Clinical translation of a simple cognitive task to reduce the occurrence of intrusive memories after a psychological trauma

Thesis

Preventive interventions after psychological trauma are lacking. Intrusive memories in the first few weeks after a traumatic event can be highly distressing, and also predict later post-traumatic stress disorder (PTSD). Laboratory studies with healthy volunteers have found that engaging in a visuospatial cognitive task soon after an experimental trauma film can reduce the frequency of intrusive memories over the following week. The aims of this research were to a) develop the a simple cognitive task intervention (a memory reactivation cue followed by playing the computer game "Tetris") for use in a hospital emergency department (ED) with patients who had experienced a road traffic accident, and b) provide a preliminary test of the efficacy of the intervention using a randomised controlled trial design.

First, the current evidence base for preventive interventions after trauma was reviewed, and theory was drawn from experimental psychology and clinical psychology to propose that delivering a simple cognitive task involving playing Tetris in the immediate aftermath of trauma may offer a novel preventive intervention for PTSD symptoms (Chapter 1). Next, the laboratory procedure was adapted for use in a hospital ED, based on direct observation in the ED, and existing literature (Chapter 2).

An initial pilot study (n = 10) tested key procedures in the ED, namely recruitment of road traffic accident patients, practical delivery of the intervention and completion of an intrusion diary over the first week (Chapter 3). A second pilot study (n = 23) was conducted to improve the study procedures, test both the intervention and control conditions, and assess participant experience (Chapter 4). The recruitment rate, eligibility criteria, drop-out rate and completion rate of the intrusion diary were all improved. Participant feedback was used to refine the intervention and control procedures.

Finally, a main randomised controlled study (n = 71) was conducted, comparing the simple cognitive task intervention with usual care in the emergency department (with a simple activity diary). As predicted, participants in the intervention group had fewer intrusive memories in the first week, and less severe clinical intrusion symptom scores, than those in the control group. Further, participant feedback highlighted the value of being offered an intervention in the emergency department. This research was the first to successfully translate laboratory findings to a clinical emergency department setting. Findings provide a first step towards developing an accessible, low intensity preventive intervention to target intrusive memories after trauma. Further trials and mechanism studies are warranted.

Authors: Iyadurai, L

• DOI: 10.5287/ora-rdmgmmadr
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: Trauma; Cognitive intervention; Post-traumatic stress disorder; Behavioural intervention; Computerized treatment; Preventive intervention; Intrusive memories
• Subjects: Psychiatry; Post-traumatic stress disorder; Experimental psychopathology; Clinical psychology; Mental health