1. Introduction
posttraumatic stress disorder, 3MDR, Psychiatric, traumas, traumatic, treatment-resistant PTSD, PTSD, trauma
EVENTS
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.Military members (MMs) and veterans are exposed to experiences which often include traumatic elements, large scale human suffering, and the transgression of universal human morals. The potential harm caused by exposure to such traumatic experiences was recognized by the American Psychiatric Association (1980) with the introduction of the posttraumatic stress disorder (PTSD) diagnosis in the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) [Exposure to potentially morally injurious events (pMIEs) has been discussed as the precursor leading to MI [It is possible that “moral dilemmas” can exist in the absence of trauma. Studies of military personnel and veterans have found that a significant minority of index traumas for PTSD are events that do not primarily evoke fear/threat [The possible link between MI and PTSD may have particularly relevant implications for emerging discussions of treatment-resistant PTSD (TR-PTSD). The classification of TR-PTSD has been adopted for the many MMs and veterans who do not experience a clinically significant reduction in symptoms following receipt of at least two evidence-based treatments [