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

Lorraine Smith-MacDonald; Chelsea Jones; Matthew R G Brown; Rachel S Dunleavy; Annelies VanderLaan; Zornitsa Kaneva; Tristin Hamilton; Lisa Burback; Eric Vermetten; Suzette Brémault-Phillips

doi:10.3390/ijerph20075415

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

Int J Environ Res Public Health. 2023 Apr 6;20(7):5415. doi: 10.3390/ijerph20075415.

Authors

Lorraine Smith-MacDonald^{1

2

3}, Chelsea Jones^{1

2

4}, Matthew R G Brown^{1

5}, Rachel S Dunleavy³, Annelies VanderLaan^{1

2}, Zornitsa Kaneva^{1

2}, Tristin Hamilton^{1

4}, Lisa Burback^{1

6}, Eric Vermetten⁷, Suzette Brémault-Phillips^{1

2}

Affiliations

¹ Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada.
² Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada.
³ St. Stephen's College, Edmonton, AB T6G 2J6, Canada.
⁴ Alberta Health Services, Edmonton, AB T5J 3E4, Canada.
⁵ Department of Computing Science, University of Alberta, Edmonton, AB T6G 2S4, Canada.
⁶ Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada.
⁷ Department of Psychiatry, Leiden University Medical Centre, Leiden University, 2333 ZA Leiden, The Netherlands.

Abstract

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.

Keywords: 3MDR; military; moral injury; treatment-resistant PTSD; veteran; virtual reality.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Military Personnel* / psychology
Self Report
Stress Disorders, Post-Traumatic* / therapy
Surveys and Questionnaires
Veterans* / psychology

Grants and funding

This study was funded by the Royal Canadian Legion AB/NWT Command RES0048730 and RES0046384; a Government of Alberta Grant #011427; Glenrose Rehabilitation Hospital Foundation RES0042203; and a Government of Canada Innovation for Defence Excellence and Security (IDEaS) Grant #CPCA-0617.