Study finds Tetris-based therapy can ease post-traumatic stress disorder symptoms

In a new study, researchers found that a single guided treatment session involving the video game Tetris could reduce symptoms of post-traumatic stress disorder in healthcare workers who faced trauma during the COVID-19 pandemic. This brief, guided session led to lasting positive effects, reducing the frequency of distressing intrusive memories for up to six months. The findings suggest that an accessible, game-based approach could offer support for people affected by trauma.

The study, conducted by researchers at Uppsala University and published in BMC Medicine, emerged from the heightened need for mental health support among healthcare workers during the COVID-19 pandemic. Frontline healthcare providers often witness severe injuries, illness, and death, which can lead to post-traumatic stress disorder, a condition marked by persistent and unwanted memories of traumatic events.

Traditional treatments for post-traumatic stress disorder involve multiple therapy sessions with a mental health professional, which can be challenging to access. Additionally, many healthcare professionals avoid seeking treatment due to stigma, time constraints, and the need for quick, practical interventions. The researchers sought to explore whether a shorter, more widely available approach could offer relief, especially in the challenging context of a global pandemic.

“Many people all over the world will experience a traumatic event in their lifetime. I’m interested in developing a relatively simple treatment that can help more people globally,” said study author Emily A. Holmes, a professor at Uppsala University and head of the PERCEPT – Mental Imagery and Mental Health lab.

“To do this we use mental health science. In this research, I am interested in exploring the concept of trauma memory – understanding its importance and why people often process experiences through mental images instead of words. I’m particularly fascinated by how we can reduce the number of times people repeatedly re-experience traumatic events in vivid images after trauma. These intrusive memories are sometimes called flashbacks.”

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To investigate this possibility, the research team recruited 164 healthcare workers from Sweden who were actively working during the pandemic. Participants reported experiencing trauma related to their work and suffered from at least two intrusive memories of traumatic events per week. The study used a randomized controlled trial design, with participants divided into two groups. One group received the “imagery-competing task intervention” involving the video game Tetris, while the other group was given a placebo-like task that consisted of listening to a podcast on philosophy, intended to control for attention and device use.

The Tetris-based intervention used a specific sequence: participants were first briefly reminded of a distressing memory, taught to use mental rotation, and then engaged in a 20-minute Tetris session using mental rotation on their smartphones. The researchers theorized that the visual and spatial elements of Tetris might disrupt the formation of unwanted traumatic memories. By occupying the brain’s imagery-processing capacities, Tetris could effectively compete with the mental replay of traumatic images, making the memories less vivid or frequent.

“The study was conducted entirely remotely,” Holmes explained. “The participants completed the tasks on a smartphone or computer, and a facilitator was present by phone or video call during the one guided treatment session. The treatment took approximately 35 minutes to complete. During that time, participants were informed about what intrusive memories are. They had to describe their memories in just a few words, but not describe their trauma in detail.”

“After that, they were briefly informed about what the concept of mental rotation means and entails and played Tetris for 20 minutes using mental rotation. The control group listened to a radio program for 20 minutes. It was a blinded study, which means that participants did not know whether they were in the treatment group or the control group.”

“The intervention is not just playing Tetris!” Holmes noted. “It’s a 30-minute process that is comprised of three components.”

After the initial guided session, participants monitored their intrusive memories over the next five weeks, and the researchers continued tracking symptoms up to six months post-intervention.

The results showed a clear difference between the two groups. Healthcare workers who played Tetris experienced a significant decrease in the number of intrusive memories, both in the short term and at the six-month follow-up. They also reported less severe symptoms of post-traumatic stress overall, including reduced distress and better emotional functioning. In contrast, the group that listened to the podcast showed less reduction in symptoms and a more gradual improvement over time.

“It was surprising to me and the team that the treatment method was so effective and that the improvement in symptoms lasted for six months,” Holmes told PsyPost. “I realize that it may seem unlikely that such a short intervention, which includes video games but doesn’t include an in-depth discussion of trauma with a therapist, could help. But the study provides scientifically controlled evidence that a single guided digital treatment session can reduce the number of intrusive memories, and that it can be used safely by participants.”

However, the study does have some limitations. First, participants were aware that they were part of an experimental treatment, which may have influenced their expectations and self-reported outcomes. Also, the study did not use clinical diagnostic tools to identify cases of post-traumatic stress disorder, so the findings apply to intrusive memories rather than the disorder as a whole. Additionally, because all participants were healthcare workers, it remains unclear whether this intervention would be as effective for individuals in other high-stress occupations or trauma-exposed populations, such as military personnel or emergency responders.

Future research could expand this approach to diverse groups and evaluate the long-term effectiveness of Tetris and similar visuospatial tasks for managing intrusive memories. Researchers also hope to explore different formats, potentially creating a streamlined digital platform that houses the intervention and tracks symptoms to enhance user experience and scalability.

“My vision is that one day we will be able to provide a tool for people such as healthcare professionals after traumatic events to help prevent and treat early PTSD symptoms, that is a ‘cognitive vaccine,’ in a similar way that we currently vaccinate against some infectious physical diseases,” Holmes explained.

The study, “A guided single session intervention to reduce intrusive memories of work-related trauma: a randomised controlled trial with healthcare workers in the COVID-19 pandemic,” was authored by Marie Kanstrup, Laura Singh, Elisabeth Johanna Leehr, Katarina E. Göransson, Sara Ahmed Pihlgren, Lalitha Iyadurai, Oili Dahl, Ann-Charlotte Falk, Veronica Lindström, Nermin Hadziosmanovic, Katja Gabrysch, Michelle L. Moulds, and Emily A. Holmes.