Trauma, Pain, and Psychological Distress Attentional Bias and Autonomic Arousal in PTSD and Chronic Pain

Posttraumatic stress disorder (PTSD) and chronic musculoskeletal pain (CMP) are highly prevalent (Breslau, 2002) and comorbid disorders (Otis, Keane, & Kerns, 2003). The shared vulnerability model explains this overlap in part through a common attentional bias toward threat (Asmundson, Coons, Taylor, & Katz, 2002). The current study made use of the acoustic startle to assess cognitive bias to threat in participants (n = 106; 64% women) who reported experiencing a motor vehicle accident (MVA). Participants were divided into five groups based on their diagnoses: PTSD, CMP, both PTSD and CMP, any general (i.e., non-PTSD) anxiety disorder with no CMP, and a no-disorder Control group. Self-report measures were used to assess psychological symptoms, trauma response, and pain-related factors. Word stimuli (i.e., trauma, sensory pain, health, pleasant, neutral) were presented visually prior to onset of the acoustic startle probe to assess for diagnosiscongruent attentional biases (e.g., persons with PTSD respond differently to trauma words). Relative to the general anxiety and control group, persons with PTSD or chronic pain demonstrated delayed startle peak and greater startle intensity across all word stimuli types; the results suggest there may be psychophysiologically measurable differences associated with PTSD and pain. The startle probe paradigm remains relatively nascent for such research, but has potential utility for assessment and treatment monitoring. Comprehensive results, discussion, and implications are analyzed.