Cognitive flexibility in PTSD individuals following nature adventure intervention: is it really that good?

Abstract

Previous studies have found that PTSD is associated with hippocampal-related impairment in cognitive flexibility. However, little is known about this impairment following nature adventure interventions. The current ex post facto study aimed to examine the relationship between cognitive flexibility, sailing-based intervention and PTSD symptoms. Thirty-nine individuals with PTSD diagnosis (17 who engaged in sailing and 22 who did not engage in sailing) and 38 healthy control (18 who engaged in sailing and 20 who did not engage in sailing) completed a performance-based reversal learning paradigm to assess cognitive flexibility and were evaluated for PTSD, depressive and anxiety symptoms. The results revealed significantly lower levels of PTSD and trait anxiety symptoms in the PTSD-sailing group, compared to the PTSD-no-sailing group. In addition, both PTSD groups showed selective, though different, impairments in reversal learning. Specifically, PTSD-no-sailing individuals showed a selective impairment in reversing the outcome of a negative stimulus- they struggled to learn that a previously negative stimulus was later associated with a positive outcome. PTSD-sailing individuals, on the other hand, displayed a selective impairment in reversing the outcome of a positive stimulus- they had difficulty learning that a previously positive stimulus was later associated with a negative outcome. The results may suggest that although individuals who participated in a sailing-based intervention had lower clinical symptoms, their hippocampal related cognitive flexibility was mot improved, and the impairment exists in a different domain.

Keywords:

• PTSD
• cognitive flexibility
• hippocampus
• reversal learning
• nature adventure intervention
• sailing

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Notes on contributors

E.L.G. developed the study concept. All authors contributed to the study design. Testing and data collection were performed by E.L.G. and O.D.. E.L.G. and R.Z. performed the data analysis and interpretation and drafted the paper. G.R.L. and E.G.S. provided critical revisions. All authors approved the final version of the paper for submission.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon request.

Additional information

Funding

The research was supported by ISRAEL SCIENCE FOUNDATION [Grant# 1128/16] awarded to Einat Levy-Gigi.