Objective: Impaired sustained attention, the ability to selectively attend to information and resist interference, has been associated with reduced response to cognitive therapies for posttraumatic stress disorder (PTSD; e.g., Crocker et al., 2018, Worse baseline executive functioning is associated with dropout and poorer response to trauma-focused treatment for veterans with PTSD and comorbid traumatic brain injury. Behaviour Research and Therapy, 108, 68-77). However, little is known about how attentional capacity impacts exposure-focused treatment. Further, as serotonin deficits relate to impaired sustained attention and SSRIs may enhance cognitive functioning, serotonergic antidepressants may moderate this impact.
Method: In 142 treatment-seeking individuals with PTSD, sustained attention was assessed using the flanker task prior to receiving prolonged exposure (PE) or PE plus sertraline.
Results: At pre-treatment, sustained attention was not strongly associated with PTSD or depression severity. Higher pre-treatment sustained attention was associated with greater pre-posttreatment reductions in PTSD symptom severity with a small to moderate effect (γ11 = -3.95, d = .46) and most predictive of lower avoidance symptoms (γ11 = -0.61, d = .43). This effect did not achieve significance for depression severity. Treatment modality did not moderate this relationship.
Conclusion: Impaired sustained attention may be one moderator to consider towards treatment optimization. Research should examine specific in-session attentional mechanisms impacting outcomes such as reduced engagement with trauma-related stimuli during exposure.
Keywords: posttraumatic stress disorder; prolonged exposure; sertraline; sustained attention.