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Cited by 55Posttraumatic Stress Disorder ResearchMemory Processes and InfluencesCognitive Functions and Memory

Tetris and Word games lead to fewer intrusive memories when applied several days after analogue trauma

Open access
Hagenaars, Muriel A., Holmes, Emily A., Klaassen, Fayette, Elzinga, Bernet·2017·European Journal of Psychotraumatology
DOI 10.1080/20008198.2017.1386959PMC PMC5678449
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Abstract

Background: Intrusive trauma memories are a key symptom of posttraumatic stress disorder (PTSD), so disrupting their recurrence is highly important. Intrusion development was hindered by visuospatial interventions administered up to 24 hours after analogue trauma. It is unknown whether interventions can be applied later, and whether modality or working-memory load are crucial factors.Objectives: This study tested: (1) whether a visuospatial task would lead to fewer intrusions compared to a reactivation-only group when applied after memory reactivation four days after analogue trauma exposure (extended replication), (2) whether both tasks (i.e. one aimed to be visuospatial, one more verbal) would lead to fewer intrusions than the reactivation-only group (intervention effect), and (3) whether supposed task modality (visuospatial or verbal) is a critical component (modality effect).Method: Fifty-four participants were randomly assigned to reactivation+Tetris (visuospatial), reactivation+Word games (verbal), or reactivation-only (no task). They watched an aversive film (day 0) and recorded intrusive memories of the film in diary A. On day 4, memory was reactivated, after which participants played Tetris, Word games, or had no task for 10 minutes. They then kept a second diary (B). Informative hypotheses were evaluated using Bayes factors.Results: Reactivation+Tetris and reactivation+Word games resulted in relatively fewer intrusions from the last day of diary A to the first day of diary B than reactivation-only (objective 1 and 2). Thus, both tasks were effective even when applied days after analogue trauma. Reactivation-only was not effective. Reactivation+Word games appeared to result in fewer intrusions than reactivation+Tetris (objective 3; modality effect), but this evidence was weak. Explorative analyses showed that Word games were more difficult than Tetris.Conclusions: Applying a task four days after the trauma film (during memory reconsolidation) was effective. The modality versus working-memory load issue is inconclusive.

AI snapshot

Written from the paper’s full text.

TL;DR

In a trauma-film analogue study, playing Tetris or Word games for 10 minutes after memory reactivation four days after the film led to relatively fewer intrusive memories than reactivation-only. The modality question remained inconclusive, with weak evidence that Word games were more effective than Tetris.

Key findings

  • Reactivation+Tetris resulted in relatively fewer intrusions from the last day of diary A to the first day of diary B than reactivation-only: H1 was 6.05 times more supported than H6.
  • Both tasks showed an intervention effect versus reactivation-only: H2 was 13.21 times more supported than H5, indicating reactivation+Tetris and reactivation+Word games had similar intrusion changes that were relatively lower than reactivation-only.
  • For modality, H4 (Word games fewer intrusions than Tetris) was only slightly preferred over H3, BF43 = 1.61, described as weak evidence; H2 and H4 received the strongest support against the unconstrained hypothesis (BFxu = 2.47 and 3.16).
  • Exploratory analyses found Word games were rated as more difficult than Tetris (mean difficulty 4.9 vs. 3.1; BF for Tetris less difficult = 1.94), Tetris was rated as more pleasant (8.1 vs. 7.6; BF for Tetris more pleasant = 1.56), and intrusions during the task did not clearly differ (1.9 vs. 1.9; equal-difficulty hypothesis BFcu = 1.72).

Methods

  • Sixty-one Dutch students began the study; seven were excluded, leaving N = 54 (18 per group), age range 18–41 years, 40 females, mean age 22.2 years. Participants were randomly assigned to reactivation+Tetris, reactivation+Word games, or reactivation-only.
  • On day 0, participants watched an 11.5-minute aversive road-traffic-accident film and kept intrusion diary A. On day 4, memory was reactivated with four still film images, followed by 10 minutes of Tetris, Word games, or sitting quietly; diary B then ran until day 7.
  • The main outcome was the change in intrusion frequency from the last day of diary A to the first day of diary B. Informative hypotheses were evaluated with Bayes factors in BIEMS.

