Attention allocation in posttraumatic stress disorder: an eye-tracking study

Abstract

Background Eye-tracking-based attentional research implicates sustained attention to threat in posttraumatic stress disorder (PTSD). However, most of this research employed small stimuli set-sizes, small samples that did not include both trauma-exposed healthy participants and non-trauma-exposed participants, and generally failed to report the reliability of used tasks and attention indices. Here, using an established eye-tracking paradigm, we explore attention processes to different negatively-valenced cues in PTSD while addressing these limitations. Methods PTSD patients (n = 37), trauma-exposed healthy controls (TEHC; n = 34), and healthy controls (HC; n = 30) freely viewed three blocks of 30 different matrices of faces, each presented for 6 s. Each block consisted of matrices depicting eight negatively-valenced faces (anger, fear, or sadness) and eight neutral faces. Gaze patterns on negative and neural areas of interest were compared. Internal consistency and test-retest reliability were evaluated for the entire sample and within groups. Results The two trauma-exposed groups dwelled longer on negatively-valenced faces over neutral faces, while HC participants showed the opposite pattern. This attentional bias was more prominent in the PTSD than the TEHC group. Similar results emerged for first-fixation dwell time, but with no differences between the two trauma-exposed groups. No group differences emerged for first-fixation latency or location. Internal consistency and 1-week test-retest reliability were adequate, across and within groups. Conclusions Sustained attention on negatively-valenced stimuli emerges as a potential target for therapeutic intervention in PTSD designed to divert attention away from negatively-valenced stimuli and toward neutral ones.

Enhanced recognition of disgusted expressions occurs in spite of attentional avoidance at encoding

“…The current dwell-time results are in line with previous findings showing attentional avoidance of disgusting stimuli and disgusted facial expressions ( Lazarov et al, 2016 , 2021 ; Armstrong et al, 2019 ). Disgusted facial expressions were shown to evoke similar neural responses to those evoked by disgusting stimuli ( Wicker et al, 2003 ), it is therefore possible that avoidance of disgusted faces reflect an intentional reaction intended to reduce the unpleasantness of exposure to disgust or a potential disgust experienced by an observed person ( Knowles et al, 2019 ).…”

“…Replicating the results of prior studies applying the freeviewing attention task in non-clinical populations (e.g., Liu et al, Lazarov et al, 2016Lazarov et al, , 2021, participants in the current study dwelled longer on neutral relative to disgusted faces. Despite this potential attentional advantage for neutral faces during encoding, participants displayed a strong recognition memory advantage for disgust faces, a finding that corresponds with a previously shown memory advantage for disgusting content (e.g., Chapman et al, 2013;Moeck et al, 2021).…”

“…The free viewing attention task (encoding) Gaze patterns were assessed using an established eye-tracking free-viewing task (Lazarov et al, 2016(Lazarov et al, , 2021Klawohn et al, 2020) adapted for the current study. The task was executed using the Experiment Builder software (version 2.1.140;SR Research Ltd.,Mississauga,Ontario,Canada).…”

“…Power analysis for sample size estimation used GPower 3.1 ( Faul et al, 2009 ). Based on data from Lazarov et al (2021) of 20 healthy participants, the effect size for preference of neutral over threat faces was ( ) = 0.39. With an alpha = 0.05 and power = 0.95 the projected sample size needed to detect a significant effect was N = 23.…”

Cognitive flexibility and attentional patterns among trauma survivors: preliminary evidence from an eye-tracking study

“…In addition, the use of eye-tracking technology constitutes an interesting method to investigate the time course of attentional deployment during this task (Gaspelin, Leonard, & Luck, 2017 ). However, eye-tracking studies in the field of PTSD are still limited (Blekic et al, 2021 ; Lazarov et al, 2021 ). Therefore, the purpose of this study was to investigate the cognitive flexibility underlying attentional processes within an emotional context among individuals who have encountered a trauma in the past but did not develop PTSD, using an overlap task and an eye-tracking device.…”