Oisin Butler, PhD; Kerstin Herr, MSc; Gerd Willmund, MD, PhD; Jürgen Gallinat, MD, PhD; Simone Kühn, PhD*; Peter Zimmermann, MD, PhD*
Background: Tetris has been proposed as a preventive intervention to reduce intrusive memories of a traumatic event. However, no neuroimaging study has assessed Tetris in patients with existing posttraumatic stress disorder (PTSD) or explored how playing Tetris may affect brain structure.
Methods: We recruited patients with combat-related PTSD before psychotherapy and randomly assigned them to an experimental Tetris and therapy group (n = 20) or to a therapy-only control group (n = 20). In the control group, participants completed therapy as usual: eye movement desensitization and reprocessing (EMDR) psychotherapy. In the Tetris group, in addition to EMDR, participants also played 60 minutes of Tetris every day from onset to completion of therapy, approximately 6 weeks later. Participants completed structural MRI and psychological questionnaires before and after therapy, and we collected psychological questionnaire data at follow-up, approximately 6 months later. We hypothesized that the Tetris group would show increases in hippocampal volume and reductions in symptoms, both directly after completion of therapy and at follow-up.
Results: Following therapy, hippocampal volume increased in the Tetris group, but not the control group. As well, hippocampal increases were correlated with reductions in symptoms of PTSD, depression and anxiety between completion of therapy and follow-up in the Tetris group, but not the control group.
Limitations: Playing Tetris may act as a cognitive interference task and as a brain-training intervention, but it was not possible to distinguish between these 2 potential mechanisms.
Conclusion: Tetris may be useful as an adjunct therapeutic intervention for PTSD. Tetris-related increases in hippocampal volume may ensure that therapeutic gains are maintained after completion of therapy.
*These authors contributed equally to the work.
Submitted Feb. 5, 2019; Revised July 23, 2019; Revised Sep. 15, 2019; Accepted Nov. 17, 2019; Published online Apr. 15, 2020
Acknowledgments: The authors thank Sarah Polk for her helpful contributions.
Affiliations: From the Max Planck Institute for Human Development, Center for Lifespan Psychology, Berlin, Germany (Butler, Kühn); the Center for Military Mental Health, Military Hospital Berlin, Berlin, Germany (Herr, Willmund, Zimmermann); and the University Medical Centre Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany (Gallinat, Kühn).
Competing interests: J. Gallinat has received research funding from AstraZeneca and speaker fees from Lundbeck, Janssen-Cilag, Lilly and Otsuka, outside the submitted work. K. Herr, G. Willmund and P. Zimmermann are employed by the German Armed Forces; their employment had no influence on the study design. No other competing interests were declared.
Funding: O. Butler received a PhD student stipend from the International Max Planck Research School on the Life Course (LIFE). J. Gallinat has received research funding from the German Federal Ministry of Education and Research and the German Science Foundation. S. Kühn has been funded by a Heisenberg grant from the German Science Foundation (DFG KU 3322/1-1), the European Union (ERC-2016-StG-Self-Control-677804) and the Jacobs Foundation (JRF 2016-2018). The study was funded by the Military Medical Academy of German Armed Forces, German Ministry of Defense.
Data sharing: Key data and materials have been made publicly available via the Open Science Framework and can be accessed at osf.io/xz32u, or are otherwise available from the authors on request (with the exception of questionnaire measures subject to third-party copyright or potentially identifying patient information).
Contributors: All authors designed the study. O. Butler, K. Herr, G. Willmund and S. Kühn acquired the data, which O. Butler, K. Herr, G. Willmund, J. Galllinat and S. Kühn analyzed. O. Butler, K. Herr and S. Kühn wrote the article, which all authors reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.
Correspondence to: Simone Kühn, Max Planck Institute for Human Development, Center for Lifespan Psychology, Lentzeallee 94, 14195 Berlin, Germany; firstname.lastname@example.org