Development and validation of the recovery-dysfunction implicit association test in military personnel and civilians with posttraumatic stress disorder.

Abstract

Posttraumatic stress disorder (PTSD) is potentially stigmatizing and among the most commonly reported combat-related mental health concerns. Little research has examined implicit cognition in individuals with PTSD. The present research was designed to develop an implicit (Recovery-Dysfunction Implicit Association Test [IAT]) assessment to examine recovery and dysfunction mindsets in individuals with PTSD. The novel IAT was then compared to an explicit measure of the same constructs (the Dispositional Recovery and Dysfunction Inventory [DRDI]) to determine the predictive and discriminant ability of an implicit measure to predict PTSD while explaining unique variance in the presence of an explicit measure of the same constructs. The stimuli used in the development of the Recovery-Dysfunction IAT and the DRDI were created through an iterative focus group and survey process that included experts in PTSD therapy and research. The results indicated that the Recovery-Dysfunction IAT successfully predicted and delineated among individuals with and without PTSD. Conversely, only the DRDI was found to be related to a range of psychiatric disorders that are frequently comorbid with PTSD. Additional research is warranted to determine if the DRDI and Recovery-Dysfunction IAT are beneficial as screening tools to predict PTSD treatment response and associated dysfunction or recovery in clinical samples.

Implicit trauma identity associations in treatment-seeking U.S. military personnel do not predict or change in response to cognitive processing therapy for PTSD.

“…It will be important for future IAT research to validate the categories and stimuli used with military samples to check fit with their preferred terms and self-concept. We note, for example, recent work by Moore et al (2022) that included focus groups with experts in the diagnosis and treatment of PTSD. Focus group members provided crucial input on stimuli to be used in a new IAT that aimed to assess associations with the maintenance of PTSD symptoms and the self.…”

“…The results of our study also suggest important future directions. The results suggest the importance of mixed-method approaches to assess and adapt implicit measures for use in active military personnel samples (see Moore et al, 2022, for an example of such an approach) and, more broadly, to validate implicit measures prior to implementation in clinical trials. Given that the effects associated with implicit measures are often small, access to large samples and the ability to obtain multiple assessments are important to gain a more comprehensive understanding of the extent to which implicit associations are (or are not) responsive to interventions.…”

“…This possibility ties to the earlier concerns about whether the optimal category labels were selected for the IAT. Rather than assessing associations about trauma and the self, it may be more effective to assess associations about the appraisal of trauma symptoms (acceptable vs. unacceptable; see Ehlers & Clark, 2000), or about associations of sustained dysfunction/symptomatology related to PTSD (recovery vs. disability; see recent work by Moore et al, 2022). These kinds of associations might be easier to shift during and following treatment.…”