Limitations

  • The paper states limitations including analogue trauma, limited sample size, intervening when intrusion numbers were low (floor effects), indirect assessment of task difficulty, and a diary A compliance difference with counterintuitive/reversed wording.
  • The text makes evident that there was no no-reactivation/no-task condition, so it cannot distinguish whether the task prevented an increase in intrusions or reactivation-only caused an increase.
  • The modality evidence was weak, and the naturalistic tasks were not pure working-memory tasks, leaving the precise verbal/visuospatial/executive demands unclear.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1080/20008198.2017.1386959

Cites

66 of 66 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 41 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Reactivation-only was not effective.

    “Reactivation-only was not effective.”
    Quote in the paperSubstantial claim
  • Findingown data

    Posterior Model Probabilities indicated that Word games being most effective of all conditions was the preferred hypothesis of all.

    “Posterior Model Probabilities also indicated that Word games being most effective of all conditions was the preferred hypothesis of all.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Tetris was rated as more pleasant than Word games.

    “Thus, it likely that Tetris was rated as more pleasant than Word games.”
    • Also stated in: § Discussion · plain
      “Participants in our study enjoyed playing Tetris more than playing Word games.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Tetris after memory reactivation four days after watching the film resulted in relatively fewer intrusive memories from the last day of diary A to the first day of diary B than reactivation-only.

    “Tetris indeed resulted relatively fewer intrusive memories than reactivation-only. That is, the participants that played Tetris after their memory of the film was reactivated four days after watching the film showed relatively fewer intrusive memories from the last day of diary A to the first day of diary B than participants who did not execute a task after their memory of the film was reactivated”
    Quote in the paperSubstantial claim
  • Findingown data

    Reactivation+Tetris resulted in relatively fewer intrusive memories from the last day of diary A to the first day of diary B than reactivation-only.

    “Reactivation+Tetris and reactivation+Word games resulted in relatively fewer intrusions from the last day of diary A to the first day of diary B than reactivation-only (objective 1 and 2).”
    • Also stated in: § Intrusive memory changes from diary A to diary B · hedged
      “For changes in intrusion frequency from diary A (last day) to diary B (first day) H1 was 6.05 times more supported than H6, indicating that reactivation+Tetris resulted in relatively fewer intrusive memories than reactivation-only”
    Quote in the paperSubstantial claim
  • May combine two claims. 34
  • Classified as probably not a substantial claim. 33
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Reactivation+Word games appeared to result in fewer intrusions than reactivation+Tetris, but this evidence was weak.

    “Reactivation+Word games appeared to result in fewer intrusions than reactivation+Tetris (objective 3; modality effect), but this evidence was weak.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    H4 and H2 received the strongest support against Hu and were the relative best hypotheses.

    “Table 4 shows H4 and H2 received the strongest support against Hu, and are therefore the relative best hypotheses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The verbal task was self-rated as more difficult and less pleasant than the visuospatial task.

    “The verbal task was self-rated as more difficult and less pleasant than the visuospatial task, which may be in line with the working memory theory and resource competition.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There is strong evidence for higher self-reported difficulty for Word games than Tetris.

    “Thus, there is strong evidence for higher self-reported difficulty for Word games than Tetris.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    H5 and H6 received less evidence than the baseline model, indicating they were highly unlikely in these data.

    “Note that H5 and H6 received less evidence than the baseline model, indicating that in these data, these hypotheses were highly unlikely.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Reactivation+Word games resulted in relatively fewer intrusions than reactivation+Tetris, with the former 1.6 times more likely than the reverse, but the evidence is weak.

    “Thus, there is some evidence that reactivation+Word games resulted in relatively fewer intrusions than reactivation+Tetris. Note however, that a Bayes factor of 1.61 reflects weak evidence, and we cannot easily distinguish between H3 and H4.”
    • Also stated in: § Discussion · plain
      “That is, having relatively fewer intrusions after playing Word games than after playing Tetris was 1.6 times more likely than the other way around (fewer intrusions after Tetris than after Word games).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The study found support for two hypotheses: visuospatial and verbal tasks were equally effective, or the verbal task was more effective than the visuospatial task.

