Comparing Cognitive Aspects of Post-Traumatic Stress Disorder and Trauma

  • Mariana Kneese FlaksEmail author
  • Pedro Fonseca Zuccolo
  • Francisco Lotufo-Neto
Reference work entry


Attentional, executive, and memory deficits have been described in PTSD, as well as emotional cognitive biases. Many findings, however, are controversial and conflicting. Here, we describe strategies for outlining a cognitive profile in PTSD. Though difficult to carry out, longitudinal and monozygotic twin studies are the best designs for measuring the cognitive effects of stress, trauma, and PTSD. Cross-sectional studies may have their reliability improved by the comparison of three groups: trauma victims who developed PTSD, trauma victims without PTSD, and healthy controls not exposed to trauma. Studies should also be homogeneous regarding type of trauma and neuropsychological instruments.


Stress Trauma PTSD Research methodologies Neuropsychology Cognitive bias False memories 

List of Abbreviations


American Psychiatric Association’s – Diagnostic and Statistical Manual, Fifth Edition


Attentional probe task


Central nervous system


Emotional Stroop test


Generalized anxiety disorder


Healthy control group of subjects who did not suffer traumatic experiences


Post-traumatic stress disorder


Stroop color-naming test


Subjects who were exposed to traumatic events and developed PTSD symptoms and consequent diagnosis


Subjects who were victims of trauma without being diagnosed with PTSD


  1. American Psychiatric Association. The diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.Google Scholar
  2. Ashley V, Honzel N, Larsen J, et al. Attentional bias for trauma-related words: exaggerated emotional Stroop effect in Afghanistan and Iraq war veterans with PTSD. BMC Psychiatry. 2003;13:86.CrossRefGoogle Scholar
  3. Aupperle RL, Melrose AJ, Stein MB, et al. Executive function and PTSD: disengaging from trauma. Neuropharmacology. 2013;62:686–94.CrossRefGoogle Scholar
  4. Barbosa ME, de Ávila LM, Feix LF, et al. Falsas memórias e diferenças individuais. In: Stein LM, editor. Falsas Memórias–Fundamentos científicos e suas aplicações clínicas e jurídicas. Porto Alegre: Artmed; 2010. p. 133–57.Google Scholar
  5. Braga LL, Fiks PJ, Mari JJ, Mello MF. The importance of the concepts of disaster, catastrophe, violence, trauma and barbarism in defining post-traumatic stress disorder in clinical practice. BMC Psychiatry. 2008;8:68.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Brewin CR. A cognitive neuroscience account of post-traumatic stress disorder and its treatment. Behav Res Ther. 2001;39:373–93.CrossRefPubMedGoogle Scholar
  7. Browning M, Holmes EA, Harmer CJ. The modification of attentional bias to emotional information: a review of the techniques, mechanisms, and relevance to emotional disorders. Cogn Affect Behav Neurosci. 2010;10(1):8–20.CrossRefPubMedGoogle Scholar
  8. Bryant RA, Harvey AG. Attentional bias in post-traumatic stress disorder. J Trauma Stress. 1997;10:635–44.PubMedGoogle Scholar
  9. Buckley TC, Blanchard EB, Neill WT. Information processing and PTSD: a review of empirical literature. Clin Psychol Rev. 2000;28:1041–65.CrossRefGoogle Scholar
  10. Constans JJ. Information-processing biases in PTSD. In: Vasterling JJ, Brewin CR, editors. Neuropsychology of PTSD: biological, cognitive, and clinical perspectives. New York: The Guildford Press; 2005. p. 105–30.Google Scholar
  11. Dalgleish T, Taghavi R, Neshat-Doost H, et al. Patterns of processing bias for emotional information across clinical disorders: a comparison of attention, memory, and prospective cognition in children and adolescents with depression, generalized anxiety, and posttraumatic stress disorder. J Clin Child Adolesc Psychol. 2003;32:10–21.CrossRefPubMedGoogle Scholar
  12. Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000;38:319–45.CrossRefPubMedGoogle Scholar
  13. Flaks MK, Malta SM, Almeida PP, et al. Attentional and executive functions are differentially affected by post-traumatic stress disorder and trauma. J Psychiatr Res. 2014;48(1):32–9.CrossRefPubMedGoogle Scholar
  14. Foa EB, Feske U, Murdock TB, et al. Processing of threat-related information in rape victims. J Abnorm Psychol. 1991;100:156–62.CrossRefPubMedGoogle Scholar
  15. Golier JA, Yehuda R, Lupien SJ, et al. Memory for trauma-related information in Holocaust survivors with PTSD. Psychiatry Res. 2003;121:133–43.CrossRefPubMedGoogle Scholar
  16. Guyard A, Piolino P. Les faux souvenirs: à la fronteire du normal et du pathologique. Psychol Neuropsychiatr Vieil. 2006;4(2):127–34.PubMedGoogle Scholar
  17. Hirsch CR, Mathews A. Impaired positive inferential bias in social phobia. J Abnorm Psychol. 2000;109(4):705–12.CrossRefPubMedGoogle Scholar
  18. Holt DJ, Lebron-Milad K, Rauch SL, et al. Extinction memory is impaired in schizophrenia. Biol Psychiatry. 2009;65(6):455–63.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Just NA, Abramsom LY, Alloy LB. Remitted depression studies as tests of the cognitive vulnerability hypotheses of depression onset: a critique and conceptual analysis. Clin Psychol Rev. 2001;21:63–83.CrossRefPubMedGoogle Scholar
  20. Kaspi SP, McNally RJ, Nader A. Cognitive processing of emotional information in post-traumatic stress disorder. Cogn Ther Res. 1995;19:433–44.CrossRefGoogle Scholar
  21. Kopelman MD. Disorders of memory. Brain. 2002;125:2152–90.CrossRefPubMedGoogle Scholar
  22. Lezak M. Neuropsychological assessment. England: Oxford University; 2004.Google Scholar
  23. Luria AR. Fundamentos de Neuropsicologia. São Paulo: EDUSP; 1981.Google Scholar
  24. MacLeod A, Mathews C, Tata P. Attentional bias in emotional disorders. J Abnorm Psychol. 1986;95:15–20.CrossRefPubMedGoogle Scholar
  25. MacLeod C, Rutherford E, Campbell L, et al. Selective attention and emotional vulnerability: assessing the causal basis of their association through the experimental manipulation of attentional bias. J Abnorm Psychol. 2002;111:107–23.CrossRefPubMedGoogle Scholar
  26. Mathews A, MacLeod C. Cognitive vulnerability to emotional disorders. Annu Rev Clin Psychol. 2005;1:167–95.CrossRefPubMedGoogle Scholar
  27. Mathews A, MacLeod C. Cognitive approaches to emotion and emotional disorders. Annu Rev Clin Psychol. 1994;45:25–50.CrossRefGoogle Scholar
  28. McNally RJ, Lasko NB, Macklin ML, et al. Autobiographical memory disturbance in combat-related post-traumatic stress disorder. Behav Res Ther. 1995;33(6):619–30.CrossRefPubMedGoogle Scholar
  29. Metzger LJ, Orr SP, Lasko NB, et al. Seeking the source of emotional Stroop interference effects in PTSD: a study of P3s to traumatic words. Integr Physiol Behav Sci. 1997;32:43–51.CrossRefPubMedGoogle Scholar
  30. Neufeld CB, Brust PG, Stein LM. Compreendendo o fenômeno das falsas memórias. In: Stein LM et al. Falsas Memórias–Fundamentos científicos e suas aplicações clínicas e jurídicas. Porto Alegre, Artmed; 2010, p. 21–41.Google Scholar
  31. Orr SP, Metzger LJ, Lasko NB, et al. De novo conditioning in trauma-exposed individuals with and without post-traumatic stress disorder. J Abnorm Psychol. 2000;109(2):290–8.CrossRefPubMedGoogle Scholar
  32. Penfold PS. The repressed memory controversy: is there middle ground. Can Med Assoc J. 1996;155(6):647–53.Google Scholar
  33. Pergher GK, Grassi-Oliveira R. Implicações Clínicas das Falsas Memórias. In: Stein LM, editor. Falsas Memórias–Fundamentos científicos e suas aplicações clínicas e jurídicas. Porto Alegre: Artmed; 2010. p. 228–39.Google Scholar
  34. Polak AR, Witteveen AB, Reitsma JB, et al. The role of executive function in post-traumatic stress disorder: a systematic review. J Affect Disord. 2012;141:11–21.CrossRefPubMedGoogle Scholar
  35. Pury CLS. Information-processing predictors of emotional response to stress. Cogn Emot. 2002;16:667–83.CrossRefGoogle Scholar
  36. Qureshi SU, Long ME, Bradshaw MR, et al. Does PTSD impair cognition beyond the effect of trauma? J Neuropsychiatry Clin Neurosci. 2011;23:16–28.CrossRefPubMedGoogle Scholar
  37. Rao SM. Neuropsychological assessment. In: Fogel BS, Schiffer RB, Rao SM, editors. Neuropsychiatry. Oxford: Williams & Wilkins; 1996. p. 29–45.Google Scholar
  38. Rohenkohl G, Gomes CFA, da Silveira RAT, et al. Emoção e falsas memórias. In: Stein LM, editor. Falsas Memórias–Fundamentos científicos e suas aplicações clínicas e jurídicas. Porto Alegre: Artmed; 2010. p. 87–100.Google Scholar
  39. Rude SS, Vladez CR, Odom S, et al. Negative cognitive biases predict subsequent depression. Cogn Ther Res. 2003;27:415–29.CrossRefGoogle Scholar
  40. Schoorl M, Putman P, Van Der Does W. Attention bias modification in posttraumatic stress disorder: a randomized controlled trial. Psychother Psychosom. 2013;82:99–105.CrossRefPubMedGoogle Scholar
  41. Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests: administration, norms, and commentary. 3rd ed. New York: Oxford University Press; 2006.Google Scholar
  42. Stroop JR. Studies of interference in serial verbal reaction. J Exp Psychol. 1935;18:643–62.CrossRefGoogle Scholar
  43. Thrasher SM, Dalgleish T, Yule W. Information processing in post-traumatic stress disorder. Behav Res and Ther. 1994;32:247–254.Google Scholar
  44. Vasterling JJ, Brailey K, Constans JI, et al. Attention and memory dysfunction in posttraumatic stress disorder. Neuropsychology. 1998;12:125–33.CrossRefPubMedGoogle Scholar
  45. Vrana SR, Roodman A, Beckman JC. Selective processing of trauma-relevant words in posttraumatic stress disorder. J Anxiety Disord. 1995;9:515–30.CrossRefGoogle Scholar
  46. Weingartner H, Miller H, Murphy DL. Mood-state-dependent retrieval of verbal associations. J Abnorm Psychol. 1977;86(3):276–84.CrossRefPubMedGoogle Scholar
  47. Weintraub S. Neuropsychological assessment of mental state. In: Mesulam MM, editor. Principles of behavioral and cognitive neurology. 2nd ed. New York: Oxford University Press; 2000. p. 121–64.Google Scholar
  48. Williams JM, Mathews A, MacLeod C. The emotional Stroop task and psychopathology. Psychol Bull. 1996;120(1):3–24.CrossRefPubMedGoogle Scholar
  49. Wray AM, Freund RA, Dougher MJ. A behavior-analytic account of cognitive bias in clinical populations. Behav Anal. 2009;32:29–49.PubMedPubMedCentralGoogle Scholar
  50. Xue YX, Luo YX, Wu P, et al. A memory retrieval-extinction procedure to prevent drug craving and relapse. Science. 2012;336(6078):241–5.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Yehuda R, Golier JA, Halligan SL, et al. Learning and memory in holocaust survivors with PTSD. Biol Psychiatry. 2004;55:291–5.CrossRefPubMedGoogle Scholar
  52. Yehuda R. Current concepts: post-traumatic stress disorder. N Engl J Med. 2002;346:108–14.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Mariana Kneese Flaks
    • 1
    Email author
  • Pedro Fonseca Zuccolo
    • 2
  • Francisco Lotufo-Neto
    • 3
  1. 1.Programa de Atendimento e Pesquisa em Violência (PROVE), Department of PsychiatryFederal University of São PauloSão PauloBrazil
  2. 2.Department of Psychology – Experimental PsychologyPsychology Institute, University of São PauloButantãBrazil
  3. 3.Department of PsychiatryPsychiatry Institute, University of São PauloCerqueira CésarBrazil

Personalised recommendations