Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

Abstract

Background: Veterans with posttraumatic stress disorder (PTSD) tend to benefit less from evidence-based treatments than other PTSD populations. A novel virtual reality and motion-assisted exposure therapy, called 3MDR, provides treatment in an immersive, personalized and activating context. Objective: To study the efficacy of 3MDR for veterans with treatment-resistant PTSD. Method: In a randomized controlled trial (n = 43) 3MDR was compared to a non-specific treatment component control group. Primary outcome was clinician-rated PTSD symptoms at baseline, after 3MDR, and at the 12-week and 16-week follow-up (primary end point). Intention-to-treat analyses of covariance and mixed models were applied to study differences between groups at the end point and over the course of intervention, controlling for baseline scores. Results: The decrease in PTSD symptom severity from baseline to end point was significantly greater for 3MDR as compared to the control group, with a large effect size (F[1, 37] = 6.43, p = 0.016, d = 0.83). No significant between-group difference was detected in the course of PTSD symptoms during treatment when including all time points. The dropout rate was low (7%), and 45% of the patients in the 3MDR group improved clinically. The number needed to treat was 2.86. Conclusions: In this trial, 3MDR significantly decreased PTSD symptoms in veterans with, on average, a history of 4 unsuccessful treatments. The low dropout rate may be indicative of high engagement. However, a lack of significant differences on secondary outcomes limits conclusions that can be drawn on its efficacy and underlines the need for larger phase III trials. These data show emerging evidence for 3MDR and its potential to progress PTSD treatment for veterans (Dutch Trial Register Identifier: NL5126).

Veterans suffering from post-traumatic stress disorder – literature analyzing: symptoms, statistics and therapies

“…Van Gelderen et al conducted a Randomized Controlled Trial in which they investigated the effectiveness of a novel virtual reality and motion-assisted exposure therapy (3MDR). The method proved effective in the final result (16 weeks after the start of therapy) in veterans [22]. It is also worth noting that the same veterans had already after 4 failed therapies on average.…”

“…It showed effectiveness in the final result of the whole session -after 16 weeks. On the one hand, this is good news, because the therapy is good and effective, but it should be remembered that the majority of patients resign from therapy during treatment, so it may not bring any adverse effects on such people [22].…”

Virtual Trauma Interventions for the Treatment of Post-traumatic Stress Disorders: A Scoping Review

“…In 3MDR, it is assumed that walking toward a traumarelated symbolic representation of the patients' traumatic experience in a CAVE decreases avoidance behavior, increases therapy adherence, and reduces PTSD symptoms (Van Gelderen et al, 2018). The virtual environment can be customized through images selected by the patients (Van Gelderen et al, 2020).…”

“…By contrast, for 3MDR, the hardware costs, for example, using CAVE, are still relatively high-ranging from $50,000-100,000 (Borrego et al, 2015;Coburn et al, 2017). Additionally, to conduct a 3MDR session, a technical operator and therapists are needed, which increases personnel costs (Vermetten et al, 2013;Van Gelderen et al, 2020). However, there is empirical evidence that 3MDR is a successful treatment for patients who cannot benefit from classic trauma-focused guidelines, which can reduce long-term therapy costs (Bisson et al, 2020;Van Gelderen et al, 2020).…”

“…The reasons for the attrition, response and remission rates are multifactorial and not completely understood (Lewis et al, 2020). Some authors argue that for example, the traumatype (Steenkamp et al, 2015;Wagenmans et al, 2018), psychiatric comorbidities (Van Minnen et al, 2012), high avoidance (Zoellner et al, 2011;Hundt et al, 2018;Van Gelderen et al, 2020) or insufficient imagination abilities (Jaycox et al, 1998) may explain whether patients can benefit from imaginal techniques. However, further work is required to verify these assumptions.…”