    “Thus, we found support for two hypotheses: visuospatial and verbal tasks were equally effective, or the verbal task was more effective than the visuospatial task.”
    • Also stated in: § Discussion · hedged
      “In our case, we found most evidence for two hypotheses (Tetris and Word games are both equally effective and Word games is the most effective task), but could not distinguish between these two.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Word games were more difficult than Tetris.

    “Explorative analyses showed that Word games were more difficult than Tetris.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    H2 and H4 cannot be easily distinguished, indicating either similar intrusion frequencies for reactivation+Tetris and reactivation+Word games, or reactivation+Word games leads to relatively fewer intrusions than reactivation+Tetris.

    “Furthermore, H2 and H4 cannot be easily distinguished, indicating that either intrusion frequencies are similar for reactivation+Tetris and reactivation+Word games, or that reactivation+Word games leads to relatively fewer intrusions compared to reactivation+Tetris.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The results pointed at either both Tetris and Word games being equally difficult (intrusions during the task) or Word games (subjective ratings) being the most difficult.

    “The results pointed at either both Tetris and Word games being equally difficult (intrusions during the task) or Word games (subjective ratings) being the most difficult.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Intrusion frequencies during Tetris and Word games did not differ, but the evidence is weak and no clear conclusion can be drawn.

    “Thus, it seems that intrusion frequencies during Tetris and Word games did not differ. However, the evidence is weak and no clear conclusion can be drawn for task Difficulty as indicated by intrusions during the task.”
    • Also stated in: § Discussion · plain
      “However, task difficulty as reflected by intrusions during the tasks, was equal for both tasks.”
    • Also stated in: § Discussion · plain
      “However, there were no differences in intrusions during the task.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    For task pleasantness, the hypothesis that Tetris is more pleasant than Word games (Hb) was most supported.

    “For task pleasantness, the hypothesis that is most supported is that Tetris is more pleasant than the Word games (Hb).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was no difference in the number of intrusions experienced during playing Tetris and Word games, yet participants rated Word games as more difficult than Tetris.

    “Note that there was no difference in the number of intrusions experienced during playing Tetris and Word games, yet participants rated Word games as more difficult than Tetris.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    H4 was slightly preferred over H3 with BF43 = 1.61.

    “Finally, for the comparison of H3 and H4, H4 was slightly preferred (BF43 = 1.61).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Self-rated task difficulty was clearly higher for the verbal tasks, but the effects on subsequent intrusion frequency were not clearly stronger.

    “Also, self-rated task difficulty was clearly higher for the verbal tasks, but the effects on subsequent intrusion frequency were not clearly stronger.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    For task difficulty ratings, the hypothesis that Tetris was rated as less difficult than Word games (Ha) was most supported, with large relative evidence.

    “As can be seen in Table 5, the hypothesis that Tetris was rated as less difficult than Word games (Ha) was most supported. The relative evidence was large; Hb and Hc did not receive much support.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    For task difficulty as indicated by intrusions during the task, the hypothesis that intrusion frequencies were equal during Tetris and Word games received the highest support (BFcu = 1.74).

    “As can be seen in Table 5, the hypothesis that intrusion frequencies were equal during the two tasks received the highest support (BFcu = 1.74).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Participants were randomly assigned to one of three conditions: reactivation+Tetris, reactivation+Word games, or reactivation-only.

    “Fifty-four participants were randomly assigned to reactivation+Tetris (visuospatial), reactivation+Word games (verbal), or reactivation-only (no task).”
    • Also stated in: § Participants · plain
      “Group allocation was random.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Working memory theory implies a dose-response relationship with stronger effects for more demanding tasks, which has been found in empirical studies.

    “Moreover, working memory theory also implies a dose–response relationship with stronger effects for more demanding tasks, which has indeed been found in empirical studies (Engelhard, Van den Hout, & Smeets, 2011; Van den Hout & Engelhard, 2012).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Engelhard, Van den Hout, & Smeets, 2011

      Not checked in the free run.

    • cites Van den Hout & Engelhard, 2012

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Dual processing theories posit that dominant perceptual information processing leads to the development of intrusions.

    “Dual processing theories that distinguish perceptual and conceptual memory (Brewin, Dalgleish, & Joseph, 1996; Ehlers & Clark, 2000; Holmes & Bourne, 2008) posit that dominant perceptual information processing leads to the development of intrusions.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Brewin, Dalgleish, & Joseph, 1996

      Not checked in the free run.

