A Brief Cognitive Intervention After Intrusive Memories of Trauma With Young Refugees

Study Overview
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Brief Summary
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This research study is designed to investigate the use of a simple cognitive task (a memory cue and 10 minute time gap, followed by playing the computer game Tetris) for decreasing the number of intrusive memories of trauma among young refugees and asylum seekers. The design is a single case experimental AB design with or without optional replication (ABAB). Participants will aim to complete a no-intervention phase ('A': baseline phase) of one week followed by a one-week intervention phase ('B'), including a one-session intervention with a researcher comprising the simple cognitive task, followed by instructions to continue to use the technique self-guided in the subsequent week. Follow ups are conducted after each week to monitor the occurrence of intrusive memories of trauma in a pen-and-paper diary. It is predicted that participants will report fewer intrusive memories during the intervention phase than during the preceding baseline phase.

Official Title
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Intrusive Memories of Trauma Experienced by Young Refugees: Using Single Case Experimental Design to Investigate a Brief Cognitive Intervention Involving Computer Gameplay

Conditions
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Intrusive Memories of Trauma, Symptom of Post Traumatic Stress Disorder (Criterion B1)

Intervention / Treatment
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* Behavioral: Brief cognitive intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Refugee or asylum seeker Experiencing intrusive memories of trauma Have access to a smartphone Able to speak or read the study material in Swedish, English or Arabic Able to attend three meetings with a researcher Exclusion Criteria: Exhibit psychotic symptoms or other symptoms of severe mental illness

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 25 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Interventional Model Description: Single case experimental AB design with or without optional replication (ABAB) (ie no random assignment)
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Baseline phase ('A') and Intervention phase ('B')<br>Baseline phase ('A'): Measurements collected in a pen-and-paper diary four times a day (morning, afternoon, evening and night) over one week for the primary outcome (occurrence of intrusive memories of trauma). Individual baseline phases will be used as control periods. Intervention phase ('B'): A one-session intervention with a researcher including a simple cognitive task (a memory cue, 10 minutes time gap and ca. 20 minutes of Tetris game-play) followed by instructions to engage in the task self-guided over the subsequent week. Measurements collected in a pen-and-paper diary four times a day over one week following the intervention for the primary outcome (occurrence of intrusive memories of trauma). | Behavioral: Brief cognitive intervention<br>* A one-session intervention with a researcher including a simple cognitive task (a memory cue, 10 minutes time gap and ca. 20 minutes of Tetris game play) with instructions to engage in the task self-guided in the subsequent week.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the occurrence of intrusive memories of trauma from baseline week to intervention week | Number of intrusive memories of traumatic event recorded by participants in a diary daily (morning, afternoon, evening and night) for one week during the baseline phase and one week during the intervention phase. | Baseline week 1 and Intervention week 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility and acceptability ratings for using a smartphone game-play intervention | Feasibility and Acceptability of the intervention was assessed with 10 self-rated items, e.g. Would you recommend playing Tetris to a friend?. Scores could range from 0 - 10 with higher scores indicating greater acceptability/feasibility. Two items had open-ended follow-up questions: How did you feel about playing Tetris after you had an intrusive memory? and Why? or How much would you prefer an intervention that is delivered by a computer/smartphone compared to seeing a doctor/psychologist in person? and Why? | Intervention week 1 | 
| Self-guided intervention adherence - usage of the gameplay intervention in daily life | Usage of the gameplay intervention was assessed with 4 self-rated items: 1. Did you play Tetris in the last week since the last meeting? (Yes/No). 2. If yes, how many days did you play Tetris in the last week since we first practiced the game together? 3. How long did you spend playing Tetris at a time? (<10 min - >30 min), 4. How often did you manage to play Tetris after you experienced an intrusive memory? (11-point scale; 0 = not at all; 10 = every time). | Intervention week 1 | 
| Impact of intrusive memories on concentration, control, sleep and stress | 7 self-rated items were used to assess the impact of intrusive memories on concentration, control, sleep and stress: 2 items assessed experienced concentration difficulties due to intrusive memories and in general (11-point scale; high scores indicating more concentration difficulties); 1 item assessed for how long intrusive memories disrupted concentration (<1 min - >60 min), 1 item assessed feeling of control over intrusive memories (11-point scale, 0 = no control; 10 = in full control); 2 items assessed sleep disturbances due to intrusive memories (11-point scale; higher scores indicating more sleep disturbance); and 1 item assessed to what degree intrusive memories affected stress levels (11-point scale, 0 = not at all; 10 = affected very much). Two open-ended questions were included: How do intrusive memories interfere with your concentration? and How do intrusive memories interfere with your ability to settle in to this country and learn new skills, such as a new language? | Baseline week 1 and Intervention week 1 |