Tackling Intrusive Traumatic Memories After Childbirth (ASTRAL)

tAckling intruSive Traumatic memoRies After chiLdbirth (ASTRAL): A Single-blind Waitlist Randomized Controlled Trial

This single-blind waitlist randomized controlled trial aims to investigate the efficacy of a single-session behavioral intervention composed of a brief evocation of the childbirth memory followed by a visuospatial task (the computer game "Tetris"), on childbirth-related intrusive traumatic memories (CB-ITM) and other childbirth-related posttraumatic stress disorder (CB-PTSD) symptoms. Women who report CB-ITM after 6 weeks postpartum can be included in the study. Participants will be randomly allocated to either the immediate treatment (IT) group or to the waitlist (WL) group.

Women in the IT group will first report their CB-ITM in a daily diary during 2 weeks (diary 1). On the 15th day, they will meet a psychologist to receive the single-session behavioral intervention. They will then complete a daily diary during the 2 weeks post-intervention (diary 2) and during the 5th and 6th weeks post-intervention (diary 3).

Women in the WL group will report their CB-ITM continuously during 4 weeks in diary 1 and 2 before receiving the same intervention on the 30th day. They will also complete a last diary during the 2 weeks post-intervention (diary 3).

It is expected that women in the immediate treatment group (IT group) will have fewer CB-ITM in diary 2, in comparison to the WL group, for which we expect no significant change in the number of CB-ITM between diary 1 and 2.

This study will contribute to the development of a single-session behavioral intervention to reduce CB-ITMs and other CB-PTSD symptoms, which would reduce the distress experienced by mothers and may improve the well-being of the whole family.

Study Overview

• Status: Completed
• Conditions: Posttraumatic Stress Disorder; Intrusive Traumatic Memories
• Intervention / Treatment: Behavioral: A single-session behavioral intervention composed of a brief evocation of the childbirth memory followed by a Tetris gameplay

• Study Type: Interventional
• Enrollment (Actual): 120
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Canton of Neuchâtel
    • Neuchâtel, Canton of Neuchâtel, Switzerland, 2000
      • Maxime Haubry
  • Canton of Vaud
    • Lausanne, Canton of Vaud, Switzerland, 1010
      • Antje Horsch

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Signed written consent
• Gave birth in one of the study centres
• Gave birth to a live baby
• Had at least 4 CB-ITM over the past two weeks
• Childbirth happened at least 6 weeks ago

Exclusion Criteria:

• Is not fluent enough in French to participate in the assessments
• Life-threatening illness of mother or infant
• Has an established intellectual disability or a psychotic illness
• Takes propranolol medication
• Alcohol and/or illicit drug abuse
• Is not able to distinguish ITM linked to other traumatic events from CB-ITM targeted during the intervention
• Has an ongoing psychological treatment in relation to her childbirth experience
• Is under 18 years old
• Being pregnant
• Perinatal loss of a child born during the index traumatic childbirth

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Immediate Treatment; Participants in the immediate treatment group will receive the single-session behavioral intervention on day 15.	Behavioral: A single-session behavioral intervention composed of a brief evocation of the childbirth memory followed by a Tetris gameplay; The intervention is composed of two tasks: The childbirth narration task (8-10 min.): To trigger the malleability of the traumatic childbirth memory through memory reactivation, a psychologist will ask the participants to briefly narrate their childbirth and the moment associated with their most frequent or distressing CB-ITM. This intervention part will take place on the maternity ward to use this context as a reactivation cue.; The visuospatial task (3 min. practice + 20 min. gameplay): Participants will be instructed to engage in a Tetris gameplay for 20 minutes on a handheld gaming device (Nintendo 3DS), which is assumed to disrupt memory reconsolidation. This part of the intervention will take place in a neutral room.
Other: Waitlist; Participants in the waitlist control group will receive the single-session behavioral intervention on day 30.	Behavioral: A single-session behavioral intervention composed of a brief evocation of the childbirth memory followed by a Tetris gameplay; The intervention is composed of two tasks: The childbirth narration task (8-10 min.): To trigger the malleability of the traumatic childbirth memory through memory reactivation, a psychologist will ask the participants to briefly narrate their childbirth and the moment associated with their most frequent or distressing CB-ITM. This intervention part will take place on the maternity ward to use this context as a reactivation cue.; The visuospatial task (3 min. practice + 20 min. gameplay): Participants will be instructed to engage in a Tetris gameplay for 20 minutes on a handheld gaming device (Nintendo 3DS), which is assumed to disrupt memory reconsolidation. This part of the intervention will take place in a neutral room.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The change in the number of maternal CB-ITM between the 2 weeks pre- and post-intervention	The number of intrusive traumatic memories related to childbirth reported by participants in a diary during the 2 weeks pre- and post-intervention	During the 2 weeks pre- and post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The intervention acceptability assessed by participants from 30 to 60 days after the intervention	Acceptability questionnaire specifically designed for the study	From 30 to 60 days after the intervention
The change in the severity of maternal CB-PTSD symptoms between the 2nd week pre- and post-intervention	City Birth Trauma Scale (CiBTS)	2nd weeks pre- and post-intervention
The change in the number of maternal CB-ITM between the 2 weeks pre-intervention, and the 5th and 6th weeks post-intervention	The number of intrusive traumatic memories related to childbirth reported by participants in a diary during the 2 weeks pre-intervention, and during the 5th and 6th weeks post-intervention	During the 2 weeks pre-intervention, and the 5th and 6th weeks post-intervention
The change in the severity of maternal CB-PTSD symptoms between the second week pre-intervention and the 6th week post-intervention	City Birth Trauma Scale (CiBTS)	2nd week pre- and 6th week post-intervention

