Visuospatial imagery-competing task interventions for reducing intrusive memories following real-world trauma: a systematic review and meta-analysis
4 affiliations
- 1College of Medicine, Qassim University
- 2College of Medicine, King Saud bin Abdulaziz University for Health Sciences
- 3Department of Psychiatry, Eradah Mental Health Hospital
- 4Department of Psychiatry, College of Medicine, Qassim University
Abstract
Background: Intrusive memories are a hallmark of PTSD and predict its course, making the early post-trauma period a critical window for prevention. Visuospatial imagery-competing task interventions (ICTI) — brief Tetris-like gameplay after a memory reactivation cue — are grounded in the working memory interference hypothesis and show strong laboratory effects. The only prior RCT synthesis in real-world trauma identified three eligible studies, all rated low certainty. No pre-registered review has synthesised RCT evidence for visuospatial ICTI exclusively in real-world trauma using intrusive memory frequency as the primary outcome.
Objectives: To estimate the pooled effect of visuospatial ICTI on intrusive memory frequency in real-world trauma; examine whether an explicit memory reactivation cue moderates this effect; evaluate effects on PTSD severity, depression, anxiety, adverse events, and attrition; and identify gaps to inform future trial design.
Methods: Seven databases were searched from inception to March 2026 for RCTs of visuospatial ICTI in adults exposed to real-world DSM-5 Criterion A trauma. The primary outcome was intrusive memory frequency via prospective daily diary. Risk of bias was assessed with RoB 2 and ROBINS-I, certainty with GRADE. Random-effects meta-analysis pooled raw mean differences for parallel-group RCTs with compatible diary data. Registered on PROSPERO (CRD420261336501); reported per PRISMA 2020.
Results: Of 818 records identified, 13 studies (9 RCTs, 4 non-randomised) met eligibility criteria. Five parallel-group RCTs (n=359) were pooled for the primary outcome: ICTI reduced intrusive memories by 6.98 fewer episodes/week versus control (95% CI −9.84 to −4.13; I ² = 21.9%), moderate-certainty evidence (downgraded for risk of bias). PTSD severity also favoured ICTI (MD −2.42, 95% CI −4.40 to −0.44), low certainty due to inconsistency and indirectness. Depression and anxiety could not be meta-analysed due to measurement heterogeneity. No serious adverse events were attributed to ICTI; attrition was generally low. Non-pooled evidence was broadly consistent, though one VR-based trial and one crossover trial in chronic PTSD found no benefit.
Conclusions: Visuospatial ICTI produces a clinically interpretable, moderate-certainty reduction in intrusive memory frequency after real-world trauma, with low-certainty but favourable effects on PTSD severity. The evidence base remains limited to five pooled RCTs. ICTI should be considered a promising targeted intervention rather than an established treatment, pending larger independent trials.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261336501 , identifier CRD420261336501.
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BibTeX
@article{allahim2026visuospatial,
title = {{Visuospatial imagery-competing task interventions for reducing intrusive memories following real-world trauma: a systematic review and meta-analysis}},
author = {Moayed A. Allahim and Sultan A. Alsallal and Ibrahim A. Almohaimeed and Abdulmajeed A. Alfouzan and Ali S. Alrashed and Rena Y. Abualjamal and Mohammed F. Alharbi and Abdullah N. Alqifari},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1925949},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1925949/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Visuospatial imagery-competing task interventions for reducing intrusive memories following real-world trauma: a systematic review and meta-analysis
AU - Moayed A. Allahim
AU - Sultan A. Alsallal
AU - Ibrahim A. Almohaimeed
AU - Abdulmajeed A. Alfouzan
AU - Ali S. Alrashed
AU - Rena Y. Abualjamal
AU - Mohammed F. Alharbi
AU - Abdullah N. Alqifari
PY - 2026
DA - 2026/10/13
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1925949
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1925949/full
AB - Background: Intrusive memories are a hallmark of PTSD and predict its course, making the early post-trauma period a critical window for prevention. Visuospatial imagery-competing task interventions (ICTI) — brief Tetris-like gameplay after a memory reactivation cue — are grounded in the working memory interference hypothesis and show strong laboratory effects. The only prior RCT synthesis in real-world trauma identified three eligible studies, all rated low certainty. No pre-registered review has synthesised RCT evidence for visuospatial ICTI exclusively in real-world trauma using intrusive memory frequency as the primary outcome. Objectives: To estimate the pooled effect of visuospatial ICTI on intrusive memory frequency in real-world trauma; examine whether an explicit memory reactivation cue moderates this effect; evaluate effects on PTSD severity, depression, anxiety, adverse events, and attrition; and identify gaps to inform future trial design. Methods: Seven databases were searched from inception to March 2026 for RCTs of visuospatial ICTI in adults exposed to real-world DSM-5 Criterion A trauma. The primary outcome was intrusive memory frequency via prospective daily diary. Risk of bias was assessed with RoB 2 and ROBINS-I, certainty with GRADE. Random-effects meta-analysis pooled raw mean differences for parallel-group RCTs with compatible diary data. Registered on PROSPERO (CRD420261336501); reported per PRISMA 2020. Results: Of 818 records identified, 13 studies (9 RCTs, 4 non-randomised) met eligibility criteria. Five parallel-group RCTs (n=359) were pooled for the primary outcome: ICTI reduced intrusive memories by 6.98 fewer episodes/week versus control (95% CI −9.84 to −4.13; I ² = 21.9%), moderate-certainty evidence (downgraded for risk of bias). PTSD severity also favoured ICTI (MD −2.42, 95% CI −4.40 to −0.44), low certainty due to inconsistency and indirectness. Depression and anxiety could not be meta-analysed due to measurement heterogeneity. No serious adverse events were attributed to ICTI; attrition was generally low. Non-pooled evidence was broadly consistent, though one VR-based trial and one crossover trial in chronic PTSD found no benefit. Conclusions: Visuospatial ICTI produces a clinically interpretable, moderate-certainty reduction in intrusive memory frequency after real-world trauma, with low-certainty but favourable effects on PTSD severity. The evidence base remains limited to five pooled RCTs. ICTI should be considered a promising targeted intervention rather than an established treatment, pending larger independent trials. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261336501 , identifier CRD420261336501.
SN - 1664-0640
ER -