How We See the World: Inflexible Interpretation Updating as a Predictor and Moderator of PTSD Symptoms in High-Risk Occupations

Objective: The way we interpret information shapes our perception of reality. Predictive processing frameworks propose that the ability to update interpretations based on disconfirming information is key to recovery from potentially traumatic events (PTEs). However, direct evidence for this assumption is scarce and comes from studies using paradigms with low ecological validity. Method: Here, we investigate the association between inflexible interpretation updating (IIU) and symptoms of posttraumatic stress disorder (PTSD) in a comprehensive sample (N = 1, 238 participants with work-related PTEs) using a scenario-based task, which exposed participants to danger-related situations that are representative of everyday life. Results: Our preregistered analyses yielded inconclusive findings regarding the relative link between PTSD symptoms and biased interpretations and interpretation updating, respectively. After conducting additional analyses to derive uncorrelated indices of biased interpretations and IIU, we found that both indices independently predicted higher PTSD symptoms. Moreover, IIU was found to moderate the association between work-related PTE exposure and PTSD symptoms such that individuals with highly flexible updating did not show a significant increase in PTSD symptoms with a rise in work-related PTE exposure. Conclusions: Our findings provide further indications that biased interpretations and IIU may be involved in the pathogenesis of PTSD. In addition, they suggest that interpretation updating may be a promising target for the prevention of PTSD symptoms in contexts of repeated PTE exposure (e.g., in high-risk occupations).