO, MEDLINE and the National Center for PTSD Research's Published International Literature on Traumatic Stress (PILOTS) database. Additional records were identified by employing the Similar Articles feature in PubMed, and the Cited Reference Search in ISI Web of Science. Reference sections of review articles, book chapters and studies selected for inclusion were searched for further studies. Ongoing studies were also sought through Clinicaltrials.gov.
Results
A total of 11 studies ( n = 456 participants in total) were included in the final review. Results indicated little support for enhanced threat detection, hypervigilance and attentional avoidance. However, consistent evidence emerged for sustained attention on threat (i.e. attention maintenance) in PTSD.
Conclusions
This review is the first to systematically evaluate extant findings in PTSD emanating from eye-tracking studies employing group-comparison designs. Results suggest that sustained attention on threat might serve as a potential target for therapeutic intervention.
... To address this need, researchers have examined the relationship between PTSD and attention for emotional words (Bryant et al., 1995;Felmingham et al., 2011;Karl et al., 2006;Khoury-Malhame et al., 2011;Pineles et al., 2009), faces (Armstrong et al. 2013;Fani et al., 2012;Lee and Lee, 2014), and images (Kimble et al., 2010;Lee and Lee, 2012;Mueller-Pfeiffer et al., 2010). For example, Bryant et al. (1995) compared motor vehicle accident survivors who developed PTSD to those who did not as they viewed groups of neutral and threat-related words. ...
... Eye tracking studies have shown that victims of dating violence spend more time looking at negative images and less time looking at positive images (Lee and Lee, 2012), as well as more time looking at angry faces (Lee and Lee, 2014) compared to subjects without a history of dating violence. Similarly, veterans with PTSD have been found to spend more time looking at fear and disgust facial expressions than happy facial expressions (Armstrong et al., 2013). Also, as Fani et al. (2012) found, individuals with PTSD have a heightened awareness, hyperarousal reaction to threatening stimuli, specifically threatening faces. ...
... These findings are consistent with a previous study which found that shorter eye fixations on fear faces prior to deployment was associated with a stronger relationship between stress exposure and PTSD symptoms in soldiers (Beevers et al., 2011). However, our findings are somewhat at odds with results obtained by Armstrong et al. (2013) who found that veterans with PTSD spend more time looking at fear and disgust faces when they are paired with a neutral face. This difference in results may be due to differences in the tasks used by each study. ...
Abnormal patterns of attention to emotional faces and images are proposed by theories of posttraumatic stress disorder (PTSD), and this has been demonstrated empirically. However, few studies have examined how PTSD symptoms are associated with attention to emotional faces in the context of emotional background images. Eye tracking data were collected from seventy-eight undergraduates with a history of experiencing at least one traumatic event as they completed the Contextual Recognition of Affective Faces Task (CRAFT; Milanak and Berenbaum, 2014), which requires subjects to identify the emotion depicted by faces superimposed on an emotional background image. Greater PTSD symptom severity was associated with more time spent looking at background contexts and less time looking at target faces. This is consistent with greater susceptibility to distraction by task-irrelevant emotional stimuli. The duration of each gaze fixation upon fear faces was shorter for those with greater PTSD symptoms, and this pattern was marginally significant for disgust faces. These findings suggest that PTSD symptoms may relate to greater attention toward non-facial background scenes and less attention toward facial stimuli, especially when conveying a fear or disgust expression.
... As a complex and dynamic process, attention involves multiple processing stages, including selective attention where the focus is directed toward specific stimuli, and sustained attention where the focus on certain stimuli is maintained over an extended (Yiend, 2010). The depth of information processing varies between these attention types and can consequently further influence both the appraisal and recall of information (Armstrong et al., 2013). For instance, selective attention, which primarily dictates "what information is processed," may be predominantly related to the subsequent appraisal processes and only marginally linked to memory (Williams, 2006). ...
... The null associations of sustained attention bias with memory bias and posttraumatic stress symptoms might be relevant to the lexical stimuli used in our study. The lexical stimuli, which can be easily and rapidly processed, enable a rapid appraisal of stimuli contents in parafoveal vision and may finally lead to enhanced threat detection instead of the maintenance of attention toward negative contents (Armstrong et al., 2013). In other words, negative words may be too simple to sustain attention (Block & Liberzon, 2016;Bomyea et al., 2017). ...
Objective: Both theoretical and empirical studies suggest that negative cognitive biases significantly influence the onset and persistence of posttraumatic stress disorder (PTSD) symptoms. However, the interplay among these cognitive biases and their conjoint contribution to the long-term trajectory of posttraumatic stress symptoms remains underexplored. This study delves into the interplay among attention, appraisal, and memory biases within a provisional PTSD population and evaluates the predictive effects of two integrative models (weakest link, additive approach) on posttraumatic stress symptoms reported 2 months later. Method: Sixty Chinese participants (Mage = 20.17, SDage = 2.11) with provisional PTSD undertook the scrambled sentences test (appraisal bias) with their eye movements recorded (attention bias) and then the free recall task (memory bias). Posttraumatic stress symptom was assessed at baseline and 2-month follow-up. Results: Selective attention bias toward negative words was positively associated with the negative appraisal of scrambled sentences, which subsequently showed a strong association with negative memory bias. Regarding the progression of posttraumatic stress symptoms, the additive approach was found to be a more reliable predictor of self-reported posttraumatic stress symptoms at 2 months than the weak link approach. Conclusions: This study provides initial evidence supporting the combined cognitive biases hypothesis in provisional PTSD. It also underscores potential avenues to enhance cognitive bias modification techniques. Replication of these findings in broader clinical samples is essential.
... On the other hand, Weidmann et al. (2020) found evidence of a maintenance bias but not of a vigilance bias in patients with PTSD compared to healthy controls. Armstrong et al. (2013) described a maintenance of gaze only for fearful and disgusted expressions relative to happy ones that sustained beyond the reflexive gaze reaction. Individuals with MDD seem to have a double bias with increased attention for sad faces and reduced attention for happy faces, where increased maintenance of gaze toward sad faces was positively associated with the severity of depressive symptoms (Duque & Vázquez, 2015). ...
... However, we did not find significant group differences with regard to gaze behavior. Findings concerning a hypervigilance or maintenance bias in PTSD are diverging, and many studies failed to find biased attention on the basis of eye movements (Armstrong et al., 2013;Thomas et al., 2013;Weidmann et al., 2020). For other patient groups, attention biases have been more consistent, such as a negativity bias for individuals with MDD that are subsequently unable to disengage from the stimulus (Nyquist & Luebbe, 2020). ...
... Gaze contingency was used such that the stimuli for each trial were only presented after the participant had attended to a central fixation cross for a duration of at least 500ms at the beginning of each trial. Following the fixation cross, two images appeared side-by-side on the screen (i.e., neutral-neutral, threat-neutral [block 1], or positiveneutral [block 2]) for 3,000 ms (Armstrong, Bilsky, Zhao, & Olatunji, 2013). Neutral-neutral image pairings were presented in both blocks (60 trials in each block) to reduce the expectancy of seeing an emotionally arousing image. ...
... Failing to do so, may mask potentially important findings and further hinder progress in this area of research. 1 Consistent with previous research (Armstrong et al., 2013;Bardeen & Daniel, 2017;Buckner et al., 2010), dwell threat and dwell positive were also calculated for each 500ms epoch interval within the larger 3000ms presentation duration to examine differences in dwell time across early and later stages of information processing. Mean differences in dwell time, based on the four combinations of each cluster score and attentional control (i.e., high and low values of each + 1 SD), were not significantly different at any of the epoch intervals, thus suggesting that differences in the slope of threat bias over time, based on these individual differences, was likely of relatively little substantive value in this study. ...
Individual differences in attentional control may explain null findings and inconsistent patterns of threat-related attentional bias (ABT) that are common in the posttraumatic stress disorder (PTSD) literature. At Time 1 (T1), trauma-exposed community participants (N = 89) completed a clinical interview, self-report measures, and an eye-tracking task developed to assess ABT. Participants completed follow-up assessments online 6 (T2) and 12 (T3) months later. Those with higher PTSD symptoms and deficits in attentional control exhibited a pattern of undercontrol, characterized by attention maintenance on threat and increased arousal. In contrast, those with higher PTSD symptoms and relatively better attentional control exhibited a pattern of overcontrol, characterized by threat avoidance and reduced arousal. These effects were specific to threat stimuli. Among PTSD symptom clusters, symptoms of hyperarousal were of central importance to the observed effects. Results from the longitudinal analysis indicate that both of these patterns of ABT are maladaptive, resulting in symptom maintenance at T2 and T3. These results have implications for (a) reconciling tensions between disparate models of ABT (i.e., vigilance-avoidance vs. attention maintenance), (b) precision medicine based approaches to targeting PTSD-related ABT, and (c) understanding the transdiagnostic role that attentional control may play in influencing ABT expression.
... interference) but not with respect to initially orienting gaze towards emotional stimuli (i.e. facilitated detection; Armstrong et al., 2013). Whereas these studies focused on temporal aspects of attentional bias (i.e. ...
... First, Ashley et al. (2013) found that veterans with PTSD had slower reaction times and delayed habituation when responding to combat-related stimuli relative to military and civilian controls. Second, Armstrong et al. (2013) found that veterans with PTSD maintained attention longer on negative vs. positive stimuli than either control group. Finally, Olatunji et al. (2013) found that veterans with PTSD demonstrated impaired target detection and accuracy on an RSVP task, indicating heightened attentional capture for threat in military PTSD. ...
Background: Some cognitive biases, such as excessive attention to threat, are associated with PTSD. However, they may be adaptive for military personnel; attending to threat may improve safety for deployed personnel.
Aims: The extent to which military personnel with vs. without PTSD differ with respect to specific cognitive biases is currently unclear. This systematic review aimed to address this question.
Methods: PRISMA guidelines were followed. Articles were identified using a comprehensive literature search; 21 studies (with 1977 participants) were reviewed.
Results: All studies were of “moderate” or “strong” quality. Military personnel with vs. without PTSD used overgeneralised language when describing autobiographical memories and demonstrated impaired performance on a modified Stroop task. Studies using dot-probe paradigms conceptualised attentional response as a dynamic process, fluctuating between bias towards and away from threat; military personnel with vs. without PTSD demonstrated greater fluctuation. Studies using visual search tasks concluded that attentional bias in PTSD involves interference (difficulty disengaging from threat) rather than facilitation (enhanced threat detection). Finally, personnel with vs. without PTSD demonstrated interpretation bias, completing ambiguous sentences with negative rather than neutral endings.
Conclusion: The implications for military populations and recommendations for further research and clinical practice are considered.
Prospero registration: PROSPERO 2018 CRD42018092235.
