Cara en la Multitud; Face in the Crowd; PTSD; TEPT; avoidance; búsqueda visual; evitación; eye-tracking; visual search task; Humans; Eye-Tracking Technology; Male; Female; Adult; Reaction Time; Middle Aged; Emotions/physiology; Stress Disorders, Post-Traumatic/physiopathology; Stress Disorders, Post-Traumatic/psychology; Attention/physiology; Attentional Bias/physiology
Abstract :
[en] Background: Maladaptive patterns of attention to emotional stimuli are a clinical feature of posttraumatic stress disorder (PTSD). Using eye-tracking-based methodology, research points out the presence of sustained attention to threatening stimuli in individuals with PTSD. However, most eye-tracking studies in this field used free-viewing tasks on negative stimuli.Methods: PTSD patients (n = 38), trauma-exposed healthy controls (TEHC; n = 30), and non-trauma-exposed healthy controls (HC; n = 33) performed a Face in the Crowd (FiC) task. The FiC task was chosen to explore specific responses to emotional stimuli within a competitive visual environment, thus providing insights into visual search patterns. Both reaction time and gaze patterns (dwell time, scanpath length, first fixation duration, and latency) were recorded.Results: Individuals with a provisional PTSD diagnosis presented decreased dwell time on both positive and negative targets in comparison with HC and TEHC, as well as shorter scanpath length for all matrixes when no targets were present. No evidence of attentional bias was observed in the TEHC group based on reaction times or eye-tracking measures in response to positive, negative, or neutral cues.Discussion: We found an attentional avoidance pattern among PTSD patients, along with indexes of lowered perceptual threshold for all emotional information. This study allows raising the question of cognitive load on the emergence of differential attentional strategies presented by PTSD participants. We discuss the generalization of fear processes across different emotional stimuli and underscore the need for incorporating a variety of emotional stimuli in PTSD research. [en] The face-in-the-crowd task allows to assess distinct attentional search processes but has never been used among trauma samples.PTSD patients spent less time looking at emotional targets, especially angry faces, which could represent an avoidant coping strategy.PTSD patients presented shorter scanpath lengths, which might indicate decreased threshold for emotion recognition. [es] Antecedentes: Los patrones desadaptativos de atención a estímulos emocionales son un rasgo clínico del trastorno de estrés postraumático (TEPT). Utilizando metodología basada en eye-tracking, la investigación indica la presencia de atención sostenida a estímulos amenazantes en individuos con TEPT. Sin embargo, la mayoría de los estudios con eye-tracking en este campo han usado tareas de visión libre en estímulos negativos. Método: Pacientes con TEPT (n = 38), controles sanos expuestos a trauma (CSET, n = 30) y controles sanos no expuestos a trauma (CS, n = 33) participaron en una tarea de Cara en la Multitud (FiC en sus siglas en inglés). La tarea FiC se eligió para explorar respuestas específicas a estímulos emocionales dentro de un ambiente visual competitivo, proporcionando así información sobre los patrones de búsqueda visual. Se grabó tiempos de reacción y patrones de la mirada (tiempo de permanencia, longitud de la trayectoria de exploración, duración de la primera fijación y latencia). Resultados: Los individuos con un diagnóstico TEPT provisional presentaron tiempo de permanencia descendido tanto en los objetivos positivos como negativos en comparación con los CS y los CSET, así como una longitud de la trayectoria de exploración más corta para todas las matrices cuando no había objetivos presentes. No se observó evidencia de sesgo atencional en el grupo CSET basado en su tiempo de reacción o medidas de eye-tracking en respuesta a claves positivas, negativas o neutras. Discusión: Encontramos un patrón de evitación atencional en los pacientes con TEPT, junto con indicadores de umbral perceptual más bajo para toda la información emocional. Este estudio permite plantear la pregunta de la carga cognitiva en la emergencia de estrategias atencionales diferenciales en los participantes con TEPT. Discutimos la generalización de procesos de miedo entre diferentes estímulos emocionales y enfatizamos la necesidad de incorporar una variedad de estímulos emocionales en la investigación sobre TEPT.
Blekic, Wivine ; Université de Mons - UMONS > Faculté de Psychologie et des Sciences de l'Education > Service de Psychologie cognitive et Neuropsychologie
Rossignol, Mandy ; Université de Mons - UMONS > Faculté de Psychologie et des Sciences de l'Education > Service de Psychologie cognitive et Neuropsychologie
Fabien D'Hondt; ULille - Université de Lille > Lille Neuroscience & Cognition
Language :
English
Title :
Examining attentional avoidance in post-traumatic stress disorder: an exploratory 'Face in the Crowd' paradigm using eye-tracking.
