잠재의식 재활성화 후 침습적 기억에 대한 테트리스 중재

실험적: Unconscious Reactivation

Participants in this experimental arm will undergo subliminal (unconscious) reactivation of trauma-related memories. Trauma-related cues are presented below the threshold of conscious awareness. Following reactivation, participants complete a 10-minute music-listening task, after which they perform a computerized visuospatial interference task (Tetris) with mental rotation instructions.

행동: Subliminal Reactivation Followed by Visuospatial Interference

In each intervention session, participants are exposed subliminally to trauma-related cues. Participants then complete a 10-minute music-listening task during the post-reactivation interval, followed by a computerized visuospatial interference task (Tetris) with mental rotation instructions.

가짜 비교기: No Reactivation Control

Participants in this control arm will not undergo trauma memory reactivation. They will proceed directly to a computerized visuospatial task (Tetris) with mental rotation instructions. This condition serves as a comparator for evaluating the effects of the experimental intervention while controlling for the nonspecific effects associated with engagement in the visuospatial task.

행동: 컴퓨터 기반 시공간 과제(테트리스)

정신 회전 지침이 포함된 컴퓨터화된 시공간 과제(테트리스).

Number of trauma-related intrusive memories

Number of trauma-related intrusive memories assessed via a daily diary.

Number of trauma-related intrusive memories

Number of trauma-related intrusive memories assessed via a daily diary.

Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)

Change in PTSD symptom severity as measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). The CAPS-5 is a structured clinical interview assessing DSM-5 PTSD symptoms. Each of the 20 PTSD symptom items is rated on a severity scale from 0 to 4. The total symptom severity score is calculated by summing the severity ratings for the 20 PTSD symptom items, yielding a total score range from 0 to 80. Higher scores indicate greater PTSD symptom severity. PTSD diagnostic status is determined according to DSM-5 symptom cluster criteria and is not based solely on the total severity score.

Intrusive memory ratings

This 7-item questionnaire assesses a number of intrusive memory characteristics. These characteristics include: frequency (7-point categorical response from 'never' to 'many times a day'); distress (0=not at all to 10=extremely); disruption to concentration (0=not at all to 10=extremely); interference with what you were doing (how much (0=not at all to 10=extremely) and for how long (6-point categorical response from '<1min' to '>60mins')); impact on work functioning (0=not at all to 10=extremely); impact on functioning in other areas of life (0=not at all to 10=extremely).

Post-Intervention Questionnaire

A 2-item questionnaire assessed participants' immediate subjective experience after each intervention session: distress experienced during the procedure (0=not at all to 10=very); acceptability of the intervention task (0=not at all to 10=very).

PTSD Checklist for DSM-5 (PCL-5)

This 20-item measure assesses symptoms of PTSD over the last month. Each of the 20 items is rated on a 5-point Likert scale ranging from 0 (Not at all) to 4 (Extremely). The total score ranges from 0 to 80.

Impact of Event Scale-Revised (IES-R)

This 22-item self-report measure subjective distress caused by traumatic events during the past seven days. It assesses three domains of post-traumatic stress: intrusion, avoidance, and hyperarousal. Each of the 22 items is rated on a 5-point scale according to symptom severity: 0 (Not at all) to 4 (Extremely). The total score is calculated by summing the scores of all 22 items, yielding a total score range from 0 to 88.

Beck Depression Inventory-II (BDI-II)

The Beck Depression Inventory-II (BDI-II) is a 21-item self-report instrument used to assess the existence and severity of depressive symptoms, covering emotional (e.g., sadness, hopelessness), cognitive (e.g., self-reproach, worthlessness), somatic (e.g., fatigue, appetite loss), and behavioral (e.g., loss of interest, social withdrawal) dimensions. Each of the 21 items consists of four statements describing increasing levels of severity, rated on a 4-point scale ranging from 0 (not present) to 3 (severe). The total score is calculated by summing the scores of all 21 items, with a total score range from 0 to 63. Higher scores indicate more severe depressive symptoms.

State-Trait Anxiety Inventory-State version (STAI-S)

The State Anxiety subscale of the State-Trait Anxiety Inventory (STAI-Form Y-I, S-AI) comprises items 1 to 20 of the inventory. Half of the items describe negative emotions and the other half describe positive emotions. It is designed to evaluate immediate or recent situational experiences of fear, tension, worry, and nervousness, making it particularly useful for assessing state anxiety under stressful conditions. Each of the 20 items is rated on a 4-point scale: 1 (not at all), 2 (somewhat), 3 (moderately so), and 4 (very much so). The total score is calculated by summing the 20 items, yielding a total score range from 20 to 80. Higher scores reflect a greater severity of the subject's current state anxiety symptoms.

Work and Social Adjustment Scale (WSAS)

The WSAS is a 5-item self-report scale designed to measure the degree of functional impairment in day-to-day activities (work, home management, social leisure, private leisure, and close relationships). Each of the 5 items is rated on a 9-point scale ranging from 0 (Not at all impaired) to 8 (Very severely impaired). The total score is calculated by summing the scores of all 5 items, yielding a total score range from 0 to 40. Lower scores indicate better functioning, while higher scores indicate greater functional impairment. Clinical thresholds are: below 10 (subclinical), 10 to 20 (significant functional impairment), and above 20 (moderately severe or worse psychopathology).

외상 관련 침습적 기억의 수

단일 항목을 통해 평가된 외상 관련 침습적 기억의 수.

Changes to health

This 4-item questionnaire assesses the number of any new traumatic events, new treatments received and the occurrence of adverse events since the last assessment.

Feedback questionnaire

A 5-item questionnaire (0=not at all to 10=very) assessed participants' subjective experience of the intervention: ease of use; perceived helpfulness; willingness to use the intervention if intrusive memories recur in the future; willingness to recommend the intervention to others with similar intrusive memories; whether they perceived the task as related to their condition during the experiment.

Subliminal Perception Check

Administered only to the unconscious cue group; following each intervention, participants are asked whether they perceived any image via a single-item binary choice (Yes/No). If the response is "Yes," an open-ended verbal description is required.