Exploring healthcare workers’ experiences of a simple intervention to reduce their intrusive memories of psychological trauma: an interpretative phenomenological analysis

ABSTRACT

Background: Many healthcare workers (HCWs) endured psychologically traumatic events at work during the coronavirus disease 2019 (COVID-19) pandemic. For some, these events are re-experienced as unwanted, recurrent, and distressing intrusive memories. Simple psychological support measures are needed to reduce such symptoms of post-traumatic stress in this population. A novel intervention to target intrusive memories, called an imagery-competing task intervention (ICTI), has been developed from the laboratory. The intervention includes a brief memory reminder cue, then a visuospatial task (Tetris® gameplay using mental rotation instructions for approximately 20 min) thought to interfere with the traumatic memory image and reduce its intrusiveness. The intervention has been adapted and evaluated in a randomized controlled trial (RCT) with Swedish HCWs (ClinicalTrials.gov identifier: NCT04460014).

Objective: We aimed to explore how HCWs who worked during the COVID-19 pandemic experienced the use of a brief intervention to reduce their intrusive memories of work-related trauma.

Method: Interpretative phenomenological analysis was used for in-depth understanding of the lived experiences of HCWs who used the intervention. Seven participants from the RCT were interviewed by an independent researcher without prior knowledge of the intervention. Interviews were conducted via telephone and transcribed verbatim.

Results: Four general themes were generated: ‘Triggers and troublesome images’, ‘Five Ws regarding support – what, when, why, by/with who, for whom’, ‘Receiving it, believing it, and doing it’ and ‘The intervention – a different kind of help’; the last two included two subthemes each. The results reflect participants’ similarities and differences in their lived experiences of intrusive memories, support measures, and intervention impressions and effects.

Conclusion: HCWs’ experiences of the novel ICTI reflect a promising appraisal of the intervention as a potential help measure for reducing intrusive memories after trauma, and gives us a detailed understanding of HCWs’ needs, with suggestions for its adaption for future implementation.

Trial registration: ClinicalTrials.gov identifier: NCT04460014.

HIGHLIGHTS

• Many healthcare workers experience images or ‘flashbacks’ of traumatic experiences from their work during the COVID-19 pandemic.

• To ensure that individual needs are met, there is a need to tailor and refine current psychological support measures and their use for healthcare workers.

• The imagery-competing task intervention was perceived as acceptable, indicating its potential utility as a help measure to reduce intrusive memories after trauma.

Antecedentes: Los trabajadores de la salud (HCW, por sus siglas en inglés) sufrieron eventos psicológicamente traumáticos en el trabajo durante la pandemia por COVID-19. Para algunos, estos acontecimientos se vuelven a experimentar como recuerdos intrusivos no deseados, recurrentes y angustiosos. Se necesitan medidas simples de apoyo psicológico para reducir estos síntomas de estrés postraumático en esta población. En el laboratorio se ha desarrollado una nueva intervención para abordar los recuerdos intrusivos, conocida como Intervención de Tareas Competitivas de Imágenes (ICTI, por sus siglas en inglés). La intervención incluye una breve señal de recordatorio de la memoria, luego una tarea visoespacial (juego de Tetris® que utiliza instrucciones de rotación mental durante aproximadamente 20 minutos) que se cree que interfiere con la imagen de la memoria traumática y reduce su intrusión. La intervención se ha adaptado y evaluado recientemente en un ECA (ensayo controlado aleatorizado) con trabajadores sanitarios suecos (identificador de ClinicalTrials.gov: NCT04460014). Aquí nuestro objetivo es explorar cómo los participantes del ECA experimentaron la nueva intervención.

Objetivo: Explorar cómo los trabajadores sanitarios que trabajaron durante la pandemia por COVID-19 experimentaron el uso de una intervención breve para reducir sus recuerdos intrusivos del trauma relacionado con el trabajo.

Método: Se utilizó un análisis fenomenológico interpretativo para comprender en profundidad las experiencias vividas por los trabajadores sanitarios que utilizaron la intervención. Siete participantes del ECA fueron entrevistados por un investigador independiente sin conocimiento previo de la intervención. Las entrevistas se realizaron por teléfono y se transcribieron palabra por palabra.

Resultados: Se generaron cuatro temas generales, ‘Desencadenantes e imágenes problemáticas’, ‘Cinco preguntas sobre el apoyo: qué, cuándo, por qué, por/con quién, para quién’, ‘Recibirlo, creerlo y hacerlo’ y ‘La intervención. – una ayuda diferente’, los dos últimos incluían dos subtemas cada uno. Los resultados reflejan similitudes y diferencias de los participantes en sus experiencias vividas de recuerdos intrusivos, medidas de apoyo e impresiones y efectos de la intervención.

Conclusión: Las experiencias de los trabajadores sanitarios con el nuevo ICTI reflejan una evaluación prometedora de la intervención como una posible medida de ayuda para reducir los recuerdos intrusivos después del trauma, y nos brinda una comprensión detallada de las necesidades de los trabajadores sanitarios, con sugerencias sobre cómo adaptarse para una implementación futura.

KEYWORDS:

• COVID-19
• healthcare staff
• digital intervention
• intrusive memories
• trauma
• qualitative study
• lived experiences
• interpretative phenomenological analysis

PALABRAS CLAVE:

• COVID-19
• personal sanitario
• intervención digital
• recuerdos intrusivos
• trauma
• estudio cualitativo
• experiencias vividas
• análisis fenomenológico interpretativo

Acknowledgements

We thank Mia Svantesson for facilitating the collaboration between LJ and the team, and Siri Hansen for her data verification of the transcriptions and translation of quotations.

Disclosure statement

The authors declare the following competing interests. EAH receives funding from the Wellcome Trust (223016/Z/21/Z), the Oak Foundation (OCAY-18-442), and Rannís The Icelandic Research Fund; received a salary partly funded by the Wellcome Trust (223016/Z/21/Z) via a consultancy to P1vital Products Ltd; developed the trademarked imagery competing task intervention and know-how in using it over the last 20 years (ANEMONE™); is on the Board of Trustees of the MQ Foundation; and reports book royalties from Guildford Press and Oxford University Press, occasional honoraria for conference keynotes and clinical workshops, and occasional consultancy fees from the Swedish agency for health technology assessment and assessment of social services. No potential conflict of interest was reported by the remaining authors.

Author contributions

The study was conceived by MK and EAH. The interview template was developed by MK and LJ. The data collection was performed by LJ with input from SAP. Transcription was done by SAP, and data analysis and interpretation were conducted by SAP and MK. SAP and MK drafted the paper. All authors provided critical revisions and approved the final version of the paper.

Data availability statement

To protect participants’ anonymity, individual participant data such as demographics are kept at the aggregate level only. Sharing of raw data and interview transcripts were not part of the ethical approval and thus these will not be shared. The interview template can be found in the Supplemental Material.

Additional information

Funding

This project was primarily supported by grants to EAH from AFA Insurance [AFA Försäkring; Grant number 200342] and the Swedish Research Council [2020-00873]. Funders were not involved in the study design, collection, analysis, and interpretation of data; writing of the paper; and/or decision to submit this report for publication.