Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation (3MDR) Treatment for Postpartum Posttraumatic Stress Disorder (PTSD) from Grief: A Case Report

Abstract

The well-being of postpartum mothers can be significantly affected by posttraumatic stress disorder (PTSD) and grief. Success with standard PTSD interventions for this population has been inconsistent. Multi-modal motion-assisted memory desensitization and reconsolidation therapy (3MDR) is an intervention that has been studied favorably with military and veteran populations with PTSD and related conditions. Minimal research is available, however, regarding its application in the civilian population. This case report investigates the use of 3MDR in facilitating trauma and grief processing and reducing PTSD symptoms in a 35-year-old postpartum mother with treatment-resistant PTSD and grief undergoing 3MDR. Qualitative data collected throughout the 3MDR intervention and at the 3-, 6-, and 10-month follow-ups were thematically analyzed. The participant reported feeling increased control over her life after 3MDR and reduced adverse reactions to normally distressing events. During the follow-up sessions, the overarching trauma process was one of peeling back layers of her experiences. The following 3 themes emerged: gaining control in chaos, shifting from an ideal to a real perspective, overcoming trauma and moving forward in life. This case report suggests that 3MDR’s immersive, motion-assisted, patient-centered psychotherapeutic approach and strong therapeutic relationship facilitated unique trauma and grief processing, empowering meaningful progress where prior interventions had failed.

Introduction

The perinatal period is a time during which both complex grief and posttraumatic stress disorder (PTSD) can arise.¹ Pregnancy and childbirth signify a transformative and vulnerable phase in a woman’s life, and navigating it can be particularly daunting for those who have previously faced trauma and grief.¹ Posttraumatic stress disorder and grief can disrupt the establishment of a secure attachment between mother and infant, thereby influencing the emotional well-being and developmental outcomes of the baby.² Relationships within the family unit can also be strained, shaping the partner’s comprehension of the mother’s experiences and potentially leading to communication breakdowns.³ Increased family tension, diminished cohesion, and an increased risk of transmitting trauma across generations can result.⁴ Women, driven by their awareness of the impact their mental health can have on themselves and their families, are often motivated to address PTSD during this crucial period to enable them to create a secure and nurturing environment for their infants.^2,5,6 By addressing PTSD and grief, they aspire to disrupt the trauma cycle, foster a positive maternal mental health trajectory, and establish the foundation for healthier, resilient family dynamics during and beyond the perinatal period.^7-9 Early detection, intervention, and comprehensive mental health support play a pivotal role in alleviating negative consequences, promoting resilience, and facilitating recovery.¹⁰

Posttraumatic stress disorder and grief can significantly affect postpartum mothers. The persistent and intrusive nature of PTSD symptoms, encompassing flashbacks, nightmares, and hypervigilance, contributes to heightened stress, anxiety, and emotional dysregulation.^11-13 Grief can overlap or co-occur with PTSD,¹⁴ adding further strain. While grief is a natural, emotional process experienced following a significant loss, including the death of a loved one,^15,16 complex grief, also known as complicated grief or prolonged grief disorder, extends beyond an expected grieving process.¹⁶ Intense feelings of longing, difficulty accepting the loss, recurrent intrusive thoughts about the departed,¹⁷ and persistent and debilitating symptoms that interfere with one’s ability to adapt to life without the deceased characterize complex grief.¹⁸ The nature of the relationship with the deceased, circumstances of the death (e.g., sudden or violent death), and individual vulnerabilities¹⁵ can influence complex grief and increase the risk of developing PTSD.^15,19,20 Individuals with pre-existing vulnerabilities, such as a history of trauma, mental health concerns, or a lack of adequate support, may be more susceptible to developing PTSD in the context of grief.²¹

Therapeutic interventions tailored to address trauma and grief in postpartum women recognize the unique challenges and vulnerabilities that arise.²² While ongoing research on evidence-based trauma-focused therapy (TFT) specific to postpartum experiences continues, existing studies indicate that modalities such as trauma-focused cognitive-behavioral therapy (TF-CBT), cognitive processing therapy, prolonged exposure, and eye-movement desensitization and reprocessing can target PTSD symptoms related to childbirth or other perinatal traumas.²³ The goal of these approaches extends beyond alleviating immediate trauma symptoms to fostering healthier coping mechanisms, enhancing maternal mental well-being, and improving the mother-infant relationship^23-25 Treatment responses for such therapies, however, have been marked by elevated dropout rates of 25%-48% and outcomes comparable to non-trauma-focused therapies.²⁶ Avoidance of trauma-related emotions and memories significantly contributes to suboptimal responses.²⁶ Even among individuals displaying a positive response, PTSD symptoms frequently persist, with approximately 30%-40% of individuals continuing to meet criteria for a PTSD diagnosis.²⁷ Personalized TFTs are needed that show promise in providing meaningful support to postpartum women during this significant life transition.^23,25

