Supplementary Material for: Walk and Talk: A Randomized Controlled Trial of Multi-modal Motionassisted Memory Desensitization and Reconsolidation therapy(3MDR) versus Treatment as Usual for Veterans and First Responders with Posttraumatic Stress Disorder

PTSD presents a significant challenge in mental health, particularly in veterans and first responders who often experience resistance to standard treatments. This study evaluated the effectiveness of a virtual reality exposure-based treatment with motion as compared to treatment as usual (TAU), as first-line treatment for PTSD within these populations. This multicenter, parallel, single-blind, non-inferiority randomized controlled trial was conducted in three centers across the Netherlands. We included adults diagnosed with occupational or combat-related PTSD, without prior treatment history. Participants were randomized (1:1) to receive either manualized Multi-modal Motion-assisted Memory Desensitization and Reconsolidation therapy (3MDR) or manualized regular trauma-focused psychotherapy (TAU). 3MDR was applied in fewer sessions than TAU. Primary outcome was self-reported PTSD severity, based on the PTSD Checklist for DSM-5, assessed at baseline, post-treatment, 3 and 6 months post-treatment. Secondary outcomes were clinician-rated PTSD, avoidance, comorbid disorders and symptoms, and functioning. Between February 2018 and July 2022, 134 participants with PTSD were enrolled, with 67 (50%) randomized to 3MDR and 67 (50%) to TAU of whom 106 (79%) were veterans, and 28 (21%) were first responders. Significant time effects were demonstrated in self-reported and clinician-rated PTSD severity for both groups, as well as in avoidance, comorbid disorders and functioning. At 6 months post-treatment, 3MDR proved to be non-inferior to TAU in terms of self-reported PTSD (mean difference = -2.91 [95% CI -7.92, 2.10], p = 0.25). 3MDR demonstrated to be an effective alternative first-line treatment for PTSD stemming from occupational traumatic events. While it leans on infrastructure with a treadmill and other hardware components it may offer an effective alternative over conventional trauma-focused psychotherapies for PTSD.