Wounds that can't be seen: Implicit Trauma Associations predict posttraumatic stress disorder symptoms

Abstract

Background and Objectives-Prominent theories suggest that explicit and implicit cognitive biases are critical in the development and maintenance of posttraumatic stress disorder (PTSD). However, studies evaluating implicit PTSD-related cognitive biases are rare, and findings are mixed. We developed two adaptions of the Implicit Association Test (IAT), the "traumatized self" IAT (evaluations of the self as traumatized vs. healthy) and the "dangerous memory" IAT (evaluations of remembering as dangerous vs. safe), and investigated their psychometric properties and relations to PTSD symptoms and trauma exposure. Results-BothIATs had good internal consistency, but only the traumatized self IAT was correlated with PSTD symptoms and identified participants meeting clinical cutoffs for PTSD symptoms. Study 2 focused on the traumatized self IAT and included explicit cognitive bias measures. The IAT correlated with PTSD symptoms and explicit cognitions, and predicted variance in PSTD symptoms above and beyond trauma exposure and explicit cognitions.Limitations-Study designs were cross-sectional; samples were unselected; and PTSD symptoms were self-reported.Conclusions-Despite these limitations, these studies provide preliminary validation of an implicit measure of PTSD-related cognitive bias -the traumatized self IAT -that is consistent with PTSD theories and may ultimately improve the identification and treatment of individuals with PTSD.

From Betrayal to the Bottle: Investigating Possible Pathways From Trauma to Problematic Substance Use

“…As a result, findings may underestimate the true frequency of betrayal in the sample (Hardt & Rutter, 2004), and may not generalize to all individuals with a history of betrayal. In research underway, we are investigating alternative methods to assess betrayal history, including measures of implicit associations between the self and betrayal (Lindgren, Kaysen, Werntz, Gasser, & Teachman, 2013).…”

Implicit Cognition and Psychopathology: Looking Back and Looking Forward

“…Implicit measures may also be useful for predicting correlates of PTSD. For example, one study found that a self + traumatization IAT predicted PTSD symptoms over and above the extent of trauma exposure and explicit cognitive measures (Lindgren et al 2013b). In line with this finding, as assessed by an IAT, trauma frequency and severity may be associated with stronger implicit associations of violence + negativity (Bluemke et al 2017), self + anxiety and self + depression ( Johnson et al 2011, van Harmelen et al 2010, and self + betrayal (Delker & Freyd 2017).…”

Betrayed? That’s Me: Implicit and Explicit Betrayed Self-Concept in Young Adults Abused as Children

“…Required sample size was computed given alpha of .05, power of .9, three predictors, one tested predictor (high-betrayal trauma < age 12), and an anticipated effect size of .02. As the current study is the first to examine betrayed-self implicit associations, we had to use a proxy estimate of anticipated effect size based on a self-concept IAT study conceptually similar to ours, which we determined to be a study that evaluated a traumatized self IAT (Lindgren, Kaysen, Werntz, Gasser, & Teachman, 2013). In the latter study, ∆R 2 upon inclusion of IAT scores to predict posttraumatic stress symptoms was .02.…”

“…Categories and word stimuli for the betrayed self IAT were "me" (me, self, my, mine) and "not me" (not me, other, they, them), and "betrayed" (betrayed, abused, shamed, violated) and "respected" (respected, nurtured, supported, protected). Stimuli were derived from other selfconcept IATs (e.g., Greenwald & Farnham, 2000;Lindgren et al, 2013) and conceptual and empirical work on betrayal, with consideration of standard IAT stimuli development guidelines (Nosek et al, 2005).…”