Tetris Therapy Eases Trauma for Healthcare Workers

Using 'mental rotation,' the treatment was also very effective at reducing the symptoms of post-traumatic stress disorder (PTSD) more generally.

The study, funded by Wellcome, offers potential to implement a highly scalable, low intensity, easily accessible, digital treatment that could transform how we prevent and treat PTSD for people worldwide who have been exposed to trauma.

The findings, published in The Lancet Psychiatry, are the result of a randomised controlled trial of 99 healthcare workers exposed to trauma at work during the Covid-19 pandemic.

Study co-author Charlotte Summers, Director of the Victor Phillip Dahdaleh Heart & Lung Research Institute and Professor of Intensive Care Medicine at the University of Cambridge, said: "Every day, healthcare workers across the world are recurrently exposed to traumatic events in the course of their work, impacting the mental and physical wellbeing of those who care for us when we are unwell.

"At a time when global healthcare systems remain under intense pressure, the discovery of a scalable digital intervention that promotes the wellbeing of health professionals experiencing work-related traumatic events is an exciting step forward."

Mental rotation and the mind's eye

The study focused on treating intrusive, vivid and unwanted memories of trauma, a hallmark symptom of PTSD. The treatment - called the 'Imagery Competing Task Intervention' (ICTI) - has been developed at Uppsala University in collaboration with P1vital, and trialled with collaborators including the University of Cambridge and the University of Oxford.

One component of this is the video game Tetris, which involves players rotating differently shaped, geometric blocks as they descend to neatly fit them together into a grid.

In the first step, participants briefly recall the traumatic memory, without needing to describe it or go into detail. Next, they are taught how to use mental rotation, a cognitive skill using the mind's eye. ICTI then requires participants to use this skill to play Tetris, but in a slower way, not typical of normal gameplay.

The ICTI method overall is thought to occupy the brain's visuospatial areas, therefore competing with the visual flashback, weakening its vividness and emotional impact, and critically, the frequency that it intrudes.

To actively compare against ICTI, 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.

The results showed that participants receiving the ICTI had 10 times fewer intrusive memories than either control group four weeks after starting the intervention. Encouragingly, ICTI was also highly effective in the long-term. After six months, 70% of participants receiving the treatment reported no intrusive memories at all - a dramatic reduction compared to the control groups.

Participants using ICTI saw vastly improved results in terms of PTSD symptoms, demonstrating a 'domino effect' of the intervention to reduce these more generally. This demonstrates highly promising potential.

Study lead Emily Holmes, Professor of Psychology at Uppsala University - who obtained her PhD at Cambridge in 2005 and was previously a Programme Leader at the MRC Cognition and Brain Sciences Unit - said: "Even a single, fleeting intrusive memory of past trauma can exert a powerful impact in daily life by hijacking attention and leaving people at the mercy of unwanted and intrusive emotions. By weakening the intrusive aspect of these sensory memories via this brief visual intervention, people experience fewer trauma images flashing back.

"[Our] intervention focuses on our mental imagery, not words, and is designed to be as gentle, brief and practical as possible to fit into people's busy lives. We hope to expand our research so it can be put into practise by determining its effectiveness for a broader range of people and scenarios."

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.

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.

Tayla McCloud, Research Lead for Digital Mental Health at Wellcome, said: "These results are impressive for such a simple to use intervention. If we can get similarly strong results in bigger trials, this could have an enormous impact. It's rare to see something so accessible, scalable and adaptable across contexts. It doesn't require patients to put their trauma into words and even transcends language barriers."

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.

Professor Summers is Director of Studies in Clinical Medicine at Selwyn College, Cambridge.

Reference

Beckenstrom, AC et al. 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. Lancet Psychiatry; 19 Feb 2025; DOI: 10.1016/S2215-0366(25)00397-9

Adapted from a press release by Wellcome