Can Tetris Cut Down Intrusive Memories Of A Trauma Film?

For unopen to inexplicable reason, you lot watched the torture gore horror cinema Hostel over the weekend. On Monday, you're having problem concentrating at work. Images of severed limbs together with bludgeoned heads maintain intruding on your attempts to code or write a paper. So you lot create upwards one's take away heed to read most the making of Hostel.You cease upwards seeing pictures of the most horrifying scenes from the movie. It's all way likewise way much to only milkshake off thence together with thence you lot create upwards one's take away heed to play Tetris.

But a funny affair happens. The unwelcome images start to locomote less frequent. By Friday, the gory mental snapshots are no longer forcing their way into your mind's eye. The ugly flashbacks are gone.

Meanwhile, your parnter inward offense is having similar images of optic gouging popular into his head. Except he didn't review the tortuous highlights on Monday, together with he didn't play Tetris. He continues to convey involuntary intrusions of Hostel images 1 time or twice a twenty-four hr catamenia for the residual of the week.

This is basically the premise (and outcome) of a novel newspaper inward Psychological Science yesteryear Ella James together with colleagues at Cambridge together with Oxford. It builds on before piece of work suggesting that salubrious participants who play Tetris presently after watching a “trauma” cinema volition convey fewer intrusive memories (Holmes et al, 2009, 2010). This is based on the thought that involuntary “flashbacks” inward existent post-traumatic stress disorder (PTSD) are visual inward nature, together with require visuospatial processing resources to generate together with maintain. Playing Tetris volition interfere alongside consolidation together with subsequent intrusion of the images, at to the lowest degree inward an experimental setting (Holmes et al, 2009):
...Trauma flashbacks are sensory-perceptual, visuospatial mental images. Visuospatial cognitive tasks selectively compete for resources required to generate mental images. Thus, a visuospatial computer game (e.g. "Tetris") volition interfere alongside flashbacks. Visuospatial tasks post-trauma, performed inside the fourth dimension window for retentiveness consolidation [6 hrs], volition reduce subsequent flashbacks. We predicted that playing "Tetris" one-half an hr after viewing trauma would reduce flashback frequency over 1-week.

The timing is primal here. In the before experiments, Tetris play commenced thirty minute after the trauma cinema experience, during the 6 hr window when memories for the trial are stabilized together with consolidated. Newly formed memories are thought to survive malleable during this time.

However, if 1 wants to extrapolate direct to clinical application inward cases of existent life trauma exposure (and this is problematic, equally we'll run into later), it's pretty impractical to play Tetris correct after an earthquake, auto accident, mortar attack, or sexual assault. So the novel newspaper relies on the physical care for of reconsolidation, when an deed of remembering volition house the retentiveness inward a labile soil 1 time again, thence it tin give the sack survive modified (James et al., 2015).

The physical care for was equally follows: 52 participants came into the lab on Day 0 together with completed questionnaires most depression, anxiety, together with previous trauma exposure. Then they watched a 12 minute trauma cinema that included eleven scenes of actual decease (or threatened death) or serious injury (James et al., 2015):
...the cinema functioned equally an experimental analogue of viewing a traumatic trial inward existent life. Scenes contained dissimilar types of context; examples include a immature daughter striking yesteryear a motorcar alongside blood dripping out of her ear, a human drowning inward the sea, together with a van hitting a teenage man child patch he was using his cellular telephone crossing the road. This cinema footage has been used inward previous studies to evoke intrusive memories...

After the film, they rated “how sad, hopeless, depressed, fearful, horrified, together with anxious they felt correct at this real moment” together with “how sad did you lot honour the cinema you lot exactly watched?” They were instructed to maintain a diary of intrusive images together with come upwards dorsum to the lab 24 hours later.

