Hypervigilance and depression as predictors of eye tracking to ambiguous pictures in trauma survivors.

Hypervigilance, attentional bias, and negative views of the world play a significant role in post trauma symptomatology and can be associated with both clinical depression and posttraumatic stress. However, both theory and research suggest there may be discernible differences in attentional patterns between these two outcomes. While depression may be associated with a general negativity bias, posttraumatic stress may be specifically associated with visual scanning, hypervigilance, and threat detection. In this study, seventy-seven community trauma survivors completed self-assessments for hypervigilance, depression, and posttraumatic cognitions and then had their eyes tracked while looking at a series of thirty neutral but ambiguous and complex pictures on a computer screen. Mean age of the sample was 36.3 with 52 % of the sample identifying as female. We found that hypervigilance scores and negative views of the world predicted both the number of fixations and area of the picture covered. These factors did not predict pupil size. These findings suggest that there are discernable gaze patterns after trauma associated with posttraumatic stress but not depression. Specifically, ambiguous pictures generate more fixations and scanning that is associated with vigilance but not depression.

Students responses to differing trigger warnings: A replication and extension.

OBJECTIVE: The goal of this study was to assess students' responses to a potentially triggering passage from literature using differing trigger warnings. PARTICIPANTS AND METHOD: 123 undergraduates read a passage which contained depictions of physical and sexual assault. Students were randomly assigned to differing trigger warning conditions prior to reading the passage that anticipated either neutral, positive, or negative emotional reactions. Measures of PTSD symptoms and distress were taken on Day 1, Day 2, and Day 14. RESULTS: Distress to the triggering passage did not vary as a function of either trauma history or trigger warning type. Those with higher PTSD scores to start did not experience more distress over time. DISCUSSION: The data suggest that instructors can assign challenging passages with the expectation that those with related traumas will not be disproportionately affected. In addition, the type of warning is not likely to impact on student emotional responses.

Functional Characterization of TRPV-Like Ion Channels Involved in Nematocyst Discharge from the Sea Anemone Diadumene lineata.

AbstractCnidarians require mechanical stimuli to trigger nematocyst discharge and initiate feeding behaviors. The interval from triggering stimulus to response is tens of microseconds, making it likely that mechanically gated ion channels trigger nematocyst discharge. Because many transient receptor potential channels are mechanically gated, we hypothesized that nematocyst discharge involves transient receptor potential channels. We therefore tested various transient receptor potential channel inhibitors to determine whether they inhibit nematocyst discharge and prey killing in the acontiate sea anemone (Actinaria) Diadumene lineata (a.k.a. Haliplanella luciae). Three types of cnidocyte supporting cell complexes regulate nematocyst discharge in anemones: Types C, B, and A. Discharge from Type Cs is directly triggered by stimulation of contact-sensitive mechanoreceptors, while Type Bs require activation of chemoreceptors from prey-derived N-acetylated sugars to sensitize contact-sensitive mechanoreceptors. In Type As, activated chemoreceptors tune vibration-sensitive mechanoreceptors that predispose contact-sensitive mechanoreceptors for triggering. The non-selective transient receptor potential channel blockers lanthanum and gadolinium dose-dependently inhibited about 80% of prey killing and all nematocyst discharge from Type Bs and Type Cs, but not Type As. The selective transient receptor potential vanilloid 4 (TRPV4) blocker GSK2193874 inhibited Type As and Type Bs. However, the selective TRPV4 blockers HC-067047 and RN-1734 inhibited only Type As. Thus, three TRPV4-selective blockers implicate TRPV-like involvement in discharge from Type As, whereas GSK2193874 also affected Type Bs. Our results suggest that a TRPV-like homolog plays an essential role in nematocyst-mediated prey killing from Type As, whereas other transient receptor potential channels are likely involved in discharge from Type B and C cnidocyte supporting cell complexes.

Student reactions to traumatic material in literature: Implications for trigger warnings.

INTRODUCTION: While trigger warnings have garnered significant debate, few studies have investigated how students typically respond to potentially triggering material. METHOD: In this study, three hundred and fifty-five undergraduate students from four universities read a passage describing incidences of both physical and sexual assault. Longitudinal measures of subjective distress, PTSD symptoms, and emotional reactivity were taken. RESULTS: Greater than 96% of participants read the triggering passage even when given a non-triggering alternative to read. Of those who read the triggering passage, those with triggering traumas did not report more distress although those with higher PTSD scores did. Two weeks later, those with trigger traumas and/or PTSD did not report an increase in trauma symptoms as a result of reading the triggering passage. CONCLUSIONS: Students with relevant traumas do not avoid triggering material and the effects appear to be brief. Students with PTSD do not report an exacerbation of symptoms two weeks later as a function of reading the passage.

