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Martinez BS, Rowland JA, Shura RD, Magnante AT, Morey RA, Martindale SL. Influence of affective instability on suicidal ideation beyond traumatic brain injury and posttraumatic stress disorder in veterans. J Psychiatr Res 2024; 172:411-419. [PMID: 38458113 DOI: 10.1016/j.jpsychires.2024.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Mild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, which may explain why some individuals continue to experience chronic psychiatric complaints following mild TBI. The purpose of the present study was to evaluate affective instability as a key factor for PTSD and suicidal ideation among Veterans with and without TBI. METHOD Participants (N = 299 Veterans; 86.96% male) completed the Personality Assessment Inventory (PAI) and structured clinical interviews for TBI and psychiatric diagnoses. Hierarchical linear regression was used to evaluate main and interaction effects. RESULTS There were no significant differences in affective instability (p = 0.140) or suicidal ideation (p = 0.453) between Veterans with or without TBI. Individuals with TBI were more likely to have a PTSD diagnosis (p = 0.001). Analyses evaluating PTSD diagnosis as an outcome indicated a main effect of affective instability (p < 0.001), but not TBI (p = 0.619). Analyses evaluating suicidal ideation as an outcome demonstrated an interaction effect between PTSD and affective instability beyond the effects of TBI (p = 0.034). CONCLUSIONS Severe Affective instability appears to be a key factor in suicidal ideation among Veterans beyond TBI or PTSD history. PTSD was more strongly associated with suicidality at lower and moderate levels of affective instability. At severe levels of affective instability, however, Veterans with and without PTSD experienced suicidal ideation at similar rates. Findings suggests that high levels of affective instability not better explained by other psychiatric conditions confers similar suicidality risk to that of PTSD in a Veteran population.
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Affiliation(s)
- Brandy S Martinez
- Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA; VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA.
| | - Jared A Rowland
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert D Shura
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna T Magnante
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rajendra A Morey
- Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA; VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Sarah L Martindale
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Physiology & Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Smith-MacDonald L, Jones C, Brown MRG, Dunleavy RS, VanderLaan A, Kaneva Z, Hamilton T, Burback L, Vermetten E, Brémault-Phillips S. Moving Forward from Moral Injury: A Mixed Methods Study Investigating the Use of 3MDR for Treatment-Resistant PTSD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5415. [PMID: 37048029 PMCID: PMC10094650 DOI: 10.3390/ijerph20075415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/05/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
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.
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Affiliation(s)
- Lorraine Smith-MacDonald
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
- St. Stephen’s College, Edmonton, AB T6G 2J6, Canada
| | - Chelsea Jones
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Matthew R. G. Brown
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Department of Computing Science, University of Alberta, Edmonton, AB T6G 2S4, Canada
| | | | - Annelies VanderLaan
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
| | - Zornitsa Kaneva
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
| | - Tristin Hamilton
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Lisa Burback
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Centre, Leiden University, 2333 ZA Leiden, The Netherlands
| | - Suzette Brémault-Phillips
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
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3
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Rogier G, Zobel SB, Rizzi D, Velotti P. Post-Traumatic Stress Disorder and Alcohol Use Disorder During the COVID-19 Outbreak: Do Dissociation and Emotional Metacognitive Beliefs Mediate the Role of Emotion Dysregulation? Psychiatry Investig 2022; 19:803-813. [PMID: 36327960 PMCID: PMC9633169 DOI: 10.30773/pi.2022.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Despite the well-documented relationship between emotion dysregulation and both post-traumatic stress disorder (PTSD) and alcohol use disorder symptoms, no studies investigated this issue in the context of the outbreak. Moreover, additional research investigating the role of mediators intervening in these pathways is required. Dissociation and emotional beliefs are two factors that may explain such relationships. However, a poor number of studies empirically tested their role. METHODS A cross-sectional study on a sample of 719 community participants (32.5% males; Mage=34.36, standard deviation=14.38 years) was conducted. Participants fulfilled a battery of self-report questionnaires measuring levels of PTSD outbreak-related symptoms, alcohol use disorder, emotion dysregulation, emotional beliefs, and dissociation. RESULTS Partial r-Pearson correlations showed that PTSD symptoms' level was positively and significantly related to all variables investigated in the study whereas alcohol use disorder level was positively and significantly associated with emotion dysregulation and only some dimension of emotional beliefs and dissociation. Results drawn from a structural equation model highlight the mediating role of both emotional belief and dissociation in the relationship linking emotion dysregulation and alcohol use disorder whereas only dissociation, but not emotional beliefs, mediated the link between emotion dysregulation and PTSD symptoms. CONCLUSION Most of the hypotheses have been supported stressing the relevance of both dissociation and emotional beliefs in PTSD and alcohol use disorder symptoms. These two variables appear important framework from which deepen the impact of emotion dysregulation in psychopathology.
