Abstract
Background: Prior cognitive research in posttraumatic stress disorder (PTSD) has focused on automatic responses to negative affective stimuli, including attentional facilitation or disengagement and avoidance action tendencies. More recent research suggests PTSD may also relate to differences in reward processing, which has lead to theories of PTSD relating to approach-avoidance imbalances. The current pilot study assessed how combat-PTSD symptoms relate to automatic behavioral tendencies to both positive and negative affective stimuli.Method: Twenty male combat veterans completed the approach-avoidance task (AAT), Clinician Administered PTSD Scale, Beck Depression Inventory-II, and State-Trait Anger Expression Inventory-II. During the AAT, subjects pulled (approach) or pushed (avoid) a joystick in response to neutral, happy, disgust, and angry faces based on border color. Bias scores were calculated for each emotion type (avoid-approach response latency differences). Main and interaction effects for psychological symptom severity and emotion type on bias score were assessed using linear mixed models.Results: There was a significant interaction between PTSD symptoms and emotion type, driven primarily by worse symptoms relating to a greater bias to avoid happy faces. Post hoc tests revealed that veterans with worse PTSD symptoms were slower to approach as well as quicker to avoid happy faces. Neither depressive nor anger symptoms related to avoid or approach tendencies of emotional stimuli.Conclusion: Posttraumatic stress disorder severity was associated with a bias for avoiding positive affective stimuli. These results provide further evidence that PTSD may relate to aberrant processing of positively valenced, or rewarding stimuli. Implicit responses to rewarding stimuli could be an important factor in PTSD pathology and treatment. Specifically, these findings have implications for recent endeavors in using computer-based interventions to influence automatic approach-avoidance tendencies.
Highlights
Posttraumatic stress disorder (PTSD) is characterized by intrusion, hypervigilance, negative alterations in mood and cognitions, and avoidance in response to distressing and/or trauma-related stimuli and situations (American Psychiatric Association, 2013)
Linear mixed effects analyses analyses revealed a significant interaction with a medium effect between PTSD symptoms and emotion type [F(3,54) = 4.80, p = 0.005, conditional effect Cohen’s d = 0.518], but no main effect for either PTSD symptoms [F(1,18) = 2.05, p = 0.692] or emotion type [F(3,54) = 1.62, p = 0.195]
To further characterize the relationship between PTSD symptoms and the avoidh-approachh bias score, we examined the individual bias scores for happy faces for approach and avoidance response directions separately compared to neutral faces
Summary
Posttraumatic stress disorder (PTSD) is characterized by intrusion, hypervigilance, negative alterations in mood and cognitions, and avoidance in response to distressing and/or trauma-related stimuli and situations (American Psychiatric Association, 2013). Anhedonia is another facet associated with PTSD, subsumed under negative alterations in mood and cognitions (American Psychiatric Association, 2013), and is often associated with decreased responsivity to reward or positive affective stimuli (Nawijn et al, 2015). Prior cognitive research in posttraumatic stress disorder (PTSD) has focused on automatic responses to negative affective stimuli, including attentional facilitation or disengagement and avoidance action tendencies. The current pilot study assessed how combat-PTSD symptoms relate to automatic behavioral tendencies to both positive and negative affective stimuli
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