Tetris: An unexpected tool against intrusive trauma memories

After a traumatic event, people can re-experience the trauma in the form of intrusive memories, which can be described as upsetting memories of the event that unexpectedly and repetitively interrupt daily life — commonly called flashbacks. Moreover, victims of trauma can be unaware that what they are experiencing is a memory and instead, feel as if they are re-living the event.

These memories are a clinical feature of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). The American Psychological Association defines ASD as “a disabling psychological condition that can occur immediately after exposure to a traumatic stressor.” If the symptoms last longer than a month, the diagnosis turns into PTSD.

Both disorders cause significant distress in people and impair daily functioning, and addressing flashbacks is a crucial part of reducing those consequences. This is where Tetris comes in.

“There are still very few evidence-based preventative treatments for people who have been exposed to a traumatic event,” Dr. Laura Singh from the Emotional Mental Imagery Lab at Uppsala University told TRT World.

That means there is still need for preventive measures against PTSD, “as most treatments are tailored to patients who have already been diagnosed,” she added.

But how would such a simple puzzle game help with such a complex disorder? And why, in the first place, would researchers think about giving Tetris a chance?

Memory consolidation

The formation of a permanent memory, called memory consolidation, is a malleable process.

After an event is witnessed, it is theorised that the mind works to solidify that experience, turning it into a long-term memory. That, however, takes time. And that time window makes the memory susceptible to intervention.

So, if an interruption takes place that competes with details of the traumatic memory — in this case, visual aspects — then the brain would need to assign its limited cognitive resources to that task instead of working on consolidating the memory.

Moreover, psychologists further theorised that conscious recall of a memory would lead to the memory becoming activated and therefore temporarily unstable, making it susceptible once again. Thus, an interference after recall would again weaken the memory before it is again stored in the brain.

A game like Tetris that requires mental energy to work out visual and spatial relationships would therefore be able to interrupt the memory consolidation process and mitigate intrusive trauma memories.

Reducing flashbacks

Seventy-one individuals who had just been in a motor vehicle accident were brought to the emergency department of John Radcliffe Hospital in Oxford, UK. Within six hours of the accident, half of them were given a rather bizarre task: Briefly visualise and describe the worst moments of the accident, then play Tetris for ten minutes.

The process took place twice, and saw the individuals play Tetris for a total of 20 minutes, as part of a study conducted by researchers from the Karolinska Institutet and Oxford University, among other institutions.

The purpose of asking people to recall the accident was to reactivate the memory in the mind, thus making it susceptible to the intervention, namely Tetris. The patients were then asked to record how many intrusive memories they experienced in the week following the accident.

One week later, the researchers found that patients who played Tetris after the trauma recall reported experiencing fewer intrusive memories than those who did not. To be more precise, playing Tetris reduced the number of flashbacks by 62 percent.

Alleviating long-standing trauma memories

In two other studies, researchers were able to significantly decrease intrusive memories of patients who were exposed to traumatic film footage during the week following the trauma-inducing experience.

The participants were also asked to recall the traumatic experience and were then instructed to play Tetris. But the noteworthy part of those studies is that the recall-intervention process was initiated after 24 hours in one study, and after four days in the other.

The game can even decrease the flashbacks of people with long-standing trauma, as shown in a study conducted in Germany involving 20 psychiatric inpatients suffering from complex PTSD who had experienced a traumatic event five weeks prior to the intervention.

Researchers targeted specific flashbacks one by one, applying the recall-intervention process each time. That was, of course, in addition to the therapies the individuals underwent at the psychiatric facility.

The results demonstrated that, after the intervention, patients reported a 64 percent decrease in flashbacks that had been targeted, as opposed to a minimal 11 percent reduction of flashbacks that had not been targeted.

By increasing the time window between trauma and intervention, these studies indicated that it is possible to intervene in more solidified memories as well.

They also reiterated that Tetris intervention only worked if the memory was recalled, or activated, shortly before playing the game — meaning that the combination is necessary to see effects.

How long do the effects last?

Researchers from Uppsala University replicated the initial study in a Swedish hospital emergency department and applied the same process of recall and intervention on 41 patients who had been submitted to the ED within 72 hours.

But this time, they looked at the number of intrusions at both week one and week five following the intervention at the hospital.

They found that compared to people who did not receive an intervention, those who did reported 48 percent fewer intrusive memories at week one, and 90 percent fewer at week five, the one-month mark for the onset of PTSD.

With this study, the researchers “could show first hints that the effects may last until a month after the traumatic event,” Dr. Singh, co-author of the article, explained.

It’s not yet established how long the effects can last, but Singh and colleagues are currently conducting further research into the topic. “Once those results are finalised, we can make more confident claims about longer-term effects of this intervention,” Singh says.

Preventive post-trauma intervention

While Tetris intervention is not yet part of clinical practice and further research is necessary, it has emerged as an easy, early and noninvasive strategy that could help prevent the onset of PTSD.

And it is not just Tetris. Researchers have hypothesised that any other game or task with high visuospatial demands, such as Candy Crush, could have the same effect.

While it is important to note that this type of intervention only targets flashbacks and is not a replacement for therapy, it carries crucial potential for several reasons.

Tetris entails a low-intensity intervention. Following the study at the Oxford emergency department, patients reported that, overall, it was very easy, very helpful and minimally distressing. And no adverse effects of the intervention were observed or reported.

The study quoted a participant as saying: “It certainly took my mind off of it [the accident] at a time when I probably would have sat brooding and feeling very sorry for myself … when you're running the whole thing through your mind and you're on your own at a vulnerable time after the ambulance crew have left you.”

Another participant said Tetris helped them focus and brought some “normality” back to their mind.

Dr. Singh also noted that “it requires few resources (i.e. can be done on a smartphone), it may require little guidance from a researcher/clinician and has the potential for peer-/self-administration in the future.”

That makes the intervention “more widely accessible also in parts of the world where access to traditional mental health treatments is limited but trauma is common.”