Multi-modal motion-assisted memory desensitization and reconsolidation (3MDR) therapy has gained recognition for its approach to addressing trauma-related conditions.²⁸ Studies of 3MDR with military and veteran populations highlight 3MDR’s efficacy in alleviating symptoms associated with PTSD and other stress-related mental health issues, and facilitating emotional regulation and overall well-being.^29,30 Delivered while a patient walks on a treadmill in an immersive, personalized environment toward self-selected trauma reminders, participants report finding this brief exposure-based psychotherapeutic intervention to be more accessible, acceptable, and less intrusive than traditional exposure therapies.^30-34 Given favorable findings with other trauma-affected populations, the use of 3MDR in perinatal populations struggling with symptoms of PTSD and complex grief warrants exploration.

Objective

This case study explored the application of 3MDR for a 35-year-old postpartum mother (referred to as K) with treatment-resistant PTSD, a query of complex grief, and the intervention’s ability to facilitate trauma and grief processing and reduce PTSD symptoms.

Methods

Multimodal motion-assisted memory desensitization and reconsolidation therapy-trained clinicians conducted 2 preparatory sessions and delivered 8 3MDR treadmill sessions with K following the standard protocol. Follow-up interviews were also conducted at 3-, 6-, and 10-month follow-up. Qualitative data consisting of session video and transcript recordings were thematically analyzed (inductively and deductively) using the Braun and Clarke reflexive method.^35,36 Four research team members who did not administer 3MDR independently reviewed the qualitative data, formulated initial codes, and generated semantic and latent themes. Themes were discussed before being verified by the larger research team, including those who administered 3MDR.

Case Report

Case Presentation

K is a 35-year-old Caucasian Canadian female in a common-law relationship who was under the care of a psychiatrist in an outpatient reproductive mental health clinic. She was 10 months postpartum with her second child when she was referred to 3MDR after having been offered TF-CBT³⁷ and accelerated resolution therapy (ART)³⁸ to little effect. K had diagnoses of PTSD, attention deficit hyperactivity disorder (ADHD), anxiety, and depression, with a query of complex grief. This participant was taking Vyvanse 40mg and Guanfacine 1 mg daily, pre-3MDR. K reported the sudden passing of her father by suicide 3 years prior. Her parents separated when she was 8 years old after her mother left in the middle of the night amidst her father’s struggle with substance misuse, untreated schizophrenia, and domestic violence. K described adverse childhood experiences,³⁹ including emotional, physical, and emotional neglect and abuse (ACE = 9). The eldest of 4 siblings, K was a parentified child who took on caring responsibilities for her siblings and the household. She continued to care for and keep the family together into adulthood. K saw her father make efforts to get his life together and build his own home before his unexpected passing.

This study was approved by the Ethics Committee of the University of Alberta (Approval no.: Pro00084466; Date: January 23, 2019). Informed consent was obtained from the patients who agreed to take part in the study.

Preparatory Sessions 1-2: Rapport Building and The Therapeutic Relationship

The development of rapport in the 2 preparatory sessions was essential to K’s trauma processing. These sessions enabled the therapists to understand K’s index trauma, assist her in selecting photos and music, and familiarize her with the 3MDR process. Establishing a strong therapeutic relationship was a cornerstone of the intervention, as it provided a foundation of trust, safety, and support that enabled K to fully engage in 3MDR and trauma processing. By building rapport, the therapists were able to attune to the patient’s emotional needs, pace the sessions in alignment with K’s comfort level, and reinforce her sense of control throughout the treatment. The supportive relationship also served to validate K’s experiences of grief and trauma, encouraging her to remain engaged and to trust in the therapeutic process. Overall, the therapists’ role in establishing and maintaining rapport and a therapeutic alliance was critical to the intervention’s impact and positive outcomes.

Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation Therapy Treadmill Sessions 1-8

K’s initial treadmill session focused on the complex relationship with her father and family of origin. She self-selected photos of her siblings, parents, and father (see Figure 1 for examples) and music (see Figure 2 for an excerpt of lyrics from her warm-up and cool-down songs). Song lyrics from her opening song reflect her deep yearning for a safe, enduring home and the profound loss of this idealized space. They also capture her sense of belonging, resilience, and the emotional connection she shared with her family despite the ultimate impermanence of her imagined sanctuary. Treadmill sessions 2-8 revealed K’s deep longing for the stability and closeness she had hoped for with her family—a vision unfulfilled due to family struggles and forever lost with her father’s passing. Key themes that emerged across sessions captured the progression of her trauma and grief processing (see Table 1 for focus and descriptions of treadmill sessions). Each session brought to light distinct aspects of her inner experiences, from profound regret and yearