Tetris and Word games lead to fewer intrusive memories when applied several days after analogue trauma

Muriel A Hagenaars, Emily A Holmes, Fayette Klaassen, Bernet Elzinga, Muriel A Hagenaars, Emily A Holmes, Fayette Klaassen, Bernet Elzinga

Abstract

Background: Intrusive trauma memories are a key symptom of posttraumatic stress disorder (PTSD), so disrupting their recurrence is highly important. Intrusion development was hindered by visuospatial interventions administered up to 24 hours after analogue trauma. It is unknown whether interventions can be applied later, and whether modality or working-memory load are crucial factors. Objectives: This study tested: (1) whether a visuospatial task would lead to fewer intrusions compared to a reactivation-only group when applied after memory reactivation four days after analogue trauma exposure (extended replication), (2) whether both tasks (i.e. one aimed to be visuospatial, one more verbal) would lead to fewer intrusions than the reactivation-only group (intervention effect), and (3) whether supposed task modality (visuospatial or verbal) is a critical component (modality effect). Method: Fifty-four participants were randomly assigned to reactivation+Tetris (visuospatial), reactivation+Word games (verbal), or reactivation-only (no task). They watched an aversive film (day 0) and recorded intrusive memories of the film in diary A. On day 4, memory was reactivated, after which participants played Tetris, Word games, or had no task for 10 minutes. They then kept a second diary (B). Informative hypotheses were evaluated using Bayes factors. Results: Reactivation+Tetris and reactivation+Word games resulted in relatively fewer intrusions from the last day of diary A to the first day of diary B than reactivation-only (objective 1 and 2). Thus, both tasks were effective even when applied days after analogue trauma. Reactivation-only was not effective. Reactivation+Word games appeared to result in fewer intrusions than reactivation+Tetris (objective 3; modality effect), but this evidence was weak. Explorative analyses showed that Word games were more difficult than Tetris. Conclusions: Applying a task four days after the trauma film (during memory reconsolidation) was effective. The modality versus working-memory load issue is inconclusive.

Keywords: PTSD; Trauma film; intrusions; intrusive memory; involuntary memory; mental imagery; posttraumatic stress disorder; reconsolidation; working memory; • A trauma film paradigm was used to examine effects of a supposedly visuospatial (Tetris) and a more verbal task (Word games) versus no task (reactivation-only) on intrusion frequency in a reconsolidation time frame.; • Participants rated Word games as more difficult than Tetris, but there was no difference in intrusion frequencies during the performance of both tasks. • Tetris and Word games lead to fewer intrusive memories when applied several days after analogue trauma.; • Reactivation+Tetris and reactivation+Word games lead to relatively fewer intrusions than reactivation-only, even when applied four days after analogue trauma.; • Two hypotheses were supported: (a) There is an intervention effect with both task conditions being equally effective (reactivation+Tetris = reactivation+Word games

Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Intrusive memories of the film from before to after the intervention (diary A day 5 to diary B day 1).

