Visuospatial game task after trauma (Tetris intervention)

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Emily A. Holmes, Lalitha Iyadurai · Oxford

What it is

What it is: a brief, low-intensity cognitive task targeted at one symptom, intrusive memories (sensory, image-based memories of a trauma that come to mind unbidden). It is not a full trauma therapy and does not process the trauma narrative. The client briefly brings one specific intrusive memory to…

Format

• Criteria for moving from one target memory to the next: the Iceland study retargeted the same intrusion at the next session if it persisted, or chose a different one the client wanted to reduce. No published rule for when a memory counts as finished was found. A workable rule: move on when the…
• B. Early single-session version (hours to days after a trauma): one session in the hospital emergency department after a traumatic event (Kanstrup: within 72 hours of arrival), consisting of the memory reminder cue plus Tetris with mental-rotation instructions, then an intrusion diary for a week.

Who practises it, and how they are trained or regulated

• Developers: Emily A. Holmes (Uppsala University and Oxford) and Lalitha Iyadurai (Oxford; P1vital), with Michael Kanstrup, Laura Singh, Beau Gamble and colleagues. Henrik Kessler's Bochum group has tested related versions in Germany; Badawi, Steel and colleagues in Australia. Tetris is a registered trademark; the trials used Tetris on a handheld or tablet, the free browser version at tetris.com (Iceland), or a…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the same as 4.8–4.9.
• clear escalation routes to a qualified clinician for risk or worsening.
• the client feeling the method trivialises their trauma ("a video game?"); see Section 5.
• targeted intrusions falling while others stay the same, which suggests moving on rather than stopping.
• a client choosing the least distressing image to avoid discomfort; this is acceptable as a first practice round.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.