Category Archives: Technology

Trauma, Tetris and Memory: A Cheap Way to Reduce the Impact of Intrusive Memories

Body Image

What if I was to tell you that playing video games can be good for you? That despite derision and their use in political point scoring, games such as Tetris and Candy Crush could one day be used to help people deal with traumatic events in their lives? You might be initially sceptical but there is growing evidence to support this. Although not a new idea, Tetris has been shown to be useful in reducing the uncontrollable intrusions associated with a traumatic experience.

So, how can we use a video game such as Tetris to interfere with traumatic memories? Well, in much the same way that you would interfere with any memory. As you create a new memory and have converted all the constituent parts into a form which the brain can understand, it goes through a period of consolidation. That is where the memory is stored within your brain so you are able to recall it at a later point. Now if we interfere with the memory during this period of consolidation it is less likely that we will recall said memory. For example, if we can provide some competition for the neural real estate the original memory is vying for then we can weaken the strength of that original memory. It seems to be important that the type of memory is relatively specific and needs to match the original memory’s modality (e.g. a visual-spatial task needs another visual-spatial task to compete with it effectively). This is essentially where Tetris comes in. The authors argued that if both the trauma memory and Tetris rely on the same visual-spatial resources then you can reduce the intrusiveness of the initial trauma memory.

This is exactly what Emily Holmes at the University of Oxford and her collaborators found in studies conducted over the past eight years. If you ask a participant to play Tetris 30 minutes after a lab-controlled trauma induction you can reduce the impact of the traumatic memory compared to a control condition. These early studies showed that, at least in the lab, you could interfere with traumatic memories in a therapeutic way by reducing their intrusive nature. Although they were not carried out in a naturalistic setting they provided evidence that the proposed mechanism existed and could be manipulated. It is also key to keep in mind that this study showed that playing Tetris reduced specifically the intrusiveness of the traumatic memories and not the deliberate recall memory for the event. As the uncontrollable nature of the traumatic memory is a source of considerable distress in PTSD it is important that any intervention can have a targeted effect. What about evidence for the use of Tetris to deal with naturally occurring trauma outside of the lab? This is where their latest study, published in Molecular Psychiatry, last week comes into play (it’s open access so you can read the full article yourself here).

In a small-scale naturalistic study in Oxford, Emily Holmes, and colleagues at the Karolinska Institute in Sweden, examined individuals in A&E who had recently (within 6 hours) experienced a motor accident as a driver, passenger or pedestrian.  They randomised 71 eligible participants to either an intervention or control condition to test the real-life application of their previous findings. In the intervention condition, participants were asked to recall the traumatic event initially and to then spend at least 10 minutes (maximum 20 minutes) playing Tetris. By contrast, the control condition asked participants to write down all the activities they carried out during their time in A&E (e.g. completing a crossword, speaking to a friend, etc.). Participants were assessed at one week and one month following either the control or intervention task. During the initial week participants were required to complete a daily diary of the number of intrusive memories they experienced which were related to the trauma (e.g. motor accident). The participants were instructed not to report “memories recalled deliberately or general verbal thoughts”. The number of intrusions provided a primary way to assess the success of the use of the intervention (memory cue and Tetris).

Header Image

So, what did the researchers find? Primarily, they showed that the use of Tetris and memory recall was an effective intervention. The number of intrusions was significantly reduced in the intervention group after one week (9 intrusions on average) compared to the control condition (23 intrusions on average). Furthermore, they also found that the intervention group also reported significantly less distress after one week. However, this reduction in distress did not remain when participants were followed up after one month. To supplement this data, the authors also asked the participants about their subjective experience of using the intervention. Their reports were positive and it was apparent that they appreciated the distraction from the accident which playing Tetris offered. One participant highlighted this clearly with, “it certainly took my mind off of it at a time when I probably would have sat brooding and feeling very sorry for myself…”. Another participant, who had not played Tetris before, was keen to keep playing it following the allotted 20 minutes. The intervention thus proved to be both feasible and acceptable.

Together, these findings support the usefulness and viability of using Tetris to combat intrusive traumatic memories in a real-life setting. The reduction in the number of intrusions following a natural traumatic event (e.g. motor accident) supports the intervention and suggests it could be a low-cost, easy to administer, therapy. As the authors highlight in the paper, waiting times in A&E can be as long as 4 hours and this would be an ideal time to target individuals who have experienced a traumatic accident. As a well-tolerated, and simple, intervention it seems ideal. However, this study is simply the beginning of translating Tetris, or similar aproaches, into the realms of clinical practice. Although this trial did not show an effect on distress at a one month follow-up, a larger trial may be better suited to pick out subtle effects for longer periods of time. Furthermore, additional doses of the intervention may also prove effective as a ‘booster’ to the initial dose. As any good piece of research, this trial raises more questions and exciting avenues for further study.

