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Posttraumatic Psychological Symptoms are Associated with Reduced Inhibitory Control, not General Executive Dysfunction

Published online by Cambridge University Press:  30 June 2015

Joseph DeGutis ,
Michael Esterman ,
Bay McCulloch ,
Andrew Rosenblatt ,
William Milberg  and
Regina McGlinchey
Joseph DeGutis*
Affiliation:
Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI Center of Excellence, VA Boston Healthcare System, Boston, Massachusetts Department of Medicine, Harvard Medical School, Boston, Massachusetts
Michael Esterman
Affiliation:
Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI Center of Excellence, VA Boston Healthcare System, Boston, Massachusetts Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
Bay McCulloch
Affiliation:
Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI Center of Excellence, VA Boston Healthcare System, Boston, Massachusetts
Andrew Rosenblatt
Affiliation:
Department of Psychology, University of Houston, Houston, Texas
William Milberg
Affiliation:
Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI Center of Excellence, VA Boston Healthcare System, Boston, Massachusetts Geriatric Research Education and Clinical Center (GRECC), Boston Division VA Healthcare System, Boston, Massachusetts Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
Regina McGlinchey
Affiliation:
Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI Center of Excellence, VA Boston Healthcare System, Boston, Massachusetts Geriatric Research Education and Clinical Center (GRECC), Boston Division VA Healthcare System, Boston, Massachusetts Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
*
Correspondence and reprint requests to: Joseph DeGutis, Geriatric Research Education and Clinical Center (GRECC), Boston VA Healthcare System, Boston, MA 02130. E-mail: [email protected]
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Abstract

Although there is mounting evidence that greater PTSD symptoms are associated with reduced executive functioning, it is not fully understood whether this association is more global or specific to certain executive function subdomains, such as inhibitory control. We investigated the generality of the association between PTSD symptoms and executive function by administering a broad battery of sensitive executive functioning tasks to a cohort of returning Operation Enduring Freedom/Operation Iraqi Freedom Veterans with varying PTSD symptoms. Only tasks related to inhibitory control explained significant variance in PTSD symptoms as well as symptoms of depression, while measures of working memory, measures of switching, and measures simultaneously assessing multiple executive function subdomains did not. Notably, the two inhibitory control measures that showed the highest correlation with PTSD and depressive symptoms, measures of response inhibition and distractor suppression, explained independent variance. These findings suggest that greater posttraumatic psychological symptoms are not associated with a general decline in executive functioning but rather are more specifically related to stopping automatic responses and resisting internal and external distractions. (JINS, 2015, 21, 342–352)

Keywords

Response inhibitionDistractor suppressionPosttraumatic stress disorderTraumaDepressionOEF/OIF veterans
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 21 , Issue 5 , May 2015 , pp. 342 - 352
Copyright
Copyright © The International Neuropsychological Society 2015 

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References

