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

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.

Virtual realities, real recoveries: exploring the efficacy of 3MDR therapy for treatment-resistant PTSD

“… Smith-MacDonald et al (2023) conducted a mixed methods study uniquely aimed at investigating (1) whether moral injury occurs concurrently with TR-PTSD in military personnel and (2) the perspectives of military personnel with TR-PTSD on 3MDR as a treatment for moral injury and PTSD ( Smith-MacDonald et al, 2023 , pp. 2–3).…”

“…The participants were Canadian soldiers with TR-PTSD ( N = 17). However, four participants were unable to complete the treatment due to COVID-19 restrictions ( Smith-MacDonald et al, 2023 , p. 4). Two other participants did not complete the treatment for other reasons, leaving 11 remaining participants for data analysis.…”

“…Additionally, PTSD-related concepts such as depression symptoms (PHQ-8), anxiety symptoms (GAD-7), psychological functioning (OQ-45.2), psychological resilience (C-DRS), alcohol problems (AUDIT), and emotion regulation (DERS-18) were measured. A significant relationship between the decrease in moral injury and PTSD symptoms (CAPS-5 and PCL-5) was observed ( Smith-MacDonald et al, 2023 ). Furthermore, there was a significant association between moral injury and all PTSD-related concepts, except alcohol problems.…”

“…In the qualitative analysis, a thematic analysis of data collected through semi-structured interviews was conducted. Three overarching themes were identified: (1) Realities of war, (2) Wrestling scruples, and (3) Creation of moral sensemaking ( Smith-MacDonald et al, 2023 , pp. 9–11).…”

“…Central to the theme “wrestling scruples” was participants’ experience of unresolved dissonance between what had happened to them and what should have happened to them. They reported feelings of shame and guilt resulting from being exposed to conflicting emotions and experiences over an extended period ( Smith-MacDonald et al, 2023 ).…”