Vigilance/Avoidance to Expected and Presented Stimuli in Trauma Survivors: An Eye-Tracking Study.

Attention in trauma-related disorders has been characterized by both vigilance and avoidance of trauma-related or aversive stimuli. This study used eye-tracking technology to investigate how cumulative trauma, as well as hypervigilance and dissociative symptoms, affected attentional patterns to anticipated negative stimuli and actual negative stimuli. A sample of forty-two trauma participants recruited from the community had a choice about where to look on a computer screen knowing which segments of the screen negative stimuli were likely to appear. Participants could look at those stimuli for as long as they chose before pushing a button to move onto the next trial. A measure of hypervigilance predicted looking to quadrants in which a negative stimulus was to appear. Cumulative trauma predicted avoidance of those stimuli. Neither cumulative trauma or symptom profiles predicted how long participants looked at the negative pictures once they were presented. These data suggest that hypervigilance is associated with looking for threats that are not yet present, and that cumulative trauma may be associated with motivation to avoid negative stimuli. The findings are discussed with respect to the characteristics of the sample and the limited dissociative pathology.

Negative world views after trauma: Neurophysiological evidence for negative expectancies.

OBJECTIVE: Negative views of both the self and the world are commonly seen in individuals who have suffered psychological trauma. These negative cognitions are thought to be significant as they are likely to play a critical role in furthering, if not promoting, other symptoms and exacerbating the dysfunction sometimes seen after a traumatic event. This has led to the inclusion of "persistent negative beliefs and expectations about oneself or the world" in the DSM-5 (American Psychiatric Association, 2013). Although there is considerable self-report and behavioral evidence for negative biases after trauma, there is less concurrent neurophysiological data. This study used the N400, an event-related potential sensitive to semantic expectancies, to assess negative expectations in a trauma sample. METHOD: In this study, 39 participants completed an N400 task in which they read ambiguous sentence stems that ended either with a positive final word (Things will turn out . . . fine) or a negative final word (Things will turn out . . . badly). The authors predicted that those trauma survivors with negative cognitions (as measured by the Posttraumatic Cognitions Inventory [PTCI]: Foa et al., 1999) would show N400 amplitudes indicating expectancies for negative endings. Augmenting the previous self-report data, this would provide evidence for negative expectancies that are fairly early and relatively automatic. RESULTS: N400 amplitudes to negative sentence endings were significantly related to negative views of the world as measured by the PTCI. CONCLUSIONS: This suggests that negative world views in trauma survivors have demonstrable neurophysiological correlates and impact on expectations in ambiguous situations. (PsycINFO Database Record

Assessing civilian perceptions of combat veterans: An IAT study.

OBJECTIVE: Evidence suggests that civilians may have considerable ambivalence to returning veterans. While civilians are frequently grateful for the service of military personnel, they can often be wary of the mental health and stability of returning veterans. If civilians do hold such negative biases toward veterans, whether implicit or explicit, this may have a significant impact on the ability of military personnel to integrate back into society. The goal of the study was to test whether participants held an implicit bias of mental instability toward veterans. METHOD: In this study, 48 participants took an adapted version of the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998). Pictures of veterans and civilians were paired with words that either reflected mental stability (safe, sane, reliable, responsible) or instability (crazy, dangerous, unstable, unpredictable). RESULTS: The results demonstrated a finding of moderate effect size for an association between veterans and instability. Participants had significantly shorter response times (RTs) for IAT blocks in which veteran pictures and negative words were paired. CONCLUSIONS: This is the first study in the literature to demonstrate implicit biases of veterans as unstable. If implicit biases do in fact exist, the reintegration issues that veterans face may be due, at least in part, to a negative bias they face upon their return. (PsycINFO Database Record

Sexual Assault Victimization Among Female Undergraduates During Study Abroad: A Single Campus Survey Study.

