Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: a proof-of-concept randomized controlled trial

L Iyadurai,J R Geddes,M B Bonsall,E A Holmes,A C Nobre,P C Watson,S E Blackwell,R Meiser-Stedman

doi:10.1038/mp.2017.23

Abstract

After psychological trauma, recurrent intrusive visual memories may be distressing and disruptive. Preventive interventions post trauma are lacking. Here we test a behavioural intervention after real-life trauma derived from cognitive neuroscience. We hypothesized that intrusive memories would be significantly reduced in number by an intervention involving a computer game with high visuospatial demands (Tetris), via disrupting consolidation of sensory elements of trauma memory. The Tetris-based intervention (trauma memory reminder cue plus c. 20 min game play) vs attention-placebo control (written activity log for same duration) were both delivered in an emergency department within 6 h of a motor vehicle accident. The randomized controlled trial compared the impact on the number of intrusive trauma memories in the subsequent week (primary outcome). Results vindicated the efficacy of the Tetris-based intervention compared with the control condition: there were fewer intrusive memories overall, and time-series analyses showed that intrusion incidence declined more quickly. There were convergent findings on a measure of clinical post-trauma intrusion symptoms at 1 week, but not on other symptom clusters or at 1 month. Results of this proof-of-concept study suggest that a larger trial, powered to detect differences at 1 month, is warranted. Participants found the intervention easy, helpful and minimally distressing. By translating emerging neuroscientific insights and experimental research into the real world, we offer a promising new low-intensity psychiatric intervention that could prevent debilitating intrusive memories following trauma.

Highlights

After psychological trauma, sensory memories can recurrently spring to mind unbidden,[1] bringing back sights and sounds of the events, evoking strong emotion, hijacking attention and profoundly disrupting current activities
In line with the hypotheses, the results show that visuospatial tasks during or soon after the event consistently lead to a reduction in the number of subsequent intrusive memories,[15,27,28,29,30] whereas some verbal tasks do not and can even increase intrusions indicating possible harmful effects[15,27,31,32]
We suggest that visuospatial cognitive tasks act not merely via distraction, but by modality-specific interference with sensory aspects of intrusive memory

Summary

Introduction

Sensory memories can recurrently spring to mind unbidden,[1] bringing back sights and sounds of the events, evoking strong emotion, hijacking attention and profoundly disrupting current activities. Intrusive memories comprise a core clinical feature[2] of acute stress disorder and post-traumatic stress disorder (PTSD).[1] In the first days post trauma, intrusive memories (among other symptoms) have been associated with a diagnosis of PTSD at 1 year,[3] and early intrusion symptoms with a non-remitting PTSD trajectory over 15 months.[4] Intrusive memories occur across a range of other mental disorders from depression[5] to complicated grief,[6] comprising an important transdiagnostic target[7] for preventive psychiatric interventions. Currently preventive interventions after trauma targeting the full syndrome of PTSD are either ineffective[8,9] or unappealing/inaccessible[10,11] to most people. New approaches are needed—we suggest targeting preventive efforts on a focal symptom—here, intrusive memories of the trauma

Methods

Results

Conclusion