Attention to threat in posttraumatic stress disorder as indexed by eye-tracking indices: a systematic review

Lazarov, Amit; Suarez‐Jimenez, Benjamin; Tamman, Amanda J. F.; Falzon, Louise; Lee, Seonjoo; Edmondson, Donald; Neria, Yuval

doi:10.1017/s0033291718002313

Cited by 78 publications

(81 citation statements)

References 170 publications

(500 reference statements)

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“…While attempting to address this by including depressive symptoms and a functioning measure, many other non-symptoms may play a causal role in PTSD, as well as in bridging PTSD and other disorders (Jones et al, 2017). These may include, among others, threat-related cognitive biases (Lazarov et al, 2018(Lazarov et al, , 2019, neural abnormalities (O'Doherty et al, 2015;Koch et al, 2016), social functioning (Wilcox, 2010), and other factors which have been implicated in PTSD such as age (Konnert and Wong, 2015) and gender (Lehavot et al, 2018). Thus, future network-based research should include additional non-symptom nodes to enrich our understanding of PTSD (Jones et al, 2017).…”

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confidence: 99%

Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

et al. 2019

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Background Despite extensive research, symptom structure of posttraumatic stress disorder (PTSD) is highly debated. The network approach to psychopathology offers a novel method for understanding and conceptualizing PTSD. However, extant studies have mainly used small samples and self-report measures among sub-clinical populations, while also overlooking co-morbid depressive symptoms. Methods PTSD symptom network topology was estimated in a sample of 1489 treatment-seeking veteran patients based on a clinician-rated PTSD measure. Next, clinician-rated depressive symptoms were incorporated into the network to assess their influence on PTSD network structure. The PTSD-symptom network was then contrasted with the network of 306 trauma-exposed (TE) treatment-seeking patients not meeting full criteria for PTSD to assess corresponding network differences. Finally, a directed acyclic graph (DAG) was computed to estimate potential directionality among symptoms, including depressive symptoms and daily functioning. Results The PTSD symptom network evidenced robust reliability. Flashbacks and getting emotionally upset by trauma reminders emerged as the most central nodes in the PTSD network, regardless of the inclusion of depressive symptoms. Distinct clustering emerged for PTSD and depressive symptoms within the comorbidity network. DAG analysis suggested a key triggering role for re-experiencing symptoms. Network topology in the PTSD sample was significantly distinct from that of the TE sample. Conclusions Flashbacks and psychological reactions to trauma reminders, along with their strong connections to other re-experiencing symptoms, have a pivotal role in the clinical presentation of combat-related PTSD among veterans. Depressive and posttraumatic symptoms constitute two separate diagnostic entities, but with meaningful between-disorder connections, suggesting two mutually-influential systems.

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confidence: 99%

Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

et al. 2019

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“…When associations were examined based on individual symptom clusters of PTSD, we found differential associations based on attention bias indices: PTSD avoidance symptom severity was associated with greater initial fixation to angry expressions than neutral expressions and re-experiencing symptom severity was associated with longer dwell duration to angry expressions than neutral expressions. Previous studies have shown a fairly consistent pattern of sustained attention to threatening stimuli in individuals with PTSD (see Lazarov et al, 2018, for a meta-analytic review); this includes our own research indicating attention biases toward threatrelated stimuli (angry faces; . In this sample of chronically traumatized African American women utilizing services in an urban hospital, we found further support for that pattern, observing significantly greater dwell duration toward angry emotional stimuli compared to neutral stimuli.…”

Section: Discussionmentioning

confidence: 94%

“…Studies in civilian and veteran samples have found evidence that PTSD (or higher levels of PTSD symptoms) is associated with initial and sustained attention for threatening cues (Armstrong, Bilsky, Zhao, & Olatunji, 2013;Kimble, Fleming, Bandy, Kim, & Zambetti, 2010;Thomas, Goegan, Newman, Arndt, & Sears, 2013). A recent meta-analysis including 11 eye tracking studies of PTSD found support for sustained attention to threat among individuals with PTSD compared to those without PTSD (Lazarov et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…We examined attention bias toward angry versus neutral face patterns across PTSD diagnosis as well as differential associations with PTSD symptom clusters (re-experiencing, avoidance, numbing/ anhedonia, 1 and hypervigilance). Based on prior research (see Lazarov et al, 2018), we hypothesized that women with PTSD would show greater sustained attention to threat compared with women without PTSD. No a priori hypotheses were made regarding PTSD symptom clusters since all previous studies examined overall symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Attention bias toward threatening faces in women with PTSD: eye tracking correlates by symptom cluster