Alvarez, J.A., & Emory, E. (2006). Executive function and the frontal lobes: A meta-analytic review. Neuropsychology Review, 16(1), 17–42. doi:10.1007/s11065-006-9002-x CrossRefGoogle ScholarPubMed
Amick, M.M., Clark, A., Fortier, C.B., Esterman, M., Rasmusson, A.M., Kenna, A., & McGlinchey, R. (2013). PTSD modifies performance on a task of affective executive control among deployed OEF/OIF veterans with mild traumatic brain injury. Journal of the International Neuropsychological Society, 19(07), 792–801.Google Scholar
Aupperle, R.L., Melrose, A.J., Stein, M.B., & Paulus, M.P. (2012). Executive function and PTSD: Disengaging from trauma. Neuropharmacology, 62(2), 686–694. doi:S0028-3908(11)00078-5 [pii] 10.1016/j.neuropharm.2011.02.008Google Scholar
Blake, D.D., Weathers, F.W., Nagy, L.M., Kaloupek, D.G., Gusman, F.D., Charney, D.S., & Keane, T.M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90. doi:10.1002/jts.2490080106 Google ScholarPubMed
Bliese, P.D., Wright, K.M., Adler, A.B., Cabrera, O., Castro, C.A., & Hoge, C.W. (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology, 76(2), 272–281. doi:2008-03290-009 [pii] 10.1037/0022-006X.76.2.272Google Scholar
Brandes, D., Ben-Schachar, G., Gilboa, A., Bonne, O., Freedman, S., & Shalev, A.Y. (2002). PTSD symptoms and cognitive performance in recent trauma survivors. Psychiatry Research, 110(3), 231–238. doi:S0165178102001257 [pii]Google Scholar
Bredemeier, K., Berenbaum, H., Brockmole, J.R., Boot, W.R., Simons, D.J., & Most, S.B. (2012). A load on my mind: Evidence that anhedonic depression is like multi-tasking. Acta psychologica, 139(1), 137–145. doi:S0001-6918(11)00214-9 [pii] 10.1016/j.actpsy.2011.11.007CrossRefGoogle ScholarPubMed
Bruce, A.S., Ray, W.J., & Carlson, R.A. (2007). Understanding cognitive failures: What’s dissociation got to do with it? American Journal of Psychology, 120(4), 553–563.Google Scholar
Burgess, P.W., & Shallice, T. (1996). Response suppression, initiation and strategy use following frontal lobe lesions. Neuropsychologia, 34(4), 263–272. doi:0028-3932(95)00104-2 [pii]Google Scholar
Christoff, K., Gordon, A.M., Smallwood, J., Smith, R., & Schooler, J.W. (2009). Experience sampling during fMRI reveals default network and executive system contributions to mind wandering. Proceedings of the National Academy if Sciences of the United States of America, 106(21), 8719–8724. doi:0900234106 [pii] 10.1073/pnas.0900234106Google Scholar
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001a). Delis-Kaplan Executive Function System (D-KEFS). San Antonio, TX: The Psychological Corporation.Google Scholar
Esterman, M., DeGutis, J., Mercado, R., Rosenblatt, A., Vasterling, J.J., Milberg, W., & McGlinchey, R. (2013a). Stress-related psychological symptoms are associated with increased attentional capture by visually salient distractors. Journal of the International Neuropsychological Society, 19(7), 835–840. doi:S135561771300057X [pii] 10.1017/S135561771300057XCrossRefGoogle ScholarPubMed
Esterman, M., Noonan, S.K., Rosenberg, M., & Degutis, J. (2013b). In the zone or zoning out? Tracking behavioral and neural fluctuations during sustained attention. Cerebral Cortex, 23(11), 2712–2723.Google Scholar
Esterman, M., Rosenberg, M.D., & Noonan, S.K. (2014). Intrinsic fluctuations in sustained attention and distractor processing. The Journal of Neuroscience, 34(5), 1724–1730.Google Scholar
Eysenck, M.W., Derakshan, N., Santos, R., & Calvo, M.G. (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7(2), 336–353. doi:2007-06782-011 [pii] 10.1037/1528-3542.7.2.336CrossRefGoogle ScholarPubMed