... Additionally, considerable variability in stimulus presentation duration has been observed (i.e., from 1,000 to 30,000ms; Felmingham et al., 2001;Beevers et al., 2011, respectively). Despite substantial between-study ATTENTION REGULATION IN PTSD 23 variability in task design, one finding has been observed fairly consistently -Individuals with PTSD (or relatively higher posttraumatic symptoms in some cases) spend significantly more time looking at negatively-valenced stimuli than trauma control participants (i.e., attention maintenance; Armstrong et al., 2013;Bardeen & Daniel, 2017b;Kimble et al., 2010, Lee & Lee, 2012. The only study in which the results suggested facilitated engagement to both traumaspecific and threat-general stimuli was also the only study in which word stimuli were used and the measure of facilitation that was used is known for having unacceptably low reliability (i.e., number of initial fixations; Felmingham et al., 2011). ...
... To date, free-viewing tasks have been used in all of the published studies in which eye tracking has been employed to examine PTSD-related ABT(Armstrong, Bilsky, Zhao, & Olatunji, 2013;Bardeen & Daniel, 2017b;Beevers, Lee, Wells, Ellis, & Telch, 2011;Felmingham, Rennie, Manor, & Bryant, 2011;Kimble, Fleming, Bandy, Kim, & Zambetti, 2010; ...
Attentional deployment is one of the primary regulation strategies discussed in prominent information processing models of emotion regulation. Despite its theoretical relevance to emotion regulation, attentional deployment has received relatively little focus in the emotion regulation literature compared to regulatory strategies that occur later in the emotion generative process. It may be especially important to consider the regulatory role of attentional deployment in the pathogenesis of posttraumatic stress disorder (PTSD) because hypervigilance toward threatening information is a hallmark symptom of the disorder and attentional bias to threat has been suggested as a factor contributing to the development and maintenance of PTSD. In examining the regulatory role of attentional deployment in PTSD, it was first necessary to discuss information processing models of PTSD and review the extant literature in the area of PTSD-related attentional biases. Discrepancies in this literature may be the result of failing to consider the role that effortful attentional deployment plays in regulating emotional distress. The relevance of attentional deployment to recent attention-related clinical interventions for PTSD is also discussed.
... Participants were also instructed to identify a fixation target at the beginning of each trial (either an "O" or an "X") using the computer keyboard to ensure central fixation (Armstrong, Olatunji, Sarawgi, & Simmons, 2010). Next, two images appeared side-by-side on the screen (i.e., neutral-neutral or threat-neutral) for 3,000 ms (Armstrong, Blisky, Zhao, & Olatunji, 2013). Neutral-neutral image pairings were presented to reduce threat expectancy. ...
... IAPS images intersected at a visual angle of 13.3° × 12.4°. The two images were so that we could examine within-trial variability in Dwell Time (e.g., Armstrong et al., 2013;Buckner et al., 2010). Pupil diameter was recorded over the entire 3,000ms trial interval for neutral-threat pairings, as well as during the presentation of the fixation cross. ...
The purpose of the present study was to use eye-tracking technology to (a) show that attentional control can be used to reduce attentional bias to threat (ABT) among those with higher levels of posttraumatic stress (PTS) symptoms, (b) identify the specific attentional control (AC) processes (i.e., inhibition, shifting, working memory updating) that account for this effect, and (c) determine the short-(sympathetic nervous system reactivity) and long-term effects (PTS symptoms) of using attentional control in this manner. At Time 1 (T1), participants (N = 116 trauma exposed) completed self-report measures, an eye-tracking task assessing ABT, and behavioral measures assessing cognitive processes. A subsample (n = 49) completed an online follow-up assessment (T2). AC at T1 moderated the PTS-ABT relationship. Inhibitory ability appears to be driving this effect. Those with higher PTS symptoms and higher AC at T1, who spent less time attending to threat stimuli and had the lowest sympathetic response, had the highest levels of PTS symptoms at T2. Findings suggest that the habitual use of AC (especially inhibition) to shift attention from threat to neutral stimuli may alleviate distress in the short-term for those with higher PTS symptoms, but maintain, and perhaps exacerbate, PTS symptoms over longer periods.
... Therefore, first fixation latency is used to index initial attentional vigilance (Garner et al., 2006;Lazarov, Basel, Dolan, Dillon, & Schneier, 2021). In addition, gaze duration and total fixation duration can reflect attentional maintenance to addiction-related information (Armstrong, Bilsky, Zhao, & Olatunji, 2013;Armstrong & Olatunji, 2012;Elias, Massad, & Lazarov, 2021;Lazarov et al., 2019). These indices can be combined to illustrate the specific pattern of attention bias. ...
... A sample size of 20 participants per group was selected, since this is necessary to detect a large effect size, with power set at 80% and alpha at 10% (Cohen, 1992). These sample sizes were also comparable with other studies involving veterans with and without PTSD and civilian controls (e.g., Armstrong et al., 2013). ...
Deployed combat personnel are at increased risk of post-traumatic stress disorder (PTSD). People with PTSD often judge ambiguous information as negative or threatening (interpretation bias). However, this may be adaptive during deployment. The current study aimed to investigate the extent to which interpretation bias in combat personnel is associated with PTSD symptoms, rather than with appropriate situational awareness. Combat veterans with and without PTSD and civilians without PTSD generated explanations for ambiguous situations and judged the likelihood of various possible explanations. They also made judgements about future consequences of worst-case scenarios, and their coping ability. Veterans with PTSD generated more negative explanations for ambiguous situations, judged negative interpretations as more likely and felt less able to cope with the worst-case scenario than veteran and civilian controls. Veterans with versus without PTSD judged worst-case scenarios to have more severe and insurmountable consequences, although they did not differ significantly from civilians. Veteran versus civilian controls rated their coping ability as higher; this was the only difference between control groups. In summary, group differences in interpretation bias were associated with PTSD symptoms rather than combat role. Veterans without PTSD may be particularly resilient when coping with everyday adversity.
... Therefore, first fixation latency is used to index initial attentional vigilance (Garner et al., 2006;Lazarov, Basel, Dolan, Dillon, & Schneier, 2021). In addition, gaze duration and total fixation duration can reflect attentional maintenance to addiction-related information (Armstrong, Bilsky, Zhao, & Olatunji, 2013;Armstrong & Olatunji, 2012;Elias, Massad, & Lazarov, 2021;Lazarov et al., 2019). These indices can be combined to illustrate the specific pattern of attention bias. ...
... Specific phobias are characterized by a vigilant-avoidant pattern of gaze, as the initial orienting bias towards phobic stimuli (e.g., spiders, injections) is followed by increasing avoidance (Armstrong, Hemminger, et al., 2013;Rinck & Becker, 2006). In contrast, PTSD is characterized by sustained monitoring of threat across the trial (Armstrong, Bilsky, et al., 2013;Lazarov et al., 2019Lazarov et al., , 2021 These findings may suggest that voluntary gaze reflects the competing goals of harm avoidance (monitor urgent threat cues to prevent harm) and emotion regulation (avoid monitoring less urgent threat cues to reduce anxiety) (Armstrong & Olatunji, 2012). Interestingly, individuals with spider phobia do not avoid looking at spiders, but rather monitor them, when they are real (in a terrarium; Lange et al., 2004) or encountered in virtual reality (Rinck et al., 2010) consistent with the notion that appraisal of urgency (the need to provide rapid behavioral response to reduce harm) influences the strategic use of gaze in anxiety-related disorders. ...
Attentional bias for threat is an adaptive feature of human psychology, but may become maladaptive in anxiety-related disorders, causing distress, distraction, and distorted perception of danger. Reaction time measures have revealed automatic, covert attention biases to threat, whereas eye tracking has revealed voluntary biases over a larger timescale, with monitoring or avoidance depending on context. Recently, attentional bias for threat has been studied as a conditioned fear response, providing new insight into how attentional biases are acquired and inhibited through learning experiences. However, very few studies have examined voluntary gaze biases during fear learning. In a novel eye tracking paradigm (N = 78), we examine the overt components of attentional bias to threat and safety cues. We found that threat cues, but not safety cues, elicited an initial orienting bias, as well as sustained monitoring bias across 10-second trials. This collective “vigilance” response to threat cues was insensitive to extinction, whereas condition fear responding revealed by pupil size and self-report ratings showed marked extinction. Vigilance may be less prone to extinction, compared to autonomic arousal, because eye movements require less energy than preparing the body for defensive behavior. Implications for understanding vigilance in PTSD are considered.
... Third, the present study used negatively-valenced faces rather than trauma-specific stimuli, which could elicit other connectivity patterns related to trauma. However, as we only included participants for whom DSM-5 criterion A was of an interpersonal nature, we believe that faces are highly relevant stimuli for this cohort (Armstrong et al., 2013;Fonzo et al., 2010;Garrett et al., 2012;Lee & Lee, 2014). Finally, this study focused on picture-based stimuli. ...
Background
In a recent eye-tracking study we found a differential dwell time pattern for negatively-valenced and neutral faces among patients with posttraumatic stress disorder (PTSD), trauma-exposed healthy control (TEHCs), and healthy control (HC) participants. Here, we explored whether these group differences relate to resting-state functional connectivity (rsFC) patterns of brain areas previously linked to both attention processes and PTSD. These encompass the amygdala, dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (dlPFC), ventrolateral prefrontal cortex (vlPFC), and nucleus accumbens (NAcc).
Methods
Ten minutes magnetic resonance imaging rsFC scans were recorded in 17 PTSD patients, 21 TEHCs, and 16 HCs. Participants then completed a free-viewing eye-tracking task assessing attention allocation outside the scanner. Dwell time on negatively-valenced stimuli (DT%) were assessed relative to functional connectivity in the aforementioned seed regions of interest (amygdala, dACC, dlPFC, vlPFC, and NAcc) to whole-brain voxel-wise rsFC.
Results
As previously reported, group differences occurred in attention allocation to negative-valence stimuli, with longer dwell time on negatively valence stimuli in the PTSD and TEHC groups than the HC group. Higher DT% correlated with weaker NAcc-orbitofrontal cortex (OFC) connectivity in patients with PTSD. Conversely, a positive association emerged in the HC group between DT% and NAcc-OFC connectivity.
Conclusions
While exploratory in nature, present findings may suggest that reward-related brain areas are involved in disengaging attention from negative-valenced stimuli, and possibly in regulating ensuing negative emotions.
... However, we did not 399 find significant group differences with regard to gaze behavior. Findings concerning a hypervigilance 400 or maintenance bias in PTSD are diverging and many studies failed to find biased attention on the basis 401 of eye movements (Armstrong et al., 2013;Thomas et al., 2013;Weidmann et al., 2020). For other 402 patient groups, attention biases have been more consistent, such as a negativity bias for individuals with 403 MDD that are subsequently unable to disengage from the stimulus (Nyquist & Luebbe, 2020). ...