On Day 1, participants were randomized to either the experimental grouping (memory reactivation + Tetris) or the command grouping (neither manipulation). The experimental grouping viewed eleven soundless images from the cinema that served equally reminder cues to initiate reconsolidation. This was followed yesteryear a 10 minute filler chore together with and thence 12 minute of playing Tetris (the Marathon manner shown above). The game instructions aimed to maximize the amount of mental rotation the subjects would use. The controls did the filler chore together with and thence sat quietly for 12 min.

Both groups kept a diary of intrusions for the adjacent week, together with and thence returned on Day 7. All participants performed the Intrusion Provocation Task (IPT). Eleven blurred pictures from the cinema were shown, together with subjects indicated when whatever intrusive mental images were provoked. Finally, the participants completed a few to a greater extent than questionnaires, equally good equally a recognition chore that tested their verbal (T/F written statements) together with visual (Y/N for scenes) memories of the film.1

The results indicated that the Reactivation + Tetris manipulation was successful inward decreasing the number of visual retentiveness intrusions inward both the 7-day diary together with the IPT (as shown below).

modified from Fig. 1 (James et al., 2015). Asterisks signal a important departure betwixt groups (**p < .001). Error bars stand upwards for +1 SEM.

Cool picayune snowman plots (actually frequency scatter plots) illustrate the fourth dimension course of study of intrusive memories inward the 2 groups.

modified from Fig. 2 (James et al., 2015). Frequency scatter plots showing the fourth dimension course of study of intrusive memories reported inward the diary daily from Day 0 (prior to intervention) to Day 7. The intervention was on Day 1, together with the reddish arrow is 24 hrs after (when the intervention starts working). The enterprise lines are the results of a generalized additive model. The size of the bubbles represents the number of participants who reported the indicated number of intrusive memories on that especial day.

But now, you lot powerfulness survive holler for yourself if the critical chemical factor was Tetris or the reconsolidation update physical care for (or both), since the command grouping did neither. Not to worry. Experiment 2 tried to disentangle this yesteryear recruiting 4 groups of participants (n=18 inward each) the master 2 groups addition 2 novel ones: Reactivation exclusively together with Tetris only.

And the results from Exp. 2 demonstrated that both were needed.

modified from Fig. 4 (James et al., 2015). Asterisks signal that results for the Reactivation + Tetris grouping were significantly dissimilar from results for the other iii groups (*p < .01). Error bars stand upwards for +1 SEM. The No-Task Control together with Tetris Only groups did non differ for diary intrusions (n.s.).

The authors' interpretation:
Overall, the results of the acquaint experiments signal that the frequency of intrusive memories induced yesteryear experimental trauma tin give the sack survive reduced yesteryear disrupting reconsolidation via a competing cognitive-task procedure, fifty-fifty for established memories (here, events viewed 24 hours previously). ... Critically, neither playing Tetris lonely (a nonreactivation command condition) nor the command of retentiveness reactivation lonely was sufficient to cut back intrusions... Rather, their combination is required, which supports a reconsolidation-theory account. We advise that intrusive-memory reduction is due to engaging inward a visuospatial chore inside the window of retentiveness reconsolidation, which interferes alongside intrusive epitome reconsolidation (via contest for shared resources).

Surprisingly (perhaps), I don't convey anything negative to say most the study. It was carefully conducted together with interpreted alongside restraint. They don't overextrapolate to PTSD. They don't exercise the give-and-take “flashback” to depict the retentiveness phenomenon. And they repeatedly dot out that it's “experimental trauma.” I genuinely considered reviving The Neurocomplimenter for this post, but that would survive going likewise far...

Compare this flattering post alongside one I wrote inward 2010, most a related study yesteryear the same authors (Holmes et al.. 2010). That newspaper sure as shooting had a pocket-sized title: Key Steps inward Developing a Cognitive Vaccine against Traumatic Flashbacks: Visuospatial Tetris versus Verbal Pub Quiz.

Cognitive vaccine. Traumatic. Flashbacks. Twelve mentions of PTSD. This led to ridiculous headlines similar Tetris Helps Prevent Unpleasant Memories of Gory Film inward Happy People

My work wasn't alongside the actual study, but alongside the way the authors hyped the results together with exaggerated their clinical significance. So I'm pleased to run into a to a greater extent than restrained approach here.

