Supplement S1pilotstudy: Selecting Words for the Emotional Stroop Task

Supplement S1Pilotstudy: Selecting words for the Emotional Stroop Task

Seven experts for PTSD from the Department of Psychosomatic Medicine and Psychotherapy of the Central Institute of Mental Health in Mannheim categorized 400 words of the corpus-based wordlist (Institutfür Deutsche Sprache, 2013, trauma-related, generally negative, neutral and ‘other’ word category. Out of the words categorisedconcordantly into the same category, 40 wordswere selected for each category (trauma-related, generally negative, neutral), and matched for length and frequency. In a second step, seven patients with childhood abuse-related complex PTSD from the inpatient unit rated these words regarding valence and arousal on a five point likert scale by the self-assessment manikin scale (SAM). According to the patient ratings, we selected 20 words for each category (see Fig. S1). Table S1 shows the finally wordlist of the Classic and Emotional Stroop Task.

Fig. 1 Arousal and valence ratings of the finally selected words for the Emotional Stroop Task

Table 1Wordlist of the classic Stroop task, the emotional Stroop task and the Recognition task in German (English translation in italics).

Classic
Stroop / Emotional Stroop / Recognition Task
colour / trauma / negative / neutral / trauma / negative / neutral
Blau / ausgeliefert / Beschwerde / Anlage / Penetration / Attentat / Abendprogramm
blue / to be at someone’s mercy / complaint / investment / penetration / assassination / evening program
Grün / Brust / Biest / bedeuten / Peinigung / Beanstandung / Schreibheft
green / breast / beast / to mean something / torment / objection / writing book
Rot / Busen / Entsetzt / Fisch / Quälerei / Beerdigung / Bindestrich
red / bosom / horrified / fish / agony / funeral / hyphen
Gelb / Erektion / Giftgas / formen / Drangsalieren / weinen / prägen
yellow / erection / poison gas / form / harass / cry / shape
erregt / Giftmord / Fragezeichen / prügeln / einbüßen / beinhalten
aroused / murder by poisoning / question mark / thrash / forfeit / contain
Gewalt / Habgier / Käuferin / Schande / Knall / Dampfer
violence / greed / buyer / shame / bang / steamer
hilflos / Infekt / lesbar / Folter / Malheur / Entwurf
helpless / infection / readable / torture / mishap / draft
Missbrauch / Last / logisch / schutzlos / entrüstet, / händisch
abuse / burden / logical / unprotected / enraged / manually
Misshandlung / pleite / manuell / ohnmächtig / heimtückisch / goldfarben
mistreatment / bankrupt / manual / unconscious / sneaky / gold-colored
Oralsex / Schuss / Mappe / machtlos / unnötig / klar
oral sex / shot / file / powerless / unnecessary / clear
Penis / sinnlos / Maß / Blowjob / Giftspritze / Blumenvase
penis / senseless / measure / blowjob / poison syringe / flower vase
quälen / Spinne / Notizblock / Schoß / Chemiewaffe / Briefträger
agonize / spider / notepad / lap / chemical weapon / postman
Scheide / Sturz / Poster / Vulva / Ausbeutung / Weizen
vagina / plunge / poster / vulva / exploitation / wheat
schlagen / Terroranschlag / Postler / Samenerguss / Entzündung / Bild
hit / terrorist attack / post office worker / ejaculation / inflammation / picture
Schuld / Trauerfeier / Rahmenprogramm / Beischlaf / Kummer / Einheit
guilt / funeral service / supporting program / sexual intercourse / grief / unity
Sex / trauern / Roggen / Ständer / Verfall / Kundin
sex / grieve / rye / boner / deterioration / customer
Sperma / Unfall / Schiff / Schwanz / Monster / Ordner
sperm / accident / ship / cock / monster / folder
Vagina / verlieren / silberfarben / kribbelig / arm / verstehbar
vagina / lose / silver-colored / tingly / poor / understandable
Vergewaltigung / verräterisch / Tanne / Brustwarze / Fall / Teich
rape / treacherous / fir tree / nipple / case / pond
wehrlos / Verwesung / Tontopf / Büste / Insekt / Baum
defenseless / decay / clay pot / bust / insect / tree

