MedicalResearch.com interview with
Dr. Ella James, Post-Doctoral Investigator Scientist
Medical Research Council Cognition and Brain Sciences Unit
MedicalResearch: What is the background for this study?
Dr. James: Post-traumatic stress disorder (PTSD) is experienced by some people after a traumatic event. While many people who’ve been involved in traumatic events don’t experience PTSD, those who do typically have repeated visual intrusive memories of certain moments in vivid detail that pop back into mind, seemingly out of the blue. For example, with PTSD after a car crash might repeatedly ‘see’ the moment the other car crashed into them.
The recommended treatment for PTSD is cognitive behaviour therapy, a talking therapy that has been demonstrated to work well. But it is only delivered once intrusive memories have become established and PTSD is diagnosable – i.e. at least one month after the traumatic event occurred. At present, there is nothing readily available for use soon after trauma that has been shown to prevent symptoms building up and PTSD becoming established.
In previous laboratory work our research team showed that playing Tetris shortly after viewing events with traumatic content (e.g. film footage of road safety campaigns – what we call an experimental trauma) could reduce intrusive memories of those events in healthy volunteers over the following week [2, 3] when played in a 4-hour time window after viewing. We reasoned that this was because having to follow and track the shapes, colour and movement of the coloured blocks in Tetris soon after seeing the experimental trauma (the film) disrupted aspects of the visual memory of that event from being ‘laid down’ in the sensory part of the brain, whilst leaving memory for the narrative and meaning of the events unaffected.
However, it is hard to reach people so soon after a traumatic event in the real world and memories for events become ‘fixed’ in mind within hours after an event making them difficult to change. Therefore it was important to show whether we can change older, established memories of trauma.
MedicalResearch: What are the main findings?
Dr. James: To our knowledge, this work is the first to show that it is theoretically possible to disrupt involuntary intrusive memory for events that are ‘fixed’ in mind, in the current study a memory for an experimental trauma that is 1 day old. The study addressed memory ‘reconsolidation’ and used a simple cognitive blockade procedure (rather than drugs or a more complex task) involving 3 steps;
- 1) reactivation of the memory (volunteers viewed non-traumatic still images from the film watched 24 hours earlier,
- 2) a wait period of 10 minutes to allow for memory for the experimental trauma to ‘become malleable’, then
- 3) Tetris game play to interfere with the malleable memory, and reduce the occurrence of subsequent intrusive memories over the week.
We showed that merely playing ‘Tetris’ (without prior reactivation) did not reduce intrusions – by analogy, distraction by enjoyable computer games alone may not help. Further, just being exposed to reminders of the event (without Tetris play afterwards) did not reduce subsequent intrusion frequency – by analogy then, simply recalling/talking about a trauma in the absence of the cognitive task, may not help reduce intrusive memories. Rather, it is the critical combination of both reactivating the trauma memory followed by a short break and then playing ‘Tetris’ that is necessary to reduce the occurrence of later intrusive memories.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. James: The first key take-home message is that these findings relate to experimental research that is still in the early stages, so no immediate clinical implications can be drawn.
Our research uses an experimental trauma to study intrusive, visual images that pop back to mind involuntary as an analogue of intrusive memories that are the hallmark symptom of post-traumatic stress disorder (PTSD).
From a research perspective our findings indicate that it may be possible, under certain conditions, to render old memory for emotional events as less intrusive, even for memories have consolidated and are established in mind. Further research is needed to develop this approach as a potential intervention to reduce intrusive memories. Again, we are keen to emphasise that this research is still in the early stages, and careful steps need to be taken to translate findings from the laboratory to the clinic.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. James: Again, it is important to highlight that findings thus far are from laboratory-based experimental research. However, a future step is to investigate whether findings can be extended to real-world traumatic events, e.g. after traumatic events while people are waiting in Hospital Emergency Departments.
 James, E. L., Bonsall, M. B., Hoppitt, L., Tunbridge, E. M., Geddes, J. R., Milton, A. L., & Holmes, E. A. (2015). Computer game play reduces intrusive memories of experimental trauma via reconsolidation update mechanisms. Psychological Science, OnlineFirst. doi: 10.1177/0956797615583071
 Holmes, E.A., et al., Can playing the computer game “Tetris” reduce the build-up of flashbacks for trauma? A proposal from cognitive science. PLoS ONE, 2009. 4(1): p. e4153.
 Holmes, E. A., James, E. L., Kilford, E. J., & Deeprose, C. (2010). Key steps in developing a cognitive vaccine against traumatic flashbacks: visuospatial Tetris versus verbal Pub Quiz. PLoS ONE, 5(11), e13706. doi: 10.1371/journal.pone.0013706
Dr. Ella James, Post-Doctoral Investigator Scientist (2015). May Be Possible To Use Video Games To Block PTSD Intrusive Memories