Objective: Childhood trauma is highly prevalent and can have a negative impact on the development of socioemotional processes resulting in a higher vulnerability for mental disorders in adulthood. Previous studies have associated the severity of childhood trauma with deficits in social functioning, such as a negative attention bias, suggesting altered social information processing as a mechanism underlying the association between childhood trauma and transdiagnostic psychopathologies. Method: In a cross-sectional setup with a total of 103 participants (26 with major depressive disorder, MDD; 24 with posttraumatic stress disorder, PTSD; 22 with somatic symptom disorder, SDD; and 31 healthy volunteers, HV), this study applied eye tracking in an emotion recognition paradigm. Reaction times, accuracy, and gaze behavior were analyzed for 4 different facial expressions as a function of self-reported childhood trauma and diagnosis. The aim was to investigate to what extent emotion processing is associated with (a) childhood trauma, (b) psychopathology, and (c) respective interacting effects. Results: Patients showed higher reaction times and error rates overall in classifying emotions than HVs, especially for the recognition of anger and fear. Individuals with a diagnosis of PTSD and MDD were particularly slow in their response to these emotions. Higher scores of reported childhood trauma were associated with faster responses for classifying anger and fear and slower initiation of eye movements for SSD, MDD, and HVs for anger. Conclusion: These findings indicate that childhood trauma may contribute to attentional and information-processing biases relevant for social interaction. Identifying individual social deficits offers implications for tailored therapeutic interventions.
... In a review of eye-tracking studies assessing attention to threat in patients with PTSD, results consistently showed that these individuals exhibit sustained attention to threatening stimuli compared to controls (Lazarov et al., 2019). Veterans with PTSD have been found to maintain attention longest on fearful and disgusted facial expressions specifically (Armstrong et al., 2013). Veterans with lifetime combatrelated PTSD were found to have impaired emotion recognition accuracy for all seven emotions studied (Castro-Vale et al., 2020). ...
Nonverbal communication is integral to the success of psychotherapy and facial expression is an important component of nonverbal communication. The SARS CoV-2 pandemic has caused alterations in how psychotherapy services are provided. In this paper, potential issues that may arise from conducting psychotherapy when both the patient and therapist are wearing masks are explored. These include higher likelihood of misidentifying facial expression, especially when expression is incongruent with body language, and when the lower face is more important for correct identification of emotion. These issues may be particularly problematic for patient populations for whom emotion recognition may be a problem at baseline, or for those more prone to biases in emotional recognition. Suggestions are made for therapists to consider when seeing patients in-person when masks are necessary.
... Patients with depression experienced shorter scanpath length in the free-viewing test, shorter duration of saccades and lower peak saccade velocity in the smooth pursuit test (Takahashi et al., 2021), as well as showed a greater latency, a reduction in movement precision, and a reduced peak velocity in the antisaccade task (Bittencourt et al., 2013;Li et al., 2016). Furthermore, individuals affected by PTSD and/or depression maintained their attention longer on the fearful, disgusted, and depressed expressions relative to the happy expression in comparison to controls (Sears et al., 2011;Armstrong et al., 2013;Lee and Lee, 2014;Powers et al., 2019). Additionally, PTSD patients demonstrated a greater number of initial eye fixations on the threat word and more orienting responses on all threatening and neutral words than controls (Felmingham et al., 2011;Powers et al., 2019). ...
The COVID-19 pandemic has adverse consequences on human psychology and behavior long after initial recovery from the virus. These COVID-19 health sequelae, if undetected and left untreated, may lead to more enduring mental health problems, and put vulnerable individuals at risk of developing more serious psychopathologies. Therefore, an early distinction of such vulnerable individuals from those who are more resilient is important to undertake timely preventive interventions. The main aim of this article is to present a comprehensive multimodal conceptual approach for addressing these potential psychological and behavioral mental health changes using state-of-the-art tools and means of artificial intelligence (AI). Mental health COVID-19 recovery programs at post-COVID clinics based on AI prediction and prevention strategies may significantly improve the global mental health of ex-COVID-19 patients. Most COVID-19 recovery programs currently involve specialists such as pulmonologists, cardiologists, and neurologists, but there is a lack of psychiatrist care. The focus of this article is on new tools which can enhance the current limited psychiatrist resources and capabilities in coping with the upcoming challenges related to widespread mental health disorders. Patients affected by COVID-19 are more vulnerable to psychological and behavioral changes than non-COVID populations and therefore they deserve careful clinical psychological screening in post-COVID clinics. However, despite significant advances in research, the pace of progress in prevention of psychiatric disorders in these patients is still insufficient. Current approaches for the diagnosis of psychiatric disorders largely rely on clinical rating scales, as well as self-rating questionnaires that are inadequate for comprehensive assessment of ex-COVID-19 patients’ susceptibility to mental health deterioration. These limitations can presumably be overcome by applying state-of-the-art AI-based tools in diagnosis, prevention, and treatment of psychiatric disorders in acute phase of disease to prevent more chronic psychiatric consequences.
... Amongst the many effects of PTSD, the disorder has been linked to problems with attentional processing of emotional information (Ehlers & Clark, 2000). For example, Armstrong et al. (2013) compared the eye gaze behavior of a group of veterans with combat experience to a group of non-veterans with no psychological diagnoses while looking at faces with different types of emotions. The authors reported that the veterans with PTSD diagnoses spent more time looking at the faces that were negative as opposed to positive. ...
... Second, our findings may partly explain memory deficits in neuropsychiatric conditions and open a new treatment approach. Both memory deficits and altered exploration patterns are often observed in neuropsychiatric conditions, such as depression (Kellough et al. 2008;Elliott et al. 2011), dementia (Shakespeare et al. 2015), anxiety disorders (LeMoult and Joormann 2012), autism spectrum disorders (Fedor et al. 2018), posttraumatic stress disorder (Armstrong et al. 2013;de Quervain et al. 2017), and schizophrenia (Williams et al. 2010). Patients with schizophrenia, for example, have difficulties executing simple visual tasks like smooth pursuit (O'Driscoll and Callahan 2008). ...
Only a small proportion of what we see can later be recalled. Up to date it is unknown in how far differences in visual exploration during encoding affect the strength of episodic memories. Here, we identified individual gaze characteristics by analyzing eye tracking data in a picture encoding task performed by 967 healthy subjects during fMRI. We found a positive correlation between fixation frequency during visual exploration and subsequent free recall performance. Brain imaging results showed a positive correlation of fixation frequency with activations in regions related to vision and memory, including the medial temporal lobe. To investigate if higher fixation frequency is causally linked to better memory, we experimentally manipulated visual exploration patterns in an independent population of 64 subjects. Doubling the number of fixations within a given exploration time increased subsequent free recall performance by 19%. Our findings provide evidence for a causal relationship between fixation frequency and episodic memory for visual information.
... The same applied for average fixation duration on AOIs of combat pictures. These results indicate the assumed maintenance bias based on our earlier investigation and correspond to previous research findings (Armstrong et al., 2013;Lee and Lee, 2014;Thomas et al., 2013). ...
Veterans with posttraumatic stress disorder (PTSD) often exhibit an attentional bias towards trauma-relevant or generally threatening and negative stimuli. Internet-based cognitive behavioral therapy (ICBT) has been demonstrated to be efficacious in the treatment of PTSD. However, a previous study by our own group failed to find a symptom reduction following ICBT in a sample of traumatized veterans. No previous studies have examined the usefulness of ICBT in terms of modifying attentional bias in PTSD. In an eye-tracking experiment, veterans with deployment-related PTSD were presented with combat-related pictures and general threat-related pictures. These target stimuli were simultaneously displayed with neutral pictures. Additionally, participants were presented with pairs of emotional and neutral faces. Participants received ICBT, and attentional bias was examined pre- and post-intervention and at three-month follow-up. No significant changes in attentional bias were observed, either from pre- to post-intervention or at follow-up. The findings suggest that attentional bias reduction is associated with, rather than being separable from, overall PTSD symptom improvement. The present eye-tracking study was the first longitudinal investigation to examine the effect of ICBT on PTSD-related attentional bias in a sample of veterans. More research is needed to gain a deeper understanding of the underlying mechanisms of attentional bias in PTSD and its modifiability.
... Compared to behavioural methods, which rely on motor response to characterize attention patterns, eye tracking offers a more direct way to examine attention bias, permitting examination of both attentional facilitation and sustained attention patterns. Studies in civilian and veteran samples have found evidence that PTSD (or higher levels of PTSD symptoms) is associated with initial and sustained attention for threatening cues (Armstrong, Bilsky, Zhao, & Olatunji, 2013;Kimble, Fleming, Bandy, Kim, & Zambetti, 2010;Thomas, Goegan, Newman, Arndt, & Sears, 2013). A recent meta-analysis including 11 eye tracking studies of PTSD found support for sustained attention to threat among individuals with PTSD compared to those without PTSD (Lazarov et al., 2018). ...
Maladaptive patterns of attention to emotional stimuli are a common feature of posttraumatic stress disorder (PTSD), with growing evidence supporting sustained attention to threatening stimuli across trauma samples. However, it remains unclear how different PTSD symptom clusters are associated with attentional bias patterns, particularly in urban civilian settings with high rates of trauma exposure and PTSD. The present study examined associations among these variables in 70 traumatized primarily African American women. PTSD was measured using the Clinician Administered PTSD Scale, and eye tracking was used to measure patterns of attention as participants engaged in an attention bias (dot probe) task to emotional faces; average initial fixation (1 s) and dwell duration (overall time spent looking at emotional face versus neutral face across the 5 s task) were used to assess attention bias patterns toward emotional faces. Women with PTSD showed significantly longer dwell duration toward angry faces than women without PTSD (F = 5.16, p
... Accordingly, attention may be maintained upon fear-eliciting stimuli at the cost of experiencing more distress, in order to promote the goal of harm avoidance . Indeed, eye-tracking studies have found that veterans with PTSD continue monitoring threat cues, rather than avoiding them, perhaps due to the perceived urgency of trauma cues in this disorder (Armstrong, Bilsky, Zhao, & Olatunji, 2013;. Disgusting stimuli, in contrast, are usually low in urgency. ...
A growing body of research has implicated disgust in various psychopathologies, especially anxiety-related disorders. Although the observed role of disgust in many disorders is robust, the mechanisms that may explain this role are unclear. Cutting-edge research in cognitive science has the potential to elucidate such mechanisms and consequently improve our understanding of how disgust contributes to the etiology and maintenance of psychopathology. In this qualitative review, we systematically assess cognitive bias mechanisms that have been linked to disgust and its disorders. This review suggests that disgust-related biases may be observed in memory, interpretation, judgment of expectancies, and attention, as well as at implicit levels. Of these cognitive domains, the most robust bias appears to be observed at the level of attention. However, reliable moderators of attentional biases for disgust have not yet been identified, and this bias has not been systematically linked to other levels of analysis. Despite these limitations, the available research indicates that attentional avoidance rather than orienting or maintenance may be the most characteristic of disgust. Attentional avoidance of disgust may have important implications for etiological and treatment models of disorders characterized by excessive disgust reactions. The implications for advancing such models are discussed in the context of a combined cognitive bias hypothesis.
... Next, a neutral-neutral or threat-neutral image pair appeared on the screen for 3,000 ms. The 3,000 ms trial window has been used in previous eye-tracking research to examine ABT (Armstrong, Blisky, Zhao, & Olatunji, 2013) and evidence suggests that this trial window provides ample time to disengage attention from prepotent stimuli (Amir, Elias, Klumpp, & Przeworksi, 2003;Buckner et al., 2010). Threat expectancy was reduced through the use of the neutral-neutral image pairings. ...
