Neurocognitive Functioning in Posttraumatic Stress Disorder
OVERVIEW:
The majority of people are exposed to at least one traumatic stressor during their lifetime (Kessler et al., 1995). Of those who are exposed to a traumatic stressor, a sizeable proportion (i.e., approximately 20% of females and 10% of males) will go on to develop persistent and problematic symptoms that would qualify for a diagnosis of posttraumatic stress disorder (PTSD). An emerging line of research in the study of trauma is that of cognitive functioning, with numerous studies having illustrated a significant relationship between PTSD and neuropsychological test performance. Specifically, PTSD has been associated with poorer performance on measures of attention (Marx et al., 2009), working memory (Vasterling et al., 2002), verbal and nonverbal memory (Jelinek et al., 2006; Johnson & Asbjørnsen, 2008), and processing speed (Twamley et al., 2009), among others. At this time, longitudinal studies that illustrate cognitive impairment as a direct consequence of PTSD are scarce and some research has suggested that cognitive deficits may also serve as a risk factor for developing the disorder (Hart et al., 2008; Parslow & Jorm, 2007). Despite these limitations, there is substantial evidence that a diagnosis of PTSD is associated with deficits in cognitive functioning. In a recent meta-analysis, Scott and colleagues (2015) consolidated the research within this area and provide recommendations for future study.
ABSTRACT:
Posttraumatic stress disorder (PTSD) is associated with regional alterations in brain structure and function that are hypothesized to contribute to symptoms and cognitive deficits associated with the disorder. We present here the first systematic meta-analysis of neurocognitive outcomes associated with PTSD to examine a broad range of cognitive domains and describe the profile of cognitive deficits, as well as modifying clinical factors and study characteristics. This report is based on data from 60 studies totaling 4,108 participants, including 1,779 with PTSD, 1,446 trauma-exposed comparison participants, and 895 healthy comparison participants without trauma exposure. Effect-size estimates were calculated using a mixed-effects meta-analysis for 9 cognitive domains: attention/working memory, executive functions, verbal learning, verbal memory, visual learning, visual memory, language, speed of information processing, and visuospatial abilities. Analyses revealed significant neurocognitive effects associated with PTSD, although these ranged widely in magnitude, with the largest effect sizes in verbal learning (d = -.62), speed of information processing (d = -.59), attention/working memory (d = -.50), and verbal memory (d = -.46). Effect-size estimates were significantly larger in treatment-seeking than community samples and in studies that did not exclude participants with attention-deficit/hyperactivity disorder, and effect sizes were affected by between-group IQ discrepancies and the gender composition of the PTSD groups. Our findings indicate that consideration of neuropsychological functioning in attention, verbal memory, and speed of information processing may have important implications for the effective clinical management of persons with PTSD. Results are further discussed in the context of cognitive models of PTSD and the limitations of this literature.
Scott, J. C., Matt, G. E., Wrocklage, K. M., Crnich, C., Jordan, J., Southwick, S. M., Krystal, J. H., & Schweisburg, B. C. (2015). A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder. Psychological Bulletin, 141(1), 105–140. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668974/
WEBINAR: National Center for PTSD: Continuing Education Webinars
Description: The National Center for PTSD website includes a wealth of information for professionals on the challenges faced by military veterans and others suffering from PTSD. This information includes a number of continuing education webinars on special topics related to PTSD (see link below), including clinical features of the disorder, assessment considerations, and treatment options. Users are able to search within the continuing education page for topics of interest. For students and clinicians who are not working with military veterans, the information within these trainings is applicable to a broad range of clinical populations dealing with the effects of exposure to a traumatic stressor.
Link: http://www.ptsd.va.gov/PTSD/professional/continuing_ed/index.asp
FURTHER READING
The majority of people are exposed to at least one traumatic stressor during their lifetime (Kessler et al., 1995). Of those who are exposed to a traumatic stressor, a sizeable proportion (i.e., approximately 20% of females and 10% of males) will go on to develop persistent and problematic symptoms that would qualify for a diagnosis of posttraumatic stress disorder (PTSD). An emerging line of research in the study of trauma is that of cognitive functioning, with numerous studies having illustrated a significant relationship between PTSD and neuropsychological test performance. Specifically, PTSD has been associated with poorer performance on measures of attention (Marx et al., 2009), working memory (Vasterling et al., 2002), verbal and nonverbal memory (Jelinek et al., 2006; Johnson & Asbjørnsen, 2008), and processing speed (Twamley et al., 2009), among others. At this time, longitudinal studies that illustrate cognitive impairment as a direct consequence of PTSD are scarce and some research has suggested that cognitive deficits may also serve as a risk factor for developing the disorder (Hart et al., 2008; Parslow & Jorm, 2007). Despite these limitations, there is substantial evidence that a diagnosis of PTSD is associated with deficits in cognitive functioning. In a recent meta-analysis, Scott and colleagues (2015) consolidated the research within this area and provide recommendations for future study.
ABSTRACT:
Posttraumatic stress disorder (PTSD) is associated with regional alterations in brain structure and function that are hypothesized to contribute to symptoms and cognitive deficits associated with the disorder. We present here the first systematic meta-analysis of neurocognitive outcomes associated with PTSD to examine a broad range of cognitive domains and describe the profile of cognitive deficits, as well as modifying clinical factors and study characteristics. This report is based on data from 60 studies totaling 4,108 participants, including 1,779 with PTSD, 1,446 trauma-exposed comparison participants, and 895 healthy comparison participants without trauma exposure. Effect-size estimates were calculated using a mixed-effects meta-analysis for 9 cognitive domains: attention/working memory, executive functions, verbal learning, verbal memory, visual learning, visual memory, language, speed of information processing, and visuospatial abilities. Analyses revealed significant neurocognitive effects associated with PTSD, although these ranged widely in magnitude, with the largest effect sizes in verbal learning (d = -.62), speed of information processing (d = -.59), attention/working memory (d = -.50), and verbal memory (d = -.46). Effect-size estimates were significantly larger in treatment-seeking than community samples and in studies that did not exclude participants with attention-deficit/hyperactivity disorder, and effect sizes were affected by between-group IQ discrepancies and the gender composition of the PTSD groups. Our findings indicate that consideration of neuropsychological functioning in attention, verbal memory, and speed of information processing may have important implications for the effective clinical management of persons with PTSD. Results are further discussed in the context of cognitive models of PTSD and the limitations of this literature.
