Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial
Open accessAbstract
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).
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Digital health-based treatments are effective at reducing symptoms of PTSD and other mental health disorders caused by exposure to trauma.
“Current research indicates that these platforms are effective at reducing the symptoms of PTSD and other mental health disorders caused by exposure to trauma [28-32].”
From Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation (2022) · cites this paper as [31]
The Introduction describes 3MDR as a therapy combining virtual reality with other techniques, and the Discussion reports significantly reduced PTSD symptoms in veterans with treatment-resistant PTSD compared with a control group. The Discussion also reports no significant end-point difference in depression and cautions that this first trial has limited implications for efficacy. It does not establish that digital health platforms generally reduce symptoms of other trauma-related mental health disorders. Page numbers were not supplied for these passages. (LLM, conf=0.90)
Experimental — accuracy not yet measuredHealth care professionals are well-suited to use mHealth tools, such as apps, to supplement treatment and provide clients with immediate tools to help overcome psychological impairment related to traumas.
“Specific to the MMs, PSP, and veteran populations, health care professionals (HCPs) are well-suited to use mHealth tools, such as apps, to supplement treatment and provide clients with immediate tools to help them overcome psychological impairment related to their traumas [9,31].”
From Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation (2022) · cites this paper as [31]
The Treatments section describes therapist-led exposure therapy using a treadmill and projected virtual environment, not an mHealth app. The Conclusions report reduced PTSD symptoms in veterans receiving that intervention, but our copy does not address clinicians using apps to supplement treatment or give clients immediate tools. Searches for mHealth, apps, and mobile tools found no supporting passage; page numbers were unavailable for these passages. (LLM, conf=0.74)
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- Authors
- van Gelderen, M. J., Nijdam, M. J., Haagen, J. F. G., & Vermetten, E.
- Affiliations
- Arq Psychotrauma Expert Group (NL)
- Leiden University Medical Center (NL)
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2020
- Volume
- 89
- Issue
- 4
- Pages
- 215-227
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- OpenAlex
- W3012720932
- Cited by
- 59
- References
- 52
- Citations by year
- 2026: 11 · 2025: 7 · 2024: 9 · 2023: 8 · 2022: 9 · 2021: 7 · 2020: 8
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychotherapy and Psychosomatics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion, cc-by-nc-nd)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- GGZ Drenthe
- Leids Universitair Medisch Centrum
- Ministry of Defense
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- post-traumatic stress disorder, veterans, treatment-resistant PTSD, virtual reality exposure therapy, immersive therapy, PTSD symptom severity, treatment engagement
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Netherlands, Patient Dropouts, Stress Disorders, Post-Traumatic, Veterans, Single-Blind Method, Treatment Outcome, Intention to Treat Analysis, Virtual Reality Exposure Therapy
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