The purpose of the present study was to examine anxiety sensitivity, attentional bias to threat (ABT), and the aggregate influence of these constructs as prospective predictors of anxiety. Participants (N = 176) completed a baseline assessment session which included the completion of self-report measures of anxiety and anxiety sensitivity, as well as an eye-tracking task in which eye movements were recorded during the viewing of neutral and threat images. Measures of anxiety and anxiety sensitivity were completed again as part of an online questionnaire battery at a 1-year follow-up session. As predicted, baseline anxiety sensitivity and ABT predicted anxiety at 1-year follow-up even after accounting for baseline anxiety. However, these main effects were qualified by a significant interaction effect such that those high in anxiety sensitivity at baseline reported relatively higher anxiety at the 1-year follow-up, but only if they also exhibited higher levels of ABT at baseline. Results suggest that individuals with this combination of vulnerability factors (high levels of both anxiety sensitivity and ABT) may be at particularly high risk for developing anxiety and may benefit from preemptive efforts to reduce ABT.
... As such it is important to underscore that we are not suggesting that human scoring of web camera eye tracking data can or should replace commercially available high frame rate eye trackers; instead, the results from this study suggest that specific offline gaze duration eye tracking paradigms may be more reliably and cost-effectively addressed using the approach we have detailed. Importantly, while this study examined a specific gaze duration paradigm for the evaluation of declarative memory, the same underlying paradigm has been employed across a number of developmental and neuropsychiatric conditions, including ADHD, depression, and PTSD (Armstrong et al., 2013;Isaac et al., 2014;Türkan et al., 2016). Another-somewhat obvious-limitation of this method is the requirement of human scorers to code subject eye movements. ...
Background: Web cameras are increasingly part of the standard hardware of most smart devices. Eye movements can often provide a noninvasive “window on the brain,” and the recording of eye movements using web cameras is a burgeoning area of research.
Objective: This study investigated a novel methodology for administering a visual paired comparison (VPC) decisional task using a web camera.To further assess this method, we examined the correlation between a standard eye-tracking camera automated scoring procedure [obtaining images at 60 frames per second (FPS)] and a manually scored procedure using a built-in laptop web camera (obtaining images at 3 FPS).
Methods: This was an observational study of 54 clinically normal older adults.Subjects completed three in-clinic visits with simultaneous recording of eye movements on a VPC decision task by a standard eye tracker camera and a built-in laptop-based web camera. Inter-rater reliability was analyzed using Siegel and Castellan's kappa formula. Pearson correlations were used to investigate the correlation between VPC performance using a standard eye tracker camera and a built-in web camera.
Results: Strong associations were observed on VPC mean novelty preference score between the 60 FPS eye tracker and 3 FPS built-in web camera at each of the three visits (r = 0.88–0.92). Inter-rater agreement of web camera scoring at each time point was high (κ = 0.81–0.88). There were strong relationships on VPC mean novelty preference score between 10, 5, and 3 FPS training sets (r = 0.88–0.94). Significantly fewer data quality issues were encountered using the built-in web camera.
Conclusions: Human scoring of a VPC decisional task using a built-in laptop web camera correlated strongly with automated scoring of the same task using a standard high frame rate eye tracker camera.While this method is not suitable for eye tracking paradigms requiring the collection and analysis of fine-grained metrics, such as fixation points, built-in web cameras are a standard feature of most smart devices (e.g., laptops, tablets, smart phones) and can be effectively employed to track eye movements on decisional tasks with high accuracy and minimal cost.
... Attentional bias toward threat-related information has been implicated in both the onset and maintenance of PTSD (Armstrong et al., 2013;Kimble et al., 2010). This threat-related bias may have an impact on both information processing and subsequent behavior, as it functions as a gating mechanism that directs attention based on stimulus valence (Constans, 2005). ...
The majority of research examining affective attentional bias in posttraumatic stress disorder (PTSD) has not examined the influence of co-occurring psychiatric disorders. This study examined the individual and interactive effects of PTSD symptoms and substance use disorders (SUDs) on affective attentional processing among 323 veterans deployed to Iraq or Afghanistan. Participants were divided into those with SUD (SUD+, n = 46) and those without (SUD-, n = 277). Substance use disorder was determined using the Structured Clinical Interview for DSM-IV. Posttraumatic stress disorder was measured using the Clinician Administered PTSD Scale. A computerized go/no-go task (Robbins et al., 1994, Robbins et al.,1998) assessed affective attentional processing. Relative to those without SUD, those with SUD showed a significant association between PTSD symptoms and increased omission and commission accuracy rates and decreased d prime. No effects of valence were found. Findings suggest the need to consider co-occurring SUD when investigating the effects of PTSD on attentional control.
Posttraumatic stress disorder (PTSD) is a complex mental health condition triggered by exposure to traumatic events that leads to physical health problems and socioeconomic impairments. Although the complex symptomatology of PTSD makes diagnosis difficult, early identification and intervention are crucial to mitigate the long-term effects of PTSD and provide appropriate treatment. In this study, we explored the potential for physiological habituation to stressful events to predict PTSD status. We used passive physiological data collected from 21 active-duty United States military personnel and veterans in an immersive virtual environment with high-stress combat-related conditions involving trigger events such as explosions or flashbangs. In our work, we proposed a quantitative measure of habituation to stressful events that can be quantitatively estimated through physiological data such as heart rate, galvanic skin response and eye blinking. Using a Gaussian process classifier, we prove that habituation to stressful events is a predictor of PTSD status, measured via the PTSD Checklist Military version (PCL-M). Our algorithm achieved an accuracy of 80.95% across our cohort. These findings suggest that passively collected physiological data may provide a noninvasive and objective method to identify individuals with PTSD. These physiological markers could improve both the detection and treatment of PTSD.
Background: Maladaptive patterns of attention to emotional stimuli are a clinical feature of posttraumatic stress disorder (PTSD). Using eye-tracking-based methodology, research points out the presence of sustained attention to threatening stimuli in individuals with PTSD. However, most eye-tracking studies in this field used free-viewing tasks on negative stimuli.
Methods: PTSD patients (n = 38), trauma-exposed healthy controls (TEHC; n = 30), and non-trauma-exposed healthy controls (HC; n = 33) performed a Face in the Crowd (FiC) task. The FiC task was chosen to explore specific responses to emotional stimuli within a competitive visual environment, thus providing insights into visual search patterns. Both reaction time and gaze patterns (dwell time, scanpath length, first fixation duration, and latency) were recorded.
Results: Individuals with a provisional PTSD diagnosis presented decreased dwell time on both positive and negative targets in comparison with HC and TEHC, as well as shorter scanpath length for all matrixes when no targets were present. No evidence of attentional bias was observed in the TEHC group based on reaction times or eye-tracking measures in response to positive, negative, or neutral cues.
Discussion: We found an attentional avoidance pattern among PTSD patients, along with indexes of lowered perceptual threshold for all emotional information. This study allows raising the question of cognitive load on the emergence of differential attentional strategies presented by PTSD participants. We discuss the generalization of fear processes across different emotional stimuli and underscore the need for incorporating a variety of emotional stimuli in PTSD research.
The purpose of this study was to investigate the divergent viewpoints regarding fearful stimuli in young children by analyzing variations in eye movement tracking and detection rates when confronted with the sudden appearance of either snakes or lizards. A total of 137 five to six-year-old Chinese children (43.8% male) participated in the study, which utilized the inattentional blindness paradigm. The results indicated that young children did not display any attentional bias toward snakes when compared with lizards, as evidenced by their detection rates and eye movement tracking. Interestingly, the children fixated on lizards earlier than snakes. These findings suggest that the notion of an evolution bias toward ancestral threats may not be as credible as previously believed.
Attention to emotional signals conveyed by others is critical for gleaning information about potential social partners and the larger social context. Children appear to detect social threats (e.g., angry faces) faster than non‐threatening social signals (e.g., neutral faces). However, methods that rely on behavioral responses alone are limited in identifying different attentional processes involved in threat detection or responding. To address this question, we used a visual search paradigm to assess behavioral (i.e., reaction time to select a target image) and attentional (i.e., eye‐tracking fixations, saccadic shifts, and dwell time) responses in children (ages 7–10 years old, N = 42) and adults (ages 18–23 years old, N = 46). In doing so, we compared behavioral responding and attentional detection and engagement with threatening (i.e., angry and fearful faces) and non‐threatening (i.e., happy faces) social signals. Overall, children and adults were faster to detect social threats (i.e., angry faces), but spent a smaller proportion of time dwelling on them and had slower behavioral responses. Findings underscore the importance of combining different measures to parse differences between processing versus responding to social signals across development.
Research Highlights
Children and adults are slower to select angry faces when measured by time to mouse‐click but faster to detect angry faces when measured by time to first eye fixation.
The use of eye‐tracking addresses some limitations of prior visual search tasks with children that rely on behavioral responses alone.
Results suggest shorter time to first fixation, but subsequently, shorter duration of dwell on social threat in children and adults.
Background:
The late positive potential (LPP) is a neural marker of attention to emotional stimuli; dysregulations in those attentional processes might contribute to trauma-related psychopathology. Although higher LPP amplitudes to negative images have been found to be associated with anxiety symptoms, results have been mixed regarding depressive and PTSD symptoms, especially among trauma-exposed populations. Further, the relationships between the LPP to positive and neutral images and psychopathology symptoms have been underexamined. The purpose of the current study was to test the effects of image valence, and PTSD, anxiety, and depressive symptoms on LPP amplitude among trauma-exposed undergraduates.
Method:
Seventy-three trauma-exposed undergraduates viewed a series of negative, positive, and neutral images while LPPs were recorded. Self-report measures were used to assess recent PTSD, anxiety, and depressive symptoms. Hierarchical linear modeling tested valence and symptom main effects, as well as Valence by Symptom interactions on LPP amplitude.
Results:
We found a main effect of valence such that individuals exhibited higher LPP amplitudes to negative images compared to neutral images. We also found a Valence by Depressive Symptoms interaction such that there was an inverse relationship between depressive symptoms and the LPP to neutral images but no associations between depressive symptoms and the LPP for positive or negative images. We found no main effects or interactions for anxiety and PTSD symptoms.
Conclusion:
Depressive symptoms might be related to diminished attention to neutral stimuli among trauma-exposed undergraduates. Further investigation of the relationship between the LPP and psychopathology is needed.
Introduction:
Cognitive models of obsessive-compulsive disorder (OCD) implicate heightened attention allocation to stimuli related to one's obsessions in the disorder. Recently, to overcome several limitations of reaction time-based measures, eye-tracking methodology has been increasingly used in attentional research.
Methods:
A meta-analysis of studies examining attention allocation towards OCD-related vs. neutral stimuli, using eye-tracking methodology and a group-comparison design, was conducted conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Separate meta-analyses were performed for attentional vigilance (both latency and location of first fixations) and maintenance (total dwell time and total fixation count, conjointly). Each meta-analysis was conducted twice - once including all studies (main analysis) and once only including studies using the free-viewing paradigm (secondary analysis).
Results:
The systematic search yielded a total of nine studies. Of those, eight provided the needed data to be included in the meta-analysis. No evidence emerged for vigilance via latency to first fixation. Vigilance reflected via first fixation location emerged in the main analysis, but not in the secondary one. Evidence for attentional maintenance was found only when analyzing free-viewing studies exclusively (the secondary analysis).
