Discussion
traumas, trauma, affective or cognitive elements, traumatic
EVENTS, EVENT
Results showed strong evidence that ICU staff experiencing IMs after work-related traumatic events in the COVID-19 pandemic, had fewer IMs (median = 1 per week, IQR = 0–3) when they were given access to the brief digital imagery-competing task intervention, as opposed to usual care for 4 weeks (median = 10 per week, IQR = 6–16.5) (Fig. At trial entry, participants reported a very high number of work-related traumatic events during the pandemic (on average more than 35 traumas, Supplementary Table There remains an urgent need for scalable approaches to support the mental health of frontline healthcare workers. Given their high workload demands, we developed a brief and flexible digital imagery-competing task intervention approach to reduce IMs. After one initial session with research guidance, the intervention could thereafter be used independently and was repeatable to treat different IMs (e.g. intrusive image of a dying patients face; intrusive image of colleague on ambulance stretcher; etc) and new trauma. Compared to studies on the day of trauma [Adopting new statistical approaches for RCTs is an essential step in speeding up the development of new interventions, and associated moral and ethical decisions in the use of RCTs. By utilising advances in Bayesian trial methodology in the present study to optimise the brief digital imagery-competing task intervention, we substantially reduced the sample size and therefore the time and resources needed to run the trial (Fig. In general, the practical consequences of using more efficient adaptive Bayesian trial designs to develop therapeutic approaches are clear—they can provide information rapidly to support a go/no-go clinical development decision, thus helping treatment innovation by reducing the time required to progress to subsequently assess efficacy. Here, it helped us examine the effects of a new intervention approach. Methods advances are needed given the relatively slow progress of behavioural interventions since the 1960s [In retrospect, we could have conducted an even more efficient trial. As the evidence progression shows, there was sufficient evidence (BF > 20) when 29 participants had completed the trial to conclude that there were positive effects of the intervention. However, at that point to ensure the robustness of the results we conducted a more thorough sensitivity analyses. Simultaneously, we strived for equivalent allocation to the two arms (immediate and delayed), a balancing that ultimately delayed the conclusion of the study. Such sensitivity and balancing issues can be mitigated beforehand [The current study raises numerous questions for future research. For example, further analysis is important to identify whether the improvement is linked to intervention load. Interestingly, we think it is unlikely that there is a simple correlation between more sessions and improved outcomes—rather, when the intervention works optimally it is hypothesised that the participant would only need one session with the intervention per different intrusive memory. Thus, paradoxically we may expect that fewer sessions would be related to better outcomes, and a high number of sessions to be related to those who either have difficulties with using the intervention or who have a high number of different IMs on their list. Future work could also analyse individual differences in baseline number of IMs to determine how this impacts treatment response, as well as pre-existing mental health difficulties. Again, it may be the case that treatment response is not simply determined by the overall number of baseline IMs, but rather the number of different IMs on their list (i.e. distinct images/scenes from a traumatic event). It would be of interest to add a re-administration of the intrusive memory list post-intervention at the time of the primary outcome. This would allow a test of the hypothesis that use of the intervention is associated with a change in the sensory elements in the intrusive memory descriptions (hotspots) rather than say affective or cognitive elements, indicated by recent studies in both lab [As stated in the Introduction, the disruption of visuospatial processing while memory is being stored or updated should render the memory less likely to be triggered, i.e. from becoming intrusive [There is an urgent and unmet need to develop novel approaches to support the mental health of healthcare workers to continue to manage the emotionally traumatic nature of their clinical work [