R550 - Institut des Sciences et Technologies de la Santé
Funders :
National Center of Resources and Resilience European Union's Horizon 2020
Funding text :
Wivine Blekic is funded by the National Center of Resources and Resilience and the European Union's Horizon 2020 research and innovation program under the Marie Sk\u0142odowska-Curie Postdoctoral grant. Mandy Rossignol received support from the Research Foundations FWO and F.R.S.-FNRS under the Excellence of Science (EOS) program (EOS 40007528, TRIAD). This funding source did not exert any influence or censorship on the present work.
American Psychiatric Association (Ed.). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed). American Psychiatric Association.
Armstrong, T., Bilsky, S. A., Zhao, M., & Olatunji, B. O., (2013). Dwelling on potential threat cues: An eye-movement marker for combat-related PTSD. Depression and Anxiety, 30(5), 497–502. https://doi.org/10.1002/da.22115
Bardeen, J. R., (2020). The regulatory role of attention in PTSD from an information processing perspective. In M. T. Tull & N. A. Kimbrel (Eds.), Emotion in posttraumatic stress disorder (pp. 311–341). Academic Press. https://doi.org/10.1016/B978-0-12-816022-0.00011-9.
Bardeen, J. R., & Daniel, T. A., (2017). An eye-tracking examination of emotion regulation, attentional bias, and pupillary response to threat stimuli. Cognitive Therapy and Research, 41(6), 853–866. https://doi.org/10.1007/s10608-017-9860-y
Bardeen, J. R., Daniel, T. A., Gordon, R. D., Hinnant, J. B., & Weathers, F. W., (2020). Individual differences in attentional control explain the differential expression of threat-related attentional bias among those with posttraumatic stress symptomatology and predict symptom maintenance up to one year later. Behaviour Research and Therapy, 133, 103709. https://doi.org/10.1016/j.brat.2020.103709
Bardeen, J. R., Daniel, T. A., Hinnant, J. B., & Orcutt, H. K., (2017). Emotion dysregulation and threat-related attention bias variability. Motivation and Emotion, 41(3), 402–409. https://doi.org/10.1007/s11031-017-9604-z
Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & Van Ijzendoorn, M. H., (2007). Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study. Psychological Bulletin, 133(1), 1.
Bishop, S. J., (2008). Neural mechanisms underlying selective attention to threat. Annals of the New York Academy of Sciences, 1129(1), 141–152. https://doi.org/10.1196/annals.1417.016
Blekic, W., Wauthia, E., Kornacka, M., Kandana Arachchige, K., Lefebvre, L., & Rossignol, M., (2021). Eye-tracking exploration of inhibitory control in post-traumatic stress disorder: An emotional antisaccade paradigm. European Journal of Psychotraumatology, 12(1), 1909281. https://doi.org/10.1080/20008198.2021.1909281
Blekic, W., Wauthia, E., Loureiro, I. S., Arachchige, K., & Lefebvre, L., (2019). Étude factorielle exploratoire de la version française de l’Échelle de Contrôle Attentionnel: Liens avec les symptômes d’anxiété et de dépression. 10.
Blekić, W., Bellaert, N., Rossignol, M., & Schultebraucks, K., (2023). Validation and adaptation of the attentional control scale Among a French-speaking population through factor and network analysis. Journal of Psychopathology and Behavioral Assessment, 45(3), 884–895. https://doi.org/10.1007/s10862-023-10050-y
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D., (2011). Preliminary psychometric properties of the acceptance and action questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/10.1016/j.beth.2011.03.007
Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D., (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162(2), 214–227.
Chen, N. T. M., & Clarke, P. J. F., (2017). Gaze-Based assessments of vigilance and avoidance in social anxiety: A review. Current Psychiatry Reports, 19(9), 59. https://doi.org/10.1007/s11920-017-0808-4
Cisler, J. M., & Koster, E. H. W., (2010). Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review. Clinical Psychology Review, 30(2), 203–216. https://doi.org/10.1016/j.cpr.2009.11.003
Collet, L., & Cottraux, J., (1986). Inventaire abrégé de la dépression de Beck (13 items): Étude de la validité concurrente avec les échelles de Hamilton et de ralentissement de Widlöcher. [The shortened Beck Depression Inventory: Study of the concurrent validity with the Hamilton Depression Rating Scale and the Widlöcher retardation Rating Scale]. L’Encéphale: Revue de Psychiatrie Clinique Biologique et Thérapeutique, 12(2), 77–79.
