JMIR Publications

ABSTRACT

Background:

Frontline healthcare staff are frequently exposed to traumatic events as part of their work. Although this study commenced prior to the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many healthcare staff report intrusive memories of such events, which can elicit distress, affect functioning, and be associated with post-traumatic stress disorder (PTSD) symptoms in the long term. We need evidence-based interventions that are brief, preventative, non-stigmatising, suitable for the working lives of frontline healthcare staff, and effective for repeated trauma exposure. A brief guided imagery-competing task intervention, involving a trauma reminder cue and Tetris gameplay, may hold promise in this regard, given evidence that it can prevent and reduce the number of intrusive memories following trauma across various settings.

Objective:

The current case series aimed to (i) investigate the impact of a brief imagery-competing task intervention on the number of intrusive memories, general functioning, and symptoms of post-traumatic stress, anxiety, and depression, and (ii) examine the feasibility and acceptability of the intervention for UK NHS frontline healthcare staff. The intervention was delivered with guidance from a clinical psychologist.

Methods:

We recruited 12 clinical staff from the UK National Health Service (NHS), specifically from emergency departments (ED), the intensive care unit (ICU) and the ambulance service. We evaluated the intervention using an AB single-case experimental design, where the baseline (A) was the monitoring-only phase, and the post-intervention (B) period was the time after the intervention was first administered. Methods were adapted once the pandemic began.

Results:

There was a decrease (59%) in the mean number of intrusive memories per day from baseline (M=1.29) to post-intervention (M=0.54). There was a statistically significant reduction in the number of intrusive memories from baseline to post-intervention, as shown by an aggregated omnibus analysis with a small effect size (Tau-U=-0.38, P<.001). Depression, anxiety, and post-traumatic stress symptoms all significantly reduced from pre-intervention to post-intervention. Participants also reported improvements in functioning based on both quantitative and qualitative measures. The intervention was feasible to deliver and rated as acceptable by participants.

Conclusions:

These preliminary findings suggest that this brief therapist-guided imagery-competing task intervention offers a potential approach to mitigating the impact of work-related traumatic events in frontline healthcare staff, both during a pandemic and beyond. Randomised controlled trials will be an important next step.