Attentional control as a prospective predictor of posttraumatic stress symptomatology☆
Introduction
Although it is not uncommon to experience a traumatic event, only a small fraction of trauma exposed individuals go on to develop posttraumatic stress disorder (PTSD; Breslau & Kessler, 2001). Although a number of pre-trauma risk factors have been suggested in the development of PTSD, a great deal of attention has been paid in the extant literature to information processing biases, with a number of laboratory studies providing evidence that those with relatively higher posttraumatic stress (PTS) symptoms have a bias for attending to threat information (e.g., Bardeen and Orcutt, 2011, Olatunji et al., 2013, Pineles et al., 2009). In fact, some have suggested that PTSD is an information-processing disorder, with an emphasis on biased threat perception (van der Kolk & McFarlane, 1996).
In line with this conceptualization, research has shown that prolonged attentional engagement with threat information maintains negative affective states (Bardeen and Read, 2010, Compton, 2000). Protracted states of distress may subsequently decrease the cognitive resources that are available for the emotional processing of trauma information (Foa & Kozak, 1986), thus resulting in the development and/or maintenance of PTS symptoms. However, popular theories of attentional threat processing (i.e., goal driven/stimulus driven theory: Corbetta & Shulman, 2002; attentional control theory: Eysenck, Derakshan, Santos, & Calvo, 2007; hot/cool-system theory of self-regulation: Metcalfe & Mischel, 1999) suggest that top-down attentional control (AC: i.e., the strategic control of higher-order executive attention in regulating bottom-up, stimulus driven, emotional responses) can be used to strategically avoid threat information in an attempt to alleviate emotional distress. Consistent with these theories, preliminary evidence suggests that AC can be used to disengage and shift attention from PTS-related threat information (Schoorl, Putman, van der Werff, & van der Does, 2014), even among those with relatively higher PTS symptoms (Bardeen & Orcutt, 2011), thus reducing trauma-related distress (Bardeen & Read, 2010). The use of AC to temporarily disengage and shift attention from threat salient information may help to down-regulate sympathetic nervous system arousal, thus allowing one to remain in, and habituate to, trauma-relevant contexts rather than using less adaptive regulatory strategies which have been shown to maintain PTS symptoms (e.g., experiential avoidance; Kumpula, Orcutt, Bardeen, & Varkovitzky, 2011). Thus, AC may be one pre-trauma individual difference factor of particular relevance for understanding the development of PTS symptoms following trauma exposure.
Relatively few published studies have examined AC in the context of PTS symptomatology; however, a number of studies have shown that relatively lower levels of AC are associated with higher levels of a host of maladaptive outcomes, including PTS symptoms (Bardeen & Orcutt, 2011), poor social adaptation and externalizing behaviors (Eisenberg, Fabes, Guthrie, & Reiser, 2000), worry and rumination (Armstrong, Zald, & Olatunji, 2011), and symptoms of hyperactivity and inattention in children (Wiersema & Roeyers, 2009). Interestingly, AC has exhibited a protective effect in examinations of relations between putative risk factors and maladaptive outcomes. Specifically, empirical research has shown that AC protects (a) those who are prone to use maladaptive coping behaviors, such as worry and thought suppression from experiencing higher levels of anxiety (Fergus, Bardeen, & Orcutt, 2012), (b) those who perceive themselves as having poor emotion regulation abilities from ceasing goal-directed behavior when experiencing distress (Bardeen, Tull, Dixon-Gordon, Stevens, & Gratz, in press), (c) those with public-speaking anxiety from decrements in speech performance (Jones, Fazio, & Vasey, 2012), and (d) those with higher levels of trait anxiety from responding with fear to a CO2 challenge (Richey, Keough, & Schmidt, 2012). Taken together, these findings suggest AC as a transdiagnostic protective factor against the development of maladaptive outcomes, even among those with outcome-specific vulnerabilities.
Findings to date are consistent with Gross’s (1998) process model of emotion regulation, in which the ability to flexibly control attention is essential for maintaining psychological well-being. In Gross’s model, attention deployment is considered the gatekeeper of emotion regulation, directly influencing subsequent stages of emotion regulation. Thus, the importance of examining the role of pre-trauma AC in the development of PTS symptoms following a traumatic event cannot be overstated, especially given research which has identified dispositional emotion dysregulation as a risk factor for the development of PTS symptomatology following trauma exposure (Bardeen, Kumpula, & Orcutt, 2013).
