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Post-Traumatic Stress Disorder

Can TETRIS Prevent PTSD?

Is it possible to prevent the brain from remembering trauma?

Screenshot of an experimental 'treatment'

Can Tetris prevent PTSD?

This sounds like a ridiculous question—but research suggests that it might! A 2009 study by Emily Holmes and her colleagues at Oxford University draws upon the latest principles of cognitive science, and applies them to traumatic visual images.

Flashbacks are one of the key symptoms of posttraumatic stress disorder (PTSD).  A flashback is a "distressing re-experiencing of the trauma in the form of intrusive, image-based, sensory-perceptual memories." Neurobiology research suggests that memories are "consolidated" or laid down in the brain over an approximately six-hour period. Yet cognitive science has shown that the brain has limited capacity to consolidate memories.

So Holmes reasoned that an intensive mental task—the video game Tetris—might be able to compete successfully with traumatic experiences and thereby prevent the development of traumatic flashbacks.

In their experiment, volunteers were shown a brief video with traumatic scenes of violence and death, and half of them were then assigned to play Tetris for 10 minutes, the other half (the controls) were told to sit quietly, doing nothing. At followup a week later, the Tetris players had fewer flashbacks and lower scores on measures of trauma impact. Holmes concluded, "strategic, selective interference with the consolidation of recently triggered visual memories occurs via the demand on the player's limited visuospatial working memory resources."

And Tetris clearly takes up a lot of mental resources: just try to interrupt a kid in the midst of playing!

Clearly there's a long way to go before soldiers blasted by improvised explosive devices might be effectively treated by playing video games, but this type of advance—combining cutting-edge scientific insights with the all-consuming behavior of a video game—may be a significant start.

Can morphine prevent PTSD?
Another fascinating recent study by Troy Lisa Holbrook of the Naval Health Research Center in San Diego and published in the New England Journal of Medicine, looked at wounded soldiers who had been given opiate medications to prevent pain—and how that affected the later development of PTSD. Holbrook and her colleagues found that soldiers who had been given morphine right after being wounded had less chance of developing PTSD later on than soldiers not given opiates. Opiates such as morphine are given to control pain and anxiety, usually within an hour of the time of injury, to allow for resuscitation and trauma care.  And those soldiers who did receive opiates had less than half the risk of developing later PTSD.

Why might this work? Holbrook quotes researchers who "have hypothesized that opiates may interfere with or prevent memory consolidation through a beta-adrenergic mechanism. This theory also lends support to the idea that morphine and other opiates may prove effective in the secondary prevention of PTSD after trauma."

What do these two studies have in common?

Both apply scientific methods to the treatment of PTSD, in particular to the vulnerable period right after a trauma when traumatic memories may be seared into the brain. Both may be significant advances, or they may be dead ends. But they will surely spur more valuable research.

Whether or not they lead to practical treatments, they are both exciting examples of what I have called the "the New Neuropsychiatry". The New Neuropsychiatry (NNP) is a term to describe an approach in which the latest brain science can be applied to understand psychiatric disorders in order to design innovative and possibly more effective treatments. This is a radical change from 20 or 30 years ago, when psychiatry focused upon the DSM-IV for specific lists of symptoms, the so-called "Chinese menu approach," without any clear understanding of what brain dysfunction might underlie a particular disorder. Over the last decade, we have seen an explosion of neuroscience advances that are now being applied to psychiatric disorders and treatment.

But it is not a one way street.

Holmes's Tetris study shows how progress in the laboratory can inform clinical care.  And Holbrook's opiate study is the reverse.  In Holbrook's study, doctors who see patients "on the front lines"—in this case literally on the battlefield!—made observations which then could be tested scientifically. Opiates are an ancient treatment, in use for thousands of years, but they are still worth further investigation since they have such profound brain effects.

This is one of the great things about the New Neuropsychiatry: progress flows both ways. Scientists in the laboratory and clinicians who work with patients—and the lay public as well—all have the opportunity to make observations that can inspire new directions of scientific research.

One key insight of the New Neuropsychiatry is that the brain is always remodeling itself, throughout our lifetimes. PTSD, depression, and other psychiatric disorders cause what is called "negative neuroplasticity,"  including activation of abnormal circuitry in the brain, and strengthening of those circuits over time.  They also cause shrinkage of parts of the brain, and decreased connectivity between parts of the brain. And fascinating NNP research shows how treatments including psychotherapy, medication and exercise can stop and even reverse this damage.

Intriguingly, both the Tetris study and the opiate study suggest that it may be possible to interrupt negative neuroplasticity—even before it occurs!