    • cites Ehlers & Clark, 2000

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    • cites Holmes & Bourne, 2008

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Groups differed on diary A compliance; compliance was lower in the reactivation+Tetris and reactivation-only conditions than in the reactivation+Word games condition.

    “Groups seemed to differ on diary A compliance (BF0u = .07, i.e. difference was 14 times more likely than no difference): Compliance was lower in the reactivation+Tetris and reactivation-only control conditions than in the reactivation+Word games condition.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    According to such an interpretation of working memory theory, working memory load rather than modality is the crucial component.

    “Thus, according to such an interpretation of the working memory theory (Van den Hout & Engelhard, 2012), working memory load rather than modality is the crucial component (Gunter & Bodner, 2008).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Van den Hout & Engelhard, 2012

      Not checked in the free run.

    • cites Gunter & Bodner, 2008

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Effective preventive interventions for PTSD are lacking, although some studies have found trauma-focused Cognitive Behavioural Therapy (CBT) to be effective.

    “However, to date effective preventive interventions are lacking, although some studies have found trauma focused Cognitive Behavioural Therapy (CBT) to be effective (Roberts, Kitchiner, Kenardy, & Bisson, 2010; Rothbaum et al., 2012; Sijbrandij et al., 2007).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Roberts, Kitchiner, Kenardy, & Bisson, 2010

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    • cites Rothbaum et al., 2012

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    • cites Sijbrandij et al., 2007

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  • Classified as probably not a substantial claim.

    Premisecitation

    Memories are malleable during the consolidation phase, which is thought to end after approximately six hours.

    “Memories are malleable during the consolidation phase, which is thought to end after approximately six hours (Nader, 2003; Walker, Brakefield, Hobson, & Stickgold, 2003).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Nader, 2003

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    • cites Walker, Brakefield, Hobson, & Stickgold, 2003

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  • May combine two claims.

    Premisecitation

    A recent study found that a post-trauma intervention at 24 hours was still effective, but only if memory was activated 10 minutes before the intervention, consistent with reconsolidation processes.

    “A recent study stretched the post-trauma intervention to 24 hours post-trauma (James et al., 2015). The authors found that it was still effective, but only if memory was activated 10 minutes before the intervention, consistent with the hypothesis that reconsolidation processes are at stake here (Debiec et al., 2002; Dudai, 2004).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites James et al., 2015

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    • cites Debiec et al., 2002

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    • cites Dudai, 2004

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  • Classified as probably not a substantial claim.

    Premisecitation

    According to working memory theory, any concurrent task that taxes the central-executive component of working memory would interfere with reconsolidation, leading to reduced emotionality and vividness of the original memory.

    “Interpretations of the working memory theory in this context posit that any concurrent task that taxes the central-executive component of working memory would interfere with reconsolidation, leading to reduced emotionality and vividness of the original memory (Baddeley, 1998; Van den Hout & Engelhard, 2012).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Baddeley, 1998

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    • cites Van den Hout & Engelhard, 2012

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  • May combine two claims.

    Study design and conductown data

    The three groups seemed equal regarding age, gender, SCL-90, distress before or after the film, attention for the film, attention for the memory reactivation stills, and diary B compliance.

    “The three groups seemed equal regarding age, gender, SCL-90, Distress before or after the film, Attention for the film, Attention for the memory reactivation stills, and diary B compliance (BF0u between 1.85 and 5.96 for all variables).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    After retrieval, memories are stored again (reconsolidation); once a memory is reconsolidated, the new trace becomes stable again.

    “After retrieval, memories are stored again: reconsolidation. Once a memory is reconsolidated, the new trace becomes stable again (Dudai, 2004).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Dudai, 2004

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    An analysis plan was formulated prior to analysing and unblinding the data, specifying the analyses and primary outcome measure.

    “Prior to analysing and unblinding the data, an analysis plan was formulated that specified what analyses would be carried out and which variable would be used as a primary outcome measure.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Playing Tetris immediately after analogue trauma reduced the frequency of intrusive memories immediately, after 30 minutes, and after four hours.