Limitations:
To increase the accuracy of the research question, correlational studies were excluded, resulting in a small number of available studies.
Conclusions:
OCD may be characterized by vigilance, but mainly in tasks entailing specific demands and/or goals. Conversely, attentional maintenance may be evident only when using tasks that pose no requirements or demands for participants.
Background: Research on biased processing of aversive stimuli in posttraumatic stress disorder (PTSD) has produced inconsistent results between response time (RT) and eye-tracking studies. Recent RT-based results of dot-probe studies showed no attentional bias (AB) for threat while eye-tracking research suggested heightened sustained attention for this information. Here, we used both RT-based and eye-tracking measures to explore the dynamics of AB to negative stimuli in PTSD.
Methods: Twenty-three individuals diagnosed with PTSD, 23 trauma-exposed healthy controls, and 23 healthy controls performed an emotional dot-probe task with pairs of negative and neutral scenes presented for either 1 or 2 s. Analyses included eye movements during the presentation of the scenes and RT associated with target localization.
Results: There was no evidence for an AB toward negative stimuli in PTSD from RT measures. However, the main eye-tracking results revealed that all three groups showed longer dwell times on negative pictures than neutral pictures at 1 s and that this AB was stronger for individuals with PTSD. Moreover, although AB disappeared for the two groups of healthy controls with prolonged exposure, it persisted for individuals with PTSD.
Conclusion: PTSD is associated with an AB toward negative stimuli, characterized by heightened sustained attention toward negative scenes once detected. This study sheds light on the dynamics of AB to negative stimuli in PTSD and encourages us to consider optimized therapeutic interventions targeting abnormal AB patterns.
Currently, in the context of leadership, there is an important compromise between training activities and evaluation methods with training focused on the skills of the 21st century (such as tenacity, resilience, social empathy, and creative problem‐solving) while the evaluation continues to focus on 20th‐century methodologies. As regards leadership training and assessment methods, they could be optimized using methodologies and techniques from organisational neuroscience (ON), which uses implicit measures of brain activity to gain a better understanding of the disciplines of organizing behavior and human resource management. One of the challenges of the ON is how to create complex social situations in controlled laboratory conditions that produce ecological organizational behaviors. One way is to use digital learning environments to reproduce problems that can occur in performance‐based assessments. Extended reality technology (XR) scenarios can offer significant assessment playgrounds, providing students with situations that require the application of various skills. XR is increasingly used to reproduce natural events and social interaction. The advantage of XR is that it offers interactive, sensory, and multimodal stimuli. In this chapter, we will examine the latest developments in XR technology and organizational sciences. In it, we emphasize that XR is a very important tool for leadership research in particular to assess and train complex skills. This can create a new conceptualization of leadership biomarkers, called extended reality‐based behavioral biomarkers (XRBBs), which can be obtained for the evaluation of leadership skills using a neuroscientific organizational paradigm based on implicit brain processes measured through psychophysiological signals and the behavior of subjects exposed to complex social conditions replication using virtual reality interfaces.
Context
Cognitive theories of anxiety- and fear-related pathology suggest that individuals with these forms of pathology (versus those without) exhibit greater threat-related attentional bias (AB). However, there are a multitude of mixed and null findings in this area of research. Unlike other commonly used measures of AB, eye-tracking indices of AB exhibit acceptable reliability, and thus, may help clarify the relationship between AB and anxiety- and fear-related symptoms.
Objective
The purpose of this study was to conduct a meta-analysis, to determine whether there is evidence of a relationship between anxiety and fear-related symptoms and expressions of threat-related AB (i.e., reflexive orienting and maintenance) measured via free-viewing eye- tracking tasks.
Data synthesis
A total of 40 articles were retained for this meta-analysis. Significant relations were observed between anxiety and fear-related symptoms and both reflexive orienting toward threat (r = 0.13, 95% CI: 0.03, 0.22) and maintenance of attention on threat (r = 0.15, 95% CI: 0.05, 0.25).
Conclusions
Results from the present study suggests that it may be important to develop attention bias modification interventions that target AB at both early (bottom-up) and later (top-down) stages of information processing to reduce anxiety- and fear-related pathology.
Disasters can cause significant personal and social distress and adversely affect mental health. Compared with research on the risk factors of post-disaster post-traumatic stress disorder (PTSD), limited studies have reported protective factors against PTSD. We investigated whether resilience, social support, and trust in government were associated with PTSD in disaster survivors, after adjustment for the perceived damage and demographic variables including sex, age, and economic status. We investigated 2311 disaster survivors, using data from the “Long-term survey on the change of life of Disaster victim” performed by NDMI(National Disaster Management Research Institute). Hierarchical regression analysis was used in this study. A high level of trust in institutions was associated with few PTSD symptoms after adjustment for resilience and social support. Among the subfactors of institutional trust, psychological counseling and environmental and facility restoration were associated with PTSD. Psychological counseling and environmental and facility restoration support for disaster survivors were associated with reduced PTSD symptoms. Post-disaster policy support, including psychological counseling and environmental and facility restoration services, is important. Our findings highlight the protective factors against PTSD symptoms and may serve as guidelines for specific interventions for the management of post-disaster PTSD.
Background
Individuals with heightened anxiety vulnerability demonstrate a bias favouring attention to negative information, and it has been argued that this reflects a difficulty to disengage from negative information. Methods to manipulate attentional bias have demonstrated inconsistent effectiveness, however such methods have not targeted biases in attentional disengagement specifically. A recently developed approach to attentional bias modification, labelled Emotion-in-Motion, has been proposed to result in facilitated attentional disengagement from information. Thus, the present study empirically investigated whether the Emotion-in-Motion task modifies biased attentional disengagement from negative information using eye-movement recordings.Methods
Forty-four participants completed the Emotion-in-Motion attention manipulation task under conditions designed to enhance attention (Attend Negative) or attenuate attention (Avoid Negative) to negative information. Biased attentional engagement with, and attentional disengagement from, negative information was examined subsequently.ResultsParticipants in the Avoid Negative condition demonstrated lower levels of biased attentional disengagement from negative information as compared to participants in the Attend Negative condition. No difference in biased attentional engagement with negative information was observed.Conclusions
It is concluded that the Emotion-in-Motion task serves to independently manipulate selective attentional disengagement from negative information and may be useful in investigating the specific role of biased attentional disengagement in emotional vulnerability.
Several studies have observed heightened Pavlovian fear conditioning in PTSD. However, it is unclear how fear conditioning in PTSD is related to risk factors for the disorder, such as anxiety sensitivity. Fifty-one combat-exposed veterans (20 with PTSD, 31 without PTSD) completed a differential fear conditioning task in which one colored rectangle (CS +) predicted a loud scream (US), whereas a different colored rectangle (CS-) predicted no US. Veterans with PTSD were characterized by greater anxiety to the CS + but not the CS- during acquisition and extinction, and greater US expectancy during the CS + but not the CS- at extinction. Also, veterans with PTSD had greater pupil dilation to both CSs at extinction, but not at acquisition. Anxiety sensitivity was correlated with anxiety and US expectancy in response to the CS +, but not the CS-, at both acquisition and extinction, and also with pupil diameter to both the CS + and CS- at extinction. Nearly all of these relations held when covarying for PTSD symptoms and trait anxiety. These findings suggest that increased fear conditioning in PTSD may be related to elevated anxiety sensitivity.
Introduction:
Facial expressions and vocal intonation are key signals in the communication of emotions. Individuals with posttraumatic stress disorder (PTSD) are known to show an impaired perception of facial emotions. So far, research on multimodal emotional stimuli or the priming effects on emotion processing has been absent in PTSD. Therefore, we conducted a study to investigate the influence of vocal priming on facial emotion processing and classification in PTSD using electroencephalography.
Methods:
Twenty-one women with PTSD compared to 28 healthy women were asked to classify emotion-morphed faces with predominantly angry, ambiguous, or predominantly happy expressions primed by either an angry or a happy voice. Responses and reaction times as well as the N170, a component reflecting configural face processing, were analyzed.
Results:
Patients with PTSD were slower in classifying emotional faces that were primed by either an angry or happy voice compared to the healthy controls (HCs; η2 = 0.14). Additionally, patients with PTSD were faster in classifying facial expressions after angry compared to happy vocal primes (η2 = 0.14). HCs did not show this effect. Correlation analyses revealed positive associations between emotion (dys-)regulation and reaction times in patients with PTSD but not in HCs (r = 0.64-0.76). Furthermore, patients with PTSD showed greater N170 amplitudes for predominantly angry and ambiguous faces than HCs (η2 = 0.07).
Conclusion:
Data suggest that patients with PTSD experience more difficulties when processing complex social stimuli than HCs. The altered processing of complex social-emotional signals could amplify PTSD symptoms, thus qualifying as an explicit therapy target.
Visual avoidance of unpleasant stimuli (i.e., strategic positioning of eyes, head and torso away from an environmental stimulus) is a common attentional control behavior that may down-regulate emotion by reducing visual input. Despite its ubiquity, relatively little is known about how visual avoidance is affected by neurological diseases that impact neural circuits involved in emotional functioning. We examined visual avoidance in 56 behavioral variant frontotemporal dementia (bvFTD) patients, 43 Alzheimer's disease (AD) patients, and 34 healthy controls. Participants came to our laboratory and viewed an extremely disgusting film clip while visual avoidance was measured using behavioral coding of head, body, and eye position. Controlling for differences in cognitive functioning, bvFTD patients were less likely to engage in visual avoidance behaviors than both AD patients and healthy controls. Additional analyses revealed that diminished visual avoidance in this task was associated with lower levels of real-world emotion regulation but not with emotion reactivity as reported by the primary caregiver.
Treatment of posttraumatic stress disorder (PTSD) is time and cost-intensive. New, readily implementable interventions are needed. Two parallel randomized clinical trials tested if cognitive/affective computerized training improves cognitive/affective functions and PTSD symptoms in acute (N = 80) and chronic PTSD (N = 84). Adults age 18–65 were recruited from an Israeli hospital emergency room (acute) or from across the United States (chronic). Individuals were randomized to an active intervention (acute N = 50, chronic N = 48) that adaptively trains cognition and an affective positivity bias, or a control intervention (acute N = 30, chronic N = 36) of engaging computer games. Participants, blind to assignment, completed exercises at home for 30 min/day over 30 days (acute) or 45 min/day over 45 days (chronic). Primary outcomes were computerized cognitive/affective function metrics. Secondary outcomes were Clinician-Administered PTSD Scale (CAPS) total scores. In chronic PTSD, the active arm demonstrated facilitated speed of fearful face identification (F = 20.96, q < 0.001; d = 1.21) and a trend towards improvement in total PTSD symptoms (F = 2.91, p = 0.09, d = 0.47), which was due to improvement in re-experiencing symptoms (F = 6.14, p = 0.015; d = 0.73). Better cognitive performance at baseline moderated the training effect and was associated with more favorable improvements on both metrics. Cognitive and affective training does not have widespread benefit on symptoms and cognitive/affective functions in PTSD. Future studies targeting re-experiencing a priori, stratifying on cognitive capacity, and with modified methods to infer on mechanisms and optimized training parameters may be warranted. ClinicalTrials.gov Identifiers: NCT01694316 & NCT02085512.
