Reducing intrusive memories of childhood trauma using a visuospatial intervention : Case study in iceland

Funding Information: EAH received funding from the Oak Foundation (OCAY-18-442) and from the Swedish Research Council (2020-00873) in support of this study; EAH also received funding from AFA Insurance (200342) and the Lupina Foundation. AB received funding from the Icelandic Research Fund (11709-0270). UV received funding to establish the stress and gene analysis (SAGA) cohort from the European Research Council (StressGene, grant 726413) and the Icelandic Research Fund (grant 163362-051). EBT reports funding from the Icelandic Research Fund (185287-051). LS received funding from the Swiss National Science Foundation (P2BEP1_184378) and a Thunberg Fellowship from the Swedish Collegium for Advanced Study. EAH reports serving on the board of the charity MQ: Transforming Mental Health (UK). She also receives book royalties from Oxford University Press (Imagery and Cognitive Therapy) and Guilford Press (Imagery-Based Cognitive Therapy for Bipolar Disorder and Mood Instability) and occasional fees from clinical workshops and conference keynotes. Publisher Copyright: © 2021 JMIR Publications Inc..Background: Additional interventions are needed for survivors of psychological trauma because of several barriers to and limitations of existing treatment options (eg, need to talk about the trauma in detail). Case studies are an important step in exploring the development of novel interventions, allowing detailed examination of individual responses to treatment over time. Here, we present a case study that aims to test a novel intervention designed to disrupt memory reconsolidation, taking a single-symptom approach by focusing on intrusive memories of a traumatic event. Objective: This study aims to examine a novel brief cognitive intervention to reduce the number of intrusive memories of trauma in an Icelandic setting and to extend previous studies by examining long-term effects for up to 3 months. The intervention was guided by a clinical psychologist and comprised a brief memory reminder, followed by Tetris gameplay with mental rotation, targeting one memory at a time in each session. Methods: This was a single case study in Iceland with a woman in her 50s (drawn from an epidemiological study of trauma) with subthreshold posttraumatic stress disorder and a diagnosis of obsessive-compulsive disorder and social anxiety disorder. The participant had four different intrusive memories from a traumatic event that happened in her childhood. The primary outcome was the change in the number of intrusive memories from baseline to intervention phase and to follow-ups. The number of intrusions was monitored in a daily diary for 4 weeks preintervention, 8 weeks during the intervention, and 1 week at 1-month and 3-month follow-ups. Intrusions were targeted one by one over six intervention sessions, creating four repetitions of an AB design (ie, length of baseline A and intervention phase B varied for each memory). We examined changes in both the total number of intrusions (summed across all four memories) and individually for each memory. In addition, we explored whether having fewer intrusive memories would have an impact on functioning, posttraumatic stress, and depression or anxiety symptoms. Results: The total number of intrusions per week was 12.6 at baseline, 6.1 at the intervention phase (52% reduction from baseline), 3.0 at the 1-month follow-up (76% reduction), and 1.0 at the 3-month follow-up (92% reduction). Reductions in the symptoms of posttraumatic stress and depression were observed postintervention. Sleep, concentration, stress, and functioning improved. The participant considered the gameplay intervention acceptable and helpful in that she found that the memories disappeared while she was playing. Conclusions: This guided brief cognitive intervention reduced the number of intrusive memories over the intervention phase and follow-ups. The brief memory reminder was well tolerated, removing the need to discuss trauma in detail. The next steps require an extension to more cases and exploring remote delivery of the intervention.Peer reviewe