Cognitive flexibility moderates the efficacy of a visuospatial intervention following exposure to analog trauma

Background and objectives: Intrusive memories are the hallmark feature of Post-Traumatic-Stress-Disorder (PTSD). Recent studies show that a visuospatial intervention after viewing traumatic films reduces intrusive memories in healthy individuals. However, many individuals still exhibit high levels of symptoms following such an intervention, warranting continued investigation into specific characteristics moderating intervention effect. One such candidate is cognitive-flexibility, defined as the ability to update behavior according to contextual demands. The present study examined the interactive effect of cognitive-flexibility and a visuospatial intervention on intrusive memories, predicting that higher flexibility would be associated with stronger intervention effects. Methods: Sixty participants (M_age = 29.07, SD = 4.23) completed a performance-based paradigm evaluating cognitive-flexibility, watched traumatic films, and were allocated to either an intervention or a no-task control group. Intrusions were assessed by means of laboratory and ambulatory assessment, and the intrusion subscale of the Impact-of-Events-Scale-Revised (IES-R). Results: Participants in the intervention group experienced fewer laboratory intrusions than the control group. However, this effect was moderated by cognitive-flexibility: Whereas individuals with below-average cognitive-flexibility did not benefit from the intervention, it was significantly beneficial for individuals with average and above-average cognitive-flexibility. No group differences emerged in the number of ambulatory intrusions or IES-R scores. However, cognitive-flexibility was negatively correlated with IES-R scores across both groups. Limitations: The analog design may limit the extent of generalization to real-world traumatic events. Conclusions: These results point to a potentially beneficial effect of cognitive-flexibility on intrusion development, particularly in the context of visuospatial interventions.