A randomized trial found that a brief behavioral intervention drastically lowered intrusive memory frequency and reduced PTSD-related symptoms in healthcare workers exposed to trauma during the COVID-19 pandemic, offering a scalable solution for trauma care.

Study: A guided single session intervention to reduce intrusive memories of work-related trauma: a randomised controlled trial with healthcare workers in the COVID-19 pandemic. Image Credit: Mikhaylovskiy / Shutterstock.com

In a recent study published in BMC Medicine, researchers examine whether a simple cognitive intervention can reduce the effects and frequency of intrusive memories in healthcare workers exposed to traumatic experiences during the coronavirus disease 2019 (COVID-19) pandemic.

Supporting the mental wellbeing of healthcare workers

Healthcare workers are often exposed to trauma in the workplace, as they witness patients with severe injuries, as well as those who are dying or dead. During the COVID-19 pandemic, healthcare workers throughout the world experienced high levels of anxiety, depression, and work-related stress. Thus, it is crucial to identify different approaches that can effectively reduce these symptoms to improve the well-being of workers, patients, and the healthcare system.

Experts often recommend psychological interventions before turning to pharmacological management of these symptoms. These approaches can include eye movement desensitization and reprocessing (EMDR), which involves moving one’s eyes in a specific way while processing traumatic experiences, as well as trauma-focused cognitive behavioral therapy (CBT).

Although post-traumatic stress disorder (PTSD) is associated with over 630,000 combinations of symptoms, approaches to its treatment can focus on one key symptom. Intrusive memories, which are widely experienced by people with PTSD, are mental images that evoke strong emotional reactions and can appear in people’s minds without them intentionally recalling them. Intrusive memories can induce distress, disrupt concentration, and reduce the affected individual’s ability to function.

Imagery-competing task interventions (ICTIs), which involve asking participants to complete short cognitive tasks, may prevent intrusive memories by targeting visual aspects of the trauma-associated memory causing the intrusion. For example, ICTIs can take the form of visuospatial computer games, where participants visualize the rotation of blocks to arrange them in certain ways.

About the study

In the current study, healthcare workers from Sweden participated in a remote and digitally delivered intervention involving a game or control activity to listen to a philosophy podcast. The researchers hypothesized that participants who played the game would report experiencing fewer intrusive memories up to five weeks after the intervention, better functioning, and lower distress.

To participate in the study, healthcare workers were at least 18 years old and experienced one or more traumatic events while working in healthcare settings during the COVID-19 pandemic. Study participants were randomly assigned to intervention or control groups, and they were told that they would be exposed to a cognitive task intervention, so they did not know whether their task was the intervention or the control.

Study participants in the intervention group were asked to briefly describe what they saw in their intrusive memory before they played a well-known computer game. The game involved mentally rotating game pieces while playing to visualize how the blocks could be arranged to form complete lines. Individuals in the control group were asked to listen to a podcast and answer comprehension quizzes carefully.

Study findings

The final sample included 144 participants, 73 and 71 of whom were assigned to the intervention and control groups, respectively. Of these, 130 participants completed the study, 64 and 66 of whom were in the intervention and control groups, respectively.

The average age of the study participants was 41 years, 81.9% of whom were female. About 71% of the study cohort was employed full-time and 58.3% were nurses.

The study participants reported experiencing a mean of 17 traumatic events related to work during the pandemic, with 72.2% of study participants experiencing traumatic events in the past one to three months. These individuals also reported an average of 9.18 non-work-related traumatic events during the pandemic.

At baseline, a mean score of 12.1 was reported for the post-traumatic stress symptoms among the study participants. Both study groups reported experiencing a similar number of intrusive memories over a one-week period.

After one week, the intervention and control groups reported experiencing 4.5 and 11 intrusive memories, respectively. Five weeks after the intervention, this gap widened further, with participants in the control group reporting a median of five intrusive memories each week as compared to those in the intervention group reporting one intrusive memory.

Intervention group members also reported fewer post-traumatic stress symptoms and lower distress levels up to six months after the intervention. These individuals were also less likely to experience burnout six months after the intervention than those in the control group.

Conclusions

The study intervention has the potential to reduce distress among healthcare workers who experienced traumatic events in the workplace during the pandemic. Notably, the study participants were not asked to discuss their trauma in detail and only provided a brief reminder of the experience in a few words.

Importantly, the study participants were recruited based on their own reported experiences, and clinical interviews were not conducted. Future studies from other countries and occupations are needed to strengthen these findings and confirm the efficacy of this promising intervention.