Skip to main content Accessibility help

PTSD Modifies Performance on a Task of Affective Executive Control among Deployed OEF/OIF Veterans with Mild Traumatic Brain Injury

  • Melissa M. Amick (a1) (a2), Alexandra Clark (a1), Catherine B. Fortier (a1) (a3), Michael Esterman (a1) (a2), Ann M. Rasmusson (a1) (a2), Alexandra Kenna (a1), William P. Milberg (a1) (a3) (a4) and Regina McGlinchey (a1) (a3) (a4)...


Individuals with post-traumatic stress disorder (PTSD) show a cognitive bias for threatening information, reflecting dysregulated executive control for affective stimuli. This study examined whether comorbid mild Traumatic Brain Injury (mTBI) with PTSD exacerbates this bias. A computer-administered Affective Go/No-Go task measured reaction times (RTs) and errors of omission and commission to words with a non–combat-related positive or negative valence in 72 deployed United States service members from the wars in Iraq and Afghanistan. Incidents of military-related mTBI were measured with the Boston Assessment of Traumatic Brain Injury-Lifetime. PTSD symptoms were measured with the Clinician-Administered PTSD Scale. Participants were divided into those with (mTBI+, n = 34) and without a history of military-related mTBI (mTBI−, n = 38). Valence of the target stimuli differentially impacted errors of commission and decision bias (criterion) in the mTBI+ and mTBI− groups. Specifically, within the mTBI+ group, increasing severity of PTSD symptoms was associated with an increasingly liberal response pattern (defined as more commission errors to negative distractors and greater hit rate for positive stimuli) in the positive compared to the negative blocks. This association was not observed in the mTBI− group. This study underscores the importance of considering the impact of a military-related mTBI and PTSD severity upon affective executive control. (JINS, 2013, 19, 1–10)


Corresponding author

Correspondence and reprint requests to: Melissa M. Amick, Translational Research Center for Traumatic Brain Injury and Stress Disorders, VA Boston Healthcare System (182-JP), 150 South Huntington Avenue, Boston, MA 02130. E-mail:


