(PS4-A25) Investigating the Relationship Between the Cognitive Attentional Syndrome and Posttraumatic Stress Symptoms: The Moderating Effect of Attentional Control

Background and Purpose: The metacognitive model of PTSD suggests that the persistent use of seven maladaptive self-regulation strategies (i.e., the cognitive attentional syndrome [CAS]) increases risk for posttraumatic stress (PTS) symptoms. Additionally, the metacognitive model suggests that flexible regulation of attention might be protective against developing the maladaptive outcomes associated with the CAS. However, the moderating effect of attentional control on the association between CAS-related coping and PTS symptoms has not yet been examined. This is in part because a psychometrically sound measure with adequate coverage of the CAS did not exist. As such, the purpose of this study was to examine associations between all seven domains of the CAS and PTS symptoms using the recently developed Multidimensional Cognitive Attentional Syndrome Scale (MCASS; Conboy et al., 2021). Additionally, this study provides the first examination of the moderating effect of attentional control on the association between the CAS and PTS symptoms.

Method: Participants were trauma-exposed community adults (N = 237) who completed a battery of self-report measures via Amazon’s Mechanical Turk. Measures included the Life Events Checklist (LEC-5;Weathers et al., 2013) to establish trauma exposure, MCASS, Attentional Control Scale (ACS; Derryberry & Reed, 2002), and PTSD Checklist (PCL-5; (Weathers, Litz, et al., 2013).

Results: Bivariate correlations showed that greater CAS activation was associated with higher PTS symptoms (r = .70). Moreover, one-way analysis of variance revealed that individuals with probable PTSD (i.e., PCL-5 scores > = 31; M = 91.41, SD = 14.40) exhibited greater MCASS scores than individuals without probable PTSD (i.e., PCL-5 scores < 31; M= 66.43, SD = 17.76, p < .001). Results from linear regression analyses showed that Worry (β = .47, p < .001), Substance Use (β = .36, p < .001), and Internal Threat Monitoring (β = .15, p = .02) accounted for unique variance in PTS symptoms when all seven subscales were entered into the same model. Finally, moderation analyses showed that attentional control dampened the effect of the CAS, specifically external threat monitoring, on PTS symptoms (∆R² = .03, p = .03, β = -.12, p= .03). Simple slopes analysis revealed a positive association between External Threat Monitoring and PCL-5 total score that was significant at lower (β = .15, p = .03), but not higher (β = -.03, p = .61), levels of attentional control.

Discussion: This was the first study to simultaneously examine the effects of all seven domains of the CAS on PTS symptoms. Worry, substance use, and internal threat monitoring emerged as strong predictors of PTS symptoms when all seven CAS domains were compared. Study findings support attentional control as a protective factor against the maladaptive effects of the CAS on PTS symptoms. Taken together, these data support assumptions from the metacognitive model of PTSD that CAS activation is associated with greater PTS symptoms, but that the ability to flexibly regulate attentional control may be protective against such effects.