Almost all research on sexual assault victimization among undergraduate university students pertains to incidents that occur on domestic college and university campuses. The purpose of the present study was to investigate the prevalence of sexual assault victimization and related factors among undergraduates in the context of study-abroad programs. Two hundred eight female students (52% response rate) from a small university in the northeastern United States who had recently studied abroad responded to an online survey containing measures of sexual assault, posttraumatic stress responses (PSR), and alcohol consumption. Almost 19% of the respondents indicated one or more types of sexual assault victimization. Approximately 17% reported non-consensual sexual touching, 7% attempted rape, 4% rape, with 9% reporting attempted rape or rape. As in domestic studies, victimization in this sample was related positively to alcohol consumption and PSR. Use of force was the most frequently reported perpetrator tactic. In sum, the high rates of sexual assault victimization reported by this sample during study abroad replicate previous findings. This context requires further attention from sexual assault researchers, especially given the increasing numbers of university students engaging in study abroad, and from campus support personnel who may be unaware of the likelihood of assault in this context.

The impact of hypervigilance: evidence for a forward feedback loop.

A number of prominent theories suggest that hypervigilance and attentional bias play a central role in anxiety disorders and PTSD. It is argued that hypervigilance may focus attention on potential threats and precipitate or maintain a forward feedback loop in which anxiety is increased. While there is considerable data to suggest that attentional bias exists, there is little evidence to suggest that it plays this proposed but critical role. This study investigated how manipulating hypervigilance would impact the forward feedback loop via self-reported anxiety, visual scanning, and pupil size. Seventy-one participants were assigned to either a hypervigilant, pleasant, or control condition while looking at a series of neutral pictures. Those in the hypervigilant condition had significantly more fixations than those in the other two groups. These fixations were more spread out and covered a greater percentage of the ambiguous scene. Pupil size was also significantly larger in the hypervigilant condition relative to the control condition. Thus the study provided support for the role of hypervigilance in increasing visual scanning and arousal even to neutral stimuli and even when there is no change in self-reported anxiety. Implications for the role this may play in perpetuating a forward feedback loop are discussed.

Contributors to hypervigilance in a military and civilian sample.

Hypervigilance toward ambiguous or threatening stimuli is a prominent feature in many trauma survivors including active and returning soldiers. This study set out to investigate the factors that contribute to hypervigilance in a mixed sample. One hundred forty-five individuals, 50 of whom were war zone veterans, filled out a series of questionnaires including the Hypervigilance Questionnaire (HVQ; Kimble, Fleming, & Bennion, 2009). Other participants included military cadets, college undergraduates, and a traumatized community sample. In this sample, a history of military deployment and posttraumatic stress disorder symptoms independently predicted hypervigilance. The findings suggest that deployment to a war zone, in and of itself, can lead to hypervigilant behavior. Therefore, characterizing hypervigilance as pathological in a veteran sample must be done so with caution.

Psychological distress and post-traumatic symptoms following occupational accidents.

Depression and post-traumatic stress disorder frequently occur as a consequence of occupational accidents. To date, research has been primarily focused on high-risk workers, such as police officers or firefighters, and has rarely considered individuals whose occupational environment involves the risk of severe, but not necessarily life-threatening, injury. Therefore, the present study was aimed at assessing the psychological consequences of accidents occurring in several occupational settings (e.g., construction and industry). Thirty-eight victims of occupational accidents (injured workers) and 38 gender-, age-, and years of education-matched workers who never experienced a work accident (control group) were recruited. All participants underwent a semi-structured interview administered by a trained psychologist, and then were requested to fill in the questionnaires. Injured workers reported more severe anxious, post-traumatic and depressive symptoms, and poorer coping skills, as compared to controls. In the injured group low levels of resilience predicted post-traumatic symptomatology, whereas the degree of physical injury and the length of time since the accident did not play a predictive role. The results suggest that occupational accidents may result in a disabling psychopathological condition, and that a brief psychological evaluation should be included in the assessment of seriously injured workers.

Negative expectancies in posttraumatic stress disorder: neurophysiological (N400) and behavioral evidence.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a disorder that theoretically and clinically is thought to be associated with persistent and exaggerated negative expectancies. This study used the N400 event-related potential (ERP) to investigate expectancies for threatening endings to ambiguous sentence stems. The N400 ERP is thought to reflect the amount of effort required to integrate a stimulus into a given context. In sentence reading tasks, the N400 is reliably larger when a word is unexpected. METHOD: In this study, fifty-seven trauma survivors of various types (22 with PTSD and 35 without) read ambiguous sentence stems on a computer screen. These sentence stems were completed with either an expected ("The unfortunate man lost his…wallet"), unexpected ("The unfortunate man lost his…artist"), or threatening word endings ("The unfortunate man lost his…leg"). RESULTS: Participants with PTSD, as compared to those without, showed significantly smaller N400s to threatening sentence endings suggesting enhanced expectancies for threat. Behavioral responses supported this conclusion. CONCLUSIONS: These findings are consistent with the clinical presentation of hypervigilance and proposed revisions to the DSM-V that emphasize persistent and exaggerated negative expectations about one's self, others, or the world. Relative to earlier behavioral studies, this work further suggests that this expectancy bias occurs automatically and at the early stages of information processing. The discussion focuses on the potential impact of a negative expectancy bias in PTSD and the value of the ambiguous sentence paradigm for studying PTSD as well as other disorders.