Supplement S2Valence and Arousalratings

Table 2Valence- and arousalratings of the words of the Emotional Stroop Task in patients with complex post-traumatic stress disorder, trauma-exposed healthy subjects and non-trauma exposed healthy subjects

Descriptivedata / Statistics
cPTSD (n=28) / TC (n=28) / HC (n=28)
Ratings Stroopwords / M / (SD +-) / M / (SD +-) / M / (SD +-) / F / p / Post-hoc t tests
Valence
Negative words / 3.83 / (0.34) / 3.92 / (0.44) / 3.80 / (0.54) / n.s. / n.s. / n.s.
Trauma-relatedwords / 4.46 / (0.34) / 3.68 / (0.32) / 3.51 / (0.42) / 46.57 / <.001 / cPTSD>TC ns. HC
Neutral words / 2.51 / (0.53) / 2.63 / (0.47) / 2.81 / (0.38) / n.s. / n.s. / n.s.
Arousal
Negative words / 2.64 / (0.67) / 2.28 / (0.88) / 1.86 / (0.65) / 6.24 / <.05 / cPTSDn.s. TC n.s HC
cPTSD> HC
Trauma-relatedwords / 3.97 / (0.61) / 2.43 / (0.68) / 2.02 / (0.72) / 52.92 / <.001 / cPTSD>TC ns.
HC
Neutral words / 1.17 / (0.18) / 1.12 / (0.43) / 1.04 / (0.12) / n.s. / n.s. / n.s.

cPTSD = complex post-traumatic stress disorder; TC = trauma-exposed healthy subjects; HC = non-trauma exposed healthy subjects; M = mean; SD = standard deviation; Post-hoc t tests were performed at a significance level of p< 0.05 Bonferroni-corrected;n.s.= not significant at a significance level of p.05

Supplement S3: Overview of the results of the repeated measure analysis of variance

Table 3 Overview of the results of the repeated measure analysis of variance (rm-ANOVAs) of the classic and emotional Stroop task and related memory tasks in patients with complex post-traumatic stress disorder (cPTSD), trauma-exposed healthy subjects (TC) and non-trauma exposed healthy subjects (HC)
Rm-Anova
Maineffectgroup / Maineffectcondition / Interaction group x condition
Stroop Task
Reactiontimes (lg) / F(2,81)=2.69, p=.07+,
2p= 0.06 / F(1.81, 146.57)=28.60, p<.001***, 2p=0.26 / F(3.62, 146.57)=6.42, p<.001***, 2p=0.14
Accuracy (% correct) / F(2,81)=4.63, p<.05*,
2p= 0.10 / F(2, 162)=3.54, p<.05*,
2p=0.04 / F(4, 162)=2.97, p<.05*,
2p=0.07
Memory Tasks
Free recall (n) / F(2,81)=2.41, p=.10, 2p=0.06 / F(1, 81)=177.29, p<.001***, 2p=0.69 / F(2, 81)=1.07, p=.35,
2p=0.03
Recognition task (Accuracy (% correct)) / F(2,81)=0.36, p=.70, 2p=0.01 / F(1, 81)=99.86, p<.001***, 2p=0.55 / F(2, 81)=0.42, p=.66,
2p=0.01
Note: Rm-ANOVAs include the within-subject factor condition (negative minus neutral, trauma minus neutral and colour minus neutral; for the free recall and recognition task: negative minus neutral and trauma minus neutral) and the between-subject factor group (cPTSD, TC, or HC); Significance level p<.05; ***p<.001, **p<.01, *p<.05, +p<.09

Supplement S4: Overview of the post-hoc t-tests of the classic and emotional Stroop task and related memory tasks

