Factors associated with the outcomes of a novel virtual reality therapy for military veterans with PTSD: Theory development using a mixed methods analysis

Background: Multi-modular motion-assisted memory desensitization and reconsolidation therapy (3MDR) is an immersive virtual reality-based psychological intervention for post-traumatic stress disorder (PTSD) emphasizing engagement, recollection, and reprocessing. Objective: To explore interrelationships between person, intervention, and context factors and how these interact with outcome typologies among UK military veterans receiving 3MDR. Method: Using a convergent mixed methods approach, quantitative and qualitative data from 10 of 42 veterans in a randomized controlled trial were analyzed. Data sources included clinical outcome measures (e.g., CAPS-5), interviews, physiological recordings (breathing and heart rate, walking pace), in-session words/phrases, and subjective units of distress (SUDs). Data were organized within a person–intervention–context framework, grouped into outcome typologies, and examined for convergence/divergence and patterning. Results: Three response typologies were identified: dramatic improvement (n=4), moderate improvement (n=4), and minimal improvement (n=2). In the person domain, factors associated with outcomes included mobility/walking capacity, commitment and ability to complete therapy, and SUD trajectories. In the intervention domain, image selection and use (ability to sustain elicitation), therapeutic alliance, and preferences for tailored session dosing were associated with outcomes. In the context domain, reactions to the therapy environment were salient. Secondary outcomes generally patterned with primary outcomes within typologies. Some data showed no clear patterning within typologies.

Ben Hannigan, Robert Van Deursen, Kali Barawi, Neil Kitchiner, Jonathan I Bisson