Purpose of Review. We review recent research addressing neurocognitive and information processing abnormalities in posttraumatic stress disorder (PTSD), including studies informing direction of causality. We additionally consider neurocognition in the context of co-morbid mild traumatic brain injury (TBI) and psychosocial treatments for PTSD.
Recent Findings. Learning, memory, attention, inhibitory functions, and information processing biases frequently accompany PTSD, reflecting potential bi-directional relationships with PTSD. Although mild TBI is associated with increased risk of PTSD development and maintenance, TBI does not typically contribute significantly to sustained neurocognitive deficits in individuals with PTSD. Whereas better learning and memory is associated with mildly enhanced response to psychosocial interventions, such interventions may also improve neurocognitive performance and can be effectively provided to patients with TBI history.
Summary. PTSD is associated with cognitive abnormalities in processing both emotionally relevant and emotionally neutral information and, although mild, may underlie some PTSD symptom expression.
Attentional bias towards aversive stimuli has been demonstrated in the anxiety disorders and in posttraumatic stress disorder, and attentional bias modification has been proposed as a candidate treatment. This study rigorously assessed attentional bias towards aversive and pleasant visual imagery associated with the presence or absence of a familiar service canine in 23 veterans with chronic military-related posttraumatic stress disorder. Participants were repeatedly tested with and without their service canines present on two tasks designed to elicit spontaneous visual attention to facial and scenic image pairs, respectively. Each stimulus contrasted an emotive image with a neutral image. Via eye-tracking, the difference in visual attention directed to each image was analyzed as a function of the valence contrast and presence/absence of the canine. Across both tasks, the presence of a familiar service canine attenuated the normative attentional bias towards aversive image content. In the facial task, presence of the service canine specifically reduced attention toward angry faces. In that task, as well, accumulated days with the service canine similarly modulated attention toward facial emotion. The results suggest that the presence of a familiar service canine is associated with attenuation of attentional bias to aversive stimuli in chronic military-service-related posttraumatic stress disorder. Questions remain regarding the generalization of such effects to other populations, their dependence on the familiarity, breed, and training of the canine, and on social context.
The study investigated biases in selective attention to emotional face stimuli in generalized anxiety disorder (GAD) and depressive disorder, using a modified probe detection task. There were 4 face types: threatening, sad, happy, and neutral. Measures of attentional bias included (a) the direction and latency of the initial eye movement in response to the faces and (b) manual reaction time (RT) to probes replacing the face stimuli 1,000 ms after their onset. Results showed that individuals with GAD (without depressive disorder) were more likely to look first toward threat faces rather than neutral faces compared with normal controls and those with depressive disorder. They also shifted their gaze more quickly toward threat faces, rather than away from them, relative to the other two groups. There were no significant findings from the manual RT data. Implications of the results for recent theories of clinical anxiety and depression are discussed.
Attentional bias is a central feature of many cognitive theories of psychopathology. One of the most frequent methods of investigating such bias has been an emotional analog of the Stroop task. In this task, participants name the colors in which words are printed, and the words vary in their relevance to each theme of psychopathology. The authors review research showing that patients are often slower to name the color of a word associated with concerns relevant to their clinical condition. They address the causes and mechanisms underlying the phenomenon, focusing on J. D. Cohen, K. Dunbar, and J. L. McClelland's (1990) parallel distributed processing model.
A cognitive theory of posttraumatic stress disorder (PTSD) is proposed that assumes traumas experienced after early childhood give rise to 2 sorts of memory, 1 verbally accessible and 1 automatically accessible through appropriate situational cues. These different types of memory are used to explain the complex phenomenology of PTSD, including the experiences of reliving the traumatic event and of emotionally processing the trauma. The theory considers 3 possible outcomes of the emotional processing of trauma, successful completion, chronic processing, and premature inhibition of processing We discuss the implications of the theory for research design, clinical practice, and resolving contradictions in the empirical data.
Most theoretical models of anxiety disorders implicate maladaptive visuo-spatial attentional processing of threat-relevant information in the onset and maintenance of symptoms. We discuss the central mechanistic hypotheses in clinical science regarding problematic attentional processing of threat in anxiety, reconcile what appear to be contradictory predictions, and integrate those hypotheses to describe comprehensively the overt and covert mechanisms of attentional processing within discrete perceptual episodes. In so doing, we examine critically the prevailing theoretical assumptions and measurement models underlying the current investigations of attention and anxiety, and we advocate for increased precision in the translation of models from vision science to the examination of the mechanisms of attentional processing in anxiety. Finally, we discuss the implications of this approach for future translational research that examines the role of attention in anxiety and its treatment.
Importance Combat places soldiers at risk for posttraumatic stress disorder (PTSD). The excessive rates of PTSD and other adjustment disorders in soldiers returning home make it imperative to identify risk and resilience factors that could be targeted by novel therapeutic treatments.
Objective To investigate the interplay among attention to threat, combat exposure, and other risk factors for PTSD symptoms in soldiers deployed to combat.
Design and Setting Longitudinal prospective study of Israeli Defense Force infantry soldiers carried out in 2008 through 2010. Repeated measurements during a 1-year period included baseline and predeployment data collected in training camps and deployment data collected in the combat theater.
Participants Infantry soldiers (1085 men; mean age, 18.8 years).
Main Outcome Measures Postcombat PTSD symptoms.
Results Soldiers developed threat vigilance during combat deployment, particularly when they were exposed to high-intensity combat, as indicated by faster response times to targets appearing at the location of threat relative to neutral stimuli (P < .001). Threat-related attention bias also interacted with combat exposure to predict risk for PTSD (P < .05). Bias toward threat at recruitment (P < .001) and bias away from threat just before deployment (P < .05) predicted postcombat PTSD symptoms. Moreover, these threat-related attention associations with PTSD were moderated by genetic and environmental factors, including serotonin transporter (5-HTTLPR) genotype.
Conclusions and Relevance Combat exposure interacts with threat-related attention to place soldiers at risk for PTSD, and interactions with other risk factors account for considerable variance in PTSD vulnerability. Understanding these associations informs research on novel attention bias modification techniques and prevention of PTSD.
Pictures of emotionally neutral, positive, and negative (threat- or harm-related) scenes were presented for 3 seconds, paired with nonemotional control pictures. The eye fixations of high and low trait anxiety participants were monitored. Intensity of stimulus emotionality was varied, with two levels of perceptual salience for each picture (colour vs. greyscale). Regardless of perceptual salience, high anxiety was associated with preferential attention: (a) towards all types of emotional stimuli in initial orienting, as revealed by a higher probability of first fixation on the emotional picture than on the neutral picture of a pair; (b) towards positive and harm stimuli in a subsequent stage of early engagement, as shown by longer viewing times during the first 500 ms following onset of the pictures; and with (c) attention away from (i.e., avoidance) harm stimuli in a later phase, as indicated by shorter viewing times and lower frequency of fixation during the last 1000 ms of picture exposure. This suggests that the nature of the attentional bias varies as a function of the time course in the processing of emotional pictures.
Post-traumatic stress disorder (PTSD) develops in a minority of traumatized individuals. Attention biases to threat and abnormalities in fear learning and extinction are processes likely to play a critical role in the creation and/or maintenance of PTSD symptomatology. However, the relationship between these processes has not been established, particularly in highly traumatized populations; understanding their interaction can help inform neural network models and treatments for PTSD.
Attention biases were measured using a dot probe task modified for use with our population; task stimuli included photographs of angry facial expressions, which are emotionally salient threat signals. A fear-potentiated startle paradigm was employed to measure atypical physiological response during acquisition and extinction phases of fear learning. These measures were administered to a sample of 64 minority (largely African American), highly traumatized individuals with and without PTSD.
Participants with PTSD demonstrated attention biases toward threat; this attentional style was associated with exaggerated startle response during fear learning and early and middle phases of extinction, even after accounting for the effects of trauma exposure.
Our findings indicate that an attentional bias toward threat is associated with abnormalities in 'fear load' in PTSD, providing seminal evidence for an interaction between these two processes. Future research combining these behavioral and psychophysiological techniques with neuroimaging will be useful toward addressing how one process may modulate the other and understanding whether these phenomena are manifestations of dysfunction within a shared neural network. Ultimately, this may serve to inform PTSD treatments specifically designed to correct these atypical processes.
The present experimental analogue study used computerised attention training to investigate the role of attention bias in the prediction of intrusive memories. After exposure to a trauma film, participants in a training group (n=22) were presented with a variant of the exogenic cueing task (ECT) in which visual film reminders (i.e., stills from the trauma film) were always presented during invalid and neutral control stimuli always during valid trials. The purpose of this cue-location contingency was reinforcing the direction of attention away from film reminders. Control participants (n=23) performed a similar training without such a contingency. Post-training processing bias was assessed with a single target Rapid Serial Visual Presentation (RSVP) task, in which trauma-film reminders served as task-irrelevant distracters appearing shortly before a neutral target. The frequency of film-related intrusions was recorded in a take-home diary and at a follow-up session three days after film viewing. Participants who underwent attention training reported fewer film-related intrusions and showed less interference by visual film distracters than controls. Implications for research on attention bias after real-life trauma are discussed.
Biased processing of emotion stimuli is thought to confer vulnerability to psychopathology, but few longitudinal studies of this link have been conducted. The authors examined the relationship between predeployment gaze bias for emotion stimuli and later symptoms of posttraumatic stress disorder (PTSD) and depression in soldiers deployed to Iraq.
An eye-tracking paradigm was used to assess line of gaze in 139 soldiers while they viewed a two-by-two matrix of fearful, sad, happy, and neutral facial expressions before they were deployed to Iraq. Once they were deployed, the soldiers periodically reported on their levels of war zone stress exposure and symptoms of PTSD and depression.
War zone stress exposure predicted higher scores on PTSD and depression symptom measures; however, eye gaze bias moderated this relationship. In soldiers with war zone stress exposure, shorter mean fixation time when viewing fearful faces predicted higher PTSD symptom scores, and greater total fixation time and longer mean fixation time for sad faces predicted higher depressive symptom scores.
Biased processing of emotion stimuli, as measured by gaze bias, appears to confer vulnerability to symptoms of PTSD and depression in soldiers who experience war zone stress.
Acute stress disorder involves prominent symptoms of threat avoidance. Preliminary cross-sectional data suggest that such threat-avoidance symptoms may also manifest cognitively, as attentional threat avoidance. Confirming these findings in a longitudinal study might provide insights on risk prediction and anxiety prevention in traumatic exposures.
Attention-threat bias and post-traumatic symptoms were assessed in soldiers at two points in time: early in basic training and 23 weeks later, during advanced combat training. Based on random assignment, the timing of the repeat assessment occurred in one of two schedules: for a combat simulation group, the repeat assessment occurred immediately following a battlefield simulation exercise, and for a control group, the assessment occurred shortly before this exercise.
