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.

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.

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.

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.

Sentence completion test in combat veterans with and without PTSD: preliminary findings.

This study used a sentence completion task to assess semantic choice in combat veterans. Twenty-eight combat veterans with (n=14) and without (n=14) posttraumatic stress disorder (PTSD) filled in the final word for 33 incomplete sentences after receiving a combat prime. The veterans with PTSD completed sentences with significantly more trauma-relevant final words than those without PTSD. Findings are interpreted with respect to current language models and information-processing theories of PTSD.

Cognitive-behavioral treatment for PTSD among people with severe mental illness: a proposed treatment model.

The lifetime prevalence of posttraumatic stress disorder (PTSD) is about 8%-14% in the general population, and trauma victimization (51%-98%) and PTSD (up to 42%) are even more prevalent among persons treated within public-sector mental health clinics. Despite this, individuals with PTSD and severe mental illness (SMI) who are treated within the public sector tend to receive inadequate mental health services. In addition, treatments for PTSD for this population remain undeveloped, with virtually no available empirical treatment outcome data to guide clinicians. We propose a model for a comprehensive, multicomponent cognitive-behavioral treatment program for this target population that includes elements of consumer education, anxiety management training, social skills training, exposure therapy, "homework" assignments, and long-term follow-up care. Special considerations for public-sector consumers with PTSD and SMI are addressed, as are directions for future research.

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.

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.

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.

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.

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.

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.

Emotional numbing in relation to stressful civilian experiences among college students.

Investigators have shown that hyperarousal is the best predictor of emotional numbing (EN), as compared with avoidance and reexperiencing. The aim of the present study was to extend this finding to the context of stressful civilian experiences among college students. Participants (N = 1,292) completed self-report checklists of stressful civilian experiences and PTSD symptoms. The results of multiple regression analyses in two subsamples consistently indicated that both hyperarousal and avoidance were good predictors of EN. These findings suggest that avoidance may play a more important role in the relationship between hyperarousal and EN in college students.

Peritraumatic dissociation and physiological response to trauma-relevant stimuli in Vietnam combat veterans with posttraumatic stress disorder.

A recent study found that female rape victims with acute posttraumatic stress disorder (PTSD) who received a high score on the Peritraumatic Dissociative Experiences Questionnaire exhibited suppression of physiological responses during exposure to trauma-related stimuli. The goal of our present study was to test whether the same relationship holds true for male Vietnam combat veterans with chronic PTSD, using secondary analyses applied to data derived from a Veteran's Affairs Cooperative Study. Vietnam combat veterans (N = 1238) completed measures to establish combat-related PTSD diagnostic status, extent of PTSD-related symptomatic distress, and presence of dissociative symptoms during their most stressful combat-related experiences. Extreme subgroups of veterans with current PTSD were classified as either low dissociators (N = 118) or high dissociators (N = 256) based on an abbreviated version of the Peritraumatic Dissociative Experiences Questionnaire. Dependent variables reflected subjective distress along with heart rate, skin conductance, electromyographic, and blood pressure data when responding to neutral and trauma-related audiovisual and imagery presentations. Veterans in the current PTSD group had significantly higher dissociation scores than did veterans in the lifetime and never PTSD groups. Among veterans with current PTSD, high dissociators reported greater PTSD-related symptomatic distress than did low dissociators, but the groups did not differ with respect to physiological reactivity to the trauma-related laboratory presentations. Our results replicate the previously reported relationship between peritraumatic dissociation and PTSD status in Vietnam combat veterans. However, we found no association between peritraumatic dissociation and the extent of physiological responding to trauma-relevant cues in male veterans with chronic combat-related PTSD.