Theoretical and clinical characterizations of attention in PTSD acknowledge the possibility for both hypervigilance and avoidance of trauma-relevant stimuli. This study used eye tracking technology to investigate visual orientation and attention to traumatic and neutral stimuli in nineteen veterans of the Iraq War. Veterans saw slides in which half the screen had a negatively valenced image and half had a neutral image. Negatively valenced stimuli were further divided into stimuli that varied in trauma relevance (either Iraq war or civilian motor vehicle accidents). Veterans reporting relatively higher levels of PSTD symptoms had larger pupils to all negatively valenced pictures and spent more time looking at them than did veterans lower in PTSD symptoms. Veterans higher in PTSD symptoms also showed a trend towards looking first at Iraq images. The findings suggest that posttraumatic pathology is associated with vigilance rather than avoidance when visually processing negatively valenced and trauma relevant stimuli. Keywords PTSD; eye tracking; attention; hypervigilance; veteransHypervigilance is an increase in attention to threatening, potentially threatening, or traumarelevant stimuli and is a widely reported symptom in post traumatic stress disorder (APA, 2000). This symptom may have numerous manifestations including constant visual scanning for suspicious behavior in pubic places, an alertness for unusual sounds, noting of entrances and exits in enclosed places, constant checking of locks inside the home, or investigation of circumstances that seem out of the ordinary. Hypervigilance is also critical to theoretical characterizations of the disorder in which attentional biases toward threat is thought to be a central organizing feature in post traumatic thought and behavior (Litz and Keane, 1989;Chemtob, Roitblat, Hamada, Carlson, and Twentyman, 1988;Ehlers and Clark, 2000). Such models posit that increased attentional bias to threat might maintain or even initiate other symptoms in the disorder such as intrusive memories, flashbacks, concentration difficulties, and avoidance behaviors.Understandably, there has been considerable effort dedicated to understanding the nature and extent of attentional biases in PTSD. The majority of this work has been accomplished through Please address correspondence to: Matthew O. Kimble, Psychology Department, Middlebury College, Middlebury VT 05753, Phone: 802 443 5402, Fax: 802 443 2072, mkimble@middlebury.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (Dagleish, Moradi, Taghavi, Neshat,-Doost, and Yule, 2001;Harvey,...

A number of prominent theories suggest that hypervigilance and attentional bias play a central role in anxiety disorders and PTSD. It is argued that hypervigilance may focus attention on potential threats and precipitate or maintain a forward feedback loop in which anxiety is increased. While there is considerable data to suggest that attentional bias exists, there is little evidence to suggest that it plays this proposed but critical role. This study investigated how manipulating hypervigilance would impact the forward feedback loop via self-reported anxiety, visual scanning, and pupil size. Seventy-one participants were assigned to either a hypervigilant, pleasant, or control condition while looking at a series of neutral pictures. Those in the hypervigilant condition had significantly more fixations than those in the other two groups. These fixations were more spread out and covered a greater percentage of the ambiguous scene. Pupil size was also significantly larger in the hypervigilant condition relative to the control condition. Thus the study provided support for the role of hypervigilance in increasing visual scanning and arousal even to neutral stimuli and even when there is no change in self-reported anxiety. Implications for the role this may play in perpetuating a forward feedback loop is discussed.

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Hypervigilance toward ambiguous or threatening stimuli is a prominent feature in many trauma survivors including active and returning soldiers. This study set out to investigate the factors that contribute to hypervigilance in a mixed sample. One hundred and forty-five individuals, 50 of whom were war zone veterans, filled out a series of questionnaires including the Hypervigilance Questionnaire (HVQ; Kimble, Fleming, & Bennion, 2009). Other participants included military cadets, college undergraduates, and a traumatized community sample. In this sample, a history of military deployment and posttraumatic stress disorder symptoms independently predicted hypervigilance. The findings suggest that deployment to a war zone, in and of itself, can lead to hypervigilant behavior. Therefore, characterizing hypervigilance as pathological in a veteran sample must be done so with caution.

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