Powers

Fani

Murphy

et al. 2019

European Journal of Psychotraumatology

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Maladaptive patterns of attention to emotional stimuli are a common feature of posttraumatic stress disorder (PTSD), with growing evidence supporting sustained attention to threatening stimuli across trauma samples. However, it remains unclear how different PTSD symptom clusters are associated with attentional bias patterns, particularly in urban civilian settings with high rates of trauma exposure and PTSD. The present study examined associations among these variables in 70 traumatized primarily African American women. PTSD was measured using the Clinician Administered PTSD Scale, and eye tracking was used to measure patterns of attention as participants engaged in an attention bias (dot probe) task to emotional faces; average initial fixation (1 s) and dwell duration (overall time spent looking at emotional face versus neutral face across the 5 s task) were used to assess attention bias patterns toward emotional faces. Women with PTSD showed significantly longer dwell duration toward angry faces than women without PTSD (F = 5.16, p < .05). Bivariate correlation analyses with the PTSD symptom clusters showed a significant association between average initial fixation toward angry faces and higher levels of avoidance symptoms (r = 0.29, p < .05) as well as sustained attention to angry faces and higher levels of re-experiencing symptoms (r = 0.24, p < .05). Using separate linear regression models based on initial significant correlations, we found that PTSD avoidance symptoms were significantly related to average initial fixation toward angry faces (R2∆ = 0.09, p < .05) and PTSD re-experiencing symptoms were significantly related to dwell duration toward angry faces (R2∆ = 0.06, p < .05). These findings contribute to evidence that PTSD is related to both initial vigilance and sustained attention to threat and that certain symptom clusters may either drive or be more impacted by attentional biases, highlighting the benefits of addressing attentional biases within treatment.

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“…Generalized defense and hypervigilance consequent to mOFC damage present similarly to symptoms seen in GAD (Newman et al, 2013) or panic disorder (Lieberman et al, 2016). On the other hand, stimulus-specific hyper-reactivity following lOFC damage appears to be more akin to the symptoms of post-traumatic stress disorder (Lazarov et al, 2019), specific phobia (Hermann et al, 2009), or obsessive-compulsive disorders (Sizino da Victoria et al, 2012; e.g., defensive responses in response to specific "triggering" events or stimuli). Though this interpretation oversimplifies the complexity of anxiety disorder subtypes, it highlights the need for frameworks that propose unique neural substrates underlying distinct symptoms within a common class of disorders (e.g., anxiety).…”

Section: Contribution Of Ofc Subregions To Anxiety Disordersmentioning

confidence: 99%

Heightened Defensive Responses Following Subtotal Lesions of Macaque Orbitofrontal Cortex

et al. 2019

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Anxiety disorders are characterized by excessive attention to threat. Several brain areas, including the orbitofrontal cortex (OFC), have been associated with threat processing, with more recent work implicating specialized roles for the medial and lateral subregions of the OFC in mediating specific symptoms of anxiety disorders. Virtually no causal work, however, has evaluated the role of these OFC subregions in regulating behavioral responses under threat. To address this gap, we compared male rhesus monkeys (Macaca mulatta) with bilateral excitotoxic lesions restricted to either the lateral OFC (lOFC), targeting Walker's areas 11 and 13, or the medial OFC (mOFC), targeting Walker's area 14, to a group of unoperated controls on behavioral responses to the presentation of a fake rubber snake, fake spider, and neutral stimuli. Both lesion groups showed heightened defensive and reduced approach responses, accompanied by longer latencies to retrieve a food reward, in the presence of the threatening stimuli. Compared to unoperated controls, the mOFC lesion group also showed longer latencies to reach for rewards and a greater proportion of defensive responses (e.g., piloerection) in the presence of neutral stimuli. Thus, monkeys with mOFC lesions displayed a greater tendency to express defensive responses even in the absence of threat. Overall, our data reveal that both the mOFC and lOFC contribute to the attenuation of defensive responses. Notably, these findings, obtained following selective, excitotoxic lesions of the OFC, are diametrically opposed to the effects of aspiration lesions of OFC observed in macaques.

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Attention to threat in posttraumatic stress disorder as indexed by eye-tracking indices: a systematic review

Abstract: This review is the first to systematically evaluate extant findings in PTSD emanating from eye-tracking studies employing group-comparison designs. Results suggest that sustained attention on threat might serve as a potential target for therapeutic intervention.

Cited by 78 publications

References 170 publications

Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

Attention bias toward threatening faces in women with PTSD: eye tracking correlates by symptom cluster

Heightened Defensive Responses Following Subtotal Lesions of Macaque Orbitofrontal Cortex

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