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... Show moreIntroduction: 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. Show less
Multi-modal motion-assisted memory desensitization and reconsolidation therapy (3MDR), an interactive, virtual reality-assisted, exposure-based intervention for PTSD, has shown promising results... Show moreMulti-modal motion-assisted memory desensitization and reconsolidation therapy (3MDR), an interactive, virtual reality-assisted, exposure-based intervention for PTSD, has shown promising results for treatment-resistant posttraumatic stress disorder (TR-PTSD) among military members (MMs) and veterans in randomized controlled trials (RCT). Previous research has suggested that emotional regulation (ER) and emotional dysregulation (ED) may be factors which are correlated with symptom severity and maintenance of TR-PTSD. This embedded mixed-methods pilot study (n = 9) sought to explore the impact of 3MDR on ER and ED of MMs and veterans. Difficulties in Emotional Regulation Scale (DERS-18) data were collected at baseline, prior to each session, and at one week, one month, and three months postintervention and analyzed. Qualitative data collected from sessions, debriefs, and follow-up interviews were transcribed and descriptively analyzed. Results demonstrated statistically significant decreases in DERS-18 scores from preintervention to postintervention at each timepoint. Qualitatively, participants perceived improvements in ER within specified DERS-18 domains. We describe how 3MDR's unique and novel approach addresses ED through cognitive-motor stimulation, narration, divergent thinking, reappraisal of aversive stimuli, dual-task processing, and reconsolidation of traumatic memories. More studies are needed to better understand the underlying neurobiological mechanisms by which 3MDR addresses ER and PTSD. Show less
The current study explores whether different stressors in a virtual reality (VR) military training scenario cause increases in physiological stress. This would validate the use of VR simulation for... Show moreThe current study explores whether different stressors in a virtual reality (VR) military training scenario cause increases in physiological stress. This would validate the use of VR simulation for stress training, as well as the physiological monitoring of trainees for educational purposes. Military cadets (n = 63) performed a patrol scenario (military convoy) in which they answered questions about their surroundings. Stressors (task difficulty, noise, lighting changes, social evaluations, electric muscle stimulation, and a simulated attack on the convoy) were stepwise added in four phases. Electrocardiogram, blood pressure, electrodermal activity, cortisol, and the cadets' subjective threat/challenge appraisal were measured. We found that only the first phase caused a significant increase in physiological stress, as measured with heart rate, heart rate variability, and electrodermal activity. Physiological stress appeared to stay high in the second phase as well, but decreased to baseline level in the third and fourth phases, even though these phases were designed to be the most stressful. Cadets classified as threat responders based on physiological data (n = 3) scored significantly higher on subjective threat/challenge appraisal than those classified as challenge responders (n = 21). It seems that in the tested VR training scenario, the novelty of the scenario was the only effective stress stimuli, whereas the other implemented stressors did not cause a measurable physiological response. We conclude that if VR training scenarios are to be used for stress training, these should confront trainees with unpredictable but context-specific demands. Show less
