Walk and talk: a randomized controlled trial of multi-modal motion-assisted memory desensitization and reconsolidation therapy versus treatment as usual for veterans and first responders with posttraumatic stress disorder

Abstract

Introduction: Posttraumatic stress disorder (PTSD) presents a significant challenge within the treatment of mental health issues, particularly in veterans and first responders who often experience resistance to standard treatments. This study evaluated the effectiveness of a virtual reality exposure-based treatment with motion as compared to treatment as usual (TAU), as first-line treatment for PTSD within these populations.

Methods: This multicenter, parallel, single-blind, non-inferiority randomized controlled trial was conducted in three centers across the Netherlands. We included adults diagnosed with occupational or combat-related PTSD, without prior treatment history. Participants were randomized (1:1) to receive either manualized multi-modal motion-assisted memory desensitization and reconsolidation (3MDR) therapy or manualized regular trauma-focused psychotherapy (TAU). 3MDR was applied in fewer sessions than TAU. Primary outcome was self-reported PTSD severity, based on the PTSD Checklist for DSM-5, assessed at baseline, post-treatment, 3 and 6 months post-treatment. Secondary outcomes were clinician-rated PTSD, avoidance, comorbid disorders and symptoms, and functioning. The trial was prospectively registered in the Dutch Trial Register, NL-OMON55588.

Results: Between February 15, 2018, and July 22, 2022, 134 participants with PTSD were enrolled, with 67 (50%) randomized to 3MDR and 67 (50%) to TAU of whom 106 (79%) were veterans, and 28 (21%) were first responders. Significant time effects were demonstrated in self-reported and clinician-rated PTSD severity for both groups, as well as in avoidance, comorbid disorders, and functioning. At 6 months post-treatment, 3MDR proved to be non-inferior to TAU in terms of self-reported PTSD (mean difference = -2.91 [95% CI -7.92, 2.10], p = 0.25). Conclusion: 3MDR demonstrates to be an effective alternative first-line treatment for PTSD stemming from occupational traumatic events. Even though it leans on infrastructure with a treadmill and other hardware components, it may offer an alternative over conventional trauma-focused psychotherapies for PTSD that yields savings of a quarter of time spent within therapy. Plain Language Summary: Experiencing traumatic events can lead to the development of posttraumatic stress disorder (PTSD), a condition that is burdensome for patients and their loved ones. This study investigated the effects of a novel form of psychotherapy for PTSD called multi-modal motion-assisted memory desensitization and reconsolidation (3MDR). In this treatment, patients process traumatic events while walking on a treadmill in a virtual environment. The virtual environment is personalized by self-selected pictures and music that remind the person of the traumatic events. We investigated this treatment in 134 military veterans and first responders (such as police officers, firefighters and paramedics) in three treatment centers in the Netherlands. They had PTSD after work-related traumatic events such as losing a mate in a bombing, witnessing a suicide, unsuccessful resuscitation of a child, or severe violence by hooligans. They had not received trauma therapy before. Half of the participants received 3MDR and the other half received standard trauma therapy in a sitting position. Results showed that 3MDR measured up to standard trauma therapy, even though it was given in fewer treatment sessions. Effects on a range of questionnaires (measuring PTSD, depressive symptoms, avoidance, and daily functioning) were comparable. The fact that 3MDR could be given in a smaller number of sessions may be advantageous for patients and therapists. 3MDR may also efficiently address multiple traumatic memories. Moreover, walking in 3MDR can appeal to veterans and first responders who are often physically active in their work. The findings of the study support the application of 3MDR as a first treatment for work-related PTSD.