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Treating intrusive memories after trauma in healthcare workers using Tetris

Presented by
Prof. Emily Holmes, Uppsala University, Sweden
ECNP 2022
In the GAINS trial, the frequency of intrusive memories caused by working in an intensive care unit (ICU) during the COVID-19 pandemic was significantly decreased by playing the computer game Tetris.

During the COVID-19 pandemic, many healthcare workers, in particular those working in ICUs and caring for COVID-19 patients, experienced stressful or even traumatic psychological events from their daily work, causing mental disorders like anxiety, depression, alcohol misuse, and post-traumatic stress disorder (PTSD) [1]. Prof. Emily Holmes (Uppsala University, Sweden) presented results from a novel intervention aimed at decreasing intrusive memories, a core symptom of PTSD [2]. This intervention is based on the idea that the vividness and intensity of a visual memory brought to mind can be updated and limited by another visually engaging task. In the GAINS trial (NCT04992390; https://www.p1vital-gains.com/), this task was playing the computer game Tetris for 20 minutes after the traumatic memory was brought to mind. Tetris was chosen because the inherent ‘mental rotation task’ maximises the visual working memory load, Prof. Holmes explained. In a proof-of-concept study, the same intervention proved to be feasible and effective for patients within 6 hours of a motor vehicle accident and the observed effect was persistent [3,4].

In the GAINS trial, 86 healthcare workers who reported intrusive memories from working in an ICU during the COVID-19 pandemic were enrolled and randomised 1:1 to immediate access to the intervention for 4 weeks versus delayed access after usual care for 4 weeks. On average, participants experienced more than 35 work-related traumas, most of which had taken place over 3 months before entering the trial. More than 30% of participants reported 1 or more new traumatic events during the trial. A researcher guided the first interventional session; thereafter the intervention was used independently by the participants, with the option for support. The primary outcome of GAINS was the number of intrusive memories in week 4.

In participants who had immediate access to the intervention, the median number of intrusive memories decreased from 14 per week at baseline to 1 per week at week 4. In contrast, in participants who had usual care, the median number of intrusive memories decreased from 14 to 10 per week. After having accessed the intervention at week 4, these participants also had a decrease in the frequency of intrusive memories to a median of 1 per week at week 8 (see Figure) [5]. No side effects of the intervention were observed and the participants found the intervention easy to use and more convenient than talking therapy.

Figure: Immediate and delayed access to gameplay intervention show a similar effect [2]

Based on these results, Dr Holmes concluded that “this gameplay intervention shows promise for further development.”

  1. Lamb D, et al. Occup Environ Med. 2021;78:801–808.
  2. Holmes EA, et al. Gameplay to reduce replay? Targeting intrusive memories after trauma via an imagery competing task intervention including Tetris. Abstract S06.01, ECNP Congress 2022, 15–18 October, Vienna, Austria.
  3. Iyadurai L, et al. Mol Psychiatry. 2018;23:674–682.
  4. Kanstrup M, et al. Transl Psychiatry. 2021;11:30.
  5. Ramineni V, et al. medRxiv. 12 Oct 2022. Doi: 10.1101/2022.10.06.22280777.


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