Eye-tracking and cognitive patterns in post-traumatic stress disorder: a scoping review.

Abstract

<b>Background:</b> PTSD is associated with alterations in attentional processing and executive control, particularly in response to threat-related or emotionally salient cues. Early research emphasised sustained hypervigilance, whereas recent evidence indicates that attentional biases in PTSD are dynamic, context-dependent, and may also involve avoidance. Eye-tracking, especially combined with neurophysiological measures, provides fine-grained indices of visual attention and oculomotor control.<b>Objective:</b> This scoping review synthesises empirical findings on attentional bias and cognitive control in PTSD, focusing on eye-tracking paradigms-including antisaccade, free-viewing, and visual search tasks-and their neurobiological correlates, integrating advances published up to 2025.<b>Method:</b> A literature search was conducted in Scopus, PubMed, and PsycINFO from 2010 to 2025 using terms related to PTSD, eye-tracking, attentional bias, inhibition, and executive functioning, updated to include 2025 publications.<b>Results:</b> Eye-tracking studies suggest that PTSD is associated with heterogeneous and dynamic attentional patterns. While some studies report sustained attention to threatening stimuli, recent evidence also describes attentional avoidance under increased cognitive load, reduced visual exploration, and shortened scanpaths. Alterations in early perceptual processing have been documented in a small number of multimodal studies, with trauma-related sensory encoding differences and contextual-memory difficulties reported in specific paradigms. Attention bias variability, reflecting fluctuations between vigilance and avoidance, has been proposed as a relevant correlate of PTSD severity, with some studies suggesting added sensitivity of eye-tracking indices relative to reaction-time measures. Attentional patterns are further modulated by trauma type and symptom composition, indicating substantial interindividual variability.<b>Conclusion:</b> Eye-tracking can capture early and late attentional processes in PTSD with high temporal resolution, showing that attentional dysregulation may extend beyond hypervigilance to include avoidance and instability across contexts. Eye-tracking studies reveal dynamic and heterogeneous attentional patterns in PTSD, extending beyond sustained hypervigilance.Attentional avoidance, instability, and early perceptual alterations emerge under cognitive load and vary across trauma types and symptom clusters.Eye-tracking may provide sensitive indices of attentional dysregulation in PTSD and may complement reaction-time-based measures in personalised models.