    “For example, playing the computer game Tetris immediately after analogue trauma reduced the frequency of intrusive memories of the aversive film immediately (Deeprose, Zhang, Dejong, Dalgliesh & Holmes, 2012), after 30 minutes (Holmes, James, Coode-Bate, & Deeprose, 2009; Holmes, James, Kilford, & Deeprose, 2010, experiment 1), and after four hours (Holmes et al., 2010, experiment 2), as did”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Deeprose, Zhang, Dejong, Dalgliesh & Holmes, 2012

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    • cites Holmes, James, Coode-Bate, & Deeprose, 2009

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    • cites Holmes et al., 2010

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisereasoning

    Visuospatial interventions use resources needed for perceptual processing and should lead to a shift towards conceptual processing and decreased intrusions, and vice versa for verbal interventions.

    “Visuospatial interventions use resources needed for perceptual processing hence should lead to a shift towards conceptual processing and decreased intrusions, and vice versa for verbal interventions.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    Findings on verbal tasks are less consistent; verbal interventions increased intrusion frequencies in some studies but not others, and were also found to decrease intrusion frequency.

    “The findings on verbal tasks are less consistent.”
    • Also stated in: § Abstract · plain
      “Verbal interventions increased intrusion frequencies in some studies (counting backwards in threes/sevens: Bourne, Frasquilho, Roth, & Holmes, 2010, exp 2; Holmes et al., 2004; Pub quiz: Holmes et al., 2010, exp 1), but not in others”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Bourne, Frasquilho, Roth, & Holmes, 2010

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    • cites Holmes et al., 2004

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    • cites Holmes et al., 2010

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  • Classified as probably not a substantial claim.

    Premisecitation

    Intrusive trauma memories are a key symptom of posttraumatic stress disorder (PTSD).

    “Intrusive trauma memories are a key symptom of posttraumatic stress disorder (PTSD), so disrupting their recurrence is highly important.”
    • Also stated in: § Abstract · plain
      “PTSD is a disorder characterized by intrusive memories, avoidance, and negative alterations in cognitions, mood, arousal, and reactivity (American Psychiatric Association, 2013).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites American Psychiatric Association, 2013

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In James et al. (2015), participants in a no-reactivation/no-task group had similar intrusion frequencies in the days following the intervention as those in a reactivation/no-task condition, suggesting that no task with or without reactivation has the same effect.

    “Such a condition was included in a previous study that investigated intrusion development in the reconsolidation phase (James et al., 2015). It was found that participants in a no-reactivation/no-task group had similar intrusion frequencies in the days following the intervention as those in a reactivation/no-task condition, suggesting that no task with or without reactivation has the same effect.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites James et al., 2015

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationown data

    The reversed and counterintuitive wording of the answering scale might have elicited mistakes in scoring this question, indicated by two participants scoring extreme non-compliance on diary A only.

    “Also, the reversed and counterintuitive wording of the answering scale might have elicited mistakes in scoring this question, which might be indicated by the fact that two participants scored extreme non-compliance on diary A only.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The study has limitations including the use of analogue trauma, limited sample size, and intervening when intrusion numbers are low (floor effects).

    “Our study has several limitations, such as the use of analogue trauma, limited sample size, and intervening when intrusion numbers are low (floor effects).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The trauma film paradigm produces intrusive memories that are a valid analogue for real trauma.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Participants were assessed within a certain time window to limit between-subject variation in day-length before and after the intervention.

    “They were assessed within a certain time window (e.g. not in the evening or early morning) to limit between-subject variation in day-length before and after the intervention.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    This would explain the increase in intrusions after the task in the reactivation-only control group, as well as the fast decline in the succeeding days (re-extinction).

    “This would explain the increase in intrusions after the task in the reactivation-only control group, as well as the fast decline in the succeeding days (re-extinction).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    There was a difference in diary compliance.

    “Finally, we found a difference in diary compliance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Seven participants were excluded from analyses, leaving 18 participants in each group (N = 54).

    “These seven participants were excluded from analyses leaving 18 participants in each group (N = 54).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationown data

    The word games used here seem adequate in terms of effect on intrusions and are thought to tap into conceptual processing, though experimental tests are lacking.