Alongside the compelling results, why should we be so excited about this research? It provides clear evidence that marrying cognitive neuroscience and clinical practice are vital for progress in both fields. It is still early days for this collaborative approach but hopefully this soon blossoms into a powerful and fruitful relationship. Basic science studies can be blamed for being too distant from the disorders and clinical fields they are trying to unpick and affect. However, with a greater understanding of the mechanisms at work behind mental distress we can develop novel therapies, like the use of Tetris, to target them and help real people. Personally, that is one of the amazing things about research and one of the reasons why I fell in love with science in the first place. More work is needed to validate these findings but, at least for the time being, they provide you with a great retort to anyone who claims video games are good for nothing. To quote Emily Holmes’ original Tetris paper in 2009, “…clearly not all computer games are bad for you.”

ResearchBlogging.org

Iyadurai, L., Blackwell, S., Meiser-Stedman, R., Watson, P., Bonsall, M., Geddes, J., Nobre, A., & Holmes, E. (2017). Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: a proof-of-concept randomized controlled trial Molecular Psychiatry DOI: 10.1038/mp.2017.23

Additional References:

Holmes, E. A., James, E. L., Coode-Bate, T., & Deeprose, C. (2009). Can playing the computer game “Tetris” reduce the build-up of flashbacks for trauma? A proposal from cognitive science. PloS one, 4(1), e4153.
Chicago

Image Credits:

Tetris (Header)

Tetris Building (Body)

Advertisements

Leave a comment

Filed under Memory, Psychology, Technology, Trauma, Work and Society

How Might Escaping Technology Help Improve Our Sleep Problems?

Won_t_somebody_please_think_of_the_children.gif

“Won’t someone please think of the children?!”

Besides infancy, we don’t initially think of sleep as a big problem in childhood. Yet, a slew of recent articles have highlighted that insomnia and other sleep problems are not simply an issue of adulthood. A BBC Panorama documentary released last week commented on the surge in problems with sleep in children. Although there were a number of culprits identified for this increase in the problems with children’s sleep, one key point was technology and later exposure to artificial light.

We are all glued to our smartphones, laptops, and Fitbits. Modern artificial lighting allows us to work and entertain ourselves further into the night than natural light permits but the normality surrounding their use before bed is negatively influencing sleep. As people are educated more about the effects of technology on sleep, these issues should hopefully reduce but whether education can effect this change is uncertain. The question remains: How can we improve sleep without dragging people away from technology? One love-it or hate-it option may be camping.

Last month, a research group led by Kenneth Wright carried out two studies which examined how artificial light interferes with our natural sleep rhythms and our body’s concept of day and night. Study one assessed the sleep of participants firstly during artificial lighting and then natural lighting during the winter. The second study attempted to understand the impact of weekend camping on sleep. The researchers studied sleep by asking them to wear a watch to track movements and by tracking changes in a hormone called melatonin. Melatonin is released prior to sleep, reaches a midpoint during the first half of sleep and dips as you wake up. During the day, it is only detectable at trace levels because in the presence of light melatonin’s production is inhibited. This, in part, explains why we feel tired and want to go to bed at night rather than during the day. As a result, melatonin serves as a useful and precise marker of the internal biological night (i.e. when the body feels we should be sleeping).

The first study had participants spend a week, during winter, camping with no artificial light (e.g. torches or phones) and then a week in their normal, modern, environment which served as a baseline. Participants’ melatonin levels were measured during sleep after about 6 days of the modern environment and after 6 days of the natural light, camping, condition.

This initial study found that the internal biological night (e.g. melatonin onset, midpoint, and offset) is affected by seasonal fluctuations. Specifically, internal biological night is longer during winter and shorter during the summer. In the camping condition, melatonin onset and sleep onset were around 2 hours earlier compared to the modern, artificially lit, condition. However, melatonin offset and sleep offset were similar between camping and baseline. When comparing the winter data to previously collected summer data, the melatonin onset was earlier and melatonin offset was significantly later in the winter condition. More specifically, they showed a four-hour difference in internal biological night between winter and summer. However, there were no change in internal biological night between summer and winter offset when comparing the artificial light conditions. The modern, artificially lit, environment had extinguished the seasonal fluctuations in melatonin and sleep patterns.