Falconer, E., Bryant, R., Felmingham, K.L., Kemp, A.H., Gordon, E., Peduto, A., … Williams, L.M. (2008). The neural networks of inhibitory control in posttraumatic stress disorder. Journal of Psychiatry & Neuroscience, 33(5), 413–422.Google Scholar
Fani, N., Kitayama, N., Ashraf, A., Reed, L., Afzal, N., Jawed, F., & Bremner, J.D. (2009). Neuropsychological functioning in patients with posttraumatic stress disorder following short-term paroxetine treatment. Psychopharmacology Bulletin, 42(1), 53–68.Google Scholar
Fortier, C.B., Amick, M.A., Grande, L., McGlynn, S., Kenna, A., Morra, L., … McGlinchey, R.E. (2013). The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) semi-structured interview: Preliminary evidence of research utility and validity. The Journal of Head Trauma. [Epub ahead of print]. doi:10.1097/HTR.0b013e3182865859 Google Scholar
Friedman, N.P., & Miyake, A. (2004). The relations among inhibition and interference control functions: A latent-variable analysis. Journal of Experimental Psychology: General, 133(1), 101–135. doi:10.1037/0096-3445.133.1.1012004-10964-007 [pii]CrossRefGoogle ScholarPubMed
Geuze, E., Vermetten, E., de Kloet, C.S., Hijman, R., & Westenberg, H.G. (2009). Neuropsychological performance is related to current social and occupational functioning in veterans with posttraumatic stress disorder. Depression & Anxiety, 26(1), 7–15. doi:10.1002/da.20476 Google Scholar
Gilbertson, M.W., Paulus, L.A., Williston, S.K., Gurvits, T.V., Lasko, N.B., Pitman, R.K., & Orr, S.P. (2006). Neurocognitive function in monozygotic twins discordant for combat exposure: Relationship to posttraumatic stress disorder. Journal of Abnormal Psychology, 115(3), 484–495. doi:2006-09167-010 [pii] 10.1037/0021-843X.115.3.484CrossRefGoogle ScholarPubMed
Johnsen, G.E., Kanagaratnam, P., & Asbjørnsen, A.E. (2008). Memory impairments in posttraumatic stress disorder are related to depression. Journal of Anxiety Disorders, 22(3), 464–474. doi:S0887-6185(07)00104-1 [pii] 10.1016/j.janxdis.2007.04.007CrossRefGoogle ScholarPubMed
Jovanovic, T., Ely, T., Fani, N., Glover, E.M., Gutman, D., Tone, E.B., … Ressler, K.J. (2013). Reduced neural activation during an inhibition task is associated with impaired fear inhibition in a traumatized civilian sample. Cortex, 49(7), 1884–1891. doi:S0010-9452(12)00252-3 [pii] 10.1016/j.cortex.2012.08.011Google Scholar
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. doi:62/6/593 [pii] 10.1001/archpsyc.62.6.593Google Scholar
Kubany, E.S., Haynes, S.N., Leisen, M.B., Owens, J.A., Kaplan, A.S., Watson, S.B., & Burns, K. (2000). Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: The Traumatic Life Events Questionnaire. Psychological Assessment, 12, 210–224.CrossRefGoogle ScholarPubMed
Kuckertz, J.M., Amir, N., Boffa, J.W., Warren, C.K., Rindt, S.E., Norman, S., … McLay, R. (2014). The effectiveness of an attention bias modification program as an adjunctive treatment for post-traumatic stress disorder. Behaviour Research and Therapy, 63, 25–35.Google Scholar
Leskin, L.P., & White, P.M. (2007). Attentional networks reveal executive function deficits in posttraumatic stress disorder. Neuropsychology, 21(3), 275–284. doi:2007-06185-001 [pii] 10.1037/0894-4105.21.3.275Google Scholar
Lovibond, P.F., & Lovibond, S.H. (1995). The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research & Therapy, 33(3), 335–343. doi:0005-7967(94)00075-U [pii]CrossRefGoogle ScholarPubMed
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., Howerter, A., & Wager, T.D. (2000). The unity and diversity of executive functions and their contributions to complex “Frontal Lobe” tasks: A latent variable analysis. Cognitive Psychology, 41(1), 49–100. doi:10.1006/cogp.1999.0734S0010-0285(99)90734-X [pii]CrossRefGoogle ScholarPubMed
Mohlman, J., & Gorman, J.M. (2005). The role of executive functioning in CBT: A pilot study with anxious older adults. Behaviour Research & Therapy, 43(4), 447–465. doi:S0005-7967(04)00086-5 [pii] 10.1016/j.brat.2004.03.007Google Scholar
Moore, S.A. (2009). Cognitive abnormalities in posttraumatic stress disorder. Currernt Opinion in Psychiatry, 22(1), 19–24. doi:10.1097/YCO.0b013e328314e3bb00001504-200901000-00005 [pii]Google Scholar
Morey, R.A., Petty, C.M., Cooper, D.A., LaBar, K.S., & McCarthy, G. (2008). Neural systems for executive and emotional processing are modulated by symptoms of posttraumatic stress disorder in Iraq War veterans. Psychiatry Research: Neuroimaging, 162(1), 59–72. doi:S0925-4927(07)00151-5 [pii] 10.1016/j.pscychresns.2007.07.007Google Scholar
Müller, H.J., Geyer, T., Zehetleitner, M., & Krummenacher, J. (2009). Attentional capture by salient color singleton distractors is modulated by top-down dimensional set. Journal of Experimental Psychology: Human Perception and Performance, 35(1), 1. doi:2009-00768-001 [pii] 10.1037/0096-1523.35.1Google Scholar
Pannu Hayes, J., LaBar, K.S., Petty, C.M., McCarthy, G., & Morey, R.A. (2009). Alterations in the neural circuitry for emotion and attention associated with posttraumatic stress symptomatology. Psychiatry Research: Neuroimaging, 172(1), 7–15. doi:S0925-4927(08)00085-1 [pii] 10.1016/j.pscychresns.2008.05.005Google Scholar
Parslow, R.A., & Jorm, A.F. (2007). Pretrauma and posttrauma neurocognitive functioning and PTSD symptoms in a community sample of young adults. American Journal of Psychiatry, 164(3), 509–515. doi:164/3/509 [pii] 10.1176/appi.ajp.164.3.509Google Scholar
Peter, J.P., Churchill, G.A. Jr., & Brown, T.J. (1993). Caution in the use of difference scores in consumer research. Journal of Consumer Research, 655–662.CrossRefGoogle Scholar
Pineles, S.L., Shipherd, J.C., Welch, L.P., & Yovel, I. (2007). The role of attentional biases in PTSD: Is it interference or facilitation? Behaviour Research & Therapy, 45(8), 1903–1913. doi:S0005-7967(06)00204-X [pii] 10.1016/j.brat.2006.08.021Google Scholar
Polak, A.R., Witteveen, A.B., Reitsma, J.B., & Olff, M. (2012). The role of executive function in posttraumatic stress disorder: A systematic review. Journal of Affective Disorders, 141(1), 11–21. doi:S0165-0327(12)00007-9 [pii] 10.1016/j.jad.2012.01.001Google Scholar
Porter, R.J., Gallagher, P., Thompson, J.M., & Young, A.H. (2003). Neurocognitive impairment in drug-free patients with major depressive disorder. The British Journal of Psychiatry, 182(3), 214–220.Google Scholar
Quinn, C.R., Harris, A., & Kemp, A.H. (2012). The impact of depression heterogeneity on inhibitory control. Austrailia New Zealand Journal of Psychiatry, 46(4), 374–383. doi:0004867411432073 [pii] 10.1177/0004867411432073Google Scholar
Qureshi, S.U., Long, M.E., Bradshaw, M.R., Pyne, J.M., Magruder, K.M., Kimbrell, T., … Kunik, M.E. (2011). Does PTSD impair cognition beyond the effect of trauma? Journal of Neuropsychiatry & Clinical Neuroscience, 23, 16–28. doi:23/1/16 [pii] 10.1176/appi.neuropsych.23.1.16Google Scholar
Rende, B., Ramsberger, G., & Miyake, A. (2002). Commonalities and differences in the working memory components underlying letter and category fluency tasks: A dual-task investigation. Neuropsychology, 16(3), 309.Google Scholar
Rosenberg, M., Noonan, S., DeGutis, J., & Esterman, M. (2013). Sustaining visual attention in the face of distraction: A novel gradual-onset continuous performance task. Attention, Perception, & Psychophysics, 75(3), 426–439. doi:10.3758/s13414-012-0413-x Google Scholar