Attention to novel and target stimuli in trauma survivors.

Trauma and its consequences can have lasting biological and cognitive effects on those who experience them. This study investigated the extent to which trauma, posttraumatic stress disorder (PTSD), and dissociation influenced attention to basic auditory stimuli in a sample of military cadets. After filling out a series of psychometric questionnaires, 27 male military cadets varying in their trauma history participated in the "novelty" oddball task in which participants were asked to count high-pitched tones while ignoring other auditory stimuli. Electroencephalogram (EEG) was continually recorded in order to assess P300 responses, an event-related potential (ERP) associated with attention and memory processes. Trauma history only, and not dissociation or PTSD scores, predicted smaller P300 amplitudes to target tones. To distracting novel sounds, only trauma history and dissociation predicted unique variance in P300 amplitudes. The findings suggest that PTSD may not be central to the attentional disturbances found in traumatized samples, while trauma history and dissociation may play a more important role. Future studies investigating attentional processes post trauma should utilize dissociation scales and a non-trauma sample.

Eye tracking and visual attention to threating stimuli in veterans of the Iraq war.

Theoretical and clinical characterizations of attention in PTSD acknowledge the possibility for both hypervigilance and avoidance of trauma-relevant stimuli. This study used eye tracking technology to investigate visual orientation and attention to traumatic and neutral stimuli in nineteen veterans of the Iraq war. Veterans saw slides in which half the screen had a negatively valenced image and half had a neutral image. Negatively valenced stimuli were further divided into stimuli that varied in trauma relevance (either Iraq war or civilian motor vehicle accidents). Veterans reporting relatively higher levels of PSTD symptoms had larger pupils to all negatively valenced pictures and spent more time looking at them than did veterans lower in PTSD symptoms. Veterans higher in PTSD symptoms also showed a trend towards looking first at Iraq images. The findings suggest that post-traumatic pathology is associated with vigilance rather than avoidance when visually processing negatively valenced and trauma-relevant stimuli.

Decisions to shoot in a weapon identification task: The influence of cultural stereotypes and perceived threat on false positive errors.

The decision to shoot a gun engages executive control processes that can be biased by cultural stereotypes and perceived threat. The neural locus of the decision to shoot is likely to be found in the anterior cingulate cortex (ACC), where cognition and affect converge. Male military cadets at Norwich University (N=37) performed a weapon identification task in which they made rapid decisions to shoot when images of guns appeared briefly on a computer screen. Reaction times, error rates, and electroencephalogram (EEG) activity were recorded. Cadets reacted more quickly and accurately when guns were primed by images of Middle-Eastern males wearing traditional clothing. However, cadets also made more false positive errors when tools were primed by these images. Error-related negativity (ERN) was measured for each response. Deeper ERNs were found in the medial-frontal cortex following false positive responses. Cadets who made fewer errors also produced deeper ERNs, indicating stronger executive control. Pupil size was used to measure autonomic arousal related to perceived threat. Images of Middle-Eastern males in traditional clothing produced larger pupil sizes. An image of Osama bin Laden induced the largest pupil size, as would be predicted for the exemplar of Middle East terrorism. Cadets who showed greater increases in pupil size also made more false positive errors. Regression analyses were performed to evaluate predictions based on current models of perceived threat, stereotype activation, and cognitive control. Measures of pupil size (perceived threat) and ERN (cognitive control) explained significant proportions of the variance in false positive errors to Middle-Eastern males in traditional clothing, while measures of reaction time, signal detection response bias, and stimulus discriminability explained most of the remaining variance.

Exposure-based cognitive-behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder: a pilot study.

