Future-Oriented Cognition in PTSD

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Future-oriented thoughts occupy a prominent position in spontaneous mental activity. They serve an important adaptive function, in that they enable us to represent multiple hypothetical outcomes and act in light of those anticipated outcomes. Although a core feature of PTSD is reliving of past traumatic experiences, the anticipation of future threat plays an important role in maintenance of the disorder. Yet, future thinking has not been systematically evaluated in PTSD. Cognitive neuroscience research has shown that there is considerable overlap between the processes involved in remembering the past and envisioning the future. The well- documented alterations in autobiographical memory in PTSD raise the intriguing possibility of changes in future-oriented cognition in PTSD as well. Nonetheless, because thinking about the future is not simply a mirror image of remembering the past, the study of future thinking in PTSD merits systematic investigation in its own right. The current proposal provides the first comprehensive, theoretically motivated analysis of future thinking in individuals with PTSD. The first part of the proposal assesses the scope of PTSD-associated abnormalities in the simulation and appraisal of positive and negative future events and draws on insights from studies of autobiographical memory in PTSD to elucidate the cognitive mechanisms that may underlie these abnormalities. Further, the neural bases of impairments in future thinking are examined using functional neuroimaging. The second part of the proposal evaluates the implications of alterations in future thinking for decision making by examining how decisions made now are impacted by the way their future outcomes are envisioned in the context of an intertemporal choice task. This section of the proposal also explores the contribution of altered risk assessment and altered valuation of future choices to the observed impairment. The third part of the proposal evaluates the feasibility of enhancing future thinking in PTSD through information- processing manipulations shown to impact future thinking in studies of cognition in healthy individuals. The studies comprising this proposal provide a principled way to gauge the nature of the impairment in future- oriented cognition in PTSD. Further, by uncovering mechanisms responsible for these PTSD-associated abnormalities, this proposal lays the foundation for a theoretically motivated approach to information- processing interventions. Given the important ways in which future thought shapes our emotions, motivations, and actions, understanding future-oriented thought in PTSD has wide-range implications for Veterans' quality of life.