Avoidance behaviour generalizes to eye processing in posttraumatic stress disorder

BACKGROUND: Avoidance describes any action designed to prevent an uncomfortable situation or emotion from occurring. Although it is a common reaction to trauma, avoidance becomes problematic when it is the primary coping strategy, and plays a major role in the development and maintenance of posttraumatic stress disorder (PTSD). Avoidance in PTSD may generalize to non-harmful environmental cues that are perceived to be unsafe. OBJECTIVE: We tested whether avoidance extends to social cues (i.e. emotional gazes) that are unrelated to trauma. METHOD: A total of 159 participants (103 who had been exposed to the 2015 Paris terrorist attacks and 56 who had not) performed a gaze-cueing task featuring sad, happy and neutral faces. Attention to the eye area was recorded using an eyetracker. Of the exposed participants, 52 had been diagnosed with PTSD (PTSD+) and 51 had not developed PTSD (PTSD-). As a result of the preprocessing stages, 52 PTSD+ (29 women), 50 PTSD- (20 women) and 53 nonexposed (31 women) participants were included in the final analyses. RESULTS: PTSD+ participants looked at sad eyes for significantly less time than PTSD- and nonexposed individuals. This effect was negatively correlated with the intensity of avoidance symptoms. No difference was found for neutral and happy faces. CONCLUSIONS: These findings suggest that maladaptive avoidance in PTSD extends to social processing, in terms of eye contact and others’ emotions that are unrelated to trauma. New therapeutic directions could include targeting sociocognitive deficits. Our findings open up new and indirect avenues for overcoming maladaptive avoidance behaviours by remediating eye processing. Trial registration: ClinicalTrials.gov identifier: NCT02810197. HIGHLIGHTS: Avoidance is a key symptom of posttraumatic stress disorder (PTSD). Avoidance is often viewed as limited to reminders linked to the trauma. Results show that attention to the eyes of sad faces is also affected by PTSD. This effect is correlated with avoidance symptoms in PTSD.