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Affiliation(s)
- Guyonne Rogier
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Sara Beomonte Zobel
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Patrizia Velotti
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Jones C, Smith-MacDonald L, Brown MRG, Pike A, Vermetten E, Brémault-Phillips S. Quantitative changes in mental health measures with 3MDR treatment for Canadian military members and veterans. Brain Behav 2022; 12:e2694. [PMID: 35849703 PMCID: PMC9392526 DOI: 10.1002/brb3.2694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/05/2022] [Accepted: 06/23/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Military members and veterans are at elevated risk of treatment-resistant posttraumatic stress disorder (TR-PTSD) due to higher rates of exposure to potentially traumatic events during the course of duty. Knowledge of TR-PTSD is limited, and specific protocols or evidence-based TR-PTSD therapies are lacking. Multimodal motion-assisted memory desensitization and reconsolidation (3MDR) therapy is an emerging intervention for combat-related TR-PTSD. The purpose of this study was to preliminarily assess the effectiveness of 3MDR in addressing TR-PTSD in Canadian military members and veterans. METHODS This study is a longitudinal mixed-methods clinical trial. English-speaking military members and veterans aged 18-60 with TR-PTSD were recruited to participate. The intervention consisted of six sessions of 3MDR therapy. Quantitative data were collected pretreatment, posttreatment, and longitudinally at 1, 3, and 6 months after completion of 3MDR. RESULTS Results from the first 11 participants to complete the 3MDR protocol exhibited statistically significant improvement (surviving multiple comparison correction) in clinically administered and self-reported scores for PTSD (CAPS-5 and PCL-5), moral injury (MISS-M-SF), depression (PHQ-9), anxiety (GAD-7), emotional regulation (DERS-18), and resilience (CD-RS-25). CONCLUSION The preliminary and exploratory results from this clinical trial support the growing body of literature illustrating 3MDR as an effective treatment for military-related TR-PTSD. These results are notable given participants' previous lack of success with frontline psychotherapeutic and pharmacological interventions. Given that there are currently very limited treatment options for TR-PTSD, 3MDR could prove to be a valuable treatment option for military members and veterans with TR-PTSD.
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Affiliation(s)
- Chelsea Jones
- Leiden University Medical Centre, Leiden University, Leiden, the Netherlands.,Alberta Health Services, Edmonton, Ottawa, Canada.,Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Lorraine Smith-MacDonald
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Ashley Pike
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Eric Vermetten
- Leiden University Medical Centre, Leiden University, Leiden, the Netherlands.,ARQ National Psychotrauma Center, Diemen, the Netherlands.,Military Mental Health Service, Dutch Ministry of Defence, Utrecht, the Netherlands
| | - Suzette Brémault-Phillips
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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5
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Rooney EA, Hallauer CJ, Xie H, Shih CH, Rapport D, Elhai JD, Wang X. Longitudinal PTSD symptom trajectories: Relative contributions of state anxiety, depression, and emotion dysregulation. J Affect Disord 2022; 308:281-288. [PMID: 35452754 PMCID: PMC10693746 DOI: 10.1016/j.jad.2022.04.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Prospective research on the development and trajectory of PTSD symptoms after a traumatic event is crucial for assessment and early intervention. Further, examining predictors of PTSD pathology provides a better conceptualization of the temporal course of PTSD in trauma victims. METHODS The present study examined PTSD symptom severity in individuals presenting to the emergency department (ED) following a traumatic event. Participants (N = 147) were assessed at four timepoints: 2-weeks, 3-months, between 6 and 9 months, and 12-months after ED admission. Growth curve modeling was conducted to examine changes in PTSD symptom severity over time. Age, sex, state anxiety, trait anxiety, emotion dysregulation, depression, and trauma type (motor vehicle accident [MVA] and assault), and PTSD diagnosis were included as covariates in the model. RESULTS Results demonstrated that baseline PTSD symptom severity was positively associated with severity of depression and state (but not trait) anxiety, emotion dysregulation, and PTSD diagnosis. Results also revealed significant associations with PTSD symptom changes over time; greater state anxiety and depression symptoms at baseline were associated with steeper declines in PTSD symptoms over time. LIMITATIONS Data were collected at only four timepoints over the course of 12-months. Results may be different with more measurement points over longer periods and inclusion of pre-, peri- and post-trauma risk factors. CONCLUSIONS Results illustrate the relevance of assessing state anxiety, depression, and emotion dysregulation in following trauma victims for trauma-related psychopathology over the course of time to alleviate the negative impact of the same.
