A mental health treatment that includes Tetris?

The global prevalence of trauma

 According to the World Health Organization, psychological trauma – exposure to severe injury, death, or sexual violence – affects seven out of 10 of people at least once in their lifetime. Severe trauma can lead to PTSD, experienced by millions of people globally, and often presents as sudden, unwanted intrusive memories accompanied by very distressing emotions.

Existing therapies for PTSD are effective yet remain widely inaccessible. They tend to be resource-intensive requiring multiple sessions with specialists, are widely unavailable, and are not recommended for those facing ongoing trauma.

Healthcare workers are regularly exposed to traumatic events, with limited treatment options often owing to a lack of availability. In the UK, PTSD prevalence among NHS staff increased from 13% before Covid-19 to 25% at the height of the pandemic. Health systems are under increased strain from untreated traumatic stress reactions among health professionals, with poor mental health resulting in people unable to work or leaving the healthcare profession.

Mental rotation and the mind’s eye

 The study focused on treating intrusive, vivid and unwanted memories of trauma, a hallmark symptom of PTSD. A research team, combining decades of mental health and trauma research experience, expertise from a world-leading intensive care research unit, and the latest mathematical approaches, undertook a randomised controlled trial to test the effectiveness of a brief digital intervention in healthcare workers during the Covid-19 pandemic.

The treatment – called the ‘Imagery Competing Task Intervention’ (ICTI) and detailed below – has been developed and refined over many years of lab research. One component of this is the video game Tetris^?, which involves players rotating differently shaped, geometric blocks as they descend to neatly fit them together into a grid.

• In the first step, participants briefly recall the memory, without needing to describe it or go into detail.
• Next, they are taught how to use mental rotation, a cognitive skill using the mind’s eye.
• ICTI then requires participants to use this skill to play Tetris^?, but in a particular slower way, not typical of normal gameplay.
• The ICTI method overall is thought to occupy the brain’s visuospatial areas, therefore competing with the visual flashback, weakening its vividness and emotional impact, and critically, the frequency that it intrudes.

To actively compare against ICTI, one control group of the trial listened to music by Mozart, reputed for therapeutic benefits to alleviate stress, and informational podcasts about him. In a second control group, participants received only standard care.

The results showed that participants receiving the ICTI had 10 times fewer intrusive memories than either control group four weeks after starting the intervention. Encouragingly, ICTI was also highly effective in the long-term. After six months, 70% of participants receiving the treatment reported no intrusive memories at all – a dramatic reduction compared to the control groups.

Participants using ICTI saw vastly improved results in terms of PTSD symptoms, demonstrating a ‘domino effect’ of the intervention to reduce these more generally. This demonstrates highly promising potential.

Tayla McCloud, Research Lead for Digital Mental Health at Wellcome, said:

These results are impressive for such a simple to use intervention. If we can get similarly strong results in bigger trials, this could have an enormous impact. It’s rare to see something so accessible, scalable and adaptable across contexts. It doesn’t require patients to put their trauma into words and even transcends language barriers. This study is a key example of why Wellcome is investing in a wide range of mental health interventions, so that in the future everyone will have access to treatments that work for them.