Cooper, S. E., Van Dis, E. A. M., Hagenaars, M. A., Krypotos, A.-M., Nemeroff, C. B., Lissek, S., Engelhard, I. M., & Dunsmoor, J. E., (2022). A meta-analysis of conditioned fear generalization in anxiety-related disorders. Neuropsychopharmacology, 47(9), 1652–1661. https://doi.org/10.1038/s41386-022-01332-2
Derryberry, D., & Reed, M. A., (2002). Anxiety-related attentional biases and their regulation by attentional control. Journal of Abnormal Psychology, 111(2), 225–236. https://doi.org/10.1037/0021-843X.111.2.225
Difede, J., Olden, M., & Cukor, J., (2014). Evidence-based treatment of post-traumatic stress disorder. Annual Review of Medicine, 65(1), 319–332. https://doi.org/10.1146/annurev-med-051812-145438
Ehlers, A., & Clark, D. M., (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. https://doi.org/10.1016/S0005-7967(99)00123-0
Ehlers, A., Ehring, T., Wittekind, C. E., & Kleim, B., (2022). Information processing in posttraumatic stress disorder. In J. G. Beck & D. M. Sloan (Eds.), In The Oxford handbook of traumatic stress disorders (2nd ed., pp. 367–414). Oxford University Press.
Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G., (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7(2), 336.
Fani, N., Tone, E. B., Phifer, J., Norrholm, S. D., Bradley, B., Ressler, K. J., Kamkwalala, A., & Jovanovic, T., (2012). Attention bias toward threat is associated with exaggerated fear expression and impaired extinction in PTSD. Psychological Medicine, 42(3), 533–543. https://doi.org/10.1017/S0033291711001565
Fraunfelter, L., Gerdes, A. B. M., & Alpers, G. W., (2022). Fear one, fear them all: A systematic review and meta-analysis of fear generalization in pathological anxiety. Neuroscience & Biobehavioral Reviews, 139, 104707. https://doi.org/10.1016/j.neubiorev.2022.104707
Gauthier, J., & Bouchard, S., (1993). Adaptation canadienne-française de la forme révisée du State–Trait Anxiety Inventory de Spielberger. [A French-Canadian adaptation of the revised version of Spielberger’s State–Trait Anxiety Inventory]. Canadian Journal of Behavioural Science / Revue Canadienne Des Sciences Du Comportement, 25(4), 559–578. https://doi.org/10.1037/h0078881
Hansen, C. H., & Hansen, R. D., (1988). Finding the face in the crowd: An anger superiority effect. Journal of Personality and Social Psychology, 4(8), 917–924.
Iacoviello, B. M., Wu, G., Abend, R., Murrough, J. W., Feder, A., Fruchter, E., Levinstein, Y., Wald, I., Bailey, C. R., Pine, D. S., Neumeister, A., Bar-Haim, Y., & Charney, D. S., (2014). Attention bias variability and symptoms of posttraumatic stress disorder: Attention bias variability in PTSD. Journal of Traumatic Stress, 27(2), 232–239. https://doi.org/10.1002/jts.21899
Kausch, O., Rugle, L., & Rowland, D. Y., (2006). Lifetime histories of trauma among pathological gamblers. American Journal on Addictions, 15(1), 35–43. https://doi.org/10.1080/10550490500419045
Kessler, R. C., Rose, S., Koenen, K. C., Karam, E. G., Stang, P. E., Stein, D. J., Heeringa, S. G., Hill, E. D., Liberzon, I., McLaughlin, K. A., McLean, S. A., Pennell, B. E., Petukhova, M., Rosellini, A. J., Ruscio, A. M., Shahly, V., Shalev, A. Y., Silove, D., Zaslavsky, A. M., … Carmen Viana, M., (2014). How well can post-traumatic stress disorder be predicted from pre-trauma risk factors? An exploratory study in the WHO world mental health surveys. World Psychiatry, 13(3), 265–274. https://doi.org/10.1002/wps.20150
Kimble, M. O., Fleming, K., Bandy, C., Kim, J., & Zambetti, A., (2010). Eye tracking and visual attention to threating stimuli in veterans of the Iraq war. Journal of Anxiety Disorders, 24(3), 293–299. https://doi.org/10.1016/j.janxdis.2009.12.006
Kumpula, M. J., Orcutt, H. K., Bardeen, J. R., & Varkovitzky, R. L., (2011). Peritraumatic dissociation and experiential avoidance as prospective predictors of posttraumatic stress symptoms. Journal of Abnormal Psychology, 120(3), 617–627. https://doi.org/10.1037/a0023927