Although the extant literature has provided evidence suggesting that relatively higher levels of AC may promote psychological well-being, even among those who are vulnerable to experiencing maladaptive psychological outcomes, the cross-sectional nature of research in this area precludes inferences regarding temporal relations among AC and maladaptive outcomes. Thus, in the present study, we examined AC as a prospective predictor of PTS symptoms over the course of two assessment sessions. We hypothesized that AC at the first assessment session (T1) would be negatively associated with PTS symptoms at T1 and at the follow-up assessment session (T2). In addition, we examined exposure to a traumatic event between assessment sessions as a moderator of the relationship between T1 AC and T2 PTS symptoms. Given that increased PTS symptoms are not uncommon in the acute aftermath of trauma exposure, as well as evidence suggesting AC as a protective factor, we expected that an inverse relation between T1 AC and T2 PTS symptoms would be significantly stronger among participants who had experienced a traumatic event between assessment sessions when accounting for pre-T1 trauma history and T1 PTS symptoms. This hypothesis is consistent with theory, and empirical research, which suggests that AC can be used to alleviate trauma-related distress. Thus, among participants who experience a traumatic event, those with higher AC abilities may be significantly less likely to experience PTS symptoms in the acute aftermath of the event.
Section snippets
Participants and procedure
This study was conducted as part of a larger study investigating relations among constructs of distress tolerance, emotion regulation, and emotional distress. Participants were recruited from introductory psychology courses at a Midwestern U.S. University. Over the course of an academic semester, 135 participants completed two assessment sessions. To be included in the present study, participants had to endorse having experienced at least one traumatic event at the first assessment session
Results
An examination of bivariate correlations showed that the relation between the ACS total score and T1 and T2 PTS symptoms did not reach statistical significance (T1: r = −.15, p = .16; T2: r = −.19, p = .09). As expected, regression analysis showed that T1 PTS symptoms predicted T2 PTS symptoms (ps < .001; see Table 1). Of the remaining covariates, T1 Anxiety symptoms predicted T2 PTS Symptoms (p < .001), but T1 Exposure and the interval between T1 and T2 did not (ns). After accounting for T1 PTS symptoms,
Discussion
In the present study, we sought to examine the concurrent and temporal relations (from pre- to post-trauma) among AC and PTS symptoms. Although the bivariate relations between both T1 and T2 PTS symptoms and T1 AC did not reach statistical significance (ps = .15 and .09, respectively), the observed effects are similar in magnitude to that which was observed by Bardeen and Orcutt (2011) (r = −.24, p < .05); thus suggesting that the lack of statistical significance in the present study may be a
References (45)
- et al.
Attentional control in OCD and GAD: Specificity and associations with core cognitive symptoms
Behaviour Research and Therapy
(2011) - et al.
Emotion regulation difficulties as a prospective predictor of posttraumatic stress symptoms following a mass shooting
Journal of Anxiety Disorders
(2013) - et al.
Attentional control as a moderator of the relationship between posttraumatic stress symptoms and attentional threat bias
Journal of Anxiety Disorders
(2011) - et al.
Psychometric properties of the PTSD Checklist (PCL)
Behavioral Research and Therapy
(1996) - et al.
The stressor criterion in DSM-IV posttraumatic stress disorder: An empirical investigation
Biological Psychiatry
(2001) - et al.
Taxometric investigation of PTSD: Data from two nationally representative samples
Behavior Therapy
(2006) - et al.
Attentional control moderates the relationship between activation of the cognitive attentional syndrome and symptoms of psychopathology
Personality and Individual Differences
(2012) - et al.
The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories
Behaviour Research and Therapy
(1995) - et al.
Attentional biases in PTSD: More evidence for interference
Behaviour Research and Therapy
(2009) - et al.
Attentional control moderates fearful responding to a 35% CO2 challenge
Behavior Therapy
(2012)
Attentional bias and attentional control in posttraumatic stress disorder
Journal of Anxiety Disorders
Multiple regression: Testing and interpreting interactions
Diagnostic and statistical manual of mental disorders
Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample
Psychological Assessment
Attentional control, trauma, and affect regulation: A preliminary investigation
Traumatology
Manual for the beck anxiety inventory
Transfer effects in task-set cost and dual-task training in older and younger adults: Further evidence for cognitive plasticity in attentional control in late adulthood
Experimental Aging Research
Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat
Journal of Consulting and Clinical Psychology
Acute stress reactions: Can biological responses predict posttraumatic stress disorder?
CNS Spectrums: The International Journal of Neuropsychiatric Medicine
Applied multiple regression/correlation analysis for the behavioral sciences
Ability to disengage attention predicts negative affect
Cognition and Emotion
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2021, International Journal of PsychophysiologyCitation Excerpt :Attentional focusing is the ability to willfully maintain focus despite distraction, and attentional shifting as the ability to intentionally shift attention between competing stimuli (Ólafsson et al., 2011). Higher attentional control has been associated with resilience to stressful events (Bardeen et al., 2015; Crouch et al., 2012), and lower attentional control predicted greater vulnerability to stress when performing cognitive tasks (Grillon et al., 2016). Participants also completed the Emotion Regulation Questionnaire (ERQ; Gross and John, 2003), the Locus of Control of Behavior Scale (LCBS; Craig et al., 1984), and the Satisfaction with Life Scale (SLS; Diener et al., 1985).
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This article is a Special issue article – “Young researcher award 2014”.