Scott, J. C., Matt, G. E., Wrocklage, K. M., Crnich, C., Jordan, J., Southwick, S. M., Krystal, J. H., & Schweisburg, B. C. (2015). A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder. Psychological Bulletin, 141(1), 105–140. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668974/
WEBINAR: National Center for PTSD: Continuing Education Webinars
Description: The National Center for PTSD website includes a wealth of information for professionals on the challenges faced by military veterans and others suffering from PTSD. This information includes a number of continuing education webinars on special topics related to PTSD (see link below), including clinical features of the disorder, assessment considerations, and treatment options. Users are able to search within the continuing education page for topics of interest. For students and clinicians who are not working with military veterans, the information within these trainings is applicable to a broad range of clinical populations dealing with the effects of exposure to a traumatic stressor.
Link: http://www.ptsd.va.gov/PTSD/professional/continuing_ed/index.asp
FURTHER READING
- Bremner, J. D., Vermetten, E., Afzal, N., & Vythilingam, M. (2004). Deficits in verbal declarative memory function in women with childhood sexual abuse-related posttraumatic stress disorder. The Journal of Nervous and Mental Disease, 192(10), 643–649. http://www.ncbi.nlm.nih.gov/pubmed/15457106
- Foa, E. B., Gillihan, S. J., & Bryant, R. A. (2013). Challenges and successes in dissemination of evidence-based treatments for posttraumatic stress: Lessons learned from prolonged exposure therapy for PTSD. Psychological Science in the Public Interest, 14(2), 66–111. http://www.psychologicalscience.org/index.php/publications/journals/pspi/ptsd.html
- Hart, J. Jr., Kimbrell, T., Fauver, P., Cherry, B. J., Pitcock, J., Booe, L. Q., Tillman, G., & Freeman, T. W. (2008). Cognitive dysfunctions associated with PTSD: Evidence from World War II prisoners of war. The Journal of Neuropsychiatry and Clinical Neurosciences, 20(3), 309–316. http://www.ncbi.nlm.nih.gov/pubmed/18806234
- Jelinek, L., Jacobsen, D., Kellner, M., Larbig, F., Biesold, K.-H., Barre, K., & Moritz, S. (2006). Verbal and nonverbal memory functioning in posttraumatic stress disorder (PTSD). Journal of Clinical and Experimental Neuropsychology, 28, 940–948. http://www.ncbi.nlm.nih.gov/pubmed/16822734
- Johnson, G. E., & Asbjørnsen, A. E. (2008). Consistent impaired verbal memory in PTSD: A meta-analysis. Journal of Affective Disorders, 111, 74–82. http://www.ncbi.nlm.nih.gov/pubmed/18377999
- Johnsen, G. E., Kanagaratnam, P., & Asbjørnsen, A. E. (2008). Memory impairments in posttraumatic stress disorder are related to depression. Journal of Anxiety Disorders, 22, 464–474. http://www.sciencedirect.com/science/article/pii/S0887618507001041
- Kessler, R. C., Sonnega, A., Hughes, M., & Nelson, C. B. (1995) Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048–1060. http://www.ncbi.nlm.nih.gov/pubmed/7492257
- Marx, B. P, Brailey, K., Proctor, S. P., MacDonald, H. Z., Graefe, A. C., Amoroso, P., Heeren, T., & Vasterling, J. J. (2009). Association of time since deployment, combat intensity, and posttraumatic stress symptoms with neurological outcomes following Iraq war deployment. JAMA Psychiatry, 66(9), 996–1004. http://www.ncbi.nlm.nih.gov/pubmed/19736356
- Parslow, R. A., & Jorm, A. F. (2007). Pretrauma and posttrauma neurocognitive functioning and PTSD symptoms in a community sample of young adults. The American Journal of Psychiatry, 164(3), 509–515. http://www.ncbi.nlm.nih.gov/pubmed/17329477
- Samuelson, K. W., Metzler, T. J., Rothlind, J., Choucroun, G., Neylan, T. C., Lenoci, M., & Henn-Haase, C. (2006). Neuropsychological functioning in posttraumatic stress disorder and alcohol abuse. Neuropsychology, 20(6), 716–726. http://www.ncbi.nlm.nih.gov/pubmed/17100516
- Twamley, E. W., Allard, C. B., Thorp, S. R., Norman, S. B., Cissell, S. H., Berardi, K. H., Grimes, E. M., & Stein, M. B. (2009). Cognitive impairment and functioning in PTSD related to intimate partner violence. Journal of the International Neuropsychological Society, 15, 879–887. http://www.ncbi.nlm.nih.gov/pubmed/19703324
- Vasterling, J. J., Duke, L. M., Brailey, K., Constans, J. I., Allain, A. N. Jr., & Sutker, P. B. (2002). Attention, learning, and memory performances and intellectual resources in Vietnam veterans: PTSD and no order comparisons. Neuropsychology, 16(1), 5–14. http://www.apa.org/pubs/journals/releases/neu-1615.pdf
Contributor:
Joseph Babione is a graduate student at the Illinois School of Professional Psychology at Argosy University in Chicago.
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