Rubin, D.C., Berntsen, D., & Bohni, M.K. (2008). A memory-based model of posttraumatic stress disorder: Evaluating basic assumptions underlying the PTSD diagnosis. Psychological Reviews, 115 (4), 985–1011. doi:2008-14936-017 [pii] 10.1037/a0013397Google Scholar
Sanchez-Cubillo, I., Perianez, J.A., Adrover-Roig, D., Rodriguez-Sanchez, J.M., Rios-Lago, M., Tirapu, J., … Barcelo, F. (2009). Construct validity of the Trail Making Test: Role of task-switching, working memory, inhibition/interference control, and visuomotor abilities. Journal of the International Neuropsychological Society, 15(03), 438–450. doi:S1355617709090626 [pii] 10.1017/S1355617709090626Google Scholar
Schuitevoerder, S., Rosen, J.W., Twamley, E.W., Ayers, C.R., Sones, H., Lohr, J.B., … Thorp, S.R. (2013). A meta-analysis of cognitive functioning in older adults with PTSD. Journal of Anxiety Disorders, 27(6), 550–558. doi:S0887-6185(13)00003-0 [pii] 10.1016/j.janxdis.2013.01.001Google Scholar
Selzer, M.L., Vinokur, A., & Rooijen, L.V. (1975). A self-administered short Michigan alcoholism screening test (SMAST). Journal of Studies on Alcohol and Drugs, 36(01), 117.CrossRefGoogle ScholarPubMed
Skinner, H.A., & Sheu, W.J. (1982). Reliability of alcohol use indices; the lifetime drinking history and the MAST. Journal of Studies on Alcohol and Drugs, 43(11), 1157.Google Scholar
Stuss, D.T., Floden, D., Alexander, M.P., Levine, B., & Katz, D. (2001). Stroop performance in focal lesion patients: Dissociation of processes and frontal lobe lesion location. Neuropsychologia, 39(8), 771–786. doi:S0028-3932(01)00013-6 [pii]Google Scholar
Swick, D., Honzel, N., Larsen, J., Ashley, V., & Justus, T. (2012). Impaired response inhibition in veterans with post-traumatic stress disorder and mild traumatic brain injury. Journal of the International Neuropsychological Society, 18(5), 917–926. doi:S1355617712000458 [pii] 10.1017/S1355617712000458Google Scholar
Tanielian, T., & Jaycox, L. (eds.) 2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Corporation. doi:10.1093/occmed/kqp006 Google Scholar
Theeuwes, J., & Burger, R. (1998). Attentional control during visual search: The effect of irrelevant singletons. Journal of Experimental Psychology: Human Perception and Performance, 24(5), 1342–1353.Google Scholar
Theeuwes, J. (2010). Top–down and bottom–up control of visual selection. Acta Psychologica, 135(2), 77–99. doi:S0001-6918(10)00042-9 [pii] 10.1016/j.actpsy.2010.02.006Google Scholar
Vasterling, J.J., & Verfaellie, M. (2009). Introduction-posttraumatic stress disorder: A neurocognitive perspective. Journal of the International Neuropsychological Society, 15(6), 826–829. doi:S1355617709990683 [pii] 10.1017/S1355617709990683Google Scholar
Vogt, D.S., Proctor, S.P., King, D.W., King, L.A., & Vasterling, J.J. (2008). Validation of scales from the Deployment Risk and Resilience Inventory in a sample of Operation Iraqi Freedom veterans. Assessment, 15(4), 391–403. doi:1073191108316030 [pii] 10.1177/1073191108316030Google Scholar
Weathers, F.W., Litz, B.T., Herman, D., Huska, J., & Keane, T. (1994). The PTSD checklist—civilian version (PCL-C). Boston, MA: National Center for PTSD.Google Scholar
Wechsler, D. (1997). Manual for the Wechsler Adult Intelligence Scale-III. San Antonio, TX: Psychological Corporation.Google Scholar
Wu, J., Ge, Y., Shi, Z., Duan, X., Wang, L., Sun, X., … Zhang, K. (2010). Response inhibition in adolescent earthquake survivors with and without posttraumatic stress disorder: A combined behavioral and ERP study. Neuroscience Letters, 486(3), 117–121. doi:S0304-3940(10)00951-1 [pii] 10.1016/j.neulet.2010.07.040Google Scholar
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