BARCELONA – The therapeutic setting for individual psychotherapy has shifted over the years from the analytic couch, with the therapist discretely tucked out of sight, to facing chairs, a similarly sedentary format. The next evolutionary development might be to plop a patient with posttraumatic stress disorder on an exercise treadmill and don a virtual reality helmet to engage in an interactive motion-assisted form of psychotherapy in which the therapist stands alongside the walking patient while providing guidance on processing traumatic memories, Eric Vermetten, MD, PhD, said at the annual congress of the European College of Neuropsychopharmacology.
Bruce Jancin/MDedge News
Dr. Eric Vermetten
He and his colleagues have developed an innovative approach to delivering trauma-focused psychotherapy. They call it Multimodular Motion-Assisted Memory Desensitization and Reconsolidation (3MDR), or more informally, “walk and talk therapy,” explained Dr. Vermetten, professor of psychiatry at Leiden (the Netherlands) University and a military mental health researcher for the Dutch Ministry of Defense.
3MDR is a combination of personalized virtual reality using a headset, multisensory input using self-selected trauma-related pictures, and a dual-attention task borrowed from eye movement desensitization and reprocessing therapy, with treadmill walking throughout the treatment session.
3MDR is designed to boost this process of memory retrieval and reconsolidation by creating a more totally immersive patient experience intended to enhance treatment engagement and overcome behavioral avoidance. Through virtual reality, the PTSD patient literally walks toward his personal fear-related images.
Dr. Vermetten and his coinvestigators came up with 3MDR as a treatment designed for military veterans with chronic, combat-related, treatment-resistant PTSD. The impetus was the evident need for new and better forms of psychotherapy for such patients. Even though an array of evidence-based psychotherapies are available as guideline-recommended first-line treatments for PTSD, individuals with combat-related PTSD have a notoriously low response rate to these interventions, presumably because of the intensity and repetitive nature of their traumatic experiences. Indeed, up to two-thirds of veterans with PTSD experience substantial residual symptoms post treatment such that they still meet diagnostic criteria for the disorder.
3MDR is an amped up form of exposure-based therapy in which patients walk through a personalized virtual reality installation toward self-chosen trauma-related pictures of their deployment. The investigators developed this intensely immersive type of psychotherapy because they believe avoidance and lack of emotional engagement figure prominently in the low success rate of established forms of psychotherapy in combat-related PTSD. The treadmill walking aspect is considered key because of the large body of research showing that walking entails cognitive-motor interactions that facilitate problem solving, the psychiatrist explained.
The investigators recently published a detailed description of the therapeutic rationale for 3MDR and the nuts and bolts of the novel therapy (Front Psychiatry. 2018 May 4;9:176. doi: 10.3389/fpsyt.2018.00176). Early anecdotal experience has been positive. However, as cochair of the ECNP Traumatic Stress Network, Dr. Vermetten is acutely aware of the need to demonstrate efficacy in rigorous randomized controlled trials.
“This is a way psychotherapy can be shaped in the future. We’re collaborating with various centers across the globe now to see whether this is effective for treatment-resistant PTSD patients,” Dr. Vermetten said.
If those studies prove positive, it will be worthwhile to determine whether 3MDR also has a role as a first-line treatment for earlier-stage PTSD and for forms of the disorder unrelated to military combat, he added.
Funding for the project has been provided by the Dutch Ministry of Defense.