    “Note that the word games used here seem adequate in terms of effect on intrusions and are thought to tap into conceptual processing, though experimental tests are lacking in this respect.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The word games task taps conceptual or verbal processing.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The pre-to-post increase in distress was calculated as a manipulation check because distress should increase after watching the film in all conditions.

    “Specifically, the pre to post increase in distress was calculated as a manipulation check because in all conditions the distress should increase after watching the film (Clark, Mackay, & Holmes, 2015).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Clark, Mackay, & Holmes, 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning

    Task difficulty was explored as an explanatory factor because working memory theories predict that resource competition is stronger for more demanding tasks, and thus effects would be larger.

    “Task difficulty was explored as an explanatory factor, because working memory theories would predict that resource competition is stronger for more demanding tasks, and thus effects would be larger.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Other mechanisms may be at stake besides cognitive load and modality.

    “That is, other mechanisms may be at stake besides cognitive load and modality.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The difference in diary compliance was in diary A, when participants were not yet allocated to a condition.

    “Note that this was in diary A, when participants were not yet allocated to a condition.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Either subjective difficulty ratings do not reflect actual difficulty levels, or intrusions during the task are not a good indicator for task difficulty, or difficulty is not a uniform concept.

    “Thus, either subjective difficulty ratings do not reflect actual difficulty levels, or intrusions during the task are not a good indicator for task difficulty (e.g. they could also be affected by task pleasantness), or difficulty is not a uniform concept.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The finding that Tetris after reactivation reduced intrusions is in line with previous findings and may indicate that visuospatial tasks may be quite strong in influencing memory (re)consolidation.

    “Our finding is in line with previous findings and may indicate that visuospatial tasks may be quite strong in influencing memory (re)consolidation.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The memory reactivation procedure engaged the reconsolidation window.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Limited evidence suggests that the end of the reconsolidation window is likely to be around six hours, but the neurobiology of reconsolidation is largely unknown and does not allow estimations about the start of such a window.

    “Limited evidence suggests that the end of the reconsolidation window is likely to be around six hours, but the neurobiology of reconsolidation is largely unknown and not allowing estimations about the start of such a window (e.g. Horne, Rodriguez, Wright, & Padilla, 1997; Rodriguez, Horne, & Padilla, 1999; Sara, 2000).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Horne, Rodriguez, Wright, & Padilla, 1997

      Not checked in the free run.

    • cites Rodriguez, Horne, & Padilla, 1999

      Not checked in the free run.

    • cites Sara, 2000

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationown data

    The fact that the visuospatial task was rated as more pleasant may hint at another mechanism that merits further exploration.

    “The fact that the visuospatial task was rated as more pleasant may hint to another mechanism that merits further exploration.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Both tasks could have worked as distractors, thereby interfering with perceptual processing, and leading to fewer intrusions.

    “In that light, both tasks could have worked as distractors, thereby interfering with perceptual processing, and leading to fewer intrusions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Naturalistic tasks as ours may draw on multiple modalities, so it is unclear precisely what balance of verbal, visuospatial and executive resources were being used to perform the task.

    “Naturalistic tasks as ours (rather than pure working memory or pure verbal tasks) may also draw on multiple modalities so it is unclear as yet precisely what balance of verbal, visuospatial and executive resources were being used to perform the task.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Task difficulty was assessed indirectly.

    “Additionally, task difficulty was assessed indirectly.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Naturalistic tasks as used here are not pure working memory tasks, so it is unknown how truly verbal the word games task was, as it can also draw on visuospatial strategies.

    “Further, naturalistic tasks as we used here are not pure working memory tasks, so we do not know for example how truly verbal the word games tasks was, as clearly it can also draw on visuospatial strategies – work calibrating the precise working memory demands of these tasks is needed before strong claims about modality could be made.”
    Quote in the paperNot a substantial claim
53 of 53

  • The paper relies on this without support.

    It is unknown whether interventions can be applied later than 24 hours after analogue trauma, and whether modality or working-memory load are crucial factors.

    “It is unknown whether interventions can be applied later, and whether modality or working-memory load are crucial factors.”

  • The paper relies on this without support.

    In daily life, interventions may not be administered within a few hours or even 24 hours after actual trauma, but may more readily be applied later when the trauma memory is already consolidated.

