4. Discussion
GAD, guilt, anxiety disorder, voice, anxiety, peritraumatic, shame, traumatic, depressive disorder, PTS, psychiatric, PTSD, fractures, MDD, depression
DISORDER
The purpose of this proof-of-concept study was to investigate (1) whether MI co-occurs in MMs and veterans with TR-PTSD, and (2) the perspectives of MMs and veterans with TR-PTSD in utilizing 3MDR for the treatment of MI. It was hypothesized that 3MDR would be an acceptable modality for addressing TR-PTSD within MMs and veterans, and that MI would correlate with the TR-PTSD experienced by the participants. Triangulation of both data sets supported the hypothesis that MI was co-occurring in MMs and veterans with TR-PTSD. Quantitatively, these results illustrated that MISS-M-SF scores were statistically significantly related to scores of PTSD, major depressive disorder (MDD), generalized anxiety disorder (GAD), peritraumatic dissociation, emotional regulation, interpersonal relationships and social role, and resilience. While the research to date has repeatedly shown a strong association between MI, PTSD, MDD, and GAD [Given the growing body of literature illustrating that MI is correlated with PTSD, GAD, and MDD, it may be helpful to begin a transdiagnostic exploration of the mechanisms driving the pathologies of these from both an MI perspective and a psychiatric disorder perspective. The question of dissociation and MI, for example, has not been addressed to date, and therefore it is unclear in what ways MI may be contributing to dissociation symptoms or vice-versa. This raises some interesting questions about if and how MI may be related to dissociative-type PTSD. In this study, the CAPS-5 dissociation score’s association with the MI score was not statistically significant; however, the PDE-Q did show a statistically significant association. Dissociation was not mentioned in the qualitative results despite the discussion of extreme emotional responses. Some research has identified that intense shame, guilt, or psychological conflict can push people into a dissociative state [Regarding a potential relationship between MI and alcohol consumption, scores from the AUDIT did not show a significant relationship with MI scores. The AUDIT is most sensitive to severe alcohol consumption, as would be seen with a substance use disorder. We suspect that the AUDIT was not sufficiently sensitive to changes in alcohol consumption falling in a more moderate range, as exhibited by the study participants, to detect any changes that might have occurred.Questions related to the role of emotional (dys)regulation in MI and PTSD are also found in these results. Previous literature has highlighted the potential role of emotional dysregulation in PTSD [The quantitative results also demonstrate an association between the overall DER-18 score and the MISS-M-SF. Only one of the six subscores—clarity—however, was significant. Again, while the reasons for this cannot be presumed, it may be that in processing cognitions and symptoms, participants were able to learn, identify and clarify their own emotions. Qualitatively, participants also spoke of the importance of emotions in the maintenance of their PTSD and MI, and the power of being able to label and give a voice to emotions during and after their traumatic experiences.While guilt and shame have been the signature emotions associated with MI, our participants also experienced a range of moral emotions [The potential importance of MI to combat-related TR-PTSD is notable and appears deeply woven in the fabric of this qualitative analysis. Participants’ self-disclosed qualitative experiences illustrated that while they were not always aware or fully able to articulate the nature, harm and scope of what happened to them, they were aware that harm had occurred at a deeper and fundamental level. These results support the notion that MI seemingly fractures a person at the level of “self” [Based on these preliminary results, it is theorized that MI may fundamentally impact the ability to trust, resulting in fragmented relationships and poor mental health outcomes [Researchers have theorized that treadmill walking during 3MDR may enhance divergent thinking. It is tempting to speculate that this may facilitate greater cognitive flexibility, allowing for the recognition and processing of problematic thoughts related to morally injurious experiences. Bravo et al., (2020) noted that both self-directed and other-directed MI was associated with increased rumination and problem-focused thoughts, which in turn was associated with higher reported symptoms of depression, anxiety, and PTS [As participants expressed their emotions, it is hypothesized that they were able to engage in meaning-making processes which enabled them to either accept or come to terms with previously unacceptable components of their stories [