Posttraumatic stress disorder (PTSD) affects a sizeable proportion of the American population and is associated with severe psychological suffering and impairment. Evidence suggests that individuals with PTSD have an impairment in attention in the presence of threat information, often described as an attentional bias for threat. It is thought that this attentional bias serves to maintain and exacerbate PTSD symptoms. While a bottom-up (i.e., more automatic, sensory-driven) attentional bias to threat has been studied extensively in PTSD, relatively little is known about the role of top-down (i.e., more controlled, effortful, and goal-directed) attentional processes in this line of research. Theory and preliminary evidence suggests that attentional control processes (inhibition, shifting, working memory updating) may be used to override bottom-up, or more reactive attentional bias to threat. Thus, these cognitive processes may be used to alleviate trauma-related distress in the short-term, and perhaps, over longer periods of time as well. The proposed study will utilize innovative translational research methods to elucidate the cross-sectional and prospective roles that top-down cognitive processes play in threat-related attentional bias in PTSD. The use of three assessment sessions, over the course of one year, will allow us to determine the degree to which the use of these cognitive processes to regulate threat-related attentional biases is adaptive over a prolonged period of time. Moreover, we will remedy several limitations of previous research by (a) using state-of-the-art eye-tracking equipment to provide a reliable continuous measurement of attentional biases, (b) measuring the specific components of attentional control via behavioral tasks, and (c) examining both positive and negative emotionally arousing images. Adult participants (2 groups [Trauma-exposed Control and PTSD]) will complete a battery of self-report questionnaires, an eye tracking task, and a comprehensive battery of behavioral measures assessing multiple domains of effortful cognitive processes at a single laboratory session. Additionally, participants will complete all of the self-report measures administered at the laboratory session at two follow-up sessions, six and twelve months after the laboratory session. This study is innovative in that it seeks to examine the interactive effect of top-down and bottom-up attentional processes in order to explicate the nature of threat-related attentional biases in PTSD. This innovative approach, using objective behavioral measures of top-down cognitive processes in combination with eye-tracking equipment, may greatly advance our understanding of the complex nature of threat biases in PTSD, provide more accurate predictions of vulnerability for experiencing prolonged PTSD symptoms, and have important treatment implications. Specifically, identifying the specific cognitive processes that modulate this threat bias may result in the development of clinical interventions that directly target these processes in the service of alleviating trauma-related distress.
Public Health Relevance The proposed study seeks to (a) identify the specific cognitive processes that modulate threat-related attentional biases in PTSD, and (b) determine whether the use of these cognitive abilities to regulate threat bias is adaptive or maladaptive over a prolonged period of time. Findings from the proposed study may support the development of clinical interventions that directly target specific cognitive processes to alleviate trauma- related distress. The portability and cost-effectiveness of these types of interventions (e.g., automated attention training programs) may be especially transformative in areas where mental health staff and other resources are limited.
