The emotional Stroop task and posttraumatic stress disorder: A meta-analysis

doi:10.1016/j.cpr.2011.03.007

Clinical Psychology Review

Volume 31, Issue 5, July 2011, Pages 817-828

https://doi.org/10.1016/j.cpr.2011.03.007 Get rights and content

Abstract

Posttraumatic stress disorder (PTSD) is associated with significant impairment and lowered quality of life. The emotional Stroop task (EST) has been one means of elucidating some of the core deficits in PTSD, but this literature has remained inconsistent. We conducted a meta-analysis of EST studies in PTSD populations in order to synthesize this body of research. Twenty-six studies were included with 538 PTSD participants, 254 non-trauma exposed control participants (NTC), and 276 trauma exposed control participants (TC). PTSD-relevant words impaired EST performance more among PTSD groups and TC groups compared to NTC groups. PTSD groups and TC groups did not differ. When examining within-subject effect sizes, PTSD-relevant words and generally threatening words impaired EST performance relative to neutral words among PTSD groups, and only PTSD-relevant words impaired performance among the TC groups. These patterns were not found among the NTC groups. Moderator analyses suggested that these effects were significantly greater in blocked designs compared to randomized designs, toward unmasked compared to masked stimuli, and among samples exposed to assaultive traumas compared to samples exposed to non-assaultive traumas. Theoretical and clinical implications are discussed.

Section snippets

The emotional Stroop task

The classic Stroop task (Stroop, 1935) displays color words (e.g., blue) in varying colors of ink (e.g., red). The participant is asked to ignore the semantic content of the word and name the color in which the word is displayed. The critical trials are when the color is incongruent with the semantic word (e.g., the word ‘blue’ displayed in green ink). This manipulation induces conflict between task-relevant stimuli (the color) and distracting stimuli (the semantic content). The Stroop task can

PTSD and the emotional Stroop task

Despite the wealth of research conducted on the EST effect in PTSD over the past 20 years, there remain two gaps in the literature. First, whether an EST effect exists at all in PTSD has recently been questioned (Kimble, Frueh, & Marks, 2009) due to the inconsistencies in demonstrating the general effect (i.e., slowed RTs for disorder-relevant words relative to neutral words; e.g., Devineni, Blanchard, Hickling, & Buckley, 2004). Kimble et al. (2009) argued that dissertations tend to produce

Selection of studies

We identified appropriate studies by conducting searches in the PsychINFO database and searching the reference sections of review articles on this topic (Bar-Haim et al., 2007, Buckley et al., 2000). To address the possible publication bias suggested by Kimble et al. (2009), we also included the dissertations pertaining to PTSD and the EST that these authors located as well as additional dissertations identified through searches of the PsychINFO database. We conducted searches using a PTSD term

Basic study information

The meta-analysis included 26 studies. The studies were published between 1990 and 2007, and included a total of 538 PTSD participants, 254 no trauma control participants, and 276 trauma control participants. Mean age for the PTSD, no trauma control, and trauma control samples were 36.3 (SD = 10.8), 28.1 (SD = 8.5), and 35.4 (SD = 11.5), respectively. The groups were predominantly female, with percentages of 51, 79, and 58, respectively, for PTSD, no trauma control, and trauma control groups. While

Discussion

PTSD is associated with low quality of life (Olatunji, Cisler, & Tolin, 2007) and significant psychosocial impairment (Amaya-Jackson et al., 1999, Breslau, 2001, Breslau et al., 1991, Kessler, 2000). Research has used the EST as one means of elucidating some of the core deficits associated with PTSD (Buckley et al., 2000, ⁎McNally et al., 1990). Whether an EST effect exists at all in PTSD has been questioned (Kimble et al., 2009), necessitating a quantitative review to examine the EST effect in

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^*: indicates an article included in the meta-analysis.

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The emotional Stroop task and posttraumatic stress disorder: A meta-analysis

Abstract

Section snippets

The emotional Stroop task

PTSD and the emotional Stroop task

Selection of studies

Basic study information

Discussion

Trends in Cognitive Sciences

Clinical Psychology Review

Behav Res Ther

Journal of Anxiety Disorders

J Psychiatr Res

Neuroimage

Journal of Anxiety Disorders

Personality and Individual Differences

Biol Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Clinical Psychology Review

Trends in Cognitive Sciences

Journal of Anxiety Disorders

Behaviour Research and Therapy

Psychoneuroendocrinology

Clin Psychol Rev

Journal of Anxiety Disorders

Trends in Cognitive Sciences

J Behav Ther Exp Psychiatry

Biological Psychiatry

Biol Psychiatry

A rational look at the emotional Stroop paradigm: A generic slowdown, not a Stroop effect

Journal of Experimental Psychology. General

Functional impairment and utilization of services associated with posttraumatic stress in the community

J Trauma Stress

Attention training in individuals with generalized social phobia: A randomized controlled trial

J Consult Clin Psychol

The effect of a single-session attention modification program on response to a public-speaking challenge in socially anxious individuals

J Abnorm Psychol

Affective influences on the attentional dynamics supporting awareness

Journal of Experimental Psychology. General

Stress signalling pathways that impair prefrontal cortex structure and function

Nature Reviews. Neuroscience

Threat-related attentional bias in anxious and non-anxious individuals: A meta-analytic study

Psychological Bulletin

Specificity of Stroop interference in patients with pain and PTSD

Journal of Abnormal Psychology

Smoking withdrawal symptoms in response to a trauma-related stressor among Vietnam combat veterans with posttraumatic stress disorder

Addictive Behaviors

Serotonin transporter genetic variation and biased attention for emotional word stimuli among psychiatric inpatients

Journal of Abnormal Psychology

Association of the serotonin transporter gene promoter region (5-HTTLPR) polymorphism with biased attention for emotional stimuli

Journal of Abnormal Psychology

Neural mechanisms underlying selective attention to threat

Ann N Y Acad Sci

Trait anxiety and impoverished prefrontal control of attention

Nature Neuroscience

COMT genotype influences prefrontal response to emotional distraction

Cognitive, Affective & Behavioral Neuroscience

Prefrontal cortical function and anxiety: Controlling attention to threat-related stimuli

Nature Neuroscience

The development of a clinician-administered PTSD scale

Journal of Traumatic Stress

Outcomes of posttraumatic stress disorder

J Clin Psychiatry

Previous exposure to trauma and PTSD effects of subsequent trauma: Results from the Detroit area survey of trauma

American Journal of Psychiatry

Traumatic events and posttraumatic stress disorder in an urban population of young adults

Archives of General Psychiatry

Memory for emotionally neutral information in posttraumatic stress disorder: A meta-analytic investigation

Journal of Abnormal Psychology

Anxiety disorders interview schedule for DSM-IV

Processing threatening information in posttraumatic stress disorder

Journal of Abnormal Psychology

Enhanced amygdala and medial prefrontal activation during nonconscious processing of fear in posttraumatic stress disorder: an fMRI study

Hum Brain Mapp

Automatic and strategic processing of threat stimuli: A comparison between PTSD, panic disorder, and non-anxiety controls

Cognitive Therapy and Research

Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene

Science

Suppression of attentional bias in PTSD