Attentional bias and its temporal dynamics among war veterans suffering from chronic pain: Investigating the contribution of post-traumatic stress symptoms

Studying the Prevalence of PTSD in Veterans, Combatants and Freed Soldiers of Iran-Iraq War: A Systematic and Meta-analysis Review

War as an unpleasant and stressful phenomenon could be the cause of psychiatric disorders. This study aims to collect and compare conducted research to estimate the prevalence of Post-Traumatic Stress Disorder (PTSD) in combatants, veterans, and freed soldiers of the 1980-88 Iran-Iraq war. This study is a case review study in which articles were found using keywords, such as Post-Traumatic Stress Disorder (PTSD), veterans, combatants, captive, soldiers and war in domestic and foreign databases, personal archives, libraries of Iran and Tehran Universities of Medical Sciences and the National Library. The cumulative incidence of PTSD was determined to be 27.8% in veterans, combatants, and freed soldiers. The prevalence of PTSD as seen in civilian and some military studies is less than the values determined in this study. Reasons for this discrepancy may be due to longer durations of exposure and greater numbers of in-the-field missions, multiple traumas, and higher rates of combat exposure, as well as differences in sampling and measurement strategies (e.g. the use of questionnaires instead of clinical interviews).

Selective attention to pain and empathy: Studying frequent blood donors

INTRODUCTION

Empathy is an interpersonal experience that enables understanding of other's emotions and can lead to altruistic behavior such as blood donation. Cognitive theories of empathy refer to selective attention as one of its cognitive dimensions. The current study examined if individuals who engage in altruistic behavior are characterized by a distinct pattern of selective attention to observation of pain in others.

METHODS

We recruited 50 volunteer blood donors. Half (n = 25) of the volunteers donated for a self-declared altruistic reason, and the other half of the volunteers donated blood for a health-related reason. We assessed the individuals' self-reported empathy with the Interpersonal Reactivity Index (IRI). We then measured the individuals' selective attention toward faces expressing pain in a pictorial dot-probe task.

RESULTS

Consistent with the proposed hypothesis, participants who donated blood out of altruism reported significantly higher empathic concern on the IRI than those who donated blood for a health-related reason. The altruistic donors also showed significantly greater selective attention toward facial expressions of pain. Moreover, among all donors, self-report empathic concern on the IRI was significantly correlated with greater selective attention toward faces expressing pain.

DISCUSSION

These findings suggest that altruistic individuals not only show higher levels of empathy, but also attend more to the pain of others. Limitations, implications, and suggestions for future research are discussed.

The questionable validity of attention bias variability: Evidence from two conceptually unrelated cognitive tasks

Background

Attention bias variability is thought to measure fluctuations in attention towards and away from threat-related information and is elevated in affective disorders. However, recent evidence suggests that attention bias variability may quantify general reaction time variability rather than attention bias behavior per se.

Methods

The current study calculated "attention bias variability" from two conceptually unrelated cognitive tasks: the dot-probe task (measuring attentional bias) and the arrow flanker task (measuring cognitive control).

Results

Attention bias variability measures were correlated across these unrelated tasks. Yet, when general reaction time variability was controlled, attention bias variability across tasks was no longer correlated. In addition, the reliability of attention bias variability measures decreased when controlling for general reaction time variability. Finally, although attention bias variability calculated from the dot-probe task initially correlated with anxious symptoms, this association was no longer significant when controlling for general reaction time variability.

Limitations

Our sample was comprised of high trait anxious individuals. Replication in clinical samples is warranted.

Conclusions

These findings collectively provide strong empirical evidence that attention bias variability is not a valid measure of attention-related behavior, but reflective of general reaction time variability more broadly.

The remediating effect of Attention Bias Modification on aggression in young offenders with antisocial tendency: A randomized controlled trial

BACKGROUND AND OBJECTIVES

An attention bias toward hostile stimuli is associated with an increased risk of aggressive behavior. Thus, reducing hostile attention bias may help to reduce aggression in young offenders. We evaluated the remediating effects of Attention Bias Modification (ABM) on hostile attention bias and aggressive behavior in Chinese male young offenders with antisocial tendencies.