References

    1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
    1. Arntz A. (2012). Imagery rescripting as a therapeutic technique: Review of clinical trials, basic studies, and research agenda. Journal of Experimental Psychopathology, 3, 189–14. doi:10.5127/jep.024211
    1. Baddeley A. (2000). Working memory: Looking back and looking forward. Narute Neuroscience Reviews, 4(829–839). doi:10.1038/nrn1201
    1. Baddeley A. D. (1998). Human memory: Theory and practice. Needham Heights, MA: Allyn & Bacon.
    1. Baddeley A. D. (2012). Working memory: Theories, models and controversies. Annual Review of Psychology, 63, 1–29. doi:10.1146/annurev-psych-120710-100422
    1. Bourne C., Frasquilho F., Roth A. D., & Holmes E. A. (2010). Is it mere distraction? Peri-traumatic verbal tasks can increase analogue flashbacks but reduce voluntary memory performance. Journal of Behavior Therapy and Experimental Psychiatry, 41(3), 316–324. doi:10.1016/j.jbtep.2010.03.001
    1. Brewin C. R. (2001). A cognitive neuroscience account of posttraumatic stress disorder and its treatment. Behaviour Research and Therapy, 39, 373–393. doi:10.1016/S0005-7967(00)00087-5
    1. Brewin C. R. (2014). Episodic memory, perceptual memory, and their interaction: Foundations for a theory of posttraumatic stress disorder. Psychological Bulletin, 140, 69–97. doi:10.1037/a0033722
    1. Brewin C. R. (2015). Re-experiencing traumatic events in PTSD: New avenues in research on intrusive memories and flashbacks. European Journal of Psychotraumatology, 6, 27180. doi:10.3402/ejpt.v6.27180
    1. Brewin C. R., & Burgess N. (2014). Contextualisation in the revised dual representation theory of PTSD: A response to Pearson and colleagues. Journal of Behavior Therapy and Experimental Psychiatry, 45, 217–219. doi:10.1016/j.jbtep.2013.07.011
    1. Brewin C. R., Dalgleish T., & Joseph S. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review, 103, 670–686. doi:10.1037/0033-295X.103.4.670
    1. Clark I. A., Mackay C. E., & Holmes E. A. (2015). Low emotional response to traumatic footage is associated with an absence of analogue flashbacks: An individual participant data meta-analysis of 16 trauma film paradigm experiments. Cognition and Emotion, 29(4), 702–713. doi:10.1080/02699931.2014.926861
    1. Creamer M., O’Donnell M. L., & Pattison P. (2004). The relationship between acute stress disorder and posttraumatic stress disorder in severely injured trauma survivors. Behaviour Research and Therapy, 42, 315–328. doi:10.1016/S0005-7967(03)00141-4
    1. Debiec J., LeDoux J. E., & Nader K. (2002). Cellular and systems reconsolidation in the hippocampus. Neuron, 36, 527–538.
    1. Deeprose C., Zhang S., Dejong H., Dalgleish T., & Holmes E. A. (2012). Imagery in the aftermath of viewing a traumatic film: Using cognitive tasks to modulate the development of involuntary memory. Journal of Behavior Therapy and Experimental Psychiatry, 43, 758–764. doi:10.1016/j.jbtep.2011.10.008
    1. Derogatis L. R. (1992). The symptom checklist-90-revised. Minneapolis, MN: NCS Assessments.
    1. DeVietti T. L., Conger G. L., & Kirkpatrick B. R. (1977). Comparison of the enhancement gradients of retention obtained with stimulation of the mesencephalic reticular formation after training or memory reactivation. Physiology & Behavior, 19, 549–554. doi:10.1016/0031-9384(77)90232-3
    1. Dibbets P., & Arntz A. (2016). Imagery rescripting: Is incorporation of the most aversive scenes necessary? Memory, 24, 683–695. doi:10.1080/09658211.2015.1043307
    1. Dudai Y. (2004). The neurobiology of consolidations, or, how stable is the engram? Annual Review of Psychology, 55, 51–86. doi:10.1146/annurev.psych.55.090902.142050
    1. Ehlers A, & Clark D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research And Therapy, 38, 319–345. doi: 10.1016/S0005-7967(99)00123-0
    1. Engelhard I. M., Leer A., Lange E., & Olatunji B. O. (2014). Shaking that icky feeling: Effects of extinction and counterconditioning on disgust-related evaluative learning. Behavior Therapy, 45, 708–719. doi:10.1016/j.beth.2014.04.003
    1. Engelhard I. M., van den Hout M. A., & Smeets M. A. M. (2011). Taxing working memory reduces vividness and emotional intensity of images about the Queen’s Day tragedy. Journal of Behavior Therapy and Experimental Psychiatry, 42, 32–37. doi:10.1016/j.jtep.2010.09.004
