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Randomized Controlled Trial
, 5 (11), e13706

Key Steps in Developing a Cognitive Vaccine Against Traumatic Flashbacks: Visuospatial Tetris Versus Verbal Pub Quiz

Affiliations
Randomized Controlled Trial

Key Steps in Developing a Cognitive Vaccine Against Traumatic Flashbacks: Visuospatial Tetris Versus Verbal Pub Quiz

Emily A Holmes et al. PLoS One.

Erratum in

  • PLoS One. 2012;7(11). doi:10.1371/annotation/eba0a0c8-df20-496b-a184-29e30b8d74d0

Abstract

Background: Flashbacks (intrusive memories of a traumatic event) are the hallmark feature of Post Traumatic Stress Disorder, however preventative interventions are lacking. Tetris may offer a 'cognitive vaccine' [1] against flashback development after trauma exposure. We previously reported that playing the computer game Tetris soon after viewing traumatic material reduced flashbacks compared to no-task [1]. However, two criticisms need to be addressed for clinical translation: (1) Would all games have this effect via distraction/enjoyment, or might some games even be harmful? (2) Would effects be found if administered several hours post-trauma? Accordingly, we tested Tetris versus an alternative computer game--Pub Quiz--which we hypothesized not to be helpful (Experiments 1 and 2), and extended the intervention interval to 4 hours (Experiment 2).

Methodology/principal findings: The trauma film paradigm was used as an experimental analog for flashback development in healthy volunteers. In both experiments, participants viewed traumatic film footage of death and injury before completing one of the following: (1) no-task control condition (2) Tetris or (3) Pub Quiz. Flashbacks were monitored for 1 week. Experiment 1: 30 min after the traumatic film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz led to a significant increase in flashbacks. Experiment 2: 4 hours post-film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz did not.

Conclusions/significance: First, computer games can have differential effects post-trauma, as predicted by a cognitive science formulation of trauma memory. In both Experiments, playing Tetris post-trauma film reduced flashbacks. Pub Quiz did not have this effect, even increasing flashbacks in Experiment 1. Thus not all computer games are beneficial or merely distracting post-trauma - some may be harmful. Second, the beneficial effects of Tetris are retained at 4 hours post-trauma. Clinically, this delivers a feasible time-window to administer a post-trauma "cognitive vaccine".

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Experiment 1 study design overview.
Participants completed the trauma film paradigm, a well established experimental analog for PTSD. All participants viewed a traumatic film followed by a 30-min structured break. Participants were then allocated to one of three experimental conditions [Tetris vs. no-task control vs. Pub Quiz] which they completed for 10 min. Afterwards participants in the computer game conditions rated their enjoyment of the game. Flashbacks (involuntary memories) were monitored for 1 week using an intrusion diary. After 1 week, diary compliance was checked and a test of voluntary memory (recognition memory test) for the trauma film was administered.
Figure 2
Figure 2. Experiment 1 key outcome variable: flashback frequency in diary over 1-week for the three conditions (mean +/− sem).
Figure 3
Figure 3. Experiment 2 study design overview.
Participants completed the trauma film paradigm. All participants viewed a traumatic film followed by a 4-hr break where participants went about their daily business. Participants then returned to the laboratory and were allocated to one of three experimental conditions (as in experiment 1) which they completed for 10 min. Participants in the computer game conditions rated their enjoyment of the game. Flashbacks (involuntary memories) were monitored for 1 week using an intrusion diary. After 1 week, diary content and compliance was checked and a test of voluntary memory (recognition memory test) for the trauma film was administered.
Figure 4
Figure 4. Experiment 2 key outcome variable: flashback frequency in diary over 1-week for the three conditions (mean +/− sem).

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References

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