Both groups showed no threat-related attention bias at initial assessments. Following acute stress, the combat simulation group exhibited a shift in attention away from threat whereas the control group showed no change in attention bias. Stronger threat avoidance in the combat simulation group correlated with severity of post-traumatic symptoms. Such an association was not found in the control group.
Acute stress may lead some individuals to shift their attention away from threats, perhaps to minimize stress exposure. This acute attention response may come at a psychological cost, given that it correlates with post-traumatic stress disorder (PTSD) symptoms. Further research is needed to determine how these associations relate to full-blown PTSD in soldier and civilian populations.
Although the DSM-IV recognizes that events can traumatize by evoking horror, not just fear, the role of disgust in the development of posttraumatic stress disorder (PTSD) has received little research attention. In a study of soldiers deployed to Afghanistan, we examined whether reports of peritraumatic disgust and trait disgust vulnerability factors (disgust propensity and disgust sensitivity) predict PTSD-symptoms, independently of peritraumatic fear, neuroticism, and anxiety sensitivity. Participants (N = 174) enrolled in this study before deployment, and were retested around 6 months (N = 138; 79%) and, again, 15 months (N = 107; 62%) after returning home. The results showed that (1) greater peritraumatic disgust and fear independently predicted PTSD-symptom severity at 6 months, (2) greater disgust propensity predicted more peritraumatic disgust, but not PTSD-symptom severity, and (3) disgust sensitivity moderated the relationship between peritraumatic disgust and PTSD-symptom severity. Implications of these findings for broadening the affective vulnerabilities that may contribute to PTSD will be discussed.
Life-threatening danger is assumed to produce, in tandem, increases in both vigilance toward threat and stress-related symptoms, but no data test the validity of this assumption. The authors examined associations, in real time, among imminent life-threatening danger, stress-related symptoms, and vigilance.
Symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety were measured in a civilian population (N=131) as a function of war-related stress, operationalized as the time available for seeking cover from rocket attack. A computerized measure of threat-related vigilance using a classic dot-probe attention task was also collected.
PTSD symptoms, depression, and anxiety increased as a function of war-related threat. Acute proximal threat was associated with avoidance of, rather than vigilance toward, negative valence information. For participants within rocket range, the magnitude of threat bias varied with the magnitude of distress symptoms, such that as bias away from threat increased, distress symptoms increased.
These data challenge current thinking about the role of attention in stress responding. Attentional threat avoidance may reduce the acute impact of imminent threat, but this may come at a price in terms of an elevated risk for psychopathology.
Attentional biases to trauma-related stimuli have been widely demonstrated in individuals with posttraumatic stress disorder (PTSD). However, the majority of these studies used methods not suited to differentiating difficulty disengaging attention from threatening stimuli (interference) from facilitated detection of threat. In the current study, a visual search task (VST) with a lexical decision component was used to differentiate between attentional interference and facilitation. Forty-six sexual assault survivors with High PTSD or Low PTSD symptoms completed the VST with three types of stimuli (trauma-related, general threat-related, and semantically-related neutral words), to examine the specificity of attentional biases associated with PTSD symptoms. High PTSD participants showed increased interference to trauma-related words relative to Low PTSD participants. Furthermore, the increased attentional interference in High PTSD participants was specific to trauma-related stimuli. No evidence was found for facilitated detection of threatening stimuli in PTSD. These results provide additional support for attentional biases in PTSD relating to attentional interference with trauma-related cues rather than facilitated detection of threat. The implications for this pattern of results are discussed in relation to anxiety disorders that are characterized by rumination and/or intrusions (e.g., PTSD, GAD) rather than those more circumscribed to fight or flight response (e.g., phobias).
A set of face stimuli called the NimStim Set of Facial Expressions is described. The goal in creating this set was to provide facial expressions that untrained individuals, characteristic of research participants, would recognize. This set is large in number, multiracial, and available to the scientific community online. The results of psychometric evaluations of these stimuli are presented. The results lend empirical support for the validity and reliability of this set of facial expressions as determined by accurate identification of expressions and high intra-participant agreement across two testing sessions, respectively.
Recent research has suggested that anxiety may be associated with processing biases that favor the encoding of emotionally threatening information. However, the available data can be accommodated by alternative explanations, including response bias accounts. The current study introduces a novel paradigm that circumvents such interpretative problems by requiring subjects to make a neutral response (button press) to a neutral stimulus (visual dot probe). The position of this dot probe was manipulted on a VDU (visual display unit) screen relative to visually displayed words, which could either be threat related or neutral in content. Probe detection latency data were then used to determine the impact of threat-related stimuli on the distribution of visual attention. Clinically anxious (but not clinically depressed) subjects consistently shifted attention toward threat words, resulting in reduced detection latencies for probes appearing in the vicinity of such stimuli. Normal control subjects, on the other hand, tended to shift attention away from such material. The results were interpreted as supporting the existence of anxiety-related encoding bias, and it is suggested that this cognitive mechanism may contribute to the maintenance of such mood disorders.
Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated life-time prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.
Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.
The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.
Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
A cognitive theory of posttraumatic stress disorder (PTSD) is proposed that assumes traumas experienced after early childhood give rise to 2 sorts of memory, 1 verbally accessible and 1 automatically accessible through appropriate situational cues. These different types of memory are used to explain the complex phenomenology of PTSD, including the experiences of reliving the traumatic event and of emotionally processing the trauma. The theory considers 3 possible outcomes of the emotional processing of trauma, successful completion, chronic processing, and premature inhibition of processing We discuss the implications of the theory for research design, clinical practice, and resolving contradictions in the empirical data.
The present study examined biases in visual attention for emotional material in children and adolescents with post-traumatic stress disorder (PTSD) and healthy controls.
The participants carried out an attentional deployment task in which probe detection latency data were used to determine the distribution of visual attention for threat-related and depression-related material.
The results showed that children and adolescents with PTSD, relative to controls, selectively allocated processing resources towards socially threatening stimuli and away from depression-related stimuli. This attentional avoidance of depression-related information in the PTSD participants declined with age.
The results of the study are interpreted as a consolidation and extension of previous research on attentional bias and emotional disorder in younger participants.
The role of Stroop processes in the emotional Stroop effect was subjected to a conceptual scrutiny augmented by a series of experiments entailing reading or lexical decision as well as color naming. The analysis showed that the Stroop effect is not defined in the emotional Stroop task. The experiments showed that reading, lexical decision, and color naming all are slower with emotional words and that this delay is immune to task-irrelevant variation and to changes in the relative salience of the words and the colors. The delay was absent when emotional and neutral words appeared in a single block. A threat-driven generic slowdown is implicated, not a selective attention mechanism associated with the classic Stroop effect.
Anxiety patients exhibit attentional biases toward threat, which have often been demonstrated as increased distractibility by threatening stimuli. In contrast, speeded detection of threat has rarely been shown. Therefore, the authors studied both phenomena in 3 versions of a visual search task while eye movements were recorded continuously. Spider-fearful individuals and nonanxious control participants participated in a target search task, an odd-one-out search task, and a category search task. Evidence for disorder-specific increased distraction by threat was found in all tasks, whereas speeded threat detection did not occur in the target search task. The implications of these findings for cognitive theories of anxiety are discussed, particularly in relation to the concept of disengagement from threat.
Although attentional biases have been demonstrated in individuals with posttraumatic stress disorder (PTSD), the cognitive methodologies used have not allowed for disambiguation of two types of attentional biases. It remains unclear if PTSD involves difficulty disengaging attention from threatening stimuli (interference) or facilitated detection. To differentiate between attentional interference and facilitation, 57 male Vietnam-era veterans (30 High PTSD and 27 Low PTSD) completed a visual search task with a lexical decision component. High PTSD veterans who engaged in the interference task first showed increased interference to threat-relevant words relative to Low PTSD veterans. However, no evidence was found for facilitated detection of threatening stimuli in PTSD.
Background:
Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods:
Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results:
The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions:
Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
Several experiments have shown that anxious individuals have an attentional bias towards threat cues. It is also known, however, that exposure to a subjectively threatening but relatively harmless stimulus tends to lead to a reduction in fear. Accordingly, some authors have hypothesised that high trait anxious individuals have a vigilant-avoidant pattern of visual attention to threatening stimuli. In the present study, 52 high trait anxious and 48 low trait anxious subjects were shown pairs of emotional faces, while their direction of gaze was continuously monitored. For 0-1000 ms, both groups were found to view angry faces more than happy faces. For 2000-3000 ms, however, only high trait anxious subjects averted their gaze from angry faces more than they did from happy faces.
Posttraumatic stress disorder (PTSD) is a well recognized reaction to traumatic events, such as assault, disasters, and severe accidents. The symptoms include involuntary reexperiencing of aspects of the event, hyperarousal, emotional numbing, and avoidance of stimuli that could serve as reminders of the event. Many people experience at least some of these symptoms in the immediate aftermath of a traumatic event. A large proportion recover in the ensuing months or years, but in a significant subgroup the symptoms persist, often for many years (Ehlers, Mayou, & Bryant, 1998; Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). This raises the question of why PTSD persists in some individuals and how the condition can be treated. The present chapter overviews our group's cognitive approach to these questions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A large body of research has demonstrated that affective disorders are characterized by attentional biases for emotional stimuli. However, this research relies heavily on manual reaction time (RT) measures that cannot fully delineate the time course and components of attentional bias. Eye tracking technology, which allows relatively direct and continuous measurement of overt visual attention, may provide an important supplement to RT measures. This article reviews eye tracking research on anxiety and depression, evaluating the experimental paradigms and eye movement indicators used to study attentional biases. Also included is a meta-analysis of extant eye tracking research (33 experiments; N=1579) on both anxiety and depression. Relative to controls, anxious individuals showed increased vigilance for threat during free viewing and visual search, and showed difficulty disengaging from threat in visual search tasks, but not during free viewing. In contrast, depressed individuals were not characterized by vigilance for threat during free viewing, but were characterized by reduced orienting to positive stimuli, as well as reduced maintenance of gaze on positive stimuli and increased maintenance of gaze on dysphoric stimuli. Implications of these findings for theoretical accounts of attentional bias in anxiety and depression are discussed, and avenues for future research using eye-tracking technology are outlined.
The past two decades have brought dramatic progress in the neuroscience of anxiety due, in no small part, to animal findings specifying the neurobiology of Pavlovian fear-conditioning. Fortuitously, this neurally mapped process of fear learning is widely expressed in humans, and has been centrally implicated in the etiology of clinical anxiety. Fear-conditioning experiments in anxiety patients thus represent a unique opportunity to bring recent advances in animal neuroscience to bear on working, brain-based models of clinical anxiety. The current presentation details the neural basis and clinical relevance of fear conditioning, and highlights generalization of conditioned fear to stimuli resembling the conditioned danger cue as one of the more robust conditioning markers of clinical anxiety. Studies testing such generalization across a variety of anxiety disorders (panic, generalized anxiety disorder, and social anxiety disorder) with systematic methods developed in animals will next be presented. Finally, neural accounts of overgeneralization deriving from animal and human data will be described with emphasis given to implications for the neurobiology and treatment of clinical anxiety.
