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Post-retrieval Tetris should not be likened to a ‘cognitive vaccine’

Molecular Psychiatry volume 23, pages 1972–1973 (2018)Cite this article

Iyadurai et al. 1 report a randomized controlled trial intended to mitigate post-trauma symptoms in motor vehicle collision (MVC) survivors presenting to an emergency department. The intervention, motivated by memory ‘(re)consolidation’ theory, consisted of a brief reminder of the accident followed by playing the computer game Tetris. The findings are taken to indicate a promising preventive intervention akin to a ‘cognitive therapeutic vaccine’ and comparable to ‘a rabies vaccine after a dog bite’ (p. 7). We will describe several reasons why this characterization is misleading.

The trial aims to reduce memory intrusions as a relevant clinical outcome per se, but also as a surrogate end point, whereby intrusions would represent a risk factor for subsequently developing other mental disorders, primarily post-traumatic stress disorder (PTSD). It is imperative these objectives are not conflated, as the trial does not support any compelling inferences about PTSD. First, Iyadurai et al. imply that memory intrusions are predictive of subsequent PTSD development, but the cited evidence is weak and inconclusive. One study2 actually showed that post-trauma intrusions had a small predictive effect on PTSD development, not statistically significant when analyses were adjusted for other relevant predictors. The extension of the other study cited, a machine learning application, did not find a predictive role for early re-experiencing.3 Second, the ‘anxious-re-experiencing’ type of PTSD accounts for about 32% of diagnosed patients, but is mostly associated with interpersonal violence and has only a weak relationship with MVC.4 Third, a longer follow-up would have been needed to accurately assess PTSD development, which requires at least 1 month containing a minimum of 6 out of 20 possible symptoms,5 intrusions being just one type.

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Acknowledgments

Data availability statement: Data and analysis scripts are publicly available on the Open Science Framework (https://osf.io/2mcra/).

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  1. These authors contributed equally to this work.

Authors and Affiliations

  1. Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, CA, USA

    I A Cristea, F Naudet & T E Hardwicke

  2. Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania

    I A Cristea

  3. Division of Psychology and Language Sciences, University College, London, UK

    D R Shanks

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  1. I A Cristea
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  2. F Naudet
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  4. T E Hardwicke
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Correspondence to T E Hardwicke.

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Cristea, I.A., Naudet, F., Shanks, D.R. et al. Post-retrieval Tetris should not be likened to a ‘cognitive vaccine’. Mol Psychiatry 23, 1972–1973 (2018). https://doi.org/10.1038/mp.2017.222

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