A randomised control trial of digital memory flexibility training (MemFlex) as a stepped care intervention for individuals with post-traumatic stress disorder (PTSD)

MemFlex: The MemFlex intervention aims to improve the ability to retrieve any autobiographical memory type on demand, using cued recall exercises. Participants are never asked to retrieve negative memories or trauma memories. In particular, the intervention trains three core skills: balancing, elaboration, and flexibility. Balancing aims to improve access to personally relevant memories that are emotionally positive. Improving ease of access to positive autobiographical information aims to balance against the negative self-appraisals that drive PTSD. Elaboration aims to increase the detail and vividness of these positive memories. Flexibility explicitly trains the ability to move between specific and general levels of memory representation. These skills are gradually introduced and build upon via eight online self-guided sessions. A 45 minute Zoom call with a support worker introduces the intervention. Participants are emailed a link to access the online sessions, which involve an initial psychoeducation component, and memory recall exercises using memory cues. In the sessions, participants are trained to recall event memories and general memories, to elaborate memories with contextual, emotional and somatic details, and to flexibly move between memory types. Participants are encouraged to complete two online, self-guided sessions (~20 mins) per week for 4 weeks, and can contact the worker with any questions. Treatment adherence is monitored by the support worker through website analytics. The worker will also check in with participants 2 weeks into the trial. MemFlex participants will be able to continue any other offered activities (e.g., medication). That is, a MemFlex+ treatment as usual (in this case, waitlist for psychiatry services at Phoenix Australia) design will be used. Amendment: Following participant feedback from the first five participants allocated to the MemFlex condition, the text of the online sessions has been reduced to enhance understanding and minimise participant burden. The core information contained in the intervention, and the intervention exercises, remain the same.