Hide All
Amir, N., Beard, C., Taylor, C.T., Klumpp, H., Elias, J., Burns, M., Chen, X. (2009). Attention training in individuals with generalized social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(5), 961973.
Atkinson, M.P., Guetz, A., Wein, L.M. (2009). A dynamic model for post traumatic stress disorder among US troops in Operation Iraqi Freedom. Management Science, 55(9), 14541468.
Aupperle, R.L., Allard, C.B., Grimes, E.M., Simmons, A.N., Flagan, T., Behrooznia, M., Stein, M.B. (2012). Dorsolateral prefrontal cortex activation during emotional anticipation and neuropsychological performance in posttraumatic stress disorder. Archives of General Psychiatry, 69(4), 360371.
Aupperle, R.L., Melrose, A.J., Stein, M.B., Paulus, M.P. (2012). Executive function and PTSD: Disengaging from trauma. Neuropharmacology, 62(2), 686694.
Belanger, H.G., Kretzmer, T., Vanderploeg, R.D., French, L.M. (2010). Symptom complaints following combat-related traumatic brain injury: Relationship to traumatic brain injury severity and posttraumatic stress disorder. Journal of International Neuropsychological Society, 16(1), 194199.
Bigler, E.D. (2004). Neuropsychological results and neuropathological findings at autopsy in a case of mild traumatic brain injury. Journal of International Neuropsychological Society, 10(5), 794806.
Blake, D.D., Weathers, F.W., Nagy, L.M. (1993). A clinician rating scale for assessing current and lifetime PTSD: the CAPS-I. Behavior Therapy, 18, 187188.
Blake, D.D., Weathers, F.W., Nagy, L.M., Kaloupek, D.G., Gusman, F.D., Charney, D.S., Keane, T.M. (1995). The development of a clinician-administered PTSD Scale. Journal of Traumatic Stress, 8(1), 7590.
Brenner, L.A., Vanderploeg, R.D., Terrio, H. (2009). Assessment and diagnosis of mild traumatic brain injury, posttraumatic stress disorder, and other polytrauma conditions: Burden of adversity hypothesis. Rehabilitation Psychology, 54(3), 239246.
Brewin, C.R., Kleiner, J.S., Vasterling, J.J., Field, A.P. (2007). Memory for emotionally neutral information in posttraumatic stress disorder: A meta-analytic investigation, 116(3), 448463.
Bryant, R. (2011). Post-traumatic stress disorder vs traumatic brain injury. Dialogues Clinical Neuroscience, 13(3), 251262.
Bryant, R.A., Harvey, A.G. (1997). Acute stress disorder: A critical review of diagnostic issues. Clinical Psychology Review, 17(7), 757773.
Buckley, T.C., Blanchard, E.B., Neill, W.T. (2000). Information processing and PTSD: A review of the empirical literature. Clinical Psychology Review, 20(8), 10411065.
Calhoun, P.S., McDonald, S.D., Guerra, V.S., Eggleston, A.M., Beckham, J.C., Straits-Troster, K. (2010). Clinical utility of the Primary Care--PTSD Screen among U.S. veterans who served since September 11, 2001. Psychiatry Research, 178(2), 330335.
Carroll, L.J., Cassidy, J.D., Peloso, P.M., Borg, J., von Holst, H., Holm, L., Pépin, M. (2004). Prognosis for mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabiliation Medicine, 43(Suppl), 84105.
Chemtob, C.M., Muraoka, M.Y., Wu-Holt, P., Fairbank, J.A., Hamada, R.S., Keane, T.M. (1998). Head injury and combat-related posttraumatic stress disorder. The Journal of Nervous & Mental Disease, 186(11), 701708.
Cisler, J.M., Olatunji, B.O., Feldner, M.T., Forsyth, J.P. (2010). Emotion regulation and the anxiety disorders: An integrative review. Journal of Psychopathoology & Behavioral Assessment, 32(1), 6882.
Constans, J.I. (2005). Information-processing biases in PTSD. In J.J. Vasterling (Ed.), Neuropsychology of PTSD: Biological, cognitive and clinical perspectives (pp. 105130). New York: Guildford Press.
Constans, J.I., McCloskey, M.S., Vasterling, J.J., Brailey, K., Mathews, A. (2004). Suppression of attentional bias in PTSD. Journal of Abnormal Psychology, 113(2), 315323.
Crawford, M.A., Knight, R.G., Alsop, B.L. (2007). Speed of word retrieval in postconcussion syndrome. Journal of International Neuropsychological Society, 13(1), 178182.
De Monte, V.E., Geffen, G.M., May, C.R., McFarland, K., Heath, P., Neralic, M. (2005). The acute effects of mild traumatic brain injury on finger tapping with and without word repetition. Journal of Clinical & Experimental Neuropsychology, 27(2), 224239.
