Reducing intrusive memories in refugees and asylum seekers with PTSD
Research type
Research Study
Full title
Reducing intrusive memories of trauma using a visuospatial interference intervention with refugees with Posttraumatic Stress Disorder (PTSD): A test of replication to a new population
IRAS ID
271061
Contact name
Emily Greenfield
Contact email
Sponsor organisation
University of Surrey
Duration of Study in the UK
1 years, 3 months, 0 days
Research summary
Research Smmary:
Refugees and asylum seekers (RAS) will have suffered severe traumatic events before leaving their country of origin and during displacement. They experience increased rates of mental health problems, such as Posttraumatic Stress Disorder (PTSD), compared to host populations and will require treatment for these. PTSD involves suffering from intrusive memories of traumatic events, which cause difficulty concentrating and high levels of distress. Government guidelines suggest trauma focused cognitive behaviour therapy (TfCBT) should be offered to people suffering from PTSD. However, there are many reasons why RAS are unable to access this intervention. For example, (1) TfCBT must be delivered by highly trained therapists of which there are a limited number available, (2) individuals may not wish to discuss the traumatic event(s) in detail (which TfCBT involves) (3) service providers often misunderstand the regulations about what health care RAS can freely access and so refuse them the free mental health care they are entitled to, (4) language barriers and difficulties accessing interpreters, and (5) not being deemed ready to engage in TfCBT due to ongoing daily stressors. There is a need for language-free interventions that do not require a therapist. The current study will evaluate a recently developed intervention which aims to reduce the core clinical symptom of PTSD; intrusive memories. The intervention, based on theories of cognition and memory, involves bringing to mind the traumatic event(s) briefly and then playing the game Tetris. It has been shown to reduce intrusive memories in patients with PTSD. Although it does not intend to replace TfCBT, it could help improve the well-being of those who are unable to access TfCBT. The current study aims to evaluate this intervention with RAS within a case-series (N=15) using a 5-week intervention. The study will be conducted at the Woodfield Trauma Service based in CNWL NHS Trust.Lay summary of study results:
Refugees are more likely than other adults to have posttraumatic stress disorder (PTSD). PTSD involves suffering from unwanted, intrusive memories of past traumatic events. These memories are very distressing and impact the person’s ability to concentrate and do their daily activities. Trauma-focused therapy is a talking therapy that is recommended to help people who have PTSD. However, lots of refugees are unable to do this therapy. It can be more difficult for refugees to do talking therapy because English is not their first language and interpreters are not always available. Also, there are not enough people trained to deliver trauma-focused therapy. Therefore, it is important that new treatments are developed that can help people who experience intrusive memories of traumatic events. The new treatments need to be easy to access and language-free.This study tested a new intervention which aims to reduce how often people experience unwanted, intrusive memories of past traumatic events. The intervention involves being reminded very briefly about an intrusive memory and then completing a visual-based task (i.e., playing the video-game Tetris and mentally rotating the blocks in the game as they appear on the screen) for 20-30 minutes. Previous research testing this intervention found some promising results. However, further research was needed. This was an exploratory study as part of the development of the intervention. The study was carried out as part of a trainee clinical psychologist’s doctoral research with the University of Surrey.
Refugees and asylum seekers who were accessing treatment for severe PTSD from a specialist NHS service could participate in the study whilst they waited for the standard treatment in the service. The study started in February 2020 and ended in April 2021. The study was conducted in a limited time frame due to the need to submit the doctoral thesis, with a planned end date of April 2021. Due to recruitment delays in the Covid-19 pandemic, recruitment was halted prematurely before the recruitment aim (15 participants) could be reached. This was in line with the pre-specified contingency plan to decrease the sample size if required outlined in the study’s protocol.
In total, ten people were recruited to the study, of which seven people completed the study. Of the three people who were recruited but did not complete the study, two gave informed consent but did not continue further due to Covid-19 restrictions and one was excluded during the intervention phase after it became apparent full inclusion criteria had not been met (i.e., they were innumerate so were unable to accurately keep an intrusion diary and complete questionnaires).Each person who completed the study waited either one, two or three weeks before starting the intervention. Then they had five weekly intervention sessions, which were delivered by the trainee clinical psychologist. In each session, a specific intrusive memory, which the person regularly experienced, was targeted using the intervention. Due to Covid-19 restrictions, most meetings were delivered by video call. Throughout the study each person kept a diary recording how many intrusive memories they had. We compared how many intrusive memories they had whilst they waited to start the intervention, to how many intrusive memories they had after they started the intervention. Each person was followed up five weeks after the intervention had ended. Participants also completed other questionnaires throughout the study assessing PTSD, low mood, concentration, and functioning.
Four out of seven people experienced less intrusive memories after they started the intervention compared to the earlier period whilst they waited to start the intervention. The extent of this effect varied across the four people. There were differences in how large the reduction in intrusive memories was, whether or not the reduction lasted five weeks after the intervention ended, and whether the reduction led to improvements in other areas (e.g., improved other symptoms of PTSD, low mood, concentration, and functioning). One refugee experienced no change in the number of intrusive memories they had after starting the intervention, and two people experienced more intrusive memories after the intervention.The findings were more varied than those reported in previous research. This may be because the sample who took part in this study had more complex difficulties than people who were involved in previous studies testing this intervention. That is, participants in this study had very severe PTSD and low levels of functioning. The study was also conducted during the start and rise of the Covid-19 pandemic, which impacted people’s mental health. Further, this meant that the intervention had to be delivered online, rather than in person, and procedures to adapt the intervention from in person to online were in their infancy at that stage and would benefit from further development. Only a small number of people took part in the study. However, the study helped us learn how the intervention might need to be adapted to be most helpful for refugees with severe PTSD. It also helped us think about what research might need to be done next.
REC name
London - Surrey Research Ethics Committee
REC reference
19/LO/1895
Date of REC Opinion
21 Jan 2020
REC opinion
Further Information Favourable Opinion