METHODS

Institutionalized male young offenders (ages 16-18) were recruited and randomly assigned to ABM (n = 28), placebo (n = 28), or waiting list (n = 28). The ABM group received four weeks of training using visual search of emotional faces; the placebo group underwent similar training using visual search of neutral objects. Before and after treatment, aggressive behavior, attention bias toward positive stimuli and hostile stimuli were assessed.

RESULTS

Linear mixed models and hierarchical multiple regression analyses showed that the intervention effect of ABM was moderated by participants' initial attention bias. Young offenders with a high level of initial hostile attention bias, or with a low level of initial positive attention bias, benefitted most from ABM.

LIMITATIONS

The small sample size impedes investigation of the mechanism of the intervention's effects. Further research can determine whether the current results can be extrapolated to the population of female young offenders.

CONCLUSION

The results of the present study suggest that ABM is helpful for young offenders who show the greatest bias toward hostile stimuli and away from positive stimuli. These findings highlight the importance of matching the intervention and the participant.

TRIAL REGISTRATION

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The prevalence of depression among iran-iraq war veterans, combatants and former prisoners of war: A systematic review and meta-analysis

By exposing individuals to trauma, wars can cause a host of psychiatric disorders. This study aimed to collect and compare the studies conducted to estimate the prevalence of depression among veterans, former prisoners of war (POWs) and military personnel in the Iran-Iraq war (1980-1988). In this systematic review, a search was conducted using relevant keywords in major national and international databases, personal archives and national academic libraries. We screened 135 records using their abstracts and selected a total of 56 studies for full-text review. Eventually, 19 studies were included in our systematic review and meta-analysis. The estimated pooled prevalence of depression among Iranian veterans and POWs was 22.4% (95% confidence interval = 15.0-32.0). Although the results indicated disparities in the prevalence of depression among veterans and POWs, the aggregate estimated prevalence was much higher than what has been reported for military personnel. Effective policies and strategies are required for prevention and treatment of depression and related psychiatric complications among veterans and former POWs.

Eating disorder-specific rumination moderates the association between attentional bias to high-calorie foods and eating disorder symptoms: Evidence from a reliable free-viewing eye-tracking task

Cognitive theories of eating disorders implicate Attentional Bias (AB) towards food-related information in the development and maintenance of eating disorders. Empirical evidence for this proposal, however, has been inconsistent, and the measures used to examine AB to food-related stimuli typically showed poor reliability. The aim of the current study was twofold. Firstly, we aimed to examine the psychometric properties of a newly devised eye-tracking task for the assessment of AB in the context of eating disorders. Secondly, we examined the role of Eating Disorder-specific (ED-specific) rumination as a potential moderator of the association between attentional bias to food images and eating disorder symptoms. One hundred and three female students were recruited and completed an eye-tracking task comprising 21 matrices that each contained 8 low-calorie and 8 high-calorie food images. Each matrix was presented for 6 s. First fixation location, first fixation latency, and total dwell time were assessed for low and high-calorie food images and the dwell-time based AB measure showed good reliability based on Cronbach's alpha, McDonald's Omega, and split-half method. In addition, the results revealed that the ED-specific rumination plays the hypothesized moderating role. Specifically, while participants with high levels of ED-specific rumination exhibited a positive association between AB to high-calorie foods and eating disorder symptoms, this association was not present among participants with lower levels of ED-specific rumination. The employed free-viewing task seems a reliable measure of AB to food-related stimuli, and the moderation analysis emphasizes the critical role of ED-specific rumination for eating disorder symptoms. Implications, limitations, and directions for future research are discussed.

