Moving Toward and Through Trauma: Participant Experiences of Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation (3MDR)

Introduction: Military members and Veterans are at risk of developing combat-related, treatment-resistant posttraumatic stress disorder (TR-PTSD) and moral injury (MI). Conventional trauma-focused therapies (TFTs) have shown limited success. Novel interventions including Multi-modal Motion-assisted Memory Desensitization and Reconsolidation therapy (3MDR) may prove successful in treating TR-PTSD.Objective: To qualitatively study the experiences of Canadian military members and Veterans with TR-PTSD who received the 3MDR intervention.Methods: This study explored qualitative data from a larger mixed-method waitlist control trial testing the efficacy of 3MDR in military members and veterans. Qualitative data were recorded and collected from 3MDR sessions, session debriefings and follow-up interviews up to 6 months post-intervention; the data were then thematically analyzed.Results: Three themes emerged from the data: (1) the participants' experiences with 3MDR; (2) perceived outcomes of 3MDR; and (3) keys to successful 3MDR treatment. Participants expressed that 3MDR provided an immersive environment, active engagement and empowerment. The role of the therapist as a coach and “fireteam partner” supports the participants' control over their therapy. The multi-modal nature of 3MDR, combining treadmill-walking toward self-selected trauma imagery with components of multiple conventional TFTs, was key to helping participants engage with and attribute new meaning to the memory of the traumatic experience.Discussion: Preliminary thematic analysis of participant experiences of 3MDR indicate that 3MDR has potential as an effective intervention for combat-related TR-PTSD, with significant functional, well-being and relational improvements reported post-intervention.Conclusion: Military members and Veterans are at risk of developing TR-PTSD, with worse outcomes than in civilians. Further research is needed into 3MDR and its use with other trauma-affected populations.

Exploring the Utility of the Emerging Adulthood Theory Among Military Members and Veterans with Risky Substance Use

Emerging adult (EA; aged 18–29) military members experience major career, life, and developmental transitions. The conglomeration of these changes may influence or exacerbate anxiety or stress, produce challenges, and lead to negative coping mechanisms, such as substance use. This study sought to understand the utility of the five Emerging Adulthood Theory (EAT) dimensions among a sample of military members and veterans with risky substance use. To our knowledge, the applicability of EAT has not been explored with United States military populations. During 2019, we completed 24 semi-structured interviews. On average, participants were 24.9 years old, male, white, and in the United States Marine Corps. We asked about experiences transitioning into adulthood, military culture, and experiences of the five EAT dimensions. Three coders employed rigorous theory-driven thematic analysis procedures to piece together themes. We report EA military members’ experiences with the EAT dimensions, focusing on nuances related to the influence of military culture.

Decreased Emotional Dysregulation Following Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation Therapy (3MDR): Identifying Possible Driving Factors in Remediation of Treatment-Resistant PTSD

Multi-modal motion-assisted memory desensitization and reconsolidation therapy (3MDR), an interactive, virtual reality-assisted, exposure-based intervention for PTSD, has shown promising results for treatment-resistant posttraumatic stress disorder (TR-PTSD) among military members (MMs) and veterans in randomized controlled trials (RCT). Previous research has suggested that emotional regulation (ER) and emotional dysregulation (ED) may be factors which are correlated with symptom severity and maintenance of TR-PTSD. This embedded mixed-methods pilot study (n = 9) sought to explore the impact of 3MDR on ER and ED of MMs and veterans. Difficulties in Emotional Regulation Scale (DERS-18) data were collected at baseline, prior to each session, and at one week, one month, and three months postintervention and analyzed. Qualitative data collected from sessions, debriefs, and follow-up interviews were transcribed and descriptively analyzed. Results demonstrated statistically significant decreases in DERS-18 scores from preintervention to postintervention at each timepoint. Qualitatively, participants perceived improvements in ER within specified DERS-18 domains. We describe how 3MDR’s unique and novel approach addresses ED through cognitive–motor stimulation, narration, divergent thinking, reappraisal of aversive stimuli, dual-task processing, and reconsolidation of traumatic memories. More studies are needed to better understand the underlying neurobiological mechanisms by which 3MDR addresses ER and PTSD.

Prescribed footwear and orthoses are not prophylactic in preventing lower extremity injuries in military tactical athletes: a systematic review with meta-analysis

IntroductionMilitary members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The purpose of this systematic review with meta-analysis was to assess if prescribed prophylactic footwear or foot orthoses reduced the risk of lower extremity injury in military tactical athletes.MethodsMEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Defense Technical Information Center databases were searched for randomised controlled trials published at any time that compared foot orthoses or prescribed footwear (to include shock-absorbing insoles and socks) with a placebo intervention or a no-treatment control. Methodological quality was assessed and the number of injuries, population at risk and duration of the study epoch were extracted and relative risk (RR) calculated. An omnibus meta-analysis was performed assessing all prescribed footwear and orthoses intervention studies, with subgroup analyses conducted on studies with similar interventions (ie, basketball athletic shoes, athletic shoes (prescribed by foot type), foot orthoses, shock-absorbing insoles, socks, tropical combat boots).ResultsOf 1673 studies identified, 22 were included. Three of eight studies that employed orthoses demonstrated significantly reduced overuse injuries compared with no-treatment controls (RR range: 0.34–0.68); one study showed neoprene insoles significantly decreased overuse injuries (RR: 0.75). There were no other significant effects in the individual studies and no protective effects observed in the omnibus meta-analysis or in the component subanalyses.ConclusionsPrescribed footwear and orthoses do not appear to have a prophylactic effect on lower quarter musculoskeletal injuries in military members and cannot be recommended at this time.

