COVID-19 will induce a lot of psychological trauma
Brutal exposure to a distressing event, like death, can induce normal Post Traumatic Stress Symptoms (PTSS) that can persist after one month and define a pathological Post Traumatic Stress Disorder (PTSD) (APA, 2013). This is also true during the COVID-19 pandemic. In the Wuhan region in China, Liu et al., reported a prevalence of 7% Post Traumatic Stress Symptoms (PTSS). Including only the COVID-19-infected population, Bo et al. found a PTSS prevalence of 96.2% (Bo et al., 2020). Risk factors and preventive factors that influence symptoms and transition to PTSD are not very well understood at the moment. Holmes called for urgent action for mental health needs such as PTSD during the Pandemic (Holmes et al. 2020).
What we suggest
A smartphone application could:
(1) collect data enabling to predict and follow the evolution of PTSS toward PTSD,
(2) assess the relative efficacy of several methods to prevent the evolution of PTSS right after exposure to trauma (1-24h),
(3) educate people about psychological effects that can occur during and after trauma, normalize acute distress and suggest that they seek professional help if they experience substantial PTSS symptoms one month (or more) after the traumatic event.
What are the best strategies? We still don't know
Three solutions are considered at the moment during the acute phase (golden hours) after trauma to prevent transition from PTSS to PTSD:
(1) Tetris use,
(2) Early psychological support, or
(3) Watchful wait,
with limited evidence favouring one over another.
Tetris use, an interesting strategy to assess
Tetris use is in accordance with studies in cognitive sciences (Kavanagh et al. 2001) that show the memorization process can be influenced in the acute phase after trauma. More recent studies have focused on early intervention by administering a task within 6 h after a real-world trauma (Horsch et al., 2017; Iyadurai et al., 2017). One proof-of-principle randomised controlled study investigated mothers who had undergone an emergency caesarean section. Women who received usual care plus a cognitive task procedure involving 15 min of Tetris game-play – whilst still in their hospital bed (i.e., the same context in which the trauma occurred) – reported fewer intrusive memories (i.e., visual flashes related to the trauma) and a trend towards reduced re-experiencing symptoms after one week, compared to those who received usual care only (using intention-to-treat analysis). At one month, groups differed in PTSD diagnosis (intervention group: 4.2%, versus control group: 30.4%; using per protocol analysis) and avoidance symptoms, although these were not primary outcomes, and the sample is small.
Iyadurai et al. performed an online survey regarding participants’ willingness to receive novel treatment approaches soon after a traumatic event (N = 350) (Iyadurai et al., 2019):
80.2% would be willing to receive a treatment delivered via mobile phone.
85.7% would be willing to play a computer game for 10- 20 minutes as part of a treatment to reduce intrusive memories.
Usually, talk therapies are provided, but they should be tested
Talk therapies that evoke traumatic memories, like debriefing, are not recommended by medical literature or scientific societies in Europe and could even worsen the consequences of trauma by disturbing the memorization process (Rose et al. 2002). However, a lot of talk therapies are being organized by different psychotherapeutic societies during the pandemic, which have limited evidence base and may be delivered by insufficiently trained people (Gargot, 2017).
First, do no harm
Watchful waiting could be a very good option in the less severe cases and especially if the participant has no medical history of psychiatric disorders.
Test the prototype
Online Meeting on Tuesday April 28th 12.30 pm CEST (GMT+2) to discuss improvement of the English main questionnaire and organise translations by psychiatriy trainees of EFPT in Croatian, Lithuanian, Romanian, Spanish, Ukrainian and Russian.
Mental imagery and imaging mental disorders,
Prof Emily A Holmes, The Brain Forum, 2016
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Bo, H., Li, W., Yang, Y., Wang, Y., Zhang, Q., Cheung, T., . . . Xiang, Y. (2020). Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychological Medicine, 1-7. doi:10.1017/S0033291720000999
Gargot, T., Dondé, C., Arnaoutoglou, N. A., Klotins, R., Marinova, P., Silva, R., & Sönmez, E. (2017). How is psychotherapy training perceived by psychiatric trainees? A cross-sectional observational study in Europe. European Psychiatry, 45, 136-138.
Gustavsson, A., Svensson, M., Jacobi, F., Allgulander, C., Alonso, J., Beghi, E., ... & Gannon, B. (2011). Cost of disorders of the brain in Europe 2010. European neuropsychopharmacology, 21(10), 718-779.
Holmes, E. A., Oconnor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., … Bullmore, E. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry. doi: 10.1016/s2215-0366(20)30168-1
Horsch, A., Vial, Y., Favrod, C., Harari, M. M., Blackwell, S. E., Watson, P., ... & Holmes, E. A. (2017). Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study. Behaviour Research and Therapy, 94, 36-47.
Iyadurai, L., Blackwell, S. E., Meiser-Stedman, R., Watson, P. C., Bonsall, M. B., Geddes, J. R., ... & Holmes, E. A. (2018). Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: a proof-of-concept randomized controlled trial. Molecular psychiatry, 23(3), 674.
Iyadurai, L., Visser, R. M., Lau-Zhu, A., Porcheret, K., Horsch, A., Holmes, E. A., & James, E. L. (2019). Intrusive memories of trauma: a target for research bridging cognitive science and its clinical application. Clinical psychology review, 69, 67-82.
Kavanagh DJ, Freese S, Andrade J, May J . Effects of visuospatial tasks on desensitization to emotive memories. Br J Clin Psychol 2001; 40: 267–280.
Liu, N., Zhang, F., Wei, C., Jia, Y., Shang, Z., Sun, L., … Liu, W. (2020). Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Research, 287, 112921. doi: 10.1016/j.psychres.2020.112921
Rose, S. C., Bisson, J., Churchill, R., & Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane database of systematic reviews, (2).
Slade, E. P., Gottlieb, J. D., Lu, W., Yanos, P. T., Rosenberg, S., Silverstein, S. M., ... & Mueser, K. T. (2017). Cost-effectiveness of a PTSD intervention tailored for individuals with severe mental illness. Psychiatric services, 68(12), 1225-1231.