Development and testing of TraumaGameplay: an iterative experimental approach using the trauma film paradigm

Abstract

Background: Vivid trauma-related intrusions are a hallmark symptom of posttraumatic stress disorder (PTSD), and may be involved in its onset. Effective interventions to reduce intrusions and to potentially prevent the onset of subsequent PTSD are scarce. Studies suggest that playing the videogame Tetris, shortly after watching aversive film clips, reduces subsequent intrusions. Other studies have shown that taxing working memory (WM) while retrieving an emotional memory reduces the memory’s vividness and emotionality. Objective: We developed TraumaGameplay (TGP), a gaming app designed to reduce intrusions. This paper describes two successive experiments to determine whether playing TGP without memory retrieval (regular TGP) or TGP with memory retrieval (dual-task TGP) reduces intrusion frequency at one week compared to a no-game control. Method: For both experiments, healthy university students were recruited. Experiment 1: 92 participants were exposed to a trauma film and randomized to (1) regular TGP1 (n = 31), (2) dual-task TGP1 (n = 31) or (3) control (n = 30). In experiment 2, 120 healthy students were exposed to a trauma film and randomized to (1) regular TGP2 (n = 30), (2) dual-task TGP2 (n = 29), (3) recall only (n = 31) or (4) control (n = 30). Results: We found no significant difference between conditions on the number of intrusions for either playing regular TGP or dual-task TGP in both experiment 1 and experiment 2. Conclusion: Our results could not replicate earlier promising findings from preceding experimental research. Several reasons may underpin this difference ranging from the visuospatial videogame used in our experiments to the method of the experiment to the difficulties of replicability in general.

Arresting visuospatial stimulation is insufficient to disrupt analogue traumatic intrusions

“…Moreover, a widely held view is that high levels of working memory engagement constitute the principal cognitive mechanism by which dual tasks reduce the build-up of intrusive memories (e.g., [8,14,19]). Indeed, this might explain why beneficial effects have been documented for very different types of cognitive tasks, including the video game Tetris, pattern tapping, or N-back tasks (e.g., [14,16,19]), although not all findings in the literature are consistent with this interpretation (e.g., [29,30]). As we discuss in the following, the present findings demonstrate that these assumptions lack one or more boundary conditions that need to be satisfied in order to effectively reduce intrusive memories.…”

“…Some recent studies with different visuospatial tasks appear to point in a similar direction. For instance, Asselbergs et al [29] used two different visuospatial games involving spatial planning and decision making (i.e., controlling an airplane in a 2D capture-and-avoid game; a spatial sorting game) shortly after exposing participants to traumatic films and failed to find any beneficial effects on intrusive memories. Similarly, van Schie et al [30] had participants perform eye movements or a counting task whilst remembering the hotspot of a traumatic film.…”

“…eye movements and counting). More problematic for the working memory account, both aforementioned series of studies [29,30] established that their interventions effectively taxed WM resources, demonstrating robust interference effects in a simple dual reaction time task. Van Schie et al also quantified the degree of dual task interference for each participant but failed to observe a correlation with a reduced intrusion vividness or emotionality, similar to our finding in Study 2 that recognition memory of the complex stimuli was unrelated to intrusive memories.…”

“…In addition, some studies have failed to replicate effects of visuospatial tasks on intrusions, or to link WM taxation to intrusion number and quality. For instance, Asselbergs et al [29] found no experimental effects for two novel visuospatial gaming apps that required spatial planning and decision making. As a potential explanation, both of these apps may have required fewer visuospatial resources than tasks that have been shown to reduce intrusions such as Tetris.…”

A decennial review of psychotraumatology: what did we learn and where are we going?

“…Researchers have begun to demonstrate the feasibility and acceptability of delivering established treatments online (Simon et al, 2019;Wild et al, 2016) and via Skype (Ashwick, Turgoose, & Murphy, 2019). Several studies are also underway to explore the possible efficacy of new technologies such as internetbased virtual reality (Freedman, Dayan, Kimelman, Weissman, & Eitan, 2015), digital reappraisal training (Beer, Neerincx, Morina, & Brinkman, 2017) and novel game-based interventions (Asselbergs et al, 2018) as early interventions.…”