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Battlefield-like stress following simulated combat and suppression of attention bias to threat

Published online by Cambridge University Press:  26 November 2010

I. Wald ,
G. Lubin ,
Y. Holoshitz ,
D. Muller ,
E. Fruchter ,
D. S. Pine ,
D. S. Charney  and
Y. Bar-Haim
I. Wald
Affiliation:
Department of Psychology, Tel Aviv University, Israel
G. Lubin
Affiliation:
Israeli Defense Force, Medical Corps, Israel
Y. Holoshitz
Affiliation:
Mount Sinai School of Medicine, NY, USA
D. Muller
Affiliation:
Mount Sinai School of Medicine, NY, USA
E. Fruchter
Affiliation:
Israeli Defense Force, Medical Corps, Israel
D. S. Pine
Affiliation:
The National Institute of Mental Health, MD, USA
D. S. Charney
Affiliation:
Mount Sinai School of Medicine, NY, USA
Y. Bar-Haim*
Affiliation:
Department of Psychology, Tel Aviv University, Israel
*
*Address for correspondence: Y. Bar-Haim, Ph.D., Department of Psychology, Tel Aviv University, Israel 69978. (Email: [email protected])
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Abstract

Background

Acute stress disorder involves prominent symptoms of threat avoidance. Preliminary cross-sectional data suggest that such threat-avoidance symptoms may also manifest cognitively, as attentional threat avoidance. Confirming these findings in a longitudinal study might provide insights on risk prediction and anxiety prevention in traumatic exposures.

Method

Attention-threat bias and post-traumatic symptoms were assessed in soldiers at two points in time: early in basic training and 23 weeks later, during advanced combat training. Based on random assignment, the timing of the repeat assessment occurred in one of two schedules: for a combat simulation group, the repeat assessment occurred immediately following a battlefield simulation exercise, and for a control group, the assessment occurred shortly before this exercise.

Results

Both groups showed no threat-related attention bias at initial assessments. Following acute stress, the combat simulation group exhibited a shift in attention away from threat whereas the control group showed no change in attention bias. Stronger threat avoidance in the combat simulation group correlated with severity of post-traumatic symptoms. Such an association was not found in the control group.

Conclusions

Acute stress may lead some individuals to shift their attention away from threats, perhaps to minimize stress exposure. This acute attention response may come at a psychological cost, given that it correlates with post-traumatic stress disorder (PTSD) symptoms. Further research is needed to determine how these associations relate to full-blown PTSD in soldier and civilian populations.

Keywords

Anxietyattention biascombatPTSDstress
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 4 , April 2011 , pp. 699 - 707
Copyright
Copyright © Cambridge University Press 2010