Cognitive Biases in Type 2 Diabetes and Chronic Pain

The aim of the present study was to investigate the role of cognitive processing biases in Type 2 diabetes (T2D) and chronic pain, 2 conditions that are highly co-morbid. The final sample comprised 333 individuals (86 with T2D and chronic pain, 65 with chronic pain, 76 with T2D, 106 without any form of diabetes or pain). Participants completed questionnaires assessing pain and diabetes-related outcomes, as well as measures of interpretation bias, attentional bias, and attentional bias variability. In a 2 (pain status) x 2 (T2D status) x 3 (bias valence) ANOVA design, interpretation biases were found to be stronger in individuals with chronic pain than individuals without pain, although there were no differences according to T2D status. No group differences in attentional biases were found. Among individuals with T2D, greater interpretation bias was associated with better blood glucose control, but also greater fear of hypoglycemia. For individuals with chronic pain, greater interpretation bias and attentional bias variability was associated with worse pain outcomes. Whilst interpretation bias may be present in chronic pain, it also appears to indicate better glycemic control in individuals with T2D. These findings suggest a more dynamic approach to understanding cognitive bias is needed, to consider when these biases are more or less adaptive, so that they can be better harnessed to improve outcomes for individuals with T2D who experience chronic pain. PERSPECTIVE: These findings suggest that cognitive biases can be associated with psychopathology in chronic pain and in T2D, but can also potentially be adaptive in those with T2D. Diabetes management interventions may require a careful balance between promoting sufficient concern to motivate engagement in adaptive diabetes self-management, whilst also minimizing fear of hypoglycemia.

Event centrality and post-traumatic stress symptoms among college students during the COVID-19 pandemic: the roles of attention to negative information, catastrophizing, and rumination

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has affected college students' mental health and caused post-traumatic stress symptoms (PTSS). Event centrality is thought to play a key role in the development of PTSS, but it is not yet clear by what mechanism. Theoretically, event centrality may affect the retrieval of traumatic memories and further prompt post-traumatic cognitions to understand events, and so may in turn be associated with PTSS in college students. However, few empirical studies have examined the mediating role of post-traumatic cognitions in the relationship between event centrality and PTSS, especially among college students during the COVID-19 pandemic.

OBJECTIVES

The objective of this study was to examine the mediating roles of post-traumatic cognitive factors (e.g. attention to negative information, catastrophizing, and rumination) in the relationship between event centrality and PTSS among college students during the COVID-19 pandemic.

METHODS

We recruited 1153 college students who completed the pandemic experiences scale, the centrality of event scale, the attention to positive and negative information scale, the cognitive emotion regulation questionnaire, and the PTSD Checklist for DSM-5 during the COVID-19 pandemic in May 2020.

RESULTS

In this sample of college students, event centrality directly predicted PTSS, and PTSS was also indirectly predicted by event centrality through attention to negative information, catastrophizing, and rumination.

CONCLUSIONS

These findings support the existing literature on the relationship between event centrality, proposed cognitive variables, and PTSS, and shed light on the mechanisms underlying PTSS. Our findings also highlight the importance and applicability of targeted cognitive interventions for PTSS in college students during the COVID-19 pandemic.

HIGHLIGHTS

The COVID-19 pandemic has caused post-traumatic stress symptoms among college students.Event centrality is a risk factor of post-traumatic stress symptoms among college students during the COVID-19 pandemic.Attention to negative information, catastrophizing and rumination mediate the relationship between event centrality and post-traumatic stress symptoms.

Attentional variability and avoidance of hostile stimuli decrease aggression in Chinese male juvenile delinquents

BACKGROUND

As a prominent issue worldwide, juveniles' aggressive and violent crimes have attracted much interest in recent years. Based on the social information processing model, the present study aimed to evaluate the Chinese male juvenile delinquents' attention bias towards hostile stimuli from both static and dynamic perspectives. Additionally, the predictive effect of attention bias on aggressive behavior and the moderating effect of group (juvenile delinquents and the controls with no criminal history) were also investigated.

METHODS

The hostile attention bias and aggressive behavior of 76 juvenile delinquents (M_age = 17.5 years, SD = 0.59 years) and 67 controls (M_age = 18.3 years, SD = 0.73 years) were measured with the emotional dot-probe task, emotional Stroop task, and the Chinese version of the Buss & Perry aggression questionnaire, respectively.

