Attention to threat in posttraumatic stress disorder as indexed by eye-tracking indices: A systematic review

Amit Lazarov*, Benjamin Suarez-Jimenez, Amanda Tamman, Louise Falzon, Xi Zhu, Donald E. Edmondson, Yuval Neria

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

69 Scopus citations


Background Cognitive models of posttraumatic stress disorder (PTSD) implicate threat-related attentional biases in the etiology and phenomenology of the disorder. However, extant attentional research using reaction time (RT)-based paradigms and measures has yielded mixed results. Eye-tracking methodology has emerged in recent years to overcome several inherent drawbacks of RT-based tasks, striving to better delineate attentional processes.Methods A systematic review of experimental studies examining threat-related attention biases in PTSD, using eye-tracking methodology and group-comparison designs, was conducted conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were selected following a systematic search for publications between 1980 and December 2017 in PsycINFO, MEDLINE and the National Center for PTSD Research's Published International Literature on Traumatic Stress (PILOTS) database. Additional records were identified by employing the Similar Articles feature in PubMed, and the Cited Reference Search in ISI Web of Science. Reference sections of review articles, book chapters and studies selected for inclusion were searched for further studies. Ongoing studies were also sought through A total of 11 studies (n = 456 participants in total) were included in the final review. Results indicated little support for enhanced threat detection, hypervigilance and attentional avoidance. However, consistent evidence emerged for sustained attention on threat (i.e. attention maintenance) in PTSD.Conclusions This review is the first to systematically evaluate extant findings in PTSD emanating from eye-tracking studies employing group-comparison designs. Results suggest that sustained attention on threat might serve as a potential target for therapeutic intervention.

Original languageEnglish
Pages (from-to)705-726
Number of pages22
JournalPsychological Medicine
Issue number5
StatePublished - 1 Apr 2019


FundersFunder number
Louise Falzon
National Institutes of Mental Health-InstitutionalMH015144, MH020004
Stand for the Troops Foundation
Value Institute of New York-Presbyterian Hospital
National Institutes of HealthU24AG052175, S15-0142
National Heart, Lung, and Blood InstituteR01HL117832


    • Attention bias
    • Eye-tracking
    • Posttraumatic stress disorder
    • Systematic review
    • Trauma exposure


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