학술논문
Reducing intrusive memories after trauma via an imagery-competing task intervention in COVID-19 intensive care staff: a randomised controlled trial.
Document Type
Academic Journal
Author
Iyadurai L; P1vital Products Ltd, Wallingford, Oxfordshire, UK.; Highfield J; Intensive Care Society, 7-9- Breams Buildings, London, UK.; Kanstrup M; Department of Psychology, Uppsala University, Uppsala, Uppsala County, Sweden.; Markham A; P1vital Products Ltd, Wallingford, Oxfordshire, UK.; Ramineni V; P1vital Products Ltd, Wallingford, Oxfordshire, UK.; Department of Psychology, Uppsala University, Uppsala, Uppsala County, Sweden.; Guo B; NIHR ARC East Midlands, University of Nottingham, Nottingham, UK.; Jaki T; MRC Biostatistics Unit, University of Cambridge, Cambridge, Cambridgeshire, UK.; University of Regensburg, Regensburg, Bavaria, Germany.; Kingslake J; P1vital Products Ltd, Wallingford, Oxfordshire, UK.; Goodwin GM; Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK.; Summers C; Heart and Lung Research Institute, University of Cambridge, Cambridge, Cambridgeshire, UK.; Bonsall MB; Department of Biology, University of Oxford, Oxford, Oxfordshire, UK.; Holmes EA; Department of Psychology, Uppsala University, Uppsala, Uppsala County, Sweden. emily.holmes@psyk.uu.se.
Source
Publisher: Nature Pub. Group Country of Publication: United States NLM ID: 101562664 Publication Model: Electronic Cited Medium: Internet ISSN: 2158-3188 (Electronic) Linking ISSN: 21583188 NLM ISO Abbreviation: Transl Psychiatry Subsets: MEDLINE
Subject
Language
English
Abstract
Intrusive memories (IMs) after traumatic events can be distressing and disrupt mental health and functioning. We evaluated the impact of a brief remotely-delivered digital imagery-competing task intervention on the number of IMs for intensive care unit (ICU) staff who faced repeated trauma exposure during the COVID-19 pandemic using a two-arm, parallel-group, single-blind randomised controlled trial, with the comparator arm receiving delayed access to active treatment (crossover). Eligible participants worked clinically in a UK NHS ICU during the pandemic and had at least 3 IMs of work-related traumatic events in the week before recruitment. Participants were randomly assigned (1:1) to immediate (weeks 1-4) or delayed (weeks 5-8) intervention access. Sequential Bayesian analyses to optimise the intervention and increase trial efficiency are reported elsewhere [1]. The primary endpoint for the pre-specified frequentist analysis of the final study population compared the number of IMs experienced in week 4 between the immediate and delayed access arms. Secondary outcomes included clinical symptoms, work functioning and wellbeing. Safety was assessed throughout the trial by scheduled questions and free report. All analyses were undertaken on an intention-to-treat basis (86 randomised participants). There were significantly fewer intrusive memories during week 4 in the immediate (median = 1, IQR = 0-3, n = 43), compared to the comparator delayed arm (median = 10, IQR = 6-17, n = 43), IRR 0.31, 95% CI: 0.20-0.48, p < 0.001. After crossover, the delayed arm also showed a significant reduction in IMs at week 8 compared to week 4. There were convergent findings for symptoms of PTSD, insomnia and anxiety, work engagement and burnout, general functioning and quality of life. The intervention was found safe and acceptable to participants. All adverse events were unrelated to the study. Our study provides the first evidence of a benefit on reducing IMs, improving other clinical symptoms, work functioning and wellbeing, as well as safety of a brief remotely-delivered digital imagery-competing task intervention. An efficacy trial with an active control and longer follow-up is warranted. The trial is registered at ClinicalTrials.gov (NCT04992390).
(© 2023. Springer Nature Limited.)
(© 2023. Springer Nature Limited.)