A brief, digital, imagery-competing task intervention for stopping intrusive memories in trauma-exposed health-care staff during the COVID-19 pandemic in the UK: a Bayesian adaptive randomised clinical trial.

Abstract

Background Psychological trauma, such as witnessing an untimely or gruesome death, commonly provokes intrusive memories that persist for days to years with adverse effects on individual mental and physical health and functioning. Despite the global prevalence of trauma, scalable evidence-based interventions are lacking. Reducing the impact of intrusive memories is critical for people frequently exposed to trauma such as healthcare workers. The study aimed to determine whether a brief digital imagery-competing task intervention (ICTI) reduced intrusive memory frequency at week-4. Harms were also assessed. Methods The GAINS-02 decentralized digital, parallel-group Bayesian adaptive randomized controlled trial tested a brief ICTI against an active comparator (AC) and treatment-as-usual (TAU) to determine impact on reducing intrusive memory frequency. Healthcare workers in facilities admitting patients with COVID-19 during the pandemic and reporting at least three intrusive memories in the week before screening were randomized 2:2:1 (ICTI:AC:TAU) via block randomisation (web-based). AC and ICTI participants were blinded to treatment allocation, both had one guided session then optional self-use. ICTI involved image-based memory retrieval then Tetris® computer gameplay with mental rotation. AC involve a music-listening task. Study statisticians were blinded to AC and ICTI arms. The primary outcome was the number of intrusive memories in week-4 (controlling for baseline), which was evaluated on an intention-to-treat basis. Secondary outcomes were assessed over 24 weeks. Harms were assessed through adverse event (AE) reporting and interim analyses on primary outcome. People with lived experience were involved from study conception and throughout the research and writing process. The trial was pre-registered at clinicaltrials.gov: NCT05616676 and is completed. Findings Between 08-December-2022 and 15-September-2023, 176 participants were screened and 99 included (ICTI N=40; AC N=39; TAU N=20) with mean age 41.2 years (SD=10.2; range=21-62). Of these, 85 (86%) self-identified as women and 89 (90%) as white. Bayesian analyses revealed robust evidence that ICTI reduced IMs at week-4. ICTI participants reported fewer intrusive memories (median=0·5, IQR=0·0–5·0), compared to AC (median=5·0, IQR=3·0–11·5; Bayes Factor(BFAC>ICTI vs. AC=ICTI)=114·1; βAC>ICTI =1·29[95% CrI=0·64,2·00]) and TAU (median=5·0, IQR=2·5–8·0; BFTAU>ICTI vs. TAU=ICTI=15·8; βTAU>ICTI=1·21[95% CrI=0·49,1·98]) groups. Secondary outcome analyses indicated those effects sustained over 24-weeks. No harms were detected for ICTI relative to AC and TAU. The most reported AE (n=7) was COVID-19. Two AEs involved burden of diary recording. Serious AEs were hospitalisations unrelated to study procedures (n=6). Interpretation This study demonstrates that ICTI reduces intrusive memory frequency and PTSD symptoms among healthcare workers exposed to trauma. As a brief, scalable digital intervention, ICTI shows promise for mitigating consequences of trauma on mental health; an important and unmet need for healthcare personnel and systems worldwide.