Moving Forward from Moral Injury: A Mixed Methods Study Investigating the Use of 3MDR for Treatment-Resistant PTSD.

BACKGROUND: Exposure to trauma and potentially morally injurious events may lead to moral injury (MI). The link between MI and posttraumatic stress disorder (PTSD) may have particularly relevant implications for treatment-resistant PTSD (TR-PTSD). Multi-modal Motion-Assisted Memory Desensitization and Reconsolidation (3MDR), a technology-assisted exposure-based trauma therapy that has been used in the treatment of PTSD, may also be an acceptable modality for patients in the treatment of TR-PTSD and MI. This proof-of-concept study aimed to investigate (1) whether MI co-occurs in military members (MMs) and veterans with TR-PTSD, and (2) the perspectives of MMs and veterans with TR-PTSD utilizing 3MDR for MI. METHODS: This study employed a mixed-methods clinical trial. Military Members and veterans participated in this study (N = 11) through self-reported questionnaires, video recordings of treatment sessions, and semi-structured interviews post-session and post-intervention, with longitudinal follow-up to 6 months. RESULTS: MI scores correlated with self-reported measures of mental health symptoms related to PTSD. The thematic analysis revealed three emergent themes: (1) Realities of War, (2) Wrestling Scruples, and (3) Moral Sensemaking. CONCLUSION: MI was highly correlated with TR-PTSD and themes regarding MI. This result, while preliminary, allows for the postulation that MI may be contributing to the continuation of PTSD symptoms in TR-PTSD, and that 3MDR may be an acceptable modality for addressing these symptoms in MMs and veterans.

Therapist and operator experiences utilizing multi-modal motion-assisted Memory Desensitization and Reconsolidation (3MDR) for treatment of combat related posttraumatic stress disorder amongst military and veteran populations.

Background: As provisions of mental healthcare services to military and veteran populations increases the risk to service providers developing secondary traumatic stress (STS), efforts are needed to examine the impact of delivering novel interventions which may include 3MDR. As a virtual-reality supported intervention, 3MDR exposes the patient, therapist and operator to graphic and sensory stimuli (i.e. narratives, imagery, smells, and music) in the course of the intervention. 3MDR is actively being researched at multiple sites internationally within military and veteran populations. It is, therefore, crucial to ensure the safety and wellbeing of 3MDR therapists and operators who are exposed to potentially distressing sensory stimuli. Objective: The purpose of this study is to qualitatively examine the impact and experiences of STS amongst therapists and operators in delivering 3MDR. For this study, impact will be defined as therapists or operators experiencing perceived STS as a result of delivering 3MDR. Methods: This exploratory qualitative study recruited 3MDR therapists and operators (N = 18) from Canada, the Netherlands, the United Kingdom, and the United States who had previously delivered 3MDR therapy. Telephone or video-conferencing interviews were used to gather data that was subsequently transcribed and thematically analyzed. Results: Four themes emerged among the therapists (n = 13) and operators (n = 5): (1) personal cost and benefits of 3MDR, (2) professional paradox of a 3MDR therapist, (3) perceived effect of 3MDR on patients, and (4) recommendations for future 3MDR use. Conclusions: STS was not noted to be a significant challenge for 3MDR therapists and operators. Future research may investigate optimal means of providing training and ongoing support for 3MDR therapists and operators. HIGHLIGHTS: Secondary Traumatic Stress was not noted to be a significant challenge for 3MDR therapists and operatorsFuture research may investigate optimal means of providing training and ongoing support for 3MDR therapists and operators.

Antecedentes: Dado que la prestación de servicios de atención en salud mental a poblaciones de militares y veteranas aumenta el riesgo de que los proveedores de la atención desarrollen estrés traumático secundario (STS en sus siglas en inglés), se requieren esfuerzos para examinar el impacto de la entrega de intervenciones novedosas que pueden incluir 3MDR. Una intervención de apoyo de realidad virtual, 3MDR expone al paciente, terapeuta y operador a estímulos sensoriales y gráficos (es decir, narrativas, imágenes, olores y música) en el transcurso de la intervención.3MD está siendo investigada activamente en múltiples sitios a nivel internacional dentro de poblaciones militares y de veteranos. Por lo tanto, es crucial garantizar la seguridad y bienestar de los terapeutas y operadores de 3MDR que están expuestos a estímulos sensoriales potencialmente perturbadores. Objetivo: El propósito de este estudio es examinar cualitativamente el impacto y las experiencias de STS entre terapeutas y operadores que entregan 3MDR. Para este estudio, el impacto se definirá como los terapeutas o los operadores experimentan los STS percibidos como resultado de la entrega de 3MDR. Método: Este estudio cualitativo exploratorio reclutó a terapeutas y operadores 3MDR (N = 18) de Canadá, Holanda, Reino Unido y Estados Unidos de Norteamérica, quienes previamente habían dado terapia 3MDR. Se usaron entrevistas telefónicas o por videoconferencias para reunir los datos que luego se transcribieron y analizaron temáticamente. Resultados: Emergieron 4 temas entre los terapeutas (N = 13) y operadores (N = 5): (1) costo personal y beneficios de 3MDR, (2) paradoja profesional de un terapeuta 3MDR, (3) efecto percibido de 3MDR en los pacientes, y (4) recomendaciones para el uso futuro de 3MDR. Conclusiones: No se notó que STS fuera un desafío significativo para los terapeutas y operadores de 3MDR. Investigaciones futuras pueden investigar medios óptimos para proporcionar formación y apoyo continuo para los terapeutas y operadores 3MDR. Destacados: No se observó que el Estrés Traumático Secundario fuera un desafío significativo para los terapeutas y operadores 3MDR. Investigaciones futuras pueden investigar medios óptimos para proporcionar formación y apoyo continuo para los terapeutas y operadores 3MDR.

Moving Toward and Through Trauma: Participant Experiences of Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation (3MDR).

Introduction: Military members and Veterans are at risk of developing combat-related, treatment-resistant posttraumatic stress disorder (TR-PTSD) and moral injury (MI). Conventional trauma-focused therapies (TFTs) have shown limited success. Novel interventions including Multi-modal Motion-assisted Memory Desensitization and Reconsolidation therapy (3MDR) may prove successful in treating TR-PTSD. Objective: To qualitatively study the experiences of Canadian military members and Veterans with TR-PTSD who received the 3MDR intervention. Methods: This study explored qualitative data from a larger mixed-method waitlist control trial testing the efficacy of 3MDR in military members and veterans. Qualitative data were recorded and collected from 3MDR sessions, session debriefings and follow-up interviews up to 6 months post-intervention; the data were then thematically analyzed. Results: Three themes emerged from the data: (1) the participants' experiences with 3MDR; (2) perceived outcomes of 3MDR; and (3) keys to successful 3MDR treatment. Participants expressed that 3MDR provided an immersive environment, active engagement and empowerment. The role of the therapist as a coach and "fireteam partner" supports the participants' control over their therapy. The multi-modal nature of 3MDR, combining treadmill-walking toward self-selected trauma imagery with components of multiple conventional TFTs, was key to helping participants engage with and attribute new meaning to the memory of the traumatic experience. Discussion: Preliminary thematic analysis of participant experiences of 3MDR indicate that 3MDR has potential as an effective intervention for combat-related TR-PTSD, with significant functional, well-being and relational improvements reported post-intervention. Conclusion: Military members and Veterans are at risk of developing TR-PTSD, with worse outcomes than in civilians. Further research is needed into 3MDR and its use with other trauma-affected populations.