Can Tetris help treat Post Traumatic Stress Disorder?

This is the last part (Part II) in the two-part series on PTSD and intrusive memories, discussing how a common and well-loved visuospatial game, Tetris, can reduce the presence of the core clinical symptom. Previous article: Boom, and you're back!

As discussed in an earlier article, psychological trauma resulting from threat to life or serious injury from events such as vehicle accidents or assault, among others, can result in development of post traumatic stress disorder (PTSD). The core clinical feature is intrusive memories, where memories of the event involuntarily intrude into a person’s consciousness after being triggered by environmental cues, resulting in extreme emotional distress.

Two of the most common and effective treatments for PTSD include trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) therapy. These approaches address an individual’s memory of the event alongside their emotional understanding of the experience. Unfortunately, there is a lack of qualified therapists and patients are often wary of delving into the event details. This results in many patients not receiving sufficient treatment.

Following an event, the memory must be consolidated into long-term memory for it to be

remembered at a later date. Memory consolidation theory states that the memory is flexible several hours following the event, meaning it can be interfered with. Engaging in a visuospatial task during this period may weaken the consolidation of the traumatic memory because the tasks compete with limited cognitive resources. Therefore, completing tasks with high visuospatial demands in the consolidation period may reduce the occurrence of intrusive memories.

Many studies have looked into this, using Tetris to disrupt the memory up to six hours post

exposure, and have found positive results. One study took this outside of the laboratory, recruiting patients in an emergency department following serious vehicle accidents. The intervention involved two steps, first patients were asked to remember the accident and state the most traumatising experience they observed. Following this they played Tetris for a minimum of 10 minutes, which competed with the visual memories they had just produced. It was found that 62% of those in the Tetris intervention group had a reduction in intrusive memories in the subsequent week, compared to those in the control group.

However, it is not always practical to play a video game in the direct aftermath of the event. The memory consolidation theory also states that memories become flexible to change when they are remembered and subsequently must be reconsolidated into long-term memory. Therefore, other studies have investigated using Tetris as an intervention for those already experiencing PTSD. In this case, combining Testis game play with EMDR therapy has been found useful. After completion of therapy, both control and Tetris groups were found to have a reduction in symptoms at 6-months. However, only the Tetris group had reductions in anxiety and depression.

Remember in the previous article we spoke about the neuroanatomy of PTSD and how that related to intrusive memories. Research has shown those with PTSD have reductions in hippocampus and ventromedial prefrontal cortex volume, with the reduced hippocampal volume correlating to symptom severity. In fact, studies investigating the use of Tetris have shown that playing this during psychological therapy increases the hippocampal volume, and this increase correlates to the reduced symptoms 6-months following treatment.

Currently, the interventions for PTSD have limitations surrounding the longevity of symptom improvements. Therefore, combining Tetris playing with psychotherapies may maintain the symptom improvements long term by increasing the hippocampal volume. Not only this, but videogames with high visuospatial demands like Tetris, may provide some utility as preventative interventions, which are currently lacking. Considering patients involved in vehicle accidents wait upto four hours in emergency departments in the UK, there is an opportunity to reach patients within the memory consolidation window. This approach is not only cost-effective and requires straightforward training for implementation but has been found acceptable in clinical populations. Notably, the earlier study found 48% of patients engaged in this approach, surpassing participation rates of 10% in a psychotherapy trial and 8% in a pharmacological trial within the same emergency department.

Overall, interfering with memory consolidation using Tetris could provide a good treatment option for intrusive memories in PTSD. So, where are we currently? Research is still being undertaken, with some even investigating the effects of other visuospatial games such as Candy Crush.

Written by Alice Jayne Greenan