Executive Functions in Post-Traumatic Stress Disorder: Their Relation to PTSD Severity and Daily Functioning

Nehal Safi^1,2*Elias Jahjah²Eyal Bergmann²Yael Caspi²Eyal Fruchter²Udi Oren³Naomi Josman¹Evelyne Klinger⁴Batya Engel-Yeger^1*

• ¹Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
• ²Department of Psychiatry at Rambam Medical Center, Haifa, Israel
• ³The EMDR Institute of Israel, Jerusalem, Israel
• ⁴Presence & Innovation Laboratory, Laval, France

Background: Executive Functions difficulties may be prevalent in people with PTSD, and they might negatively affect their behavior and daily functioning. However, knowledge about the implications of executive functions deficits on daily functioning and the assessments that reflect functional limitations is limited. This study aimed to measure how executive functions difficulties affect daily functioning in PTSD using ecologically valid assessments that imitate daily activities. Methods: Participants were 66 individuals aged 18– 65 years: 26 diagnosed with PTSD and 40 healthy controls. All participants completed a socio-demographic questionnaire, the Clinician-Administered PTSD Scale, and the Behavior Rating Inventory of Executive Functions – BRIEF-A, a self-reported tool to assess the impact of executive functions on daily activities. Participants also performed a virtual shopping activity to assess executive functions while performing in a daily activity using the Virtual Action Planning Supermarket (VAP-S 2), a novel, ecologically valid, performance-based tool. Results: Difficulties in executive functions were significantly more prevalent in PTSD patients: the BRIEF-A reflected how executive functions difficulties manifested in behavioral dysregulation, restricting daily functioning. The VAP-S 2 revealed difficulties in executive functions, expressed as higher impulsivity, lower strategy use, and decreased performance efficiency while shopping in the virtual supermarket. Correlations were found between BRIEF-A and VAP-S 2: more collisions and lower inhibition in VAP-S 2 were correlated with worse BRIEF-A scores. Difficulties in executive functions correlated with PTSD severity. Conclusions: Executive functions difficulties in PTSD may correlate with PTSD severity and restrict daily functioning. Therefore, executive functions in PTSD should be evaluated using ecologically valid assessments to illuminate the implications of real-life activities. VAP-S 2 uniquely enables objective assessment of executive functions in real-life scenarios for PTSD, complementing self-report and enhancing the ecological validity of findings. It is recommended to combine self-reports that reflect the person's authentic perspective with performance-based assessments, such as the VAP-S 2, to focus intervention on people's real-life context and, by that, improve their function and well-being.