Leaving the door open: Trauma, updating, and the development of PTSD symptoms

https://doi.org/10.1016/j.brat.2022.104098Get rights and content

Abstract

Humans try to make sense of the world using hypotheses that were formed by prior experiences. After trauma, these hypotheses can be exaggerated and resistant to change. This may result in difficulties to update expectations regarding the negative outcomes associated with traumatic stimuli. Critically, it has been proposed that such difficulties may drive the development of posttraumatic stress disorder (PTSD). However, direct evidence on the associations between trauma and impaired expectation updating is still absent. Moreover, it remains unclear whether such an impairment is correlated with PTSD symptoms. To address these gaps, we compared the ability to update traumatic and neutral stimulus-outcome expectations in 81 active-duty firefighters. Participants completed a performance-based updating task and were assessed for PTSD symptoms. We predicted and found a selective impairment in updating trauma-related expectations. This impairment was evident for negative-to-positive but not for positive-to-negative updating. Moreover, impaired negative-to-positive updating was positively associated with PTSD symptoms. These findings support the predictive processing account of PTSD and suggest that strengthening updating processes could be an important goal for promoting resilience after trauma.

Section snippets

Participants

Eighty-two Israeli male firefighters participated in the study. Sample size was based on the detection of medium-sized associations (r = 0.30; two-sided)3

Impact of traumatic vs. neutral content on updating

An ANOVA including the factors Stimulus Type (neutral vs. traumatic), Valence (positive-to-negative vs. negative-to-positive reversal), and Updating Type (target vs. context updating) and accuracy rates as dependent variable revealed a significant main effect of Updating Type, F(1,80) = 15.80, p < .001, ηp2 = 0.17, reflecting higher accuracy rates for context as opposed to target updating, t(80) = 3.97, p < .001, d = 0.66. The effect size was in the medium-to-large range (Cohen, 1988). In

Discussion

The current study investigated whether traumatic – as compared to neutral – content impairs updating and whether this impairment correlates with PTSD symptoms in a sample of active-duty firefighters. In line with the predictive processing framework, we postulated and found that traumatic – as compared to neutral content – impaired updating. This effect was only evident for negative-to-positive updating and not for positive-to-negative updating. Moreover, we found that impaired

Conclusion and outlook

Despite these limitations, the current findings contribute to the current literature. On the one hand, they support the premise of the predictive processing account of PTSD (Kube et al., 2020) that traumatic stress impacts subsequent updating of trauma-related hypotheses, which is in turn linked to PTSD symptom development. On the other hand, they underline the clinical relevance of updating processes in the context of PTSD. That is, if replicated, our findings indicate that helping traumatized

Funding statement

This work was supported by the Binational Science Foundation; BSF (Grant #2015_143) to ELG and GAB.

Acknowledgements

MRSs participation in this project was supported by a fellowship from the German Academic Exchange Service (DAAD). SHN is grateful to the Azrieli Foundation for the award of an Azrieli Fellowship. BEWs participation in this project was supported by a Minerva Fellowship of the Minerva Stiftung Gesellschaft fuer die Forschung mbH.

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      For example, high but not low-SA individuals displayed updating difficulties in a Wisconsin Card Sorting task when social information (faces) was used but not when non-social information (geometric shapes) was used (Mohlman & DeVito, 2017). Second, the inconsistent pattern of results may be related to the valence of the updating direction: positive updating entails learning that a specific stimulus that was associated with a negative outcome becomes positive, whereas negative updating entails learning that a specific stimulus that was associated with a positive outcome becomes negative (e.g., Levy-Gigi et al., 2015; Sopp et al., 2022). Indeed, studies that used positive updating (i.e., negative-to-positive direction) and negative updating (i.e., positive-to-negative direction) of social scenarios revealed that SA is associated with difficulties only in positive updating (Beltzer et al., 2019; Everaert et al., 2018, 2020).

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    These authors contributed equally to this work.

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