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,...

The modified Stroop effect (MSE), in which participants show delayed color naming to trauma specific words is one of the most widely cited findings in the literature pertaining to cognitive bias in posttraumatic stress disorder (PTSD). The current study used a novel approach (Dissertation Abstract Review; DAR) to review the presence of the MSE in dissertation abstracts. A review of dissertations that used the modified Stroop task in a PTSD sample revealed that only 8% of the studies found delayed reaction times to trauma-specific words in participants with PTSD. The most common finding (75%) was for no PTSD-specific effects in color naming trauma-relevant words. This ratio is significantly lower than ratios found in the peer reviewed literature, but even in the peer reviewed literature only 44% of controlled studies found the modified Stroop effect (MSE). These data suggest that a re-evaluation of the MSE in PTSD is warranted.

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This study provides support for a red zone and highlights the need for investigating local norms for UWS.

In an open trial design, adults (n = 20) with posttraumatic stress disorder (PTSD) and either schizophrenia or schizoaffective disorder were treated via an 11-week cognitive-behavioral intervention for PTSD that consisted of education, anxiety management therapy, social skills training, and exposure therapy, provided at community mental health centers. Results offer preliminary hope for effective treatment of PTSD among adults with schizophrenia or schizoaffective disorder, especially among treatment completers (n = 13). Data showed significant PTSD symptom improvement, maintained at 3-month follow-up. Further, 12 of 13 completers no longer met criteria for PTSD or were considered treatment responders. Clinical outcomes for other targeted domains (e.g., anger, general mental health) also improved and were maintained at 3-month follow-up. Participants evidenced high treatment satisfaction, with no adverse events. Significant improvements were not noted on depression, general anxiety, or physical health status. Future directions include the need for randomized controlled trials and dissemination efforts.

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.

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.

A recent study found that female rape victims with acute posttraumatic stress disorder (PTSD) who received a high score on the Peritraumatic Dissociative Experiences Questionnaire exhibited suppression of physiological responses during exposure to trauma-related stimuli. The goal of our present study was to test whether the same relationship holds true for male Vietnam combat veterans with chronic PTSD, using secondary analyses applied to data derived from a Veteran's Affairs Cooperative Study. Vietnam combat veterans (N = 1238) completed measures to establish combat-related PTSD diagnostic status, extent of PTSD-related symptomatic distress, and presence of dissociative symptoms during their most stressful combat-related experiences. Extreme subgroups of veterans with current PTSD were classified as either low dissociators (N = 118) or high dissociators (N = 256) based on an abbreviated version of the Peritraumatic Dissociative Experiences Questionnaire. Dependent variables reflected subjective distress along with heart rate, skin conductance, electromyographic, and blood pressure data when responding to neutral and trauma-related audiovisual and imagery presentations. Veterans in the current PTSD group had significantly higher dissociation scores than did veterans in the lifetime and never PTSD groups. Among veterans with current PTSD, high dissociators reported greater PTSD-related symptomatic distress than did low dissociators, but the groups did not differ with respect to physiological reactivity to the trauma-related laboratory presentations. Our results replicate the previously reported relationship between peritraumatic dissociation and PTSD status in Vietnam combat veterans. However, we found no association between peritraumatic dissociation and the extent of physiological responding to trauma-relevant cues in male veterans with chronic combat-related PTSD.