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References

Amir, N, Beard, C, Burns, M, Bomyea, J (2009 a). Attention modification program in individuals with generalized anxiety disorder. Journal of Abnormal Psychology 118, 28–33.CrossRefGoogle ScholarPubMed
Amir, N, Beard, C, Taylor, CT, Klumpp, H, Elias, J, Burns, M, Chen, X (2009 b). Attention training in individuals with generalized social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology 77, 961–973.CrossRefGoogle ScholarPubMed
Amir, N, McNally, RJ, Riemann, BC, Burns, J, Lorenz, M, Mullen, JT (1996). Suppression of the emotional Stroop effect by increased anxiety in patients with social phobia. Behaviour Research and Therapy 34, 945–948.CrossRefGoogle ScholarPubMed
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.Google Scholar
Bar-Haim, Y (2010). Attention Bias Modification (ABM): a novel treatment for anxiety disorders. Journal of Child Psychology and Psychiatry 51, 859–870.CrossRefGoogle ScholarPubMed
Bar-Haim, Y, Holoshitz, Y, Eldar, S, Frenkel, TI, Muller, D, Charney, DS, Pine, DS, Fox, NA, Wald, I (2010). Life-threatening danger and suppression of attention bias to threat. American Journal of Psychiatry 167, 694–698.CrossRefGoogle ScholarPubMed
Bar-Haim, Y, Lamy, D, Pergamin, L, Bakermans-Kranenburg, MJ, van IJzendoorn, MH (2007). Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychological Bulletin 133, 1–24.CrossRefGoogle ScholarPubMed
Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy 34, 669–673.CrossRefGoogle ScholarPubMed
Bremner, JD, Brett, E (1997). Trauma-related dissociative states and long-term psychopathology in posttraumatic stress disorder. Journal of Traumatic Stress 10, 37–49.CrossRefGoogle ScholarPubMed
Brewin, CR, Andrews, B, Rose, S, Kirk, M (1999). Acute stress disorder and posttraumatic stress disorder in victims of violent crime. American Journal of Psychiatry 156, 360–366.CrossRefGoogle ScholarPubMed
Briere, J, Scott, C, Weathers, F (2005). Peritraumatic and persistent dissociation in the presumed etiology of PTSD. American Journal of Psychiatry 162, 2295–2301.CrossRefGoogle ScholarPubMed
Charney, DS (2004). Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. American Journal of Psychiatry 161, 195–216.CrossRefGoogle ScholarPubMed
Constans, JI, McCloskey, MS, Vasterling, JJ, Brailey, K, Mathews, A (2004). Suppression of attentional bias in PTSD. Journal of Abnormal Psychology 113, 315–323.CrossRefGoogle ScholarPubMed
Eldar, S, Bar-Haim, Y (2010). Neural plasticity in response to attention training in anxiety. Psychological Medicine 40, 667–678.CrossRefGoogle ScholarPubMed
Fox, E, Ridgewell, A, Ashwin, C (2009). Looking on the bright side: biased attention and the human serotonin transporter gene. Proceedings. Biological Sciences/The Royal Society 276, 1747–1751.CrossRefGoogle ScholarPubMed
Garner, M, Mogg, K, Bradley, BP (2006). Orienting and maintenance of gaze to facial expressions in social anxiety. Journal of Abnormal Psychology 115, 760–770.CrossRefGoogle ScholarPubMed
Habib, KE, Gold, PW, Chrousos, GP (2001). Neuroendocrinology of stress. Endocrinology and Metabolism Clinics of North America 30, 695–728.CrossRefGoogle ScholarPubMed
Hakamata, Y, Lissek, S, Bar-Haim, Y, Britton, JC, Fox, NA, Leibenluft, E, Ernst, M, Pine, DS (2010). Attention Bias Modification Treatment: a meta-analysis towards the establishment of novel treatment for anxiety. Biological Psychiatry. Published online: 1 October 2010. doi:10.1016/j.biopsych.2010.07.021.CrossRefGoogle Scholar
Harvey, AG, Bryant, RA (1998). The relationship between acute stress disorder and posttraumatic stress disorder: a prospective evaluation of motor vehicle accident survivors. Journal of Consulting and Clinical Psychology 66, 507–512.CrossRefGoogle ScholarPubMed
Harvey, AG, Bryant, RA (2002). Acute stress disorder: a synthesis and critique. Psychological Bulletin 128, 886–902.CrossRefGoogle ScholarPubMed
Helfinstein, SM, White, LK, Bar-Haim, Y, Fox, NA (2008). Affective primes suppress attention bias to threat in socially anxious individuals. Behaviour Research and Therapy 46, 799–810.CrossRefGoogle ScholarPubMed
Lensvelt-Mulders, G, van der Hart, O, van Ochten, JM, van Son, MJM, Steele, K, Breeman, L (2008). Relations among peritraumatic dissociation and posttraumatic stress: a meta-analysis. Clinical Psychology Review 28, 1138–1150.CrossRefGoogle ScholarPubMed
Lieberman, HR, Bathalon, GP, Falco, CM, Kramer, FM, Morgan, CA, Niro, P (2005). Severe decrements in cognition function and mood induced by sleep loss, heat, dehydration, and undernutrition during simulated combat. Biological Psychiatry 57, 422–429.CrossRefGoogle ScholarPubMed
Lieberman, HR, Castellani, JW, Young, AJ (2009). Cognitive function and mood during acute cold stress after extended military training and recovery. Aviation Space and Environmental Medicine 80, 629–636.CrossRefGoogle ScholarPubMed
Lieberman, HR, Tharion, WJ, Shukitt-Hale, B, Speckman, KL, Tulley, R (2002). Effects of caffeine, sleep loss, and stress on cognitive performance and mood during US Navy SEAL training. Psychopharmacology 164, 250–261.CrossRefGoogle ScholarPubMed
Mansell, W, Clark, DM, Ehlers, A, Chen, YP (1999). Social anxiety and attention away from emotional faces. Cognition & Emotion 13, 673–690.CrossRefGoogle Scholar