In an open trial design, adults (n=20) with posttraumatic stress disorder (PTSD) and either schizophrenia or schizoaffective disorder were treated via an 11-week cognitive-behavioral intervention for PTSD that consisted of education, anxiety management therapy, social skills training, and exposure therapy, provided at community mental health centers. Results offer preliminary hope for effective treatment of PTSD among adults with schizophrenia or schizoaffective disorder, especially among treatment completers (n=13). Data showed significant PTSD symptom improvement, maintained at 3-month follow-up. Further, 12 of 13 completers no longer met criteria for PTSD or were considered treatment responders. Clinical outcomes for other targeted domains (e.g., anger, general mental health) also improved and were maintained at 3-month follow-up. Participants evidenced high treatment satisfaction, with no adverse events. Significant improvements were not noted on depression, general anxiety, or physical health status. Future directions include the need for randomized controlled trials and dissemination efforts.

Does the modified Stroop effect exist in PTSD? Evidence from dissertation abstracts and the peer reviewed literature.

The modified Stroop effect (MSE), in which participants show delayed colour naming to trauma-specific words, is one of the most widely cited findings in the literature pertaining to cognitive bias in posttraumatic stress disorder (PTSD). The current study used a novel approach (Dissertation Abstract Review; DAR) to review the presence of the MSE in dissertation abstracts. A review of dissertations that used the modified Stroop task in a PTSD sample revealed that only 8% of the studies found delayed reaction times to trauma-specific words in participants with PTSD. The most common finding (75%) was for no PTSD-specific effects in colour naming trauma-relevant words. This ratio is significantly lower than ratios found in the peer reviewed literature, but even in the peer reviewed literature only 44% of controlled studies found the modified Stroop effect. These data suggest that a reevaluation of the MSE in PTSD is warranted.

Risk of unwanted sex for college women: evidence for a red zone.

OBJECTIVE: University and college health and counseling centers frequently warn female students about the red zone-a period early in a student's first year at college during which she may be at higher risk for unwanted sexual experiences (UWS). The authors designed this study to assess temporal risk for UWS in 1st- and 2nd-year college women. PARTICIPANTS AND METHODS: In March 2006, the authors randomly selected 50 first-year and 52 second-year students (representing one-sixth of each class year) to complete a modified Sexual Experiences Survey. RESULTS: First-year women were at higher risk for UWS than were second-year women--particularly, early in the fall semester. The authors observed a significant linear effect during participants' combined first years in school, with more reports of UWS occurring early in the year. CONCLUSION: This study provides support for a red zone and highlights the need for investigating local norms for UWS.

Brain, skull, and cerebrospinal fluid volumes in adult posttraumatic stress disorder.

Children and adolescents with maltreatment-related posttraumatic stress disorder (PTSD) exhibit smaller intracranial tissue volume than controls. Linear relationships have also been observed between intracranial tissue volume and the age of maltreatment onset. The authors explored associations among adult PTSD, early trauma, and cerebral volumes in 99 combat veterans. A bone-based estimate of cranial volume was developed to adjust for variation in body size. Posttraumatic stress disorder was not associated with smaller cerebral tissue volume, but rather with smaller cerebrospinal fluid (CSF) and cranial volumes. These findings co-occurred with expected effects of alcoholism and aging on cerebral tissue and CSF volumes. The results point to early developmental divergences between groups with and without PTSD following adult trauma.

Hippocampal volume, PTSD, and alcoholism in combat veterans.

Studies imposing rigorous control over lifetime alcohol intake have usually not found smaller hippocampal volumes in persons with posttraumatic stress disorder. Because the majority of negative studies have used adolescent samples, it has been suggested that chronicity is a necessary condition for such findings. To test the hypothesis that a smaller hippocampus in PTSD is unrelated to comorbid alcoholism or to chronicity, this study estimated hippocampal volume in a relatively large group (N=99) of combat veterans in which PTSD, lifetime alcohol abuse/dependence, and Vietnam versus Gulf War service were crossed. In subjects with histories of alcoholism, unadjusted hippocampal volume was 9% smaller in persons with PTSD than in those without PTSD. In nonalcoholic subjects, the PTSD-related difference in hippocampal volume was 3%. The failure to observe a strong association between PTSD and hippocampal volume in nonalcoholic subjects was not ascribable to younger age, reduced PTSD chronicity, or lower PTSD symptom severity. The possibility that smaller hippocampal volume is limited to groups in which PTSD is compounded by comorbid alcoholism is not necessarily incompatible with results suggesting a smaller hippocampus is predispositional to PTSD. Further examination of the role of alcoholism and other comorbid conditions in studies of brain structure and function in PTSD appears warranted.