Attention training and traumatic stress symptoms : a controlled evaluation

摘要

Many of the symptoms characteristic of PTSD such as hypervigiliance towards threat, involve attentional processes. The first part of this thesis explored the role of attentional processes in the maintenance and treatment of PTSD. Although general models of anxiety give attentional processes central prominence cognitive models of PTSD (e.g., Foa & Riggs, 1993; Brewin, Dalgleish, & Joseph, 1996; Ehlers & Clark, 2000) assign an important role to trauma memory and place little or no emphasis on the role of attentional processes in maintaining symptoms. Models of anxiety have suggested that attentional bias is automatic (Mathews & Macleod, 2002) or strategic (Wells & Mathews, 1994). Wells' (2000) Metacognitive Model of PTSD is one of the few models to emphasis thinking style and attention rather then memory. In this model attentional bias is thought to be strategic in nature. The evidence reviewed supports a role of attention in PTSD and suggests it may be beneficial to modify this process. Two different attention techniques based on models of bias are reviewed.The second part of the thesis described a randomized controlled evaluation of attentional training technique (ATT; Wells, 1990) on traumatic stress symptoms in a sample of 60 university students, who had previously experienced a stressful life event. ATT is a technique used in metacognitive therapy to modify the control of attention. Participants were randomly assigned to either an ATT group (n = 29) or a control group (n = 31). An emotional attention set shifting task was included as an objective measure of attention. The results supported the hypotheses, ATT reduced intrusions and negative affect, increased self-report attention flexibility and modified performance on the attention set shifting task. The results are consistent with the metacognitive model of PTSD. Theoretical and clinical implications are discussed and the results add to studies suggesting positive effects of the technique across a range of disorders.The third part critically reflected on methodological and ethical issues from the above research study. The interpretation of the findings is limited by the student population. It is acknowledged that the results are preliminary in nature but it is believed that the study provides useful insights into the role of attentional processes in the development and treatment of traumatic stress symptoms and provides a basis for studies in the future.