Marmar, CR, Weiss, DS, Schlenger, WE, Fairbank, JA, Jordan, BK, Kulka, RA, Hough, RL (1994). Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans. American Journal of Psychiatry 151, 902–907.Google ScholarPubMed
Marx, BP, Brailey, K, Proctor, SP, MacDonald, HZ, Graefe, AC, Amoroso, P, Heeren, T, Vasterling, JJ (2009). Association of time since deployment, combat intensity, and posttraumatic stress symptoms with neuropsychological outcomes following Iraq war deployment. Archives of General Psychiatry 66, 996–1004.CrossRefGoogle ScholarPubMed
Mathews, A, Sebastian, S (1993). Suppression of emotional Stroop effects by fear-arousal. Cognition & Emotion 7, 517–530.CrossRefGoogle Scholar
MacLeod, C, Mathews, A, Tata, P (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology 95, 15–20.CrossRefGoogle ScholarPubMed
MacLeod, C, Rutherford, E, Campbell, L, Ebsworthy, G, Holker, L (2002). Selective attention and emotional vulnerability: assessing the causal basis of their association through the experimental manipulation of attentional bias. Journal of Abnormal Psychology 111, 107–123.CrossRefGoogle ScholarPubMed
McEwen, BS, Sapolsky, RM (1995). Stress and cognitive function. Current Opinion in Neurobiology 5, 205–216.CrossRefGoogle ScholarPubMed
McNally, RJ (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology 54, 229–252.CrossRefGoogle Scholar
Monk, CS, Nelson, EE, McClure, EB, Mogg, K, Bradley, BP, Leibenluft, E, Blair, RJ, Chen, G, Charney, DS, Ernst, M, Pine, DS (2006). Ventrolateral prefrontal cortex activation and attentional bias in response to angry faces in adolescents with generalized anxiety disorder. American Journal of Psychiatry 163, 1091–1097.CrossRefGoogle ScholarPubMed
Monk, CS, Telzer, EH, Mogg, K, Bradley, BP, Mai, X, Louro, HMC, Chen, G, McClure-Tone, EB, Ernst, M, Pine, DS (2008). Amygdala and ventrolateral prefrontal cortex activation to masked angry faces in children and adolescents with generalized anxiety disorder. Archives of General Psychiatry 65, 568–576.CrossRefGoogle ScholarPubMed
Morgan, CA 3rd, Rasmusson, A, Pietrzak, RH, Coric, V, Southwick, SM (2009). Relationships among plasma dehydroepiandrosterone and dehydroepiandrosterone sulfate, cortisol, symptoms of dissociation, and objective performance in humans exposed to underwater navigation stress. Biological Psychiatry 66, 334–340.CrossRefGoogle ScholarPubMed
Morgan, CA 3rd, Southwick, S, Hazlett, G, Rasmusson, A, Hoyt, G, Zimolo, Z, Charney, D (2004). Relationships among plasma dehydroepiandrosterone sulfate and cortisol levels, symptoms of dissociation, and objective performance in humans exposed to acute stress. Archives of General Psychiatry 61, 819–825.CrossRefGoogle ScholarPubMed
Morgan, CA 3rd, Wang, S, Southwick, SM, Rasmusson, A, Hazlett, G, Hauger, RL, Charney, D (2000). Plasma neuropeptide-Y concentrations in humans exposed to military survival training. Biological Psychiatry 47, 902–909.CrossRefGoogle ScholarPubMed
Morilak, DA, Barrera, G, Echevarria, DJ, Garcia, AS, Hernandez, A, Ma, S, Petre, CO (2005). Role of brain norepinephrine in the behavioral response to stress. Progress in Neuro-Psychopharmacology and Biological Psychiatry 29, 1214–1224.CrossRefGoogle ScholarPubMed
Perez-Edgar, K, Bar-Haim, Y, McDermott, JM, Gorodetsky, E, Hodgkinson, CA, Goldman, D, Ernst, M, Pine, DS, Fox, NA (2010). Variations in the serotonin-transporter gene are associated with attention bias patterns to positive and negative emotion faces. Biological Psychology 83, 269–271.CrossRefGoogle ScholarPubMed
Pine, DS, Helfinstein, SM, Bar-Haim, Y, Nelson, E, Fox, NA (2009). Challenges in developing novel treatments for childhood disorders: lessons from research on anxiety. Neuropsychopharmacology 34, 213–228.CrossRefGoogle ScholarPubMed
Pourtois, G, Grandjean, D, Sander, D, Vuilleumier, P (2004). Electrophysiological correlates of rapid spatial orienting towards fearful faces. Cerebral Cortex 14, 619–633.CrossRefGoogle ScholarPubMed
Sauro, MD, Jorgensen, RS, Pedlow, CT (2003). Stress, glucocorticoids, and memory: a meta-analytic review. Stress (Amsterdam, Netherlands) 6, 235–245.CrossRefGoogle ScholarPubMed
Schmidt, NB, Richey, JA, Buckner, JD, Timpano, KR (2009). Attention training for generalized social anxiety disorder. Journal of Abnormal Psychology 118, 5–14.CrossRefGoogle ScholarPubMed
Shalev, AY, Peri, T, Canetti, L, Schreiber, S (1996). Predictors of PTSD in injured trauma survivors: a prospective study. American Journal of Psychiatry 153, 219–225.Google ScholarPubMed
Solomon, Z, Mikulincer, M (1992). Aftermaths of combat stress reactions: a three-year study. British Journal of Clinical Psychology 31, 21–32.CrossRefGoogle ScholarPubMed
Vasterling, JJ, Proctor, SP, Amoroso, P, Kane, R, Gackstetter, G, Ryan, MA, Friedman, MJ (2006 a). The Neurocognition Deployment Health Study: a prospective cohort study of Army Soldiers. Military Medicine 171, 253–260.CrossRefGoogle ScholarPubMed
Vasterling, JJ, Proctor, SP, Amoroso, P, Kane, R, Heeren, T, White, RF (2006 b). Neuropsychological outcomes of army personnel following deployment to the Iraq war. Journal of the American Medical Association 296, 519–529.CrossRefGoogle Scholar
Weathers, FW, Litz, BT, Herman, DS, Huska, JA, Keane, TM (1993). The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX (http://www.pdhealth.mil/library/downloads/PCL_sychometrics.doc).Google Scholar