The media coverage for the novel newspaper was to a greater extent than oft than non to a greater extent than accurate too:

Can playing Tetris cut back intrusive memories? (Medical News Today)

Moving tiles equally an unintrusive way to handgrip flashbacks (Medical Express)

Intrusiveness of Old Emotional Memories Can Be Reduced yesteryear Computer Game Play Procedure (APS)

But nosotros tin give the sack e'er count on the Daily Mail for a skilful time: Could playing TETRIS banish bad memories? Retro Nintendo game 'reduces the run a endangerment of post-traumatic stress disorder' 2

Gizmodo is a flake hyperbolic equally well: Tetris Blocks Flashbacks of Traumatic Events Lodged inward the Brain [“lodged inward the brain” for all of 24 hrs]

Questions for Now together with the Future

Is in that place genuinely naught incorrect alongside this study?? Being , I e'er convey to honour something to criticize... together with hither I had to dig through the Supplemental Material to honour issues that may touching on the translational potential of Tetris-based interventions.

  • The Intrusion subscale of the Impact of Event Scale (IES-R) was used equally an exploratory measure, together with dependent land ratings were betwixt 0 together with 1.
The Intrusion subscale consists of 8 questions similar “I found myself acting or feeling similar I was dorsum at that time” together with “I had dreams most it” that are rated from 0 (not at all) to 4 (extremely). The IES-R is given to people after distressing, traumatic life events. These individuals may convey actual PTSD symptoms similar flashbacks together with nightmares.

In Exp. 1, the Reactivation + Tetris grouping (M = .68) had significantly lower scores (p = .016) on Day seven than the command grouping (M = 1.01). BUT this is non terribly meaningful, due to a flooring effect. And inward Exp. 2 in that place was no departure betwixt the 4 groups, alongside scores ranging from 0.61 to 0.81.3

As an overall comment, watching a cinema of a daughter getting striking yesteryear a motorcar is non the same equally witnessing it inward soul (obviously). But this real-life scenario may survive the most amenable to Tetris, because the witness was non inward the accident themselves together with did non know the daughter (both of which would enhance the emotional intensity together with vividness of the trauma, elements that plow over visual imagery).

It's truthful that inward PTSD, the involuntary intrusion of trauma memories (i.e., flashbacks) convey a distinctly sensory lineament to them (Ehlers et al. 2004). Visual images are most common, but bodily sensations, sounds, together with smells tin give the sack survive incorporated into a multimodal flashback. Or could occur on their own.

  • The effectiveness of the Tetris intervention was related to game grade together with self-rated chore difficulty.
This way that people who were ameliorate at playing Tetris showed a greater decrease inward intrusive memories. This outcome wasn't covered inward the chief paper, but it makes you lot wonder most crusade together with effect. Is it because the game was to a greater extent than enjoyable for them? Or could it survive that their superior visual-spatial abilities (or greater game experience) resulted inward greater interference, possibly yesteryear using upwards to a greater extent than processing resources? That's e'er a dicey argument, equally you lot could also predict that better, to a greater extent than efficient game play uses fewer visual-spatial resources.

An interesting recent newspaper found that individuals alongside PTSD (who presumably experience intrusive visual memories) convey worse allocentric spatial processing abilities than controls (Smith et al., 2015). This way they convey problems representing the locations of environmental features relative to each other (instead of relative to the self). So are weak spatial processing together with spatial retentiveness abilities caused yesteryear the trauma, or are weak spatial abilities a vulnerability factor for developing PTSD?

  • As noted yesteryear the authors, the modality-specificity of the intervention needs to survive assessed.
Their previous newspaper showed that the outcome was indeed specific to Tetris. Influenza A virus subtype H5N1 verbally based video game (Pub Quiz) actually increased the frequency of intrusive images (Holmes et al., 2010).

