Attentional capacity and PTSD treatment response: prolonged exposure alone or combined with sertraline

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.

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.

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.

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.