Dutch Psychotrauma Specialist & Clinical Psychiatrist Dr. Eric Vermetten Visions New 3MDR Initiative in Alberta

Dr.Eric Vermetten (photo credit - Dr. Chelsea Jones)

Ryan Perry has experienced the brutality of war firsthand, and the invisible, crippling psychological and emotional wounds that military serving members and military Veterans often bear.

After a 23-year career with the Canadian Armed Forces (CAF), including three tours in Afghanistan and two in Ukraine, Sgt. Perry retired last year. His road to retirement, however, was far from easy.

In 2010, midway through his military career, he was diagnosed with PTSD (Post-traumatic stress disorder) following his final tour in Afghanistan.

“I hit rock bottom in 2013 and was sent to an OSI (Operational Stress Injury) clinic. They did amazing work but I deployed two more times after that. When I came back from my second tour of Ukraine, I had a full-blown relapse,” Perry says.

“No treatment was working. I was doing biofeedback on base (in Edmonton) and the operator of that machine knew about 3MDR and HiMARC (Heroes in Mind Advocacy & Research Consortium) and asked if I wanted to be involved. I said yes. I did my initial intake interview, and everything (began to improve) after that.”

3MDR – or Motion-Assisted, Multi-Modal Memory Desensitization and Reconsolidation – is a novel PTSD treatment developed in the Netherlands. It was the focus of a special morning-long presentation and discussion Aug. 27^th at Alberta Hospital Edmonton (AHE), featuring guest speaker Dr. Eric Vermetten.

Dr. Vermetten is a 3MDR specialist, Clinical Psychiatrist and Professor of Psychiatry at Leiden University in the Netherlands and New York University. He is also a Colonel and strategic advisor of research at the Military Mental Health Service, Dutch Ministry of Defence, and the ARQ National Psychotrauma Centre in the Netherlands.

His ground-breaking research in the field of stress, trauma, neuroscience, complex PTSD and moral injury is recognized worldwide, as is his work with novel treatments such as psychedelic-assisted psychotherapy and 3MDR.

The Aug. 27^th event was sponsored by Alberta Health Services (AHS) in collaboration with HiMARC (led by the Faculty of Rehabilitation Medicine at the University of Alberta under the leadership of Dr. Suzette Brémault-Phillips) and the University of Alberta’s Department of Psychiatry.

3MDR is currently being trialled at the Glenrose Rehabilitation Hospital as HiMARC’s flagship research study. Expansion of the 3MDR trial to include AHE, the U of A, and OSI clinics is anticipated in the next year.

“Today’s presentation is a huge contributor to Mission 2023, AHE’s strategic plan. We want to become the trusted voice for mental health and an innovation hub, and this is one of the ways we are working toward that,” DeAnn Hunter, AHE’s site director, told attendees.

“This is a very exciting time here at the hospital, and I firmly believe we are here for a common purpose which is to advance the research and treatment of trauma and PTSD in first responders,” added Dr. Patrick (P.J.) White, AHE’s Medical Director. “I look forward to the ongoing future participation of AHE in this 3MDR project.”

3MDR combines physical movement with elements of virtual reality, Eye Movement Desensitization and Reprocessing (EMDR), and exposure therapy to attribute new meaning to traumatic memories and effectively alleviate the debilitating symptoms of chronic trauma-related disorders in Veterans, first responders and other trauma-affected populations.

Simply put, 3MDR facilitates immersion into traumatic memories, and helps patients learn how to face fears and overcome them. To begin, the patient is asked to self-select a handful of images tied to the events that trigger PTSD, such as a photo of a wounded child or an Afghan battle scene, and music of his or her choosing.

During a 3MDR session, a patient continuously walks on a treadmill. A therapist joins the patient, standing alongside, while the patient walks down a virtual corridor with a door at the end. When it opens, it reveals one of the troubling images on a large screen, and he / she continues walking toward it.

“You’re dealing with it on that huge eight-foot screen so you can’t run away. It’s right there and you have to deal with it. Moving forward (on the treadmill) is not only physical but it’s mental. Your body is moving forward, and your mind is moving forward,” Perry explains.

The therapist asks the patient to describe what he / she is feeling, and those words are displayed on the screen, along with a series of alternating, numbered red balls on the left or right side of the screen. Focusing on the balls forces the disturbing image to move to a different part of the patient’s brain, gradually reducing its emotional intensity.

“What Veterans appreciate about 3MDR is they like to do something while receiving therapy. They’re not just sitting in a chair, so you can attribute to yourself that you’re making this happen. It’s psychotherapy in motion. And empowerment means we have to do it together. I’m not doing it for you. That’s a big part of it,” says Dr. Vermetten.

In addition to its anticipated rollout at AHE and OSI clinics in Edmonton and Calgary, 3MDR is expected to be a core element of a new Interventional Psychiatry Program jointly led by U of A Psychiatry Department Associate Professor Dr. Yanbo Zhang and Assistant Clinical Professor Dr. Lisa Burback.

“Interventional psychiatry offers a new future for psychiatry using non-pharmacological treatments such as Transcranial Magnetic Stimulation (TMS),” says Dr. Zhang. “It includes psychedelic psychotherapy, EMDR Therapy, and 3MDR, and we’ll be working closely with Dr. Vermetten on this important initiative.”

Drs. Burback and Zhang hosted and helped to organize the Aug. 27^th event at AHE, which was attended by more than 15 leading Edmonton-area Psychiatrists and other mental health professionals. It was sponsored by Alberta Health Services (AHS) in collaboration with HiMARC and the U of A Department of Psychiatry.

Dozens of additional attendees – including Perry – participated on Zoom, including retired Canadian Senator and retired CAF Lieutenant-General Romeo Dallaire.

Dallaire led the ill-fated United Nations peacekeeping force in Rwanda in 1993-1994 that sought to halt the horrific genocide waged by Hutu extremists against the Tutsi people – an experience that left Dallaire himself with PTSD.

Dr. Vermetten referred in his talk to the destigmatizing role that General Dallaire had on PTSD and moral injury, when he as a leader disclosed his struggles. He also recognized the Cleveringa Professorship on moral courage that was awarded by the University of Leiden to General Dallaire.

“Walking and talking (employed in 3MDR sessions) is a novel approach to psychotherapy,” Dr. Vermetten told the audience.

“The 3MDR equipment (which includes virtual reality software, a treadmill for the patient to walk on, and a large TV screen that displays emotionally charged images) doesn’t alone do the trick. The patients do the work and feel empowered in doing so. It’s people themselves, accompanied by a therapist/coach, who do the work. The equipment, photos and music merely facilitate an immersive environment, enabling psychotherapy to be delivered in a novel way.”

For Perry, the 3MDR sessions were initially quite traumatic.

“I don’t sugar coat it. The first two or three weeks were brutal. The pictures (were) the hardest things, to pick those images that will bring back pain. We went back as far as 1998 and there were some haunting things I had to bring back up. But I was fortunate that by the third week I figured out how to unpack stuff and basically deal with it face to face.”

Under the leadership of Dr. Suzette Brémault-Phillips and Dr. Chelsea Jones – both of whom played key roles in facilitating Perry’s treatments, and attended the event at AHE – HiMARC is spearheading 3MDR research in Canada. It’s also a key member of an international 3MDR research consortium that spans several countries around the globe.

“Dr. Vermetten is a highly-regarded colleague of ours and for many around the world, and we have the privilege of engaging with him in building this relationship with the University of Leiden and the University of Alberta to advance multiple initiatives, particularly around trauma,” says Dr. Brémault-Phillips.

“HiMARC’s mission is to support the well-being of military members, veterans, public safety personnel and their families through research, education and service, and 3MDR is an exciting example of HiMARC’s innovative research,” says Dr. Tammy Hopper, Interim Dean of the Faculty of Rehabilitation Medicine.

“I also want to thank HiMARC’s partners, stakeholders, ambassadors and donors including the Royal Canadian Legon, the Glenrose (Rehabilitation Hospital), AHS and our military and Veterans organizations. I’d also like to thank our colleagues at AHS and the Department of Psychiatry for coordinating this special presentation.”

Dr. Andrew Greenshaw, Professor and Associate Chair of the Department of Psychiatry, and Dr. Xin-Min Li, Associate Dean, International Relations at the U of A and a former Psychiatry Department Chair, also participated in the Aug. 27^th event.

“I’d like to acknowledge the really important partnership between AHS and the University of Alberta and the presence of HiMARC at the university, which has been really instrumental in leading to this event today and the partnerships that we’re building,” Dr. Greenshaw told the crowd.

“It’s a great pleasure to be here with my friend and colleague, Dr. Vermetten. He works tirelessly all the time to improve patient care and health outcomes for Veterans, first responders and their families. This is part of a big ongoing envelope of activities, and a growing relationship, between the University of Leiden, the University of Alberta and AHS.”

For Perry, the bottom line is simple: 3MDR helped him to get his life back.

“I started living again. I still have some nightmares but they’re not the vivid, violent ones I used to have,” he says. “3MDR is a life-saving therapy. If it wasn’t for 3MDR I wouldn’t be sitting here. It saved my life. My daughter has a father, and my spouse has a partner. That’s probably the most important thing I could say about it.”