Posttraumatic Stress Disorder and Fear of Emotions: The Role of Attentional Control (original) (raw)

2013, Journal of Traumatic Stress

Individuals with posttraumatic stress disorder (PTSD) experience elevated concerns about their capacity to control, and the consequences of, strong emotions that occur in response to trauma reminders. Anxiety is theorized to compromise attentional control (Eysenck, Derakshan, Santos, & Calvo, 2007). In turn, diminished attentional control may increase vulnerability to threat cues and emotional reactivity (Ehlers & Clark, 2001). Consequently, attentional control may play a role in the fear of emotions frequently experienced by individuals with PTSD. Study participants included 64 men and 64 women with a mean age of 37 years, 86% of whom were White, non-Hispanic. Participants experienced an average of 7.68 types of traumatic events, most commonly including motor vehicle accidents and intimate partner violence. PTSD symptoms positively correlated with fear of emotions (r = .53) and negatively correlated with attentional control (r = −.38). Attentional control was negatively correlated with fear emotions (r = −.77) and partially mediated the link between PTSD and fear of emotions (R 2 = .22). Given the findings regarding top-down attentional control, these results have implications for cognitive and emotional processing theories of PTSD and emphasize the importance of clinical consideration of fear of emotions and attentional control in the treatment of PTSD. Cognitive processing biases are fundamental to posttraumatic stress disorder (PTSD). One such bias is anxiety sensitivity (i.e., negative evaluation and fear of anxiety-related symptoms due to their potential consequences; Elwood, Hahn, Olatunji, & Williams, 2009). Because PTSD is characterized by a broader array of emotions, research on fear of emotions may be more informative because it defines fear of all strong emotions and one's capacity to control or respond adaptively to such emotions (Williams, Chambless, & Ahrens, 1997). Although PTSD symptoms and fear of emotions positively correlate (e.g., Tull, Jakupcak, McFadden, & Roemer, 2007), mechanisms for their relation have not been explicated. Eysenck et al.'s (2007) attentional control theory posits that anxiety impairs attentional control (i.e., the ability to focus and shift attention). Anxiety is theorized to increase influence of the stimulus-driven attentional system that is triggered by perceived threat and decrease influence of the goal-directed system that strategically avoids threat (Eysenck et