It would survive interesting to disentangle the interfering elements of Tetris fifty-fifty further. Would whatever one-time mental rotation chore practise the trick? How most passive viewing of Tetris blocks, or is active game play necessary? Would a visuospatial n-back working retentiveness chore work? It wouldn't survive equally fun, but it evidently uses upwards visual working retentiveness processing resources. What most Asteroids or Pac-Man or...? 4

This trunk of piece of work raises a number of interesting questions most the nature of intrusive visual memories, traumatic together with non-traumatic alike. Do avid players of activity video games (or Tetris) convey fewer intrusive memories of yesteryear trauma or trauma-analogues inward everyday life? I'm non sure this is likely, but you lot could honour out pretty speedily on Amazon Mechanical Turk or 1 of its alternatives.

There are also many hurdles to surmount before Doctors Prescribe 'Tetris Therapy'. For instance, what does it hateful to convey the number of weekly Hostel intrusions driblet from v to two? How would that scale to an actual trauma flashback, which may involve a fearfulness or panic response?

The authors conclude the newspaper yesteryear briefly addressing these points:
Influenza A virus subtype H5N1 critical adjacent footstep is to  investigate  whether  findings  extend  to  reducing  the psychological impact of real-world emotional events together with media. Conversely, could reckoner gaming survive affecting intrusions of everyday events?

Influenza A virus subtype H5N1 number of dissimilar enquiry avenues await these investigators (and other interested parties). And — hold off for it — a clinical trial of Tetris for flashback reduction has already been completed yesteryear the investigators at Oxford together with Cambridge!

A Simple Cognitive Task to Reduce the Build-Up of Flashbacks After a Road Traffic Accident (SCARTA)

Holmes together with colleagues took the consolidation window real seriously: participants played Tetris inward the emergency room inside half-dozen hours of experiencing or witnessing an accident. I'll survive real curious to run into how this turns out...


1 Interestingly, voluntary retrieval of visual together with verbal memories was non affected yesteryear the manipulation, highlighting the uniqueness of flashback-like phenomena.

2 It does no such thing. But they did embed a video of doc Tom Stafford explaining why Tetris is thence compelling...

3 The maximum total grade on the IES-R is 32. The hateful total grade inward a grouping of car accident survivors was 17; inward Croatian state of war veterans it was 25. At start I assumed the authors reported the total grade out of 32, rather than the hateful grade per item. I could survive real wrong, however. By way of comparison, the hateful item grade inward female survivors of intimate partner violence was 2.26. Either way, the impact of the trauma cinema was pretty depression inward this study, equally you lot powerfulness expect.

4 OK, straight off I'm getting ridiculous. I'm also leaving aside modern first-person shooter games equally potentially likewise traumatic together with triggering.


Ehlers A, Hackmann A, Michael T. (2004). Intrusive re-experiencing inward post-traumaticstress disorder: phenomenology, theory, together with therapy. Memory 12(4):403-15.

Holmes EA, James EL, Coode-Bate T, Deeprose C. (2009). Can playing the reckoner game "Tetris" cut back the build-up of flashbacks for trauma? Influenza A virus subtype H5N1 proposal from cognitive science. PLoS One 4(1):e4153.

Holmes, E., James, E., Kilford, E., & Deeprose, C. (2010). Key Steps inward Developing a Cognitive Vaccine against Traumatic Flashbacks: Visuospatial Tetris versus Verbal Pub Quiz. PLoS ONE, 5 (11) DOI: 10.1371/journal.pone.0013706

James, E., Bonsall, M., Hoppitt, L., Tunbridge, E., Geddes, J., Milton, A., & Holmes, E. (2015). Computer Game Play Reduces Intrusive Memories of Experimental Trauma via Reconsolidation-Update Mechanisms. Psychological Science DOI: 10.1177/0956797615583071

Smith KV, Burgess N, Brewin CR, King JA. (2015). Impaired allocentric spatialprocessing inward posttraumatic stress disorder. Neurobiol Learn Mem. 119:69-76.


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