Dwelling on Verbal but Not Pictorial Threat Cues: An Eye-Tracking Study With Adult Survivors of Childhood Interpersonal Violence

Objective: Previous studies have found evidence of an attentional bias for trauma-related stimuli in posttraumatic stress disorder (PTSD) using eye-tracking (ET) technlogy. However, it is unclear whether findings for PTSD after traumatic events in adulthood can be transferred to PTSD after interpersonal trauma in childhood. The latter is often accompanied by more complex symptom features, including, for example, affective dysregulation and has not yet been studied using ET. The aim of this study was to explore which components of attention are biased in adult victims of childhood trauma with PTSD compared to those without PTSD. Method: Female participants with (n = 27) or without (n = 27) PTSD who had experienced interpersonal violence in childhood or adolescence watched different trauma-related stimuli (Experiment 1: words, Experiment 2: facial expressions). We analyzed whether trauma-related stimuli were primarily detected (vigilance bias) and/or dwelled on longer (maintenance bias) compared to stimuli of other emotional qualities. Results: For trauma-related words, there was evidence of a maintenance bias but not of a vigilance bias. For trauma-related facial expressions, there was no evidence of any bias. Conclusions: At present, an attentional bias to trauma-related stimuli cannot be considered as robust in PTSD following trauma in childhood compared to that of PTSD following trauma in adulthood. The findings are discussed with respect to difficulties attributing effects specifically to PTSD in this highly comorbid though understudied population. Clinical Impact Statement In posttraumatic stress disorder (PTSD), an attentional bias toward trauma-related stimuli may contribute to an easy triggering of intrusive memories and add to an increased awareness of threat. Using an eye-tracking paradigm, our study found inconsistent results in participants suffering from interpersonal childhood trauma, which have been underrepresented in previous research. Adult participants with symptoms of PTSD and emotional instability dwelled longer on trauma-related words than did trauma controls but did not primarily fixate on them, suggesting that only some components of attention may be biased. It appears premature to incorporate attentional bias trainings in therapeutic approaches, at least in this trauma subgroup.