The pen-and-paper tube figures mental rotation task for patients with trauma-related disorders: a randomized controlled trial

Introduction: Most patients with trauma-related disorders have intrusive memories (IMs) of trauma. Recently a new type of digital treatment (imagery-competing task intervention; ICTI) has been shown to reduce the rate of IMs and other symptoms. Here we examine a novel pen-and-paper ICTI called ‘Tube figures’ suitable for settings without digital resources.Methods and analysis: Forty patients with trauma-related disorders participated in a mono-centre, single-blind randomized controlled trial with two parallel arms (Intervention: Tube figures ICTI vs. Control: Wikipedia). Participants selected one IM to monitor daily for four weeks. After two weeks, a single intervention or control session was administered for the monitored IM. Primary outcome was the frequency of the IM monitored per week for the two weeks following the intervention. A mixed Poisson regression was fitted with intervention and study phase (baseline/pre- and post-intervention) as fixed effects and a random effect for patient. Severity of symptoms at study start and two weeks after randomization was assessed with the PTSD Checklist for DSM-5 (PCL-5).Results: The frequency of the monitored IM per week reduced significantly more after the intervention versus control (22% versus 2% reduction in the two weeks post-intervention compared to two weeks pre-intervention, respectively). PCL-5 score reduced significantly more after intervention (53–38) than control (55–47).Discussion: This single-session pen-and-paper Tube figures ICTI reduced IM frequency and trauma-related symptoms, consistent with digital ICTI studies. Limitations include the reliance on self-report measures and only having data for the two weeks after intervention. Future studies should explore the different components of the intervention and test practical aspects that could promote its use in low-resource settings.