Intrusive memories of traumatic events are a core feature of Post-Traumatic Stress Disorder (PTSD) and can cause substantial distress and functional impairment. Existing trauma-focused treatments are effective but often require deliberate recollection of traumatic experiences, which can be distressing for some individuals. Previous experimental studies in healthy participants found that masked reactivation of trauma-related cues, followed after a brief interval by a visuospatial interference task using Tetris gameplay, reduced the frequency and emotional intensity of intrusive memories. Building on these findings, the present randomized controlled trial evaluates the efficacy of this intervention in trauma-exposed individuals experiencing three or more intrusive memories per week.
This randomized controlled trial aims to evaluate an intervention for reducing intrusive memories in trauma-exposed individuals. Participants will be randomly assigned to either an intervention group or a control group. Before the intervention, participants assigned to the intervention group will provide images related to their traumatic experiences for use in the subsequent memory-reactivation procedure. The intervention group will undergo trauma-related memory reactivation, a music interval, and a visuospatial interference task, whereas the control group will complete only the visuospatial task. Intrusive memories and related symptoms will be assessed during follow-up.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
106
In each intervention session, participants are exposed subliminally to trauma-related cues. Participants then complete a 10-minute music-listening task during the post-reactivation interval, followed by a computerized visuospatial interference task (Tetris) with mental rotation instructions.
A computerized visuospatial task (Tetris) with mental rotation instructions.
School of Psychology, Shaanxi Normal University
Xi'an, Shaanxi, China
RECRUITINGNumber of trauma-related intrusive memories
Number of trauma-related intrusive memories assessed via a daily diary.
Time frame: Day 30 - 36(all arms) controlling for baseline week
Number of trauma-related intrusive memories
Number of trauma-related intrusive memories assessed via a daily diary.
Time frame: Day 12 - 18 (all arms) controlling for baseline week
Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
Change in PTSD symptom severity as measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). The CAPS-5 is a structured clinical interview assessing DSM-5 PTSD symptoms. Each of the 20 PTSD symptom items is rated on a severity scale from 0 to 4. The total symptom severity score is calculated by summing the severity ratings for the 20 PTSD symptom items, yielding a total score range from 0 to 80. Higher scores indicate greater PTSD symptom severity. PTSD diagnostic status is determined according to DSM-5 symptom cluster criteria and is not based solely on the total severity score.
Time frame: Baseline (day 0) and day 37 (all arms)
Intrusive memory ratings
This 7-item questionnaire assesses a number of intrusive memory characteristics. These characteristics include: frequency (7-point categorical response from 'never' to 'many times a day'); distress (0=not at all to 10=extremely); disruption to concentration (0=not at all to 10=extremely); interference with what you were doing (how much (0=not at all to 10=extremely) and for how long (6-point categorical response from '\<1min' to '\>60mins')); impact on work functioning (0=not at all to 10=extremely); impact on functioning in other areas of life (0=not at all to 10=extremely).
Time frame: Baseline(day 0), Day 18, day 36, 2 months after the last intervention(all arms)
Post-Intervention Questionnaire
A 2-item questionnaire assessed participants' immediate subjective experience after each intervention session: distress experienced during the procedure (0=not at all to 10=very); acceptability of the intervention task (0=not at all to 10=very).
Time frame: Day1, 2, 10, 11, 19, 20, 28, 29 (all arms)
PTSD Checklist for DSM-5 (PCL-5)
This 20-item measure assesses symptoms of PTSD over the last month. Each of the 20 items is rated on a 5-point Likert scale ranging from 0 (Not at all) to 4 (Extremely). The total score ranges from 0 to 80.
Time frame: Baseline(day 0), day19, day37, 2 months after the last intervention(all arms)
Impact of Event Scale-Revised (IES-R)
This 22-item self-report measure subjective distress caused by traumatic events during the past seven days. It assesses three domains of post-traumatic stress: intrusion, avoidance, and hyperarousal. Each of the 22 items is rated on a 5-point scale according to symptom severity: 0 (Not at all) to 4 (Extremely). The total score is calculated by summing the scores of all 22 items, yielding a total score range from 0 to 88.
Time frame: Baseline(day 0), day19, day37, 2 months after the last intervention(all arms)
Beck Depression Inventory-II (BDI-II)
The Beck Depression Inventory-II (BDI-II) is a 21-item self-report instrument used to assess the existence and severity of depressive symptoms, covering emotional (e.g., sadness, hopelessness), cognitive (e.g., self-reproach, worthlessness), somatic (e.g., fatigue, appetite loss), and behavioral (e.g., loss of interest, social withdrawal) dimensions. Each of the 21 items consists of four statements describing increasing levels of severity, rated on a 4-point scale ranging from 0 (not present) to 3 (severe). The total score is calculated by summing the scores of all 21 items, with a total score range from 0 to 63. Higher scores indicate more severe depressive symptoms.
Time frame: Baseline(day 0), day19, day37, 2 months after the last intervention(all arms)
State-Trait Anxiety Inventory-State version (STAI-S)
The State Anxiety subscale of the State-Trait Anxiety Inventory (STAI-Form Y-I, S-AI) comprises items 1 to 20 of the inventory. Half of the items describe negative emotions and the other half describe positive emotions. It is designed to evaluate immediate or recent situational experiences of fear, tension, worry, and nervousness, making it particularly useful for assessing state anxiety under stressful conditions. Each of the 20 items is rated on a 4-point scale: 1 (not at all), 2 (somewhat), 3 (moderately so), and 4 (very much so). The total score is calculated by summing the 20 items, yielding a total score range from 20 to 80. Higher scores reflect a greater severity of the subject's current state anxiety symptoms.
Time frame: Baseline(day 0), day19, day37, 2 months after the last intervention(all arms)
Work and Social Adjustment Scale (WSAS)
The WSAS is a 5-item self-report scale designed to measure the degree of functional impairment in day-to-day activities (work, home management, social leisure, private leisure, and close relationships). Each of the 5 items is rated on a 9-point scale ranging from 0 (Not at all impaired) to 8 (Very severely impaired). The total score is calculated by summing the scores of all 5 items, yielding a total score range from 0 to 40. Lower scores indicate better functioning, while higher scores indicate greater functional impairment. Clinical thresholds are: below 10 (subclinical), 10 to 20 (significant functional impairment), and above 20 (moderately severe or worse psychopathology).
Time frame: Baseline(day 0), day19, day37, 2 months after the last intervention(all arms)
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