Inefficient Attentional Control Explains Verbal-Memory Deficits Among Military Veterans With Posttraumatic Reexperiencing Symptoms

Abstract

Among individuals with posttraumatic stress disorder (PTSD), verbal learning and memory are areas of weakness compared with other cognitive domains (e.g., visuospatial memory). In this study, previously deployed military veterans completed clinical assessments of word memory and vocabulary ( n = 243) and a laboratory task measuring encoding, free recall, repetition priming, and recognition of words ( n = 147). Impaired verbal memory was selectively related to reexperiencing symptoms of PTSD but was not associated with other symptom groupings or blast-induced traumatic brain injury. Implicit priming of response times following word repetition was also unrelated to clinical symptoms. Instead, slowed response times during encoding explained associations between reexperiencing and memory performance. These findings are consistent with alterations in attentional control explaining PTSD-related verbal-memory deficits. Such findings have implications for understanding trauma-focused psychotherapy and recovery, which may depend on efficient attentional processing of words to alter posttraumatic reexperiencing symptoms.

Posttraumatic reexperiencing and alcohol use: mediofrontal theta as a neural mechanism for negative reinforcement

“…Fear extinction models suggest PTSD arises from persistent fear responses that exhibit a tendency to overgeneralize to inappropriate contexts (Duits et al, 2015; Zuj et al, 2016), leading to exaggerated salience responses to everyday stimuli. Attentional control theories (Marquardt et al, 2022; Schoorl et al, 2014) propose that PTSD is linked to a failure regulating attention towards negative stimuli. These theories, along with the predictive coding framework, all predict that reexperiencing should be associated with enhanced brain salience signaling for negatively-valenced information.…”

“…Generalized fear may then lead to larger than expected salience responses to everyday stimuli such as simple decision-making feedback. A combination of decreased attentional control (21,43) and increased salience-related brain activation to loss feedback raises the possibility that features of PTSD are linked to a failure to control attention towards negative stimuli during a benign gambling task. In this way insufficient attentional control and emotion dysregulation could underpin maladaptive reactivity to negative outcomes as seen in the current sample of veterans.…”

“…Consensus teams, including at least one licensed doctoral-level clinical psychologist, reviewed all available research and clinical information to generate consensus diagnoses which included PTSD, subthreshold PTSD, and alcohol dependence (AD). Individuals were given a subthreshold PTSD designation if they endorsed at least one symptom in each DSM-IV-TR symptom grouping for PTSD, consistent with rating schemes meant to increase sensitivity for clinically meaningful presentations of PTSD symptoms (Marquardt et al, 2022) . We assessed the severity of alcohol use with the Alcohol Use Disorders Identification Test (AUDIT)-C (Saunders et al, 1993) , a 3-item self-report measure of frequency of alcohol use, amount of alcohol use, and frequency of binge drinking.…”

“…Consensus teams including at least one licensed doctoral-level clinical psychologist reviewed all available research and clinical information to generate consensus diagnoses which included PTSD, subthreshold PTSD, and alcohol dependence (AD). Individuals were given a subthreshold PTSD designation if they endorsed at least one symptom in each DSM-IV-TR symptom grouping for PTSD, consistent with rating schemes meant to increase sensitivity for clinically meaningful presentations of PTSD symptoms (21). Interviewers characterized posttraumatic stress symptoms using the Clinician-Administered PTSD Scale for DSM-IV [CAPS-IV, fourth edition; (22,23)].…”