New research involving Oxford researchers has shown that a simple digital intervention that includes gameplay can dramatically reduce intrusive memories of trauma in a month, even to the point of being symptom-free after six months. This treatment was also very effective at reducing the symptoms of post-traumatic stress disorder (PTSD) more generally. The findings have been published this week in The Lancet Psychiatry .
The ground-breaking study, funded by Wellcome , carried out a randomised controlled trial of 99 healthcare workers exposed to trauma at work during the Covid-19 pandemic. The results demonstrate huge potential to implement a highly scalable, low intensity, easily accessible digital treatment that could transform how we prevent and treat PTSD for people who have been exposed to trauma worldwide.
The global prevalence of trauma
According to the World Health Organization , psychological trauma - exposure to severe injury, death, or sexual violence - affects seven out of 10 of people at least once in their lifetime. Severe trauma can lead to PTSD, experienced by millions of people globally, and often presents as sudden, unwanted intrusive memories accompanied by very distressing emotions.
Existing therapies for PTSD are effective yet remain widely inaccessible. They tend to be resource-intensive - requiring multiple sessions with specialists - are widely unavailable, and are not recommended for those facing ongoing trauma.
Healthcare workers are regularly exposed to traumatic events, with limited treatment options often owing to a lack of availability. In the UK, PTSD prevalence among NHS staff increased from 13% before Covid-19 to 25% at the height of the pandemic. Health systems are under increased strain from untreated traumatic stress reactions among health professionals, with poor mental health resulting in people unable to work or leaving the healthcare profession.
Mental rotation and the mind's eye
What is shown is that reactivation of intrusive memories with intermediate levels of vividness achieve the best outcomes in reducing these memories - a finding that fits with theoretical predictions.
Study co-author Professor Mike Bonsall (Department of Biology)
The new study tested an intervention developed at Uppsala University in collaboration with P1vital, and trialled with collaborators including the University of Cambridge, and Oxford University. The focus was on treating intrusive, vivid, and unwanted memories of trauma, a hallmark symptom of PTSD.
After recalling a memory, participants learned how to use a cognitive skill called mental rotation, which involves rotating 2D and 3D shapes using your 'mind's eye'. They then used this skill to play a slower form of the video game Tetris, which similarly involves rotating geometric blocks. This is thought to occupy the brain's visuospatial areas, competing with the visual flashback, weakening its vividness and emotional impact - and critically, the frequency with which it intrudes.
To actively compare against this treatment, one control group of the trial listened to music by Mozart, reputed for therapeutic benefits to alleviate stress, and informational podcasts about him. In a second control group, participants received only standard care.
After just one month, researchers found a stark reduction in intrusive memories, commonly known as flashbacks, for those using the Tetris-based treatment - ten times fewer than either control group. It remained highly effective after six months, with 70% of participants who received it reporting no intrusive memories at all, even alleviating other PTSD symptoms.
Professor Mike Bonsall (Department of Biology, Oxford University) led on the design and statistical analysis for the trial - and in particular the focus on the mechanistic understanding of how reactivation of intrusive memories, their vividness, and use of the intervention interact to determine outcomes. He said: 'What is shown is that reactivation of intrusive memories with intermediate levels of vividness achieve the best outcomes in reducing these memories - a finding that fits with theoretical predictions.'
From distressing trauma to meaningful relief
The findings demonstrate that directly targeting the visual imagery component of intrusive memories powerfully lowers their frequency and intensity, and even provides meaningful relief from PTSD more broadly.
Now, the research team are seeking options to test the effectiveness of the treatment with larger, more diverse groups of people, as well as a non-guided version. In doing so, researchers hope to demonstrate how a promising, scalable, globally available, digital intervention could help contribute towards trauma treatment around the world.
The study 'A digital imagery-competing task intervention for stopping intrusive memories in trauma-exposed health-care staff during the COVID-19 pandemic in the UK: a Bayesian
adaptive randomised clinical trial' has been published in The Lancet Psychiatry .