Indonesian Military Court Law Absolute Competence through Equality before the Law Principle

Law Number 31 Year 1997 regulates the jurisdiction of the Indonesian Military Court to handle military members who commit a general crime and military crime based on the Indonesian Penal Code and Indonesian Military Code respectively. However, the General Court also retains jurisdiction over the military members who commit a general crime based on the Indonesian Penal Code. In comparison, Indonesian Civilians who commit a general crime based on the Indonesian Penal Code are only under the General Court. This condition is against the principle of equality before the law as stated in Article 28D.1 of the 1945 Constitution. Indonesia as a state of law must hold this principle. Authors use normative legal research to solve the law issues by reviewing the related laws and the law principles in Indonesia.

Working together to address sexual misconduct in the Canadian Armed Forces

LAY SUMMARY In 2015, the Canadian Armed Forces (CAF) implemented Operation HONOUR to eliminate sexual misconduct (SM) in the military. Sexual assault, inappropriate sexual behaviours, sexual harassment, and gender discrimination are all types of SM. Experiencing SM can result in depression, substance abuse, physical health problems, and even posttraumatic stress disorder (PTSD). Despite Operation HONOUR, SM still happens in the CAF. At this time, many groups are working together to address SM and to support those who have experienced SM. Canadian-based researchers, policymakers, military members, Veterans, and clinicians are collaborating to identify new approaches to training, culture change, research, and treatment relating to SM in the CAF. The end goal of working together is to minimize SM in the CAF and ensure the health and safety of all CAF members and Veterans.

The Ties That Bind: Camaraderie in Military Interprofessional Healthcare Teams

ABSTRACT Introduction Multiple aspects of interpersonal dynamics can help or hinder the success of teams, particularly those in a Military Interprofessional Healthcare Team (MIHT). One specific mechanism for MIHTs’ success is camaraderie and how these military teams are able to achieve, maintain, and enable the development of this important characteristic. Despite our understanding of military service members as being bonded like a family, we have a limited understanding of how this bond is translated into their MIHT experiences. Materials and Methods This study conducted interviews among 30 individuals who had participated in, led individual, and/or led many MIHTs, using a grounded theory methodology. Participants represented 11 different health professions, including officers and enlisted military members, and three branches of the U.S. military (e.g., army, navy, and air force). Data were collected and analyzed in iterative cycles until saturation was achieved. Results We identified six themes that shaped the overarching concept of camaraderie in MIHTs. These themes were (1) confidence in competent peers, (2) shared goals, (3) mutual respect, (4) desire to help one another improve, (5) personal is professional, and (6) bonds of military service. This paper describes each of these themes, provides illustrative examples from the data, and describes how these components contribute to MIHTs’ team dynamics. We present a model for how to understand these themes. Conclusions Through the identification and exploration of these aspects of camaraderie, we are able to better understand how MIHTs are able to be successful. MIHTs that demonstrated confidence in their brother/sister in arms possessed shared goals and missions, while maintaining mutual respect, a desire to help one another do better, and creating a personal and professional overlap tended to form stronger bonds of military service. Critically, these six aspects support a more nuanced understanding of the spirit of camaraderie and how it underpins MIHT success.

Ethical Bearing Is About Our Conduct: Ethics as an Essential Component of Military Interprofessional Healthcare Teams

ABSTRACT Introduction The need to maintain medical ethical standards during conflict and peace has been the source of considerable academic discourse. Although still an unsolved challenge, scholars have made significant contributions to the literature, constructing categorizations that can help military providers contend with ethical conflicts. However, insights into the ethical comportment of military interprofessional healthcare teams (MIHTs) have yet to be reported. Materials and Methods This interview-based study collected insights from 30 military healthcare providers who participated in and/or led MIHTs. Altogether, participants represented 11 health professions, both officers and enlisted military members, and the U.S. Army, Navy, and Air Force. Following Grounded Theory methodology, data were collected and analyzed in iterative cycles until theme saturation was reached. Results The research team identified two themes of ethical bearing that enable MIHT success in and across care contexts. One theme of successful ethical bearing is “raising concerns,” referring to speaking up when something needs to be addressed. The other is “making compromises,” where individuals have to make sacrifices (e.g., lack of equipment, non-sterile environment, etc.) to give patient care. Conclusions These data suggest that effective MIHTs have a collective moral compass. This moral compass is the team’s ability to judge what is ethically right and wrong, as well as the team’s willingness and ability to act accordingly—to consistently “do the right thing.” There is a collective moral compass, and while the team may not all agree on what exactly is true north—they are all bending that way.