Using Tetris as a potential treatment for PTSD, Part 2 (Holmes et al., 2010)

This would traumatize Tetris players

Last year, Emily Holmes (University of Oxford) and company published a curious article in PloS One about the potential use of Tetris in treating PTSD. The one sentence summary is that the use of Tetris uses up the individual’s limited cognitive resources, specifically visual, and it would interfere the memory formation of a traumatic impact, or as they call this kind of procedure, a “cognitive vaccine”.

Now they published another PloS One article building upon the limitations of their previous study by (1) comparing Tetris with another videogame, Pub Quiz. This is to see if the effect was a distraction effect, regardless of the content. (2) Administrating the  stimuli from 30 minutes to 4 hours after seeing a traumatic film, to increase its external validity, given that counseling after trauma is rarely immediate.



Flashbacks (intrusive memories of a traumatic event) are the hallmark feature of Post Traumatic Stress Disorder, however preventative interventions are lacking. Tetris may offer a ‘cognitive vaccine’ against flashback development after trauma exposure. We previously reported that playing the computer game Tetris soon after viewing traumatic material reduced flashbacks compared to no-task. However, two criticisms need to be addressed for clinical translation: (1) Would all games have this effect via distraction/enjoyment, or might some games even be harmful? (2) Would effects be found if administered several hours post-trauma? Accordingly, we tested Tetris versus an alternative computer game – Pub Quiz – which we hypothesized not to be helpful (Experiments 1 and 2), and extended the intervention interval to 4 hours (Experiment 2).

Methodology/Principal Findings

The trauma film paradigm was used as an experimental analog for flashback development in healthy volunteers. In both experiments, participants viewed traumatic film footage of death and injury before completing one of the following: (1) no-task control condition (2) Tetris or (3) Pub Quiz. Flashbacks were monitored for 1 week. Experiment 1: 30 min after the traumatic film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz led to a significant increase in flashbacks. Experiment 2: 4 hours post-film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz did not.


First, computer games can have differential effects post-trauma, as predicted by a cognitive science formulation of trauma memory. In both Experiments, playing Tetris post-trauma film reduced flashbacks. Pub Quiz did not have this effect, even increasing flashbacks in Experiment 1. Thus not all computer games are beneficial or merely distracting post-trauma – some may be harmful. Second, the beneficial effects of Tetris are retained at 4 hours post-trauma. Clinically, this delivers a feasible time-window to administer a post-trauma “cognitive vaccine”.

Since it’s available online and for free, I’m not going to bother reviewing it. Press release: University of Oxford. News report: BBC News, Woodbridge Patch, Gamepolitics, TimeLos Angeles Times., they have a video.

Holmes EA, James EL, Kilford EJ, Deeprose C, 2010 Key Steps in Developing a Cognitive Vaccine against Traumatic Flashbacks: Visuospatial Tetris versus Verbal Pub Quiz. PLoS ONE 5(11): e13706. doi:10.1371/journal.pone.0013706.

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