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

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.

Development and testing of TraumaGameplay: an iterative experimental approach using the trauma film paradigm

“…Two recent studies have demonstrated that playing Tetris can effectively reduce intrusions in a clinical setting (Horsch et al, 2017; Iyadurai et al, 2017), highlighting the clinical relevance of playing Tetris shortly after experiencing actual trauma. Our findings are more sobering, and may also reflect a common phenomenon in intervention research, when a new intervention is proposed and tested, with the first studies showing large effects but later studies are much less positive (Ioannidis, 1998).…”

“…Although studies have shown that playing Tetris on a computer or Nintendo DS can be effective in a clinical setting (Horsch et al, 2017; Iyadurai et al, 2017), such equipment is not always readily available (e.g. in developing countries, during a natural disaster).…”

Arresting visuospatial stimulation is insufficient to disrupt analogue traumatic intrusions

“…In parallel to these analogue studies, accumulating evidence suggests that already consolidated distressing autobiographical memories can lose their vividness and emotionality when the individual repeatedly executes guided eye movements whilst remembering [13,14]. Based on these findings, many clinicians and researchers are hopeful that a disruptive effect on intrusive trauma memories can be exploited in effective treatment and preventive interventions for trauma victims (e.g., [15,16,17]).…”

Treatment of Intrusive Suicidal Imagery Using Eye Movements

“…Consequently, through eye movements (like in EMDR) and computer games like Tetris (which has recently translated into populations, e.g. Iyadurai, et al [72], Horsch, et al [73]), a considerable gain has been demonstrated with intrusive suicidal images.…”