Wounds that can't be seen: implicit trauma associations predict posttraumatic stress disorder symptoms

Background and objectives: Prominent theories suggest that explicit and implicit cognitive biases are critical in the development and maintenance of posttraumatic stress disorder (PTSD). However, studies evaluating implicit PTSD-related cognitive biases are rare, and findings are mixed. We developed two adaptions of the Implicit Association Test (IAT), the "traumatized self" IAT (evaluations of the self as traumatized vs. healthy) and the "dangerous memory" IAT (evaluations of remembering as dangerous vs. safe), and investigated their psychometric properties and relations to PTSD symptoms and trauma exposure.

Methods: Participants were visitors to the Project Implicit research website (Study 1: N = 347, Study 2: N = 501). They completed the IATs (Study 1: both IATs; Study 2: traumatized self IAT only), a trauma exposure measure, a PTSD symptom inventory, and explicit cognitive bias measures (Study 2 only).

Results: Both IATs had good internal consistency, but only the traumatized self IAT was correlated with PSTD symptoms and identified participants meeting clinical cutoffs for PTSD symptoms. Study 2 focused on the traumatized self IAT and included explicit cognitive bias measures. The IAT correlated with PTSD symptoms and explicit cognitions, and predicted variance in PSTD symptoms above and beyond trauma exposure and explicit cognitions.

Limitations: Study designs were cross-sectional; samples were unselected; and PTSD symptoms were self-reported.

Conclusions: Despite these limitations, these studies provide preliminary validation of an implicit measure of PTSD-related cognitive bias - the traumatized self IAT - that is consistent with PTSD theories and may ultimately improve the identification and treatment of individuals with PTSD.