Moving Forward from Moral Injury: A Mixed Methods Study Investigating the Use of 3MDR for Treatment-Resistant PTSD
Abstract
:1. Introduction
Multi-modal Motion-Assisted Memory Desensitization and Reconsolidation (3MDR)
2. Materials and Methods
2.1. Study Design
2.2. Sample and Setting
2.3. Sample Size
2.4. Intervention
2.5. Data Collection
2.6. Quantitative Data
2.7. Qualitative Data
2.8. Data Analysis and Triangulation
2.9. Quantitative Analysis
2.10. Qualitative Measures
3. Results
3.1. Demographics
3.2. Quantitative Results
3.3. Qualitative Results
3.3.1. Realities of War
“First time out, you know, everyone was smiling, we were having a good time and by the end of the tour, you’re basically threatening to kill kids.”(P13)
One of the pictures I have over there is a painting of what they would do with the children, they would skeet shoot them, throw them in the air and see if they could hit them with bayonets, things like that. It was a little troubling [laughing](P10)
“If you can’t dump it, you gotta file that in the back of our head, because there is still a mission that needs to go on and nobody wants to talk about that shit, ok? So, (…) unfortunately, sometimes that [door] gets cracked open and I could never shut that door completely, I could never file completely in the back of my mind to make sure that I could get rid of it.”(P19)
I couldn’t do anything because I wasn’t allowed to do anything. I didn’t do what I wanted to. It doesn’t make it okay.”(P11)
“How do I go and do this [mission] when I know it is wrong? Like, morally it’s wrong. Ethically, it’s wrong. But I’m told I gotta do this. What do you do? How do you function with that? And you know, I don’t mean squeezing the trigger. I don’t mean lobbing artillery. I don’t mean driving over stuff. It’s the fact of, people are hurt and they need help, there are good people and bad people.”(P19)
“[I felt] abandoned… When there were a lot of us, after those two weeks [spent cleaning up after the traumatic event], we were just cut loose. We were given one day off then told to go back [to regular duties]…just by the organization in general.”(P6)
3.3.2. Wrestling Scruples
“But we don’t understand that those that are left behind carry the pain, it stays with them, that we feel nothing, barren…”(P13)
“I felt trapped in my little existence, I guess, like, shit… This is the way it’s going to be from now until whenever it ended you know. And that was scary…very depressing. Like trapped. I was stuck there… I’m going to have to put up with this all the time. And eventually, it’s going to crush me.”(P6)
“Why did you do this? Like why couldn’t you get along? I was always told, ‘work things out, trust people…’ All I saw was the good and never the bad …My whole life got shattered right there and then. All I wrote about when I came back was the devastation of what I saw. I did feel devastated. I felt the heartless[ness] of people.”(P3)
“This feeling of being lost really. Not understanding, not being able to comprehend… comprehend what happened.”(P7)
The word shame is … a … Huge. You take pride in everything you have accomplished. When you don’t live up to that persona, even in your own mind or even to those around you, it’s… it’s painful.”(P13)
I’m worried that it means we were a little less than human and more mechanical in what we did. It was all mechanical… you follow the checklist; you do what you’re trained to do. Could we have done more? The honest answer is no, but we don’t know.”(P19)
“Every time the kids fight, and someone gets hurt, I just see the crying face of this little girl looking up at me and not knowing if I’m there to help or hurt. Just so little and dependent on everyone around her to help (…) I’m not looking at my grandson or kids like they’re this little girl, but it automatically takes me back to this coppery smell in the air, all that blood, and then the eyes.”(P19)
3.3.3. Moral Sensemaking
[3MDR] showed me how not to suppress the emotional aspect, but just come to grips with it (…). How you feel is how you feel. There is nothing wrong with feeling that way, but understand why you feel that way.”(P19)
“Weight on my neck, stopping me from doing what I need to do with my kids—guilt, pain, sorry, the feeling that I might actually be human. I might have emotions aside from what I’ve been trained to deal with.”(P2)
“The pain that I didn’t know was there… Never even considered… I buried it so deep that I just left it where I put it. And I open that box. Once the box is open, it basically gets poured out. And either… you can make the decision to either fill the box back up or just leave it on the ground. And I think I have left it on the ground.”(P13)
Maybe I was just there to give somebody a little bit of dignity in death. And I think that kind of helped [me].”(P6)
“Stuff still gets under my skin; I’m human. I still have reactions, I just don’t blow up about it.”(P19)
“Started to realize there is good and bad everywhere, no matter where you go.”(P2)
“Well I’m saying goodbye to my, my.. demon and my…shame; my perceived shame [strong emphasis]”(P13)
“I was very closed, I was very closed off; primarily to my family, but you know, to everyone I was very closed. I never wanted to say anything because you know what, I would stay open. [broken up] Everyone has parts of their own pasts that they have to deal with. Who am I to dump more crap on someone’s head? Right? Unfortunately, what wound up happening was me trying to internalize it was tearing me apart.”(P19)
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Gender | Age | Marital Status | Employment Status | |
---|---|---|---|---|
Female: 1 (9%) Male: 10 (91%) | 30–39 years: 2 (18%) 40–49 years: 6 (55%) 50–54 years: 3 (27%) mean: 45.4 ± 6.8 years range: 30.9 to 54.3 years | Common-law: 2 (18%) Divorced: 1 (9%) Married: 5 (45%) Separated: 1 (9%) Single: 2 (18%) | No: 5 (45%) Yes: 6 (55%) | |
Military Status | Enrollment Era | Rank | Element | Years of Service |
Active: 3 (27%) Veteran: 8 (73%) | 1976–1990: 2 (18%) 1991–2000: 8 (73%) 2001–2015: 1 (9%) | Junior NCM: 6 (55%) Senior NCM: 4 (36%) Unknown: 1 (9%) | Air: 2 (18%) Land: 9 (82%) | 5–10 years: 2 (18%) 11–15 years: 1 (9%) 20+ years: 8 (73%) |
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Smith-MacDonald, L.; Jones, C.; Brown, M.R.G.; Dunleavy, R.S.; VanderLaan, A.; Kaneva, Z.; Hamilton, T.; Burback, L.; Vermetten, E.; Brémault-Phillips, S. Moving Forward from Moral Injury: A Mixed Methods Study Investigating the Use of 3MDR for Treatment-Resistant PTSD. Int. J. Environ. Res. Public Health 2023, 20, 5415. https://doi.org/10.3390/ijerph20075415
Smith-MacDonald L, Jones C, Brown MRG, Dunleavy RS, VanderLaan A, Kaneva Z, Hamilton T, Burback L, Vermetten E, Brémault-Phillips S. Moving Forward from Moral Injury: A Mixed Methods Study Investigating the Use of 3MDR for Treatment-Resistant PTSD. International Journal of Environmental Research and Public Health. 2023; 20(7):5415. https://doi.org/10.3390/ijerph20075415
Chicago/Turabian StyleSmith-MacDonald, Lorraine, Chelsea Jones, Matthew R. G. Brown, Rachel S. Dunleavy, Annelies VanderLaan, Zornitsa Kaneva, Tristin Hamilton, Lisa Burback, Eric Vermetten, and Suzette Brémault-Phillips. 2023. "Moving Forward from Moral Injury: A Mixed Methods Study Investigating the Use of 3MDR for Treatment-Resistant PTSD" International Journal of Environmental Research and Public Health 20, no. 7: 5415. https://doi.org/10.3390/ijerph20075415