Reducing the Number of Intrusive Memories of Work-Related Traumatic Events in Frontline Healthcare Staff: A Case Series during the COVID-19 Pandemic (Preprint)

Abstract

Frontline healthcare staff are frequently exposed to traumatic events as part of their work. Whilst this study commenced prior to the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many healthcare staff report intrusive memories of such events, which can elicit distress, affect functioning, and be associated with posttraumatic stress disorder (PTSD) symptoms in the longer term. We need evidence-based interventions that are brief, preventative, non-stigmatising, suitable for the intensive working lives of frontline healthcare staff and that can be used for repeated trauma exposure. A brief cognitive task intervention involving a memory reminder cue and Tetris gameplay may hold promise in these regards, given evidence that it can prevent and reduce the number of intrusive memories after trauma in a range of settings. Moreover, given its simplicity, this intervention may be suitable for self-administration.

The current case series aimed to (i) investigate the impact of a brief cognitive task intervention on the number of intrusive memories, general functioning, and symptoms of posttraumatic stress, anxiety, and depression, and (ii) examine the feasibility and acceptability of the intervention for UK NHS frontline healthcare staff.

We recruited 14 clinical UK National Health Service (NHS) staff (from emergency department (ED), critical care and the ambulance service) and evaluated the intervention using an AB single-case experimental design methodology, where the baseline (‘A’) was the monitoring-only phase, and the post-intervention (‘B’) period was the time after the intervention was first administered. Methods were adapted once the pandemic started.

There was a decrease (60%) in the mean number of intrusive memories per day from baseline (M = 1.37) to post-intervention (M = 0.59). There was a statistically significant reduction in the number of intrusive memories from baseline to post-intervention in an aggregated omnibus analysis with a small effect size (Tau-U = -0.38, p = <.001). Posttraumatic stress, anxiety, and depression symptoms all significantly reduced from pre-intervention to post-intervention. Participants also reported improvements in functioning on quantitative and qualitative measures. The intervention was feasible to deliver and rated as acceptable by participants.

These preliminary findings suggest that this brief cognitive task intervention offers a potentially accessible and scalable approach to mitigate the impact of work-related traumatic events in frontline healthcare staff, both during an ongoing pandemic and beyond. Randomised controlled trials will be an important next step.