Table 4 Overview of the post-hoc t-tests of the classic and emotional Stroop task and related memory tasks in patients with complex post-traumatic stress disorder (cPTSD), trauma-exposed healthy subjects (TC) and non-trauma exposed healthy subjects (HC)
Post-hoc t tests
cPTSDvs TC / cPTSDvs HC / TC vs HC
Stroop Task
Reactiontimes (lg)
Negative>neutral / T(54)=-0.38, p=.71, d=-0.10 / T(54)=1.33, p=.19, d=0.36 / T(54)=1.31, p=.20, d=0.35
Trauma>neutral / T(44.14)=2.45, p<.05*, d=0.68 / T(34.38)=4.06, p<.001***, d=1.19 / T(54)=1.42, p=.16, d=0.38
Colour>neutral / T(54)=-0.39, p=.70, d=-0.10 / T(54)=-0.98, p=.33, d=-0.26 / T(54)=-0.72, p=.48, d=-0.19
Accuracy (%correct)
Negative>neutral / T(54)=0.15, p=.88, d=0.04 / T(54)=-0.42, p=.68, d=-0.11 / T(54)=-0.56, p=.58, d=-0.15
Trauma>neutral / T(27.93)=-2.21, p<.05*, d=-0.75 / T(27.93)=-2.15, p<.05*, d=-0.72 / T(54)=0.36, p=.72, d=0.10
Colour>neutral / T(28.63)=-1.89, p=.07+, d=-0.62 / T(30.55)=-1.61, p=.12, d=-0.50 / T(54)=0.84, p=.40, d=0.23
Memory tasks
Free recall (n)
Negative>neutral words / T(54)=0.84, p=.41, d=0.22 / T(54)=1.19, p=.24, d=0.32 / T(54)=0.28, p=.78, d=0.07
Trauma>neutral words / T(54)=1.42, p=.16, d=0.38 / T(54)=1.21, p=.22, d=0.36 / T(54)=1.07, p=.29, d=0.29
Recognition task
Accuracy (n)
Negative>neutral words / T(54)=0.87, p=.39, d=0.23 / T(54)=0.89, p=.38, d=0.24 / T(54)=0.08, p=.94, d=0.02
Trauma>neutral words / T(44.15)=0.00, p=1, d=0.00 / T(48.51)=0.55, p=.58, d= 0.15 / T(54)=0.73, p=.47, d=0.20
Note: Significance level p<.05; Adjustment for multiple comparisons: Bonferroni, ***p<.001, **p<.01, *p<.05, +p<.09

Supplement S5Whole brain results

Table 5Whole-brain results for the F contrast ‘main effect of condition’ (within the 3 x 3 full factorial model)

Anatomicallabel / BA / Cluster size / Peak voxel (MNI) / Voxel Z / pFWE
x / y / z
Lingual Gyrus / 17 / 1689 / -9 / -88 / 1 / Inf / <.0001
Inferior Parietal Lobule / 40 / 3478 / -48 / -43 / 46 / Inf / <.0001
Medial Frontal Gyrus / 11 / 3195 / -3 / 47 / -14 / Inf / <.0001
Middle Temporal Gyrus / 21 / 220 / -57 / -4 / -14 / Inf / <.0001
Middle Frontal Gyrus / 46 / 2394 / -45 / 35 / 25 / Inf / <.0001
Posterior Lobe / * / 448 / -9 / -76 / -26 / 7.836 / <.0001
Posterior Lobe / * / 127 / 24 / -82 / -32 / 7.402 / <.0001
Middle Temporal Gyrus / 37 / 149 / -54 / -49 / -8 / 7.335 / <.0001
Posterior Lobe / * / 222 / 36 / -67 / -44 / 7.143 / <.0001
Temporal Lobe / * / 98 / 60 / -46 / -5 / 7.105 / <.0001
Superior Temporal Gyrus / 38 / 27 / 45 / 20 / -26 / 6.748 / <.0001
Limbic Lobe / Amygdala / 46 / 21 / -7 / -14 / 6.204 / <.0001
Superior Temporal Gyrus / 22 / 59 / 54 / -10 / -11 / 6.195 / <.0001
Sub-lobar / Hypothalamus / 53 / 6 / -4 / -2 / 5.718 / <.0001
Inferior Temporal Gyrus / 37 / 15 / -42 / -46 / -17 / 5.318 / .003

Note: FWE = family-wise error corrected, p (FWE) < .05, k > 10 voxel; BA= Brodmann area.