Mental health tool, which includes Tetris, stops intrusive flashbacks

Most people are familiar with the popular computer game Tetris®, in which a player rotates differently shaped blocks to fit together. But few would consider it part of a mental health intervention for trauma.  

Emily Holmes and Charlotte Summers thought differently. The researchers are also both clinicians: Summers, an intensive care doctor, and Holmes, a clinical psychologist. They studied the effects of a treatment for intrusive memories that uses a 'mental rotation' intervention – which involves playing Tetris – on healthcare workers experiencing a key symptom of PTSD (post-traumatic stress disorder) following their work during the pandemic.

During the height of the Covid-19 pandemic, healthcare workers were repeatedly exposed to psychological trauma. Since then, healthcare professionals have reported a significant increase in PTSD symptoms. 

For many, these symptoms include intrusive memories, commonly known as flashbacks. During a flashback, images from the traumatic event repeatedly play in the ‘mind’s eye’.  

“These images are like a time capsule from a traumatic event," said Holmes. “Your brain is trying to protect you by reminding you of something it thinks is a sign of danger. But even a single, fleeting intrusive memory of past trauma can exert a powerful and disruptive impact on your daily life.” 

Flashbacks can worsen or develop into PTSD and can be distressing and debilitating in and of themselves.  

Irene, who was an intensive care nurse during Covid-19, experienced intrusive memories before taking part in the study: “I was having these flashbacks all the time – 10 times a day often. It was like a fly buzzing around me all the time, while I was trying to go about my day. And the worst part is it’s not just a memory like watching a film, it pulls you back there. So it gives you all the stress and anxiety of that moment.”   

A research team led by Holmes set out to tackle this in a surprising and simple way. It involves briefly picturing the recurring memory, then using a 20-minute game of Tetris to practice 'mental rotation': picturing each Tetris block clearly and imagining how it will look in different orientations.

Intrusive memories are caused by images or memories being ‘misfiled’ in the brain. While having a visual flashback, parts of the brain involved in visual information are activated. Similar areas are activated while practising mental rotation while playing Tetris and during other visual tasks.  

Visualising the memory and then practising mental rotation creates something called task competition, which is when your brain tries to do two similar activities at once. This can create interference between the two images. This process enables the brain to change how the traumatic memory is stored; instead of being something that can be triggered and flash back at any time without warning, it becomes just like any other memory. 

Holmes and her team have spent years refining the intervention in the lab. 

“It’s far more than just playing Tetris. Using the right technique to bring the intrusive memory to mind, and correctly using mental rotation is essential for the intervention to work. The intervention is simple to use, but the process of developing it has been complicated,” explained Holmes. 

The team conducted a randomised controlled trial with 99 healthcare workers split into three groups:

• The first group used the mental rotation intervention the team had developed
• The second group received a placebo intervention where they listened to Mozart music and podcasts
• The third group had access to standard care

“One remarkable thing about this trial is that participants in the placebo arm of the study, who were listening to Mozart, were certain that that was the real intervention – that they were getting the active treatment. This suggested to Emily and I that our findings were not the result of a placebo effect,” said Summers.  

The results showed that participants in the mental rotation group had 10 times fewer intrusive memories than those in the control and Mozart groups four weeks after starting the intervention. Furthermore after six months of the trial 70% of people in the mental rotation group were completely free of intrusive memories. 

“These results are incredibly impressive for such a simple-to-use intervention,” said Tayla McCloud, Digital Mental Health Innovation Lead at Wellcome. “It’s rare to see something so accessible, scalable and adaptable across contexts. It doesn’t require patients to put their trauma into words, and even transcends language barriers.” 

“I had no idea it would work so quickly. At first, I thought I was doing something wrong – when I tried to visualise the memory so I could do the intervention, it wasn’t coming. It was so soon after I’d started the trial, it didn’t occur to me that it was the treatment working, until I told the study team,” said Irene. “Now, when I think about those memories, I can remember what happened, but all the stress and the sadness that used to come with them have gone.”