Multi-modular Motion-assisted Memory Desensitization and Reconsolidation (3MDR) as treatment for Posttraumatic Stress Disorder

Several exposure-based therapies for treatment of Posttraumatic Stress Disorder
(PTSD) have been proven successful, in which (imaginal) exposure takes a
central role. Not all patients draw full benefit from these treatments, or drop
out from treatment, which is especially true for the population of veterans
with combat-related PTSD (cr-PTSD). For these patients the Multi-modular
Motion-assisted Memory Desensitization Reconsolidation (3MDR)-protocol may have
additional value. It incorporates elements from Virtual Reality Exposure
therapy (VREt) and Eye Movement Desensitization and Reprocessing (EMDR), while
adding a motion-based component. In this combination, veterans are challenged
to optimally approach their traumatic memories for exposure and working memory
is taxed more appropriately than with the standard EMDR procedure. The
expectation is that this approach will significantly decrease PTSD symptom
severity in comparison to a control group receiving treatment as usual

This study is aimed at assessing the effect of 3MDR treatment as compared to
treatment as usual (TAU) on PTSD symptom severity in treatment resistant
veterans with chronic cr-PTSD. It is expected that 3MDR will give a boosting
effect to TAU following 3MDR. The study further assesses perceived social
support, anxiety in general, depressive symptoms, avoidance of thoughts and
behaviours, and neuropsychological functioning (memory and attention), aimed at
assessing changes in these domains.

This study is a randomized controlled trial (RCT) in a parallel design with one
experimental group (N=20) receiving 6 sessions of 3MDR and one control group
(N=20) who will receive TAU. Both groups will be followed-up after an
additional 6 and 10 weeks of TAU. Furthermore, patients in the intervention
group will be asked to participate in a qualitative interview on their
experiences with the 3MDR. This study will be performed at Stichting Centrum
*45 in Oestgeest or at GGZ Drenthe in Beilen.

Participants will either receive six 3MDR treatment sessions followed by ten
weeks of TAU or will receive sixteen weeks of TAU, other than a trauma-focused
psychotherapy. TAU interventions may for instance include group therapy,
creative therapy or psychopharmacological therapy.

Subjects in the 3MDR group will receive six weekly 3MDR treatment sessions
instead of their treatment as usual. Before and after each sessions cortisol
will be measured in the saliva of participants to assess their stress response
during the session. Five assessments will take place which consist of
structured interviews, questionnaires and neuropsychological tests. None of the
procedures are invasive. The 3MDR-protocol includes elements from treatments as
Eye-Movement Desensitization and Reprocessing therapy and imaginal exposure
based treatments, to which most patients have been exposed before. Therefore it
is not likely that this therapy will be counterproductive and we consider the
burden of the study reasonable. In a proof of concept and first trial with a
total of 12 patients we noticed that those that received the 3MDR treatment did
well and improved on PTSD symptom severity and that lasting worsening of
symptoms did not occur.