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
CB-ITM sensorial modalities, distress, nowness, and content	Report of the sensorial modalities (visual, auditory, gustatory, olfactive, proprioceptive, tactile, and nociceptive) associated to the CB-ITM reported in the diary. Rating scale for psychological distress related to the CB-ITM that are reported in the diary on a scale ranging from 0 to 10 (0 = No distress at all while having the intrusion ; 10 = Extreme distress while having the intrusion). Rating scale of how much participants had the "impression that the memory was happening here and now" on a scale from 0 to 10 (0 = Not at all ; 10 = Extremely) while having the CB-ITM. Brief description of the content of the CB-ITM in the diary.	During 2-4 weeks pre-intervention, 2 weeks post-intervention, 5th and 6th weeks post-intervention
Participants' autonomic response and subjective distress during the intervention procedures	Autonomic response assessed via heart rate monitor during the intervention procedures. Rating scale for psychological distress assessed several times during the intervention using a Visual Analogue Scale of subjective distress going from 0 to 10 (0 = Not at all stressed and/or anxious ; 10 = Extremely stressed and/or anxious).	During the intervention procedures
The change in postnatal depression and anxiety symptoms between the 1st week pre-intervention and the 6th week post-intervention	Edinburgh Postnatal Depression Scale (EPDS) and Anxiety subscale of the Hospital Anxiety and Depression scale (HADS)	1st week pre- and 6th week post-intervention
The change in the number of maternal CB-ITM between the 2 weeks post-intervention, and the 5th and 6th weeks post-intervention	The number of intrusive traumatic memories related to childbirth reported by participants in a diary during the 2 weeks post-intervention, and during the 5th and 6th weeks post-intervention	During the 2 weeks post-intervention, and 5th and 6th weeks post-intervention
The change in the severity of maternal CB-PTSD symptoms between the 2nd week and 6th week post-intervention	City Birth Trauma Scale (CiBTS)	2nd and 6th weeks post-intervention

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire Vaudois
• Investigators: Principal Investigator: Antje Horsch, PhD, University of Lausanne and Lausanne University Hospital

Publications and helpful links

General Publications

• Horsch A, Vial Y, Favrod C, Harari MM, Blackwell SE, Watson P, Iyadurai L, Bonsall MB, Holmes EA. Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study. Behav Res Ther. 2017 Jul;94:36-47. doi: 10.1016/j.brat.2017.03.018. Epub 2017 Apr 6.
• Deforges C, Fort D, Stuijfzand S, Holmes EA, Horsch A. Reducing childbirth-related intrusive memories and PTSD symptoms via a single-session behavioural intervention including a visuospatial task: A proof-of-principle study. J Affect Disord. 2022 Apr 15;303:64-73. doi: 10.1016/j.jad.2022.01.108. Epub 2022 Jan 30.
• Fort D, Deforges C, Messerli-Burgy N, Michael T, Baud D, Lalor J, Rimmele U, Horsch A. Tackling childbirth-related intrusive memories with a single-session behavioural intervention involving a visuospatial task: protocol for a single-blind, waitlist-controlled randomised trial. BMJ Open. 2023 May 29;13(5):e073874. doi: 10.1136/bmjopen-2023-073874.

Study record dates

Study Major Dates

• Study Start (Actual): July 13, 2022
• Primary Completion (Actual): December 5, 2025
• Study Completion (Actual): January 20, 2026

Study Registration Dates

• First Submitted: May 13, 2022
• First Submitted That Met QC Criteria: May 18, 2022
• First Posted (Actual): May 19, 2022

Study Record Updates

• Last Update Posted (Actual): January 23, 2026
• Last Update Submitted That Met QC Criteria: January 22, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Randomized controlled trial; Posttraumatic Stress Disorder; Childbirth; Behavioral intervention; Visuospatial task
• Additional Relevant MeSH Terms: Trauma and Stressor Related Disorders; Mental Disorders; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
• Other Study ID Numbers: 2022-00652

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All IPD on which a publication is based will be shared in an anonymised form, at the time of the publication of the related outcomes, in an open access register.
• IPD Sharing Time Frame: The data will be available at the time of the publication of the related outcomes.
• IPD Sharing Access Criteria: Open access
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No