کنترل توجه به عنوان شاخص آینده نگر از نشانه استرس پس از سانحه

Abstract Attentional control may be used by trauma survivors to temporarily disengage and shift attention from threat salient information, allowing individuals to remain in, and habituate to, trauma-relevant contexts rather than using less adaptive regulatory strategies. Thus, greater attentional control abilities may be one factor that differentiates those who recover from trauma exposure from those who do not. In the present study, we examined attentional control as a prospective predictor of posttraumatic (PTS) symptoms over the course of two assessment sessions (T1 and T2). Consistent with the hypothesis that attentional control can be used to alleviate trauma-related distress, we predicted that an inverse relation between T1 attentional control and T2 PTS symptoms would be significantly stronger among participants who had experienced a traumatic event between time points (24% of the total sample: N = 85). Pre-T1 trauma history and T1 PTS symptoms served as covariates in regression analysis. Results revealed that T1 attentional control only predicted T2 PTS symptoms for participants who had experienced a traumatic event between time points. Thus, attentional control may be a protective factor against the development of PTS symptomatology in the aftermath of a traumatic event.

Introduction Although it is not uncommon to experience a traumatic event, only a small fraction of trauma exposed individuals go on to develop posttraumatic stress disorder (PTSD; Breslau & Kessler, 2001). Although a number of pre-trauma risk factors have been suggested in the development of PTSD, a great deal of attention has been paid in the extant literature to information processing biases, with a number of laboratory studies providing evidence that those with relatively higher posttraumatic stress (PTS) symptoms have a bias for attending to threat information (e.g., Bardeen and Orcutt, 2011, Olatunji et al., 2013 and Pineles et al., 2009). In fact, some have suggested that PTSD is an information-processing disorder, with an emphasis on biased threat perception (van der Kolk & McFarlane, 1996). In line with this conceptualization, research has shown that prolonged attentional engagement with threat information maintains negative affective states (Bardeen and Read, 2010 and Compton, 2000). Protracted states of distress may subsequently decrease the cognitive resources that are available for the emotional processing of trauma information (Foa & Kozak, 1986), thus resulting in the development and/or maintenance of PTS symptoms. However, popular theories of attentional threat processing (i.e., goal driven/stimulus driven theory: Corbetta & Shulman, 2002; attentional control theory: Eysenck, Derakshan, Santos, & Calvo, 2007; hot/cool-system theory of self-regulation: Metcalfe & Mischel, 1999) suggest that top-down attentional control (AC: i.e., the strategic control of higher-order executive attention in regulating bottom-up, stimulus driven, emotional responses) can be used to strategically avoid threat information in an attempt to alleviate emotional distress. Consistent with these theories, preliminary evidence suggests that AC can be used to disengage and shift attention from PTS-related threat information (Schoorl, Putman, van der Werff, & van der Does, 2014), even among those with relatively higher PTS symptoms (Bardeen & Orcutt, 2011), thus reducing trauma-related distress (Bardeen & Read, 2010). The use of AC to temporarily disengage and shift attention from threat salient information may help to down-regulate sympathetic nervous system arousal, thus allowing one to remain in, and habituate to, trauma-relevant contexts rather than using less adaptive regulatory strategies which have been shown to maintain PTS symptoms (e.g., experiential avoidance; Kumpula, Orcutt, Bardeen, & Varkovitzky, 2011). Thus, AC may be one pre-trauma individual difference factor of particular relevance for understanding the development of PTS symptoms following trauma exposure. Relatively few published studies have examined AC in the context of PTS symptomatology; however, a number of studies have shown that relatively lower levels of AC are associated with higher levels of a host of maladaptive outcomes, including PTS symptoms (Bardeen & Orcutt, 2011), poor social adaptation and externalizing behaviors (Eisenberg, Fabes, Guthrie, & Reiser, 2000), worry and rumination (Armstrong, Zald, & Olatunji, 2011), and symptoms of hyperactivity and inattention in children (Wiersema & Roeyers, 2009). Interestingly, AC has exhibited a protective effect in examinations of relations between putative risk factors and maladaptive outcomes. Specifically, empirical research has shown that AC protects (a) those who are prone to use maladaptive coping behaviors, such as worry and thought suppression from experiencing higher levels of anxiety (Fergus, Bardeen, & Orcutt, 2012), (b) those who perceive themselves as having poor emotion regulation abilities from ceasing goal-directed behavior when experiencing distress (Bardeen, Tull, Dixon-Gordon, Stevens, & Gratz, in press), (c) those with public-speaking anxiety from decrements in speech performance (Jones, Fazio, & Vasey, 2012), and (d) those with higher levels of trait anxiety from responding with fear to a CO2 challenge (Richey, Keough, & Schmidt, 2012). Taken together, these findings suggest AC as a transdiagnostic protective factor against the development of maladaptive outcomes, even among those with outcome-specific vulnerabilities. Findings to date are consistent with Gross’s (1998) process model of emotion regulation, in which the ability to flexibly control attention is essential for maintaining psychological well-being. In Gross’s model, attention deployment is considered the gatekeeper of emotion regulation, directly influencing subsequent stages of emotion regulation. Thus, the importance of examining the role of pre-trauma AC in the development of PTS symptoms following a traumatic event cannot be overstated, especially given research which has identified dispositional emotion dysregulation as a risk factor for the development of PTS symptomatology following trauma exposure (Bardeen, Kumpula, & Orcutt, 2013). Although the extant literature has provided evidence suggesting that relatively higher levels of AC may promote psychological well-being, even among those who are vulnerable to experiencing maladaptive psychological outcomes, the cross-sectional nature of research in this area precludes inferences regarding temporal relations among AC and maladaptive outcomes. Thus, in the present study, we examined AC as a prospective predictor of PTS symptoms over the course of two assessment sessions. We hypothesized that AC at the first assessment session (T1) would be negatively associated with PTS symptoms at T1 and at the follow-up assessment session (T2). In addition, we examined exposure to a traumatic event between assessment sessions as a moderator of the relationship between T1 AC and T2 PTS symptoms. Given that increased PTS symptoms are not uncommon in the acute aftermath of trauma exposure, as well as evidence suggesting AC as a protective factor, we expected that an inverse relation between T1 AC and T2 PTS symptoms would be significantly stronger among participants who had experienced a traumatic event between assessment sessions when accounting for pre-T1 trauma history and T1 PTS symptoms. This hypothesis is consistent with theory, and empirical research, which suggests that AC can be used to alleviate trauma-related distress. Thus, among participants who experience a traumatic event, those with higher AC abilities may be significantly less likely to experience PTS symptoms in the acute aftermath of the event.

Results An examination of bivariate correlations showed that the relation between the ACS total score and T1 and T2 PTS symptoms did not reach statistical significance (T1: r = −.15, p = .16; T2: r = −.19, p = .09). As expected, regression analysis showed that T1 PTS symptoms predicted T2 PTS symptoms (ps < .001; see Table 1). Of the remaining covariates, T1 Anxiety symptoms predicted T2 PTS Symptoms (p < .001), but T1 Exposure and the interval between T1 and T2 did not (ns). After accounting for T1 PTS symptoms, T1 Exposure, T1 Anxiety, and the interval between T1 and T2, both the ACS total scale score and T2 Exposure did not significantly predict T2 PTS symptoms (ns). In the third step of the model, the interaction term significantly predicted T2 PTS symptoms (p < .001). As predicted, simple slopes analysis revealed a significant negative association between AC and T2 PTS symptoms for participants who had experienced a traumatic event between time points (B = −.93, β = −.71, p < .001). No association was observed between AC and T2 PTS symptoms for those who had not experienced a traumatic event between time points, (B = −.06, β = −.04, p = .58; see Fig. 1). 1 Table 1. Hierarchical Multiple Regression Analysis Predicting T2 PCL-C. Predictor Step 1 Step 2 Step 3 ΔR2 B β B β B β Step 1 .59⁎⁎⁎ T1 PCL-C .49 .50⁎⁎⁎ .46 .48⁎⁎⁎ .45 .47⁎⁎⁎ T1 exposure 1.01 .10 .89 .09 1.06 .11 T1 DASS-anxiety .99 .31⁎⁎⁎ .93 .29⁎⁎⁎ .84 .27⁎⁎ Session interval −.02 −.02 −.01 −.01 −.03 −.02 Step 2 .01 T1 ACS −.05 −.03 −.18 −.14 T2 exposure 2.85 .10 1.90 .06 Step 3 .06⁎⁎⁎ T1 ACS × T2 exposure −.99 −.26⁎⁎⁎ Note: N = 85. PCL-C = PTSD Checklist-Civilian Version total score; DASS-Anxiety = Depression Anxiety Stress Scales Anxiety Scale score. ACS = Attentional Control Scale total score. ⁎⁎ p < .01. ⁎⁎⁎ p < .001. Table options The interaction effect (Attentional Control Scale [ACS] total score by T2 ... Fig. 1. The interaction effect (Attentional Control Scale [ACS] total score by T2 Exposure) was a significant predictor of the PTSD Checklist (PCL-C) total score at Time 2 (i.e., posttraumatic stress (PTS) symptoms, β = −.26, p < .001. Simple slopes analysis revealed that, among participants who experienced a traumatic event between Times 1 and 2, those with lower attentional control reported significantly higher levels of PTS symptoms than those with higher attentional control. There was not a significant association between attentional control and T2 PTS symptoms for those who did not experience a traumatic event between time points.