This study investigated the time-course characteristics of attentional bias, such as vigilance and maintenance, towards violent stimuli in dating violence (DV) survivors. DV survivors with PTSD symptoms (DV-PTSD group; n=14), DV survivors without PTSD symptoms (Trauma Control group; n=14), and individuals who were never exposed to dating violence (NDV group; n=15) viewed slides that presented four categories of images (violent, dysphoric, positive, and neutral) per slide, for ten seconds. Our results revealed that the DV-PTSD group spent more time on violent stimuli than did the Trauma Control or NDV groups. The DV survivors, both with and without PTSD symptoms, spent more time on dysphoric stimuli and less time on happy stimuli than did the NDV group. In addition to the effects of PTSD, researchers should also be considering the effects of simple traumatic exposure.
Posttraumatic stress disorder (PTSD) is associated with significant impairment and lowered quality of life. The emotional Stroop task (EST) has been one means of elucidating some of the core deficits in PTSD, but this literature has remained inconsistent. We conducted a meta-analysis of EST studies in PTSD populations in order to synthesize this body of research. Twenty-six studies were included with 538 PTSD participants, 254 non-trauma exposed control participants (NTC), and 276 trauma exposed control participants (TC). PTSD-relevant words impaired EST performance more among PTSD groups and TC groups compared to NTC groups. PTSD groups and TC groups did not differ. When examining within-subject effect sizes, PTSD-relevant words and generally threatening words impaired EST performance relative to neutral words among PTSD groups, and only PTSD-relevant words impaired performance among the TC groups. These patterns were not found among the NTC groups. Moderator analyses suggested that these effects were significantly greater in blocked designs compared to randomized designs, toward unmasked compared to masked stimuli, and among samples exposed to assaultive traumas compared to samples exposed to non-assaultive traumas. Theoretical and clinical implications are discussed.
The present study investigated specificity of attentional biases for trauma-related stimuli using an Emotional Stroop Task. Participants were 14 women suffering from posttraumatic stress disorder (PTSD) who had experienced a sexual trauma and 24 healthy non-traumatized women. They were asked to name print colors of 4 different word types: threatening sexual violence words and non-threatening sexual words, threatening accident trauma words, and positive words. Compared to control participants, PTSD patients displayed increased interference by threatening trauma-related, but not by accident trauma and positive words. Interference by non-threatening sexual words occurred as well, but only in those patients who suffered from more severe PTSD arousal symptoms. These findings suggest graded generalization of the attentional bias across stimuli of varying emotional valence, but specificity regarding the trauma topic. Results are discussed in light of current cognitive models of PTSD, and clinical implications are suggested.
Recent studies find a correlation between attentional threat avoidance under stress and posttraumatic stress symptoms. In this study, we assessed this association longitudinally in exposed and unexposed individuals. The degree of threat avoidance during exposure was expected to predict levels of posttraumatic stress symptoms 1 year later.
Thirty-two participants were recruited and followed for 12 months, including 18 subjects exposed to rocket attacks and 14 nonexposed subjects. At 1-year follow-up, participants completed self-reports and an attention dot-probe task assessing threat-related bias.
State anxiety decreased at follow-up in exposed participants, though posttraumatic stress disorder (PTSD) and depression symptoms remained higher in exposed than in the nonexposed group. Attentional threat avoidance during imminent danger in the exposed group changed to threat attendance a year later, such that both the exposed and the nonexposed group exhibited similar threat bias patterns. As hypothesized, in the exposed group, stronger attentional threat avoidance during stress exposure predicted higher levels of PTSD symptoms 1 year later.
Attention bias away from threat during acute stress may relate to risk for PTSD. This suggests that neurocognitive measures may index risk for PTSD.
The present study examines the extent to which attentional biases in contamination fear commonly observed in obsessive-compulsive disorder (OCD) are specific to disgust or fear cues, as well as the components of attention involved. Eye tracking was used to provide greater sensitivity and specificity than afforded by traditional reaction time measures of attention. Participants high (HCF; n = 23) and low (LCF; n = 25) in contamination fear were presented with disgusted, fearful, or happy faces paired with neutral faces for 3 s trials. Evidence of both vigilance and maintenance-based biases for threat was found. The high group oriented attention to fearful faces but not disgusted faces compared to the low group. However, the high group maintained attention on both disgusted and fearful expressions compared to the low group, a pattern consistent across the 3 s trials. The implications of these findings for conceptualizing emotional factors that moderate attentional biases in contamination-based OCD are discussed.
The authors reviewed 29 studies that provide prevalence estimates of posttraumatic stress disorder (PTSD) among service members previously deployed to Operations Enduring and Iraqi Freedom and their non-U.S. military counterparts. Studies vary widely, particularly in their representativeness and the way PTSD is defined. Among previously deployed personnel not seeking treatment, most prevalence estimates range from 5 to 20%. Prevalence estimates are generally higher among those seeking treatment: As many as 50% of veterans seeking treatment screen positive for PTSD, though much fewer receive a PTSD diagnosis. Combat exposure is the only correlate consistently associated with PTSD. When evaluating PTSD prevalence estimates among this population, researchers and policymakers should carefully consider the method used to define PTSD and the population the study sample represents.
Attentional bias is a central feature of many cognitive theories of psychopathology. One of the most frequent methods of investigating such bias has been an emotional analog of the Stroop task. In this task, participants name the colors in which words are printed, and the words vary in their relevance to each theme of psychopathology. The authors review research showing that patients are often slower to name the color of a word associated with concerns relevant to their clinical condition. They address the causes and mechanisms underlying the phenomenon, focusing on J.D. Cohen, K. Dunbar, and J.L. McClelland's (1990) parallel distributed processing model.
A core feature of post-traumatic stress disorder (PTSD) is hypervigilence to threatening material. This study measured processing of threat material in PTSD with simultaneously acquired initial eye movements and electrodermal activity, following presentation of threatening and neutral words. Ten PTSD subjects and 10 controls were presented with 4 words in parafoveal range. On trials in which a threat word was present, PTSD subjects demonstrated initial eye fixations on the threat word more than controls. PTSD subjects also demonstrated more orienting responses on all trials than controls. These results suggest that processing of threat information in PTSD can be usefully investigated with convergent psychophysiological methodologies.
This study investigated preferential encoding of threat material in subjects with posttraumatic stress disorder (PTSD) with a modified dot-probe paradigm. This paradigm indexes attentional bias by measuring response latency to name neutral target words that are presented adjacent to or distant from threat words. Motor vehicle accident survivors with PTSD (n = 15), subclinical PTSD (n = 15), and low anxiety (n = 15) were required to name target words that were presented either adjacent to or distant from strong threat, mild threat, positive, and neutral words. PTSD subjects named targets faster when they were in close proximity to mild threat words. Results suggested that PTSD subjects' attention was drawn to the mild threat stimuli and are discussed in the context of network models of PTSD.
The Mini-International Neuropsychiatric Interview (M.I.N.I.) is a short structured diagnostic interview, developed jointly by psychiatrists and clinicians in the United States and Europe, for DSM-IV and ICD-10 psychiatric disorders. With an administration time of approximately 15 minutes, it was designed to meet the need for a short but accurate structured psychiatric interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings. The authors describe the development of the M.I.N.I. and its family of interviews: the M.I.N.I.-Screen, the M.I.N.I.-Plus, and the M.I.N.I.-Kid. They report on validation of the M.I.N.I. in relation to the Structured Clinical Interview for DSM-III-R, Patient Version, the Composite International Diagnostic Interview, and expert professional opinion, and they comment on potential applications for this interview.
Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or its sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualization, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies have provided preliminary support for several aspects of the model.
Converging lines of evidence have implicated the amygdala in the pathophysiology of posttraumatic stress disorder (PTSD). We previously developed a method for measuring automatic amygdala responses to general threat-related stimuli; in conjunction with functional magnetic resonance imaging, we used a passive viewing task involving masked presentations of human facial stimuli.
We applied this method to study veterans with PTSD and a comparison cohort of combat-exposed veterans without PTSD.
The findings indicate that patients with PTSD exhibit exaggerated amygdala responses to masked-fearful versus masked-happy faces.
Although some previous neuroimaging studies of PTSD have demonstrated amygdala recruitment in response to reminders of traumatic events, this represents the first evidence for exaggerated amygdala responses to general negative stimuli in PTSD. Furthermore, by using a probe that emphasizes automaticity, we provide initial evidence of amygdala hyperresponsivity dissociated from the "top-down" influences of medial frontal cortex.
This article reviews a series of studies that have utilized information-processing paradigms with posttraumatic stress disorder (PTSD) populations. The review suggests that pretrauma measures of intelligence (IQ) are predictive of the development of PTSD symptoms following trauma. There is also evidence of impaired performance on standardized tests of memory (independent of IQ) in PTSD populations. PTSD populations are found to exhibit deficits in memory function that may be due to hippocampus damage secondary to excessive neuroendocrine responses to conditioned stimuli. In addition, individuals with PTSD evince an attentional bias towards trauma-related stimuli at postrecognition stages of information processing. The review also includes that there is insufficient evidence to either support, or reject, the theoretical proposition that PTSD patients are sensitive to global valence effects at the earliest stages of information processing relative to traumatized non-PTSD populations. Finally, there is some evidence to suggest that the processes associated with autobiographical memory in PTSD populations are similar to those seen in depression. The implications of these findings for the behavioral and cognitive treatment of PTSD are discussed. Directions for future research with such paradigms are also discussed in light of contemporary information processing theories of PTSD.
The study investigated biases in selective attention to emotional face stimuli in generalized anxiety disorder (GAD) and depressive disorder, using a modified probe detection task. There were 4 face types: threatening, sad, happy, and neutral. Measures of attentional bias included (a) the direction and latency of the initial eye movement in response to the faces and (b) manual reaction time (RT) to probes replacing the face stimuli 1,000 ms after their onset. Results showed that individuals with GAD (without depressive disorder) were more likely to look first toward threat faces rather than neutral faces compared with normal controls and those with depressive disorder. They also shifted their gaze more quickly toward threat faces, rather than away from them, relative to the other two groups. There were no significant findings from the manual RT data. Implications of the results for recent theories of clinical anxiety and depression are discussed.
This study used functional magnetic resonance imaging to investigate amygdala response in patients with acute posttraumatic stress disorder (PTSD) to emotional expressions.
Thirteen medication-free individuals with acute PTSD and no axis I psychiatric comorbidity were scanned while viewing pictures of fearful or happy faces, presented above or below consciousness, with backward masking.
There was a significant positive correlation between the severity of PTSD and the difference in amygdala responses between masked fearful and happy faces and a corresponding negative correlation for the difference between unmasked fearful and happy faces.
These findings suggest that functional abnormalities in brain responses to emotional stimuli observed in chronic PTSD are already apparent in its acute phase.
The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility. Paper pre-sented at the Ninth Annual Conference of the ISTSS
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Weathers FW, Litz BT, Herman DS, et al. The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility. Paper pre-sented at the Ninth Annual Conference of the ISTSS, San Anto-nio, TX; 1993.
Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: a functional MRI study
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