The second study then went on to assess whether weekend exposure to natural light (i.e. camping) could help reduce the effects of social jet lag – the mismatch between the time you wake up during the weekday and weekend. We tend to delay our sleep during the weekend and this contributes to why it is so hard to wake up on a Monday morning. In this study, fourteen participants were first tested in their normal, artificially lit, environment and their melatonin levels during the night (onset, midpoint and offset) were assessed. Participants were then separated to a camping condition (n=9; natural light) or normal condition (n=5; artificial light).

What did they find? For the camping condition, the time at which participants went to sleep and woke up were similar between weekday and weekend. However, for the artificial light condition the onset of sleep was found to be delayed by almost 2 hours and participants woke up around an hour and a half later during the weekend compared to the weekday. People were staying up later and waking up later during the weekend presumably when they didn’t have work. Overall sleep duration and efficiency were similar across and within both groups. So, participants were not sleeping for longer under artificial light but were delaying their sleep schedule.

What about the data for internal biological night? In the camping condition, melatonin onset and midpoint were about an hour earlier during the weekend compared to weekday despite there being no changes in sleep timing. Interestingly, changes in melatonin were not only seen in the camping condition but also the modern setting. Melatonin onset, midpoint and offset were delayed by about an hour compared to the weekday for the modern, artificial light, condition. This is problematic if you have to get up earlier on the Monday morning for work and is linked to what we know as social jet lag. If you feel sleepier later and want to wake up later then you may find yourself being groggy and sleep deprived during the week.

Yet, when participants went camping over the weekend, they did not see a shift in their sleep onset or offset, and their biological night became advanced (started earlier) slightly. This suggests that weekend exposure to natural light (e.g. camping) may help diminish the negative effects of living in the current, high-paced, environment we currently have. The small sample size and short sampling period makes it hard to draw definite conclusions from this study but it does highlight that artificial lighting is having a definable impact on our sleep and the biochemistry underpinning it. It also provides some preliminary evidence of the biological impact of social jet lag.

You may, quite rightly, think that the results of this study are rather obvious: we stay up later during the weekend and our biology is going to follow suit unless we hike out to the middle of nowhere for the weekend. However, it highlighted the biological impact of our modern, well-lit, environment on our body’s internal clock. We know that using our devices before bed are generally bad for sleep but very few of us actually do anything about this. We may try to adopt better bedtime habits but this may be thwarted by technology (e.g. using a kindle to read just before bed)

Also, it is key to remember that light is not the only regulator of our sleep rhythms and in societies not exposed to artificial light the key determinant of the sleep cycle is temperature. This should make us think about not a single factor (i.e. light) but a multitude of issues may cause issues with our sleep. Interestingly, such individuals in cultures not exposed to artificial light also reported problems with insomnia but at a reduced rate than reported in modern society.

Nonetheless, light from devices, rich in low-wavelength blue-light, resets our biological clocks and inhibits the release of melatonin. As a result, we feel sleepier later even though we still have to get up at the same time and go to school, college or work. The recurrent sleep deprivation can in turn lower our mood, concentration and put us at increased risk of illness and metabolic disorders. Now, it is unlikely that the rise of childhood sleep problems can be fixed by wrenching tablets from children and throwing them out into the wilderness every Friday until Sunday. Nonetheless, we can think about what these devices are doing to our sleep – at the very least when we’re sleeping poorly to begin with.

Inquisitive Tortoise

 

ResearchBlogging.orgStothard ER, McHill AW, Depner CM, Birks BR, Moehlman TM, Ritchie HK, Guzzetti JR, Chinoy ED, LeBourgeois MK, Axelsson J, & Wright KP Jr (2017). Circadian Entrainment to the Natural Light-Dark Cycle across Seasons and the Weekend. Current biology : CB, 27 (4), 508-513 PMID: 28162893

 

Additional References:

Chang, A. M., Aeschbach, D., Duffy, J. F., & Czeisler, C. A. (2015). Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proceedings of the National Academy of Sciences, 112(4), 1232-1237.

Yetish, G., Kaplan, H., Gurven, M., Wood, B., Pontzer, H., Manger, P. R., … & Siegel, J. M. (2015). Natural sleep and its seasonal variations in three pre-industrial societies. Current Biology, 25(21), 2862-2868.

 

Leave a comment

Filed under Sleep Science, Technology, Work and Society