Lazarov, A., Suarez-Jimenez, B., Tamman, A., Falzon, L., Zhu, X., Edmondson, D. E., & Neria, Y., (2019). Attention to threat in posttraumatic stress disorder as indexed by eye-tracking indices: A systematic review. Psychological Medicine, 49(5), 705–726. https://doi.org/10.1017/S0033291718002313
Lazarov, A., Suarez-Jimenez, B., Zhu, X., Pine, D. S., Bar-Haim, Y., & Neria, Y., (2022). Attention allocation in posttraumatic stress disorder: An eye-tracking study. Psychological Medicine, 52(15), 3720–3729. https://doi.org/10.1017/S0033291721000581
Lee, J.-H., & Lee, J.-H., (2012). Attentional bias to violent images in survivors of dating violence. Cognition & Emotion, 26(6), 1124–1133. https://doi.org/10.1080/02699931.2011.638906
Lee, J.-H., & Lee, J.-H., (2014). Attentional bias towards emotional facial expressions in survivors of dating violence. Cognition and Emotion, 28(6), 1127–1136. https://doi.org/10.1080/02699931.2013.867834
Lissek, S., & Van Meurs, B., (2015). Learning models of PTSD: Theoretical accounts and psychobiological evidence. International Journal of Psychophysiology, 98(3), 594–605. https://doi.org/10.1016/j.ijpsycho.2014.11.006
MacLeod, C., & Mathews, A., (1988). Anxiety and the allocation of attention to threat. Quarterly Journal of Experimental Psychology, 40(4), 653–670. doi:10.1080/14640748808402292
Mckinnon, A. I., Gray, N. S., & Snowden, R. J., (2020). Enhanced emotional response to both negative and positive images in post-traumatic stress disorder: Evidence from pupillometry. Biological Psychology, 154, 107922. https://doi.org/10.1016/j.biopsycho.2020.107922
Morey, R. A., Haswell, C. C., Stjepanović, D., Dunsmoor, J. E., & LaBar, K. S., (2020). Neural correlates of conceptual-level fear generalization in posttraumatic stress disorder. Neuropsychopharmacology, 45(8), 1380–1389. https://doi.org/10.1038/s41386-020-0661-8
Olatunji, B. O., Armstrong, T., McHugo, M., & Zald, D. H., (2013). Heightened attentional capture by threat in veterans with PTSD. Journal of Abnormal Psychology, 122(2), 397–405. https://doi.org/10.1037/a0030440
Pinkham, A. E., Griffin, M., Baron, R., Sasson, N. J., & Gur, R. C., (2010). The face in the crowd effect: Anger superiority when using real faces and multiple identities. Emotion, 10(1), 141–146. https://doi.org/10.1037/a0017387
Sarchiapone, M., Carli, V., Cuomo, C., & Roy, A., (2007). Childhood trauma and suicide attempts in patients with unipolar depression. Depression and Anxiety, 24(4), 268–272. https://doi.org/10.1002/da.20243
Schick, M. R., Weiss, N. H., Contractor, A. A., Suazo, N. C., & Spillane, N. S., (2020). Post-traumatic stress disorder’s relation with positive and negative emotional avoidance: The moderating role of gender. Stress and Health, 36(2), 172–178. https://doi.org/10.1002/smi.2920
Schoorl, M., Putman, P., Van Der Werff, S., & Van Der Does, A. J. W., (2014). Attentional bias and attentional control in posttraumatic stress disorder. Journal of Anxiety Disorders, 28(2), 203–210. https://doi.org/10.1016/j.janxdis.2013.10.001
Shasteen, J. R., Sasson, N. J., & Pinkham, A. E., (2014). Eye tracking the face in the crowd task: Why are angry faces found more quickly?PLoS One, 9(4), e93914. https://doi.org/10.1371/journal.pone.0093914
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A., (1983). Manual for the state-trait anxiety inventory (form Y): Self-evaluation questionnaire. Consulting Psychologists Press.
Veerapa, E., Grandgenevre, P., Vaiva, G., Duhem, S., Fayoumi, M. E., Vinnac, B., Szaffarczyk, S., Wathelet, M., Fovet, T., & D’Hondt, F., (2023). Attentional bias toward negative stimuli in PTSD: An eye-tracking study. Psychological Medicine, 53(12), 5809–5817. https://doi.org/10.1017/S0033291722003063
Weathers, F., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P., (2013). The PTSD Checklist for DSM-5 (PCL-5). www.ptsd.va.gov.
Weierich, M. R., Treat, T. A., & Hollingworth, A., (2008). Theories and measurement of visual attentional processing in anxiety. Cognition and Emotion, 22(6), 985–1018.