    “In daily life, interventions may not be administered within a few hours – or even 24 hours – after actual trauma. However, they may more readily be applied later, when the trauma memory is already consolidated.”

  • The paper relies on this without support.

    The four still film images shown in session 2 activated the memory of the film.

    “These stills were meant to activate the memory of the film, but there was no explicit instruction of reactivating the memory.”

  • The paper relies on this without support.

    The trauma film is an analogue of real trauma and participants are healthy, so effects are expected to be small.

    “We expected small effects, given that the trauma film is analogue of real trauma and participants are healthy, and intrusions usually diminish quickly over time after watching an aversive film.”

  • The authors state this as an assumption.

    The memory reactivation procedure engaged the reconsolidation window.

    “In sum, this study was the first to investigate the effects of two tasks applied four days after analogue trauma, after memory reactivation (i.e. proposedly having an impact during the reconsolidation window).”

  • The paper relies on this without support.

    The word games task taps conceptual or verbal processing.

    “Note that the word games used here seem adequate in terms of effect on intrusions and are thought to tap into conceptual processing, though experimental tests are lacking in this respect.”

  • The paper relies on this without support.

    The trauma film paradigm produces intrusive memories that are a valid analogue for real trauma.

    “Our study has several limitations, such as the use of analogue trauma, limited sample size, and intervening when intrusion numbers are low (floor effects).”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A word game and counting backwards in 3s are effective in reducing intrusions.

    “Other tasks that at face value do not appear to be visuospatial have been found to be effective in reducing intrusions too, such as a word game (Hagenaars, Holmes, Klaassen, & Elzinga, 2017) and counting backwards in 3′s (Krans, Näring, & Becker, 2009).”

    From Intrusive memories of trauma: A target for research bridging cognitive science and its clinical application (2019) · cites this paper as Hagenaars, Holmes, Klaassen, & Elzinga, 2017

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Intrusion-difficulty Bayes factor differs from Table 5

    Minor

    The text reports BFcu = 1.74 for equal intrusion frequencies during the tasks, whereas Table 5 gives 1.72 for that hypothesis.

  • Pleasantness comparison reverses the reported Bayes factors

    Minor

    The text says equal pleasantness received less support than Ha, but Table 5 reports a Bayes factor of 1.20 for equal pleasantness (Hc) and .42 for Ha.

  • Intrusion-based difficulty hypothesis has the opposite direction

    Minor

    Table 5 defines Ha as fewer intrusions during Tetris than during Word games. Its note says Ha indicates that Tetris is less difficult, as shown by more intrusions during Tetris; those directions are opposite.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. 10.1016/j.jtep.2010.09.004 · DOI
  2. Lang P. J., 1997, Attention and orienting: Sensory and motivational processes, 97
  3. Steil R. I, 1996, Posttraumatische intrusionennach verkehrsunfa¨ llen [posttraumatic intrusions after road traffic accidents]

Cited by

Sorted by citations

Related

Authors
Hagenaars, M. A., Holmes, E. A., Klaassen, F., & Elzinga, B.
Affiliations
  • Leiden University (NL)
  • Karolinska Institutet (SE)
  • Utrecht University (NL)
Corresponding author
Hagenaars, Muriel A.
ORCID
Venue
European Journal of Psychotraumatology
Publisher
Informa UK Limited
Published
2017-10-31
Volume
8
Issue
sup1
Pages
1386959-1386959
ISSN
2000-8066 (ISSN-L)
DOI
10.1080/20008198.2017.1386959
PMC
PMC5678449
OpenAlex
W2766832789
Cited by
52
References
66
Citations by year
2026: 4 · 2025: 6 · 2024: 6 · 2023: 8 · 2022: 6 · 2021: 5 · 2020: 4 · 2019: 8 · 2018: 4 · 2017: 1
FWCI
5.77
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Psychotraumatology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Apollo (cc-by)
Funders
  • Medical Research Council (MC-A060-5PR50)
  • Dutch Scientific Organization (#451-09-018)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
Keywords
intrusive memories, post-traumatic stress disorder, Tetris, word games, visuospatial tasks, verbal tasks, memory reactivation, memory reconsolidation, working memory load, task modality

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

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