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Affiliation(s)
- Emily A Rooney
- Department of Psychology, University of Toledo, 2801 W. Bancroft St., Toledo, OH 43606, USA
| | - Caleb J Hallauer
- Department of Psychology, University of Toledo, 2801 W. Bancroft St., Toledo, OH 43606, USA
| | - Hong Xie
- Department of Neurosciences, University of Toledo, 2801 W. Bancroft St., Toledo, OH 43606, USA
| | - Chia-Hao Shih
- Department of Emergency Medicine, University of Toledo, 2801 W. Bancroft St., Toledo, OH 43606, USA
| | - Daniel Rapport
- Department of Psychiatry, University of Toledo, 2801 W. Bancroft St., Toledo, OH 43606, USA
| | - Jon D Elhai
- Department of Psychology, University of Toledo, 2801 W. Bancroft St., Toledo, OH 43606, USA; Department of Psychiatry, University of Toledo, 2801 W. Bancroft St., Toledo, OH 43606, USA.
| | - Xin Wang
- Department of Psychiatry, University of Toledo, 2801 W. Bancroft St., Toledo, OH 43606, USA
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“Putting Down and Letting Go”: An Exploration of a Community-Based Trauma-Oriented Retreat Program for Military Personnel, Veterans, and RCMP. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Current military members, veterans, and Royal Canadian Mounted Police (RCMP) experience higher rates of posttraumatic stress disorder (PTSD) and moral injury (MI). Trauma-oriented retreats have been offered as a means of addressing these concerns. This article aims to explore the impact of a non-evidence-based trauma-oriented retreat for the above populations experiencing PTSD or MI; (2) Methods: This qualitative study, nested within the larger mixed-methods pre/post longitudinal follow-up study, examined the experiences of 124 military members, veterans, and RCMP who participated in the retreat. Data were collected from semi-structured interviews and first-hand observations of the organization. Analysis was conducted using thematic analysis while being informed by realist evaluation principles; (3) Results: The results showed that important contextual elements were related to participants being ready, having multiple comorbidities and using the program as a first or last resort. Effectual mechanisms included a home-like setting; immersion; credibility of facilitators; experiential learning; an holistic approach; letting go, and reconnecting to self. Outcomes included: re-finding self, symptom management, social connection, and hope for a meaningful life. The gendered analysis suggested less favorable results; (4) Conclusions: Care is warranted as the evidence-base and effectiveness of trauma-oriented retreats yet needs to be established prior to broad use.
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Hamilton T, Burback L, Smith-MacDonald L, Jones C, Brown MRG, Mikolas C, Tang E, O'Toole K, Vergis P, Merino A, Weiman K, Vermetten EHGJM, Brémault-Phillips S. Moving Toward and Through Trauma: Participant Experiences of Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation (3MDR). Front Psychiatry 2021; 12:779829. [PMID: 35002800 PMCID: PMC8728006 DOI: 10.3389/fpsyt.2021.779829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/24/2021] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Tristin Hamilton
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lorraine Smith-MacDonald
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Chelsea Jones
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
- Edmonton Operational Stress Injury Clinic, Alberta Health Services, Edmonton, AB, Canada
| | - Matthew R. G. Brown
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Computing Science, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Cynthia Mikolas
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Emily Tang
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kaitlin O'Toole
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Priyanka Vergis
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anna Merino
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kyle Weiman
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eric H. G. J. M. Vermetten
- Edmonton Operational Stress Injury Clinic, Alberta Health Services, Edmonton, AB, Canada
- Department of Psychiatry, ARQ National Psychotrauma Center, Diemen, Netherlands
- Military Mental Health Care, Ministry of Defense, Utrecht, Netherlands
| | - Suzette Brémault-Phillips
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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8
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Tang E, Jones C, Smith-MacDonald L, Brown MRG, Vermetten EHGJM, Brémault-Phillips S. Decreased Emotional Dysregulation Following Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation Therapy (3MDR): Identifying Possible Driving Factors in Remediation of Treatment-Resistant PTSD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12243. [PMID: 34831999 PMCID: PMC8621264 DOI: 10.3390/ijerph182212243] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 12/23/2022]
Abstract
Multi-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.
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Affiliation(s)
- Emily Tang
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (E.T.); (L.S.-M.)
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (C.J.); (M.R.G.B.)
- Neuroscience and Mental Health Institute (NMHI), University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Chelsea Jones
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (C.J.); (M.R.G.B.)
- Alberta Health Services, Edmonton, AB T5E 5R8, Canada
- Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Lorraine Smith-MacDonald
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (E.T.); (L.S.-M.)
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (C.J.); (M.R.G.B.)
| | - Matthew R. G. Brown
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (C.J.); (M.R.G.B.)
- Department of Computing Science, University of Alberta, Edmonton, AB T6G 2E8, Canada
| | - Eric H. G. J. M. Vermetten
- Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
- ARQ National Psychotrauma Center, 1112 XE Diemen, The Netherlands
- Military Mental Health, Dutch Ministry of Defense, 3584 EZ Utrecht, The Netherlands
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (E.T.); (L.S.-M.)
- Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (C.J.); (M.R.G.B.)
- Neuroscience and Mental Health Institute (NMHI), University of Alberta, Edmonton, AB T6G 2E1, Canada
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