    1. Foa E. B., Steketee G., & Rothbaum B. O. (1989). Behavioral/cognitive conceptualizations of post-traumatic stress disorder. Behavior Therapy, 20, 155–176. doi:10.1016/S0005-7894(89)80067-X
    1. Gunter R. W., & Bodner G. E. (2008). How eye movements affect unpleasant memories: Support for a working-memory account. Behaviour Research and Therapy, 46, 913–931. doi:10.1016/j.brat.2008.04.006
    1. Hagenaars M. A. (2012). Anxiety symptoms influence the effect of post-trauma interventions after analogue trauma. Journal of Experimental Psychopathology, 3, 209–222.
    1. Hagenaars M. A., & Arntz A. (2012). Reduced intrusion development after post-trauma imagery rescripting; an experimental study.. Journal of Behavior Therapy and Experimental Psychiatry, 43, 808–814. doi:10.1016/j.jbtep.2011.09.005
    1. Hagenaars M. A., Brewin C. R., Van Minnen A., Holmes E. A., & Hoogduin C. A. L. (2010). Intrusive images and thoughts after an aversive film. Memory, 18, 76–84. doi:10.1080/09658210903476522
    1. Hagenaars M. A., Oitzl M., & Roelofs K. (2014). Updating freeze: Aligning animal and human research. Neuroscience & Biobehavioral Reviews, 47, 165–176. doi:10.1016/j.neubiorev.2014.07.021
    1. Hagenaars M. A., Van Minnen A., Holmes E. A., Brewin C. R., & Hoogduin C. A. L. (2008). The effect of hypnotically induced somatoform dissociation on the development of intrusions after an aversive film. Cognition & Emotion, 22, 944–963. doi:10.1080/02699930701575151
    1. Holmes E. A., & Bourne C. (2008). Inducing and modulating intrusive emotional memories: A review of the trauma film paradigm. Acta Psychologica, 127, 553–566. doi:10.1016/j.actpsy.2007.11.002
    1. Holmes E. A., James E. L., Coode-Bate T., & Deeprose C. (2009). Can playing the computer game “Tetris” reduce the build-up of flashbacks for trauma? A proposal from cognitive science. Plosone, 4, e4153. doi:10.1371/journal.pone.0004153
    1. Holmes E. A., James E. L., Kilford E. J., & Deeprose C. (2010). Key steps in developing a cognitive vaccine against traumatic flashbacks: Visuospatial Tetris versus verbal Pub Quiz. Plosone, 5, e13706. doi:10.1371/journal.pone.0013706
    1. Holmes E. A, Brewin C.R, & Hennessy R. G (2004). Trauma films, information processing, and intrusive memory development. Journal Of Experimental Psychology: General, 133, 3–22. doi: 10.1037/0096-3445.133.1.3
    1. Horne C.A, Rodriguez W.A, Wright T.P, & Padilla J.L (1997). Time-dependent effects of fructose on the modulation of a reactivated memory. Progress In neuro-psychopharmacology And Biological Psychiatry, 21, 649–658. doi: 10.1016/S0278-5846(97)00038-9
    1. James E. L., Bonsall M. B., Hoppitt L., Tunbridge E. M., Geddes J. R., Milton A. L., & Holmes E. A. (2015). Computer game play reduces intrusive memories of experimental trauma via reconsolidation-update mechanisms. Psychological Science, 26, 1201–1215. doi:10.1177/0956797615583071
    1. James E. L., Lau-Zhu A., Clark I. A., Visser R. M., Hagenaars M. A., & Holmes E. A. (2016). The trauma film paradigm as an experimental psychopathology model of psychological trauma: Intrusive memories and beyond. Clinical Psychology Review, 47, 106–142. doi:10.1016/j.cpr.2016.04.010
    1. Kass R. E., & Raftery A. E. (1995). Bayes Factors. Journal of the American Statistical Association, 90, 773–795. doi:10.1080/01621459.1995.10476572
    1. Kemps E., & Tiggemann M. (2007). Reducing the vividness and emotional impact of distressing autobiographical memories: The importance of modality specific interference. Memory, 15, 412–422. doi:10.1080/09658210701262017
    1. Kindt M., Soeter M., & Vervliet B. (2009). Beyond extinction: Erasing human fear responses and preventing the return of fear. Nature Neuroscience, 12, 256–258. doi:10.1038/nn.2271
    1. Konijn E. A., Van de Schoot R., Winter S. D., & Ferguson C. J. (2015). Possible Solution to Publication Bias Through Bayesian statistics, including proper null hypothesis testing. Communication Methods and Measures, 9, 280–302. doi:10.1080/19312458.2015.1096332
    1. Krans J., Näring G., & Becker E. S. (2009). Count out your intrusions: Effects of verbal encoding on intrusive memories. Memory, 17, 809–815. doi:10.1080/09658210903130780
    1. Lang P. J., Bradley M. M., & Cuthbert B. N. (1997). Motivated attention: Affect, activation and action In Lang P. J., Simons R. F., & Balaban M. T. (Eds.), Attention and orienting: Sensory and motivational processes (pp. 97–135). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
    1. Mulder J., Hoijtink H., & de Leeuw C. (2012). BIEMS: A Fortran 90 program for calculating Bayes factors for inequality and equality constrained models. Journal of Statistical Software, 46, 1–39.
    1. Nader K. (2003). Memory traces unbound. Trends in Neurosciences, 26, 65–72. doi:10.1016/S0166-2236(02)00042-5
    1. Nader K., & Hardt O. (2009). A single standard for memory: The case for reconsolidation. Nature Reviews Neuroscience, 10, 224–234. doi:10.1038/nrn2590
    1. Nader K, Schafe G.E, & LeDoux J.E (2000). Fear memories require protein synthesis in the amygdala for reconsolidation after retrieval. Nature, 406, 722–726. doi: 10.1038/35021052
    1. O’Donnell M. L., Elliott P., Lau W., & Creamer M. (2007). PTSD symptom trajectories: From early to chronic response. Behaviour Research and Therapy, 45, 601–606. doi:10.1016/j.brat.2006.03.015
    1. Olatunji B. O., & Fan Q. (2015). Anxiety sensitivity and post-traumatic stress reactions: Evidence forintrusions and physiological arousal as mediating and moderatingmechanisms. Journal of Anxiety Disorders, 34, 76–85. doi:10.1016/j.janxdis.2015.06.002
    1. Pearson D., & Sawyer T. (2011). Effects of dual task interference on memory intrusions for affective images. International Journal of Cognitive Therapy, 4, 122–133. doi:10.1521/ijct.2011.4.2.122
    1. Perkonigg A., Kessler R. C., Storz S., & Wittchen H. U. (2000). Traumatic events and post-traumatic stress disorder in the community: Prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica, 101, 46–59. doi:10.1034/j.1600-0447.2000.101001046.x
    1. Pile V., Barnhofer T., & Wild J. (2015). Updating versus exposure to prevent consolidation of conditioned fear. PlosONE, 10, e0122971. doi:10.1371/journal.pone.0122971
    1. Roberts N. P., Kitchiner N. J., Kenardy J., & Bisson J. I. (2010). Early psychological interventions to treat acute traumatic stress symptoms. Cochrane Database of Systematic Reviews, 17(3), CD007944. doi:10.1002/14651858.CD007944
    1. Rothbaum B. O., Kearns M. C., Price M., Malcoun E., Davis M., Ressler K. J., … Houry D. (2012). Early intervention may prevent the development of posttraumatic stress disorder: A randomized pilot civilian study with modified prolonged exposure. Biological Psychiatry, 72, 957–963. doi:10.1016/j.biopsych.2012.06.002
    1. Sara S. J. (2000). Retrieval and reconsolidation: Toward a neurobiology of remembering. Learning & Memory, 7, 73–84. doi:10.1101/lm.7.2.73
    1. Schiller D., Monfils M., Raio C., Johnson D. C., LeDoux J. E., & Phelps E. A. (2010). Preventing the return of fear in humans using reconsolidation update mechanisms. Nature, 463, 49–53. doi:10.1038/nature08637
    1. Sijbrandij M., Olff M., Reitsma J. B., Carlier I. V. E., De Vries M. H., & Gersons B. P. R. (2007). Treatment of acute posttraumatic stress disorder with brief cognitive behavioral therapy: A randomized controlled trial. American Journal of Psychiatry, 164, 82–90. doi:10.1176/ajp.2007.164.1.82
    1. Steil R. I. (1996). Posttraumatische intrusionennach verkehrsunfa¨ llen [posttraumatic intrusions after road traffic accidents]. Frankfurt, Germany: Peter Lang.
    1. Van den Hout M. A., & Engelhard I. M. (2012). How does EMDR work? Journal of Experimental Psychopathology, 3, 724–738. doi:10.5127/jep.028212
    1. Van den Hout M. A., Engelhard I. M., Rijkeboer M., Koekebakker J., Hornsveld H., Toffolo M., … Leer A. (2011). Bilateral beeps and eye movements in EMDR: Taxing of working memory and effects on negative recollections. Behaviour Research and Therapy, 49, 92–98. doi:10.1016/j.brat.2010.11.003
    1. Walker M. P., Brakefield T., Hobson J. A., & Stickgold R. (2003). Dissociable stages of human memory consolidation and reconsolidation. Nature, 425, 616–620. doi:10.1038/nature01930
    1. Wixted J. T. (2004). The psychology and neuroscience of forgetting. Annual Review of Psychology, 55, 235–269. doi:10.1146/annurev.psych.55.090902.141555
    1. Zbozinek T. D., Holmes E. A., & Craske M. G. (2015). The effect of positive mood induction on reducing reinstatement fear: Relevance for long term outcomes of exposure therapy. Behaviour Research and Therapy, 71, 65–76. doi:10.1016/j.brat.2015.05.016

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