title: Key steps in developing a cognitive vaccine against traumatic flashbacks: visuospatial Tetris versus verbal Pub Quiz.
abstract: BACKGROUND
  Flashbacks (intrusive memories of a traumatic event) are the hallmark feature of Post Traumatic Stress Disorder, however preventative interventions are lacking. Tetris may offer a 'cognitive vaccine' [1] against flashback development after trauma exposure. We previously reported that playing the computer game Tetris soon after viewing traumatic material reduced flashbacks compared to no-task [1]. However, two criticisms need to be addressed for clinical translation: (1) Would all games have this effect via distraction/enjoyment, or might some games even be harmful? (2) Would effects be found if administered several hours post-trauma? Accordingly, we tested Tetris versus an alternative computer game--Pub Quiz--which we hypothesized not to be helpful (Experiments 1 and 2), and extended the intervention interval to 4 hours (Experiment 2).
  
  
  RESULTS
  The trauma film paradigm was used as an experimental analog for flashback development in healthy volunteers. In both experiments, participants viewed traumatic film footage of death and injury before completing one of the following: (1) no-task control condition (2) Tetris or (3) Pub Quiz. Flashbacks were monitored for 1 week. Experiment 1: 30 min after the traumatic film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz led to a significant increase in flashbacks. Experiment 2: 4 hours post-film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz did not.
  
  
  CONCLUSIONS
  First, computer games can have differential effects post-trauma, as predicted by a cognitive science formulation of trauma memory. In both Experiments, playing Tetris post-trauma film reduced flashbacks. Pub Quiz did not have this effect, even increasing flashbacks in Experiment 1. Thus not all computer games are beneficial or merely distracting post-trauma - some may be harmful. Second, the beneficial effects of Tetris are retained at 4 hours post-trauma. Clinically, this delivers a feasible time-window to administer a post-trauma "cognitive vaccine".
authors.affiliation: Department of Psychiatry, University of Oxford, Oxford, United Kingdom. emily.holmes@psych.ox.ac.uk
authors.forename: Emily A
authors.initials: EA
authors.lastname: Holmes
authors.forename: Ella L
authors.initials: EL
authors.lastname: James
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Kilford
authors.forename: Catherine
authors.initials: C
authors.lastname: Deeprose
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D019336:Cognitive Science / Q000379:methods*; D003201:Computers; D005260:Female; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009040:Motion Pictures; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D055815:Young Adult