RESULTS

The results showed that compared with controls, juvenile delinquents showed more attention biases towards hostile faces and words, and demonstrated higher levels of physical aggression and anger. Furthermore, the type of participants moderated the relationship between hostile attention bias and aggressive behavior. For juvenile delinquents, attention bias away from hostile stimuli and attention variability negatively predicted anger, while for controls, attention variability positively predicted self-directed aggression.

CONCLUSION

Attentional variability and avoidance of hostile stimuli are expected to reduce the aggressive level of Chinese male juvenile delinquents. The relationship between attention bias and aggression should be further considered and applied in the clinical practice.

What is attention bias variability? Examining the potential roles of attention control and response time variability in its relationship with anxiety

The present study examined the underlying role of attention control and response time variability in explaining the relationship between anxiety and two commonly computed measures of attention bias variability: 'moving average' and 'trial-level bias score' measures. Participants (final n = 195) completed measures of anxiety symptomatology, antisaccade performance (attention control), a stand-alone measure of response-time variability, and a probe task measure of attention bias. Average bias and moving average bias variability measures both recorded significant, but low split-half reliability. Both attention bias variability measures and average attention bias were associated with anxiety, and attention control. Both attention bias variability measures correlated with response time variability. Neither attention bias variability measure correlated with average attention bias. Attention control was the single significant mediator of the relationship between anxiety and the trial-level bias score measure of attention bias variability. Neither response time variability nor attention control significantly mediated the relationship between anxiety and the moving average measure of attention bias variability. No evidence was found for the mediating role of response time variability. The present findings suggest that the relationships observed between anxiety and the trial-level bias score measure of attention bias variability in particular may be attributable to the over-arching role of attention control.

Attentional control moderates the relationship between pain catastrophizing and selective attention to pain faces on the antisaccade task

Cognitive models of chronic pain emphasize the critical role of pain catastrophizing in attentional bias to pain-related stimuli. The aim of this study was (a) to investigate the relationship between pain catastrophizing and the ability to inhibit selective attention to pain-related faces (attentional bias); and (b) to determine whether attentional control moderated this relationship. One hundred and ten pain-free participants completed the anti-saccade task with dynamic facial expressions, specifically painful, angry, happy, and neutral facial expressions and questionnaires including a measure of pain catastrophizing. As predicted, participants with high pain catastrophizing had significantly higher error rates for antisaccade trials with pain faces relative to other facial expressions, indicating a difficulty disinhibiting attention towards painful faces. In moderation analyses, data showed that attentional control moderated the relationship between attentional bias to pain faces and pain catastrophizing. Post-hoc analyses demonstrated that it was shifting attention (not focusing) that accounted for this effect. Only for those with high self-reported ability to shift attention was there a significant relationship between catastrophizing and attentional bias to pain. These findings confirm that attentional control is necessary for an association between attentional bias and catastrophizing to be observed, which may explain the lack of relationships between attentional bias and individual characteristics, such as catastrophizing, in prior research.

The stability and reliability of attentional bias measures in the dot-probe task: Evidence from both traditional mean bias scores and trial-level bias scores

A new method of calculating attentional bias from the dot-probe task measures fluctuations in bias towards and away from emotional stimuli over time using trial level bias score metrics. We assessed the stability and reliability of traditional attentional bias scores and trial level bias score measures of attentional bias across time in two five-block dot-probe task experiments in non-clinical samples. In experiments 1 and 2, both traditional attentional bias scores and trial level bias score measures of attentional bias did not habituate/decrease across time. In general, trial level bias score metrics (i.e., attention bias variability as well as the mean biases toward and away from threat) were more reliable than the traditional attention bias measure. This pattern was observed across both experiments. The traditional bias score, however, did improve in reliability in the later blocks of the fearful face dot-probe task. Although trial level bias score measures did not habituate and were more reliable across blocks, these measures did not correlate with state or trait anxiety. On the other hand, trial level bias score measures were strongly correlated with general reaction time variability-and after controlling for this effect no longer superior in reliability in comparison to the traditional attention bias measure. We conclude that general response variability should be removed from trial level bias score measures to ensure that they truly reflect attention bias variability.