"They are no longer really flashbacks; they are memories": a qualitative study of women's experiences of a brief intervention targeting childbirth-related intrusive memories.

Introduction: Childbirth-related posttraumatic stress symptoms (CB-PTSS), including intrusive memories (CB-IM), affect a substantial proportion of mothers and can have lasting negative consequences for themselves and their families. A single-session behavioural intervention combining a childbirth memory recall in the maternity ward and a visuospatial task involving the videogame Tetris, has shown preliminary efficacy in reducing CB-IM and CB-PTSS. However, how women subjectively experience this intervention, whether they perceive it as potentially beneficial, and what mechanisms they believe may contribute to change remain unknown. This qualitative study, embedded within a multicentre single-blind waitlist-controlled randomised trial conducted in Switzerland, aimed to explore: (1) how women experienced the two components of this intervention (i.e., recall and Tetris); (2) what changes they perceived following the intervention; and (3) what mechanisms they attributed to these changes. Methods: Seventeen participants were recruited from a multicentre, single-blind, waitlist-controlled randomised trial in which they receive a single-session behavioural intervention targeting CB-IM. A maximum variation sampling strategy based on self-reported changes in CB-IM frequency following the intervention was utilised. Semi-structured interviews were realised and analysed using inductive content analysis. Results: Recalling the childbirth memory at the maternity ward was experienced as emotionally intense (i.e., stressful, destabilising), yet simultaneously meaningful for most participants. Playing Tetris elicited initial surprise or scepticism but was then experienced as engaging and soothing by most participants. Participants reported a broad range of perceived changes, most notably a reduction in CB-IM number, alongside qualitative changes in CB-IM, and greater acceptance of the childbirth memory. Perceived mechanisms of change were predominantly talking or writing about the childbirth experience. Conclusion: These findings support the broad clinical benefits of this single-session intervention for women reporting established CB-IM. This study also highlights the importance of non-specific therapeutic factors may play a meaningful role in this intervention's benefits.