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.

Background Military personnel have an elevated risk of sustaining mild traumatic brain injuries (mTBI) and postconcussion symptoms (PCS). Smartphone apps that provide psychoeducation may assist those with mTBI or PCS to overcome unique barriers that military personnel experience with stigma and access to health care resources. Objective This study aims to (1) use the Mobile Application Rating Scale (MARS) to evaluate smartphone apps purporting to provide psychoeducation for those who have sustained an mTBI or a PCS; (2) explore the relevance, utility, and effectiveness of these apps in facilitating symptom management and overall recovery from mTBI and PCS among military personnel; and (3) discuss considerations pertinent to health care professionals and patients with mTBI when considering the use of mobile health (mHealth), including apps for mTBI psychoeducation. Methods A five-step systematic search for smartphone apps for military members with mTBI or PCS was conducted on January 31, 2020. Cost-free apps meeting the inclusion criteria were evaluated using the MARS and compared with evidence-based best practice management protocols for mTBI and PCS. Results The search yielded a total of 347 smartphone apps. After applying the inclusion and exclusion criteria, 13 apps were subjected to evaluation. Two apps were endorsed by the US Department of Veterans Affairs and the US Department of Defense; all the others (n=11) were developed for civilians. When compared with evidence-based best practice resources, the apps provided various levels of psychoeducational content. There are multiple considerations that health care professionals and those who sustain an mTBI or a PCS have to consider when choosing to use mHealth and selecting a specific app for mTBI psychoeducation. These may include factors such as the app platform, developer, internet requirement, cost, frequency of updates, language, additional features, acknowledgment of mental health, accessibility, military specificity, and privacy and security of data. Conclusions Psychoeducational interventions have a good evidence base as a treatment for mTBI and PCS. The use of apps for this purpose may be clinically effective, cost-effective, confidential, user friendly, and accessible. However, more research is needed to explore the effectiveness, usability, safety, security, and accessibility of apps designed for mTBI management.

BACKGROUND Military personnel have an elevated risk of sustaining mild traumatic brain injuries (mTBI) and post-concussion symptoms (PCS). Smartphone apps that provide psychoeducation may assist those with mTBI or PCS to overcome unique barriers that military personnel experience with stigma and accessing healthcare resources. OBJECTIVE (1) to evaluate smartphone apps advertised to provide psychoeducation for those who have sustained a mTBI or PCS utilizing the Mobile Application Rating Scale (MARS) and; (2) explore the relevance, utility and effectiveness of these apps to facilitate symptom management and overall recovery from mTBIs and PCS among military personnel. METHODS A 5-step systematic search for smartphone apps for military members with mTBI or PCS was conducted on January 31, 2020. Cost-free apps meeting the inclusion criteria were evaluated using the Mobile App Rating Scale (MARS) and compared to evidence-based best-practice management protocols for mTBI and PCS. RESULTS The search yielded a total of 347 smartphone apps. After applying inclusion/exclusion criteria, 13 apps were subjected to evaluation. Two apps were endorsed by Veteran Affairs and the United States Department of Defense; all others (n=11) were developed for civilians. Once compared to evidence-based best-practice resources, the apps provided various levels of psychoeducational content. There are multiple considerations that healthcare professionals and those who sustain a mTBI or PCS should consider when choosing to utilize mobile health and choose a specific app for mTBI psychoeducation. These may include app platform, developer, internet requirement, cost, frequency of updates, language, additional features, acknowledgement of mental health, accessibility, and military specificity, as well as privacy and security of data. CONCLUSIONS Psychoeducational interventions have a good evidence-base as a treatment for mTBIs and PCS. Utilizing apps for this purpose may be clinically effective, confidential, easily accessible, and cost-effective; however, more research is needed to explore the effectiveness, usability, safety, security, and accessibility of apps designed for mTBI management. CLINICALTRIAL N/A