DeGutis, J., D'Esposito, M. (2009). Network changes in the transition from initial learning to well-practiced visual categorization. Frontiers of Human Neuroscience, 3, 44.
DeGutis, J., Van Vleet, T.M. (2010). Tonic and phasic alertness training: A novel behavioral therapy to improve spatial non-spatial attention in patients with hemispatial neglect. Frontiers in Human Neuroscience, 4, 60.
Eldar, S., Bar-Haim, Y. (2010). Neural plasticity in response to attention training in anxiety. Psychological Medicine, 40(4), 667677.
Esterman, M., Noonan, S.K., Rosenberg, M., Degutis, J. (2012). In the zone or zoning out? Tracking behavioral and neural fluctuations during sustained attention. Cerebral Cortex, [Epub ahead of print].
Falconer, E., Bryant, R., Felmingham, K.L., Kemp, A.H., Gordon, E., Peduto, A., Williams, L.M. (2008). The neural networks of inhibitory control in posttraumatic stress disorder. Journal of Psychiatric Neuroscience, 33(5), 413422.
Fortier, C.B., Amick, M.M., Grande, L., McGlynn, S., Kenna, A., Morra, L., McGlinchey, R.M. (2013). The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) semistructured interview: Evidence of research utility and validity. Journal of Head Trauma Rehabilitation, [Epub ahead of print].
Green, P. (2003). Green's Medical Symptom Validity Test (MSVT) for Windows: User's manual. Edmonton, Canada: Green's Publishing.
Harvey, A.G., Bryant, R.A. (2000). Two-year prospective evaluation of the relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury. American Journal of Psychiatry, 157(4), 626628.
Hill, J.J. III, Mobo, B.H. Jr., Cullen, M.R. (2009). Separating deployment-related traumatic brain injury and posttraumatic stress disorder in veterans: Preliminary findings from the Veterans Affairs traumatic brain injury screening program. American Journal of Physical Medicine and Rehabilitation, 88(8), 605614.
Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I., Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 1322.
Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., Castro, C.A. (2008). Mild traumatic brain injury in U.S. Soldiers returning from Iraq. New England Journal of Medicine, 358(5), 453463.
Huang, M.X., Theilmann, R.J., Robb, A., Angeles, A., Nichols, S., Drake, A., Lee, R.R. (2009). Integrated imaging approach with MEG and DTI to detect mild traumatic brain injury in military and civilian patients. Journal of Neurotrauma, 26(8), 12131226.
Iverson, G.L. (2005). Outcome from mild traumatic brain injury. Current Opinion in Psychiatry, 18(3), 301317.
Kimble, M.O., Fleming, K., Bandy, C., Kim, J., Zambetti, A. (2010). Eye tracking and visual attention to threating stimuli in veterans of the Iraq war. Journal of Anxiety Disorders, 24(3), 293299.
King, D.W., King, L.A., Vogt, D.S., Knight, J., Samper, R. (2006). Deployment Risk and Resilience Inventory: A collection of measures for studying deployment -related experiences of military personnel and veterans. Military Psychology, 18(2), 89120.
Lo, C., Shifteh, K., Gold, T., Bello, J.A., Lipton, M.L. (2009). Diffusion tensor imaging abnormalities in patients with mild traumatic brain injury and neurocognitive impairment. Journal of Computer Assisted Tomography, 33(2), 293297.
Mac Donald, C.L., Johnson, A.M., Cooper, D., Nelson, E.C., Werner, N.J., Shimony, J.S., Brody, D.L. (2011). Detection of blast-related traumatic brain injury in U. S. military personnel. New England Journal of Medicine, 364(22), 20912100.
Mayer, A.R., Mannell, M.V., Ling, J., Elgie, R., Gasparovic, C., Phillips, J.P., Yeo, R.A. (2009). Auditory orienting and inhibition of return in mild traumatic brain injury: A FMRI study. Human Brain Mapping, 30(12), 41524166.
McAllister, T.W. (2009). Psychopharmacological issues in the treatment of TBI and PTSD. The Clinical Neuropsychologist, 23(8), 13381367.
Pannu Hayes, J., Labar, K.S., Petty, C.M., McCarthy, G., Morey, R.A. (2009). Alterations in the neural circuitry for emotion and attention associated with posttraumatic stress symptomatology. Psychiatry Research, 172(1), 715.
Pineles, S.L., Shipherd, J.C., Mostoufi, S.M., Abramovitz, S.M., Yovel, I. (2009). Attentional biases in PTSD: More evidence for interference. Behavior Research and Therapy, 47(12), 10501057.
Pontifex, M.B., O'Connor, P.M., Broglio, S.P., Hillman, C.H. (2009). The association between mild traumatic brain injury history and cognitive control. Neuropsychologia, 47(14), 32103216.
Pitman, R.K., Rasmusson, A.M., Koenen, K.C., Shin, L.M., Orr, S.P., Gilbertson, M.W., Liberzon, I. (2012). Biological studies of post-traumatic stress disorder. Nature Reviews Neuroscience, 13(11), 769787.
Reger, M.L., Poulos, A.M., Buen, F., Giza, C.C., Hovda, D.A., Fanselow, M.S. (2012). Concussive brain injury enhances fear learning and excitatory processes in the amygdala. Biological Psychiatry, 71(4), 335343.
Robbins, T.W., James, M., Owen, A.M., Sahakian, B.J., Lawrence, A.D., McInnes, L., Rabbit, P.M. (1998). A study of performance on tests from the CANTAB battery sensitive to frontal lobe dysfunction in a large sample of normal volunteers: Implications for theories of executive functioning and cognitive aging. Cambridge Neuropsychological Test Automated Battery. Journal of International Neuropsychological Society, 4(5), 474490.
Robbins, T.W., James, M., Owen, A.M., Sahakian, B.J., McInnes, L., Rabbitt, P. (1994). Cambridge Neuropsychological Test Automated Battery (CANTAB): A factor analytic study of a large sample of normal elderly volunteers. Dementia, 5(5), 266281.
Schneiderman, A.I., Braver, E.R., Kang, H.K. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167(12), 14461452.
Sponheim, S.R., McGuire, K.A., Kang, S.S., Davenport, N.D., Aviyente, S., Bernat, E.M., Lim, K.O. (2011). Evidence of disrupted functional connectivity in the brain after combat-related blast injury. Neuroimage, 54(Suppl), S21S29.
Stein, M.B., McAllister, T.W. (2009). Exploring the convergence of posttraumatic stress disorder and mild traumatic brain injury. American Journal of Psychiatry, 166(7), 768776.
Swick, D., Honzel, N., Larsen, J., Ashley, V., Justus, T. (2012). Impaired response inhibition in veterans with post-traumatic stress disorder and mild traumatic brain injury. Journal of International Neuropsychological Society, 18(5), 917926.
Terrio, H., Brenner, L.A., Ivins, B.J., Cho, J.M., Helmick, K., Schwab, K., Warden, D. (2009). Traumatic brain injury screening: Preliminary findings in a US Army brigade combat team. Journal of Head Trauma Rehabilitation, 24(1), 1423.
Thrasher, S.M., Dalgleish, T., Yule, W. (1994). Information processing in post-traumatic stress disorder. Behavior Research Therapy, 32(2), 247254.
Van Zomeren, A.H., Brouwer, W.H., Deelman, B.G. (1984). Attentional deficits: The riddles of selectivity, speed and alertness. Oxford: Oxford University Press.
Vanderploeg, R.D., Belanger, H.G., Curtiss, G. (2009). Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms. Archives of Physical Medicine and Rehabilitation, 90(7), 10841093.
Vasterling, J.J., Proctor, S.P., Amoroso, P., Kane, R., Heeren, T., White, R.F. (2006). Neuropsychological outcomes of army personnel following deployment to the Iraq war. Journal of American Medical Association, 296(5), 519529.
Vogt, D.S., Proctor, S.P., King, D.W., King, L.A., Vasterling, J.J. (2008). Validation of scales from the Deployment Risk and Resilience Inventory in a sample of Operation Iraqi Freedom veterans. Assessment, 15(4), 391403.
Walilko, T., North, C., Young, L.A., Lux, W.E., Warden, D.L., Jaffee, M.S., Moore, D.F. (2009). Head injury as a PTSD predictor among Oklahoma City bombing survivors. Journal of Trauma, 67(6), 13111319.


PTSD Modifies Performance on a Task of Affective Executive Control among Deployed OEF/OIF Veterans with Mild Traumatic Brain Injury

  • Melissa M. Amick (a1) (a2), Alexandra Clark (a1), Catherine B. Fortier (a1) (a3), Michael Esterman (a1) (a2), Ann M. Rasmusson (a1) (a2), Alexandra Kenna (a1), William P. Milberg (a1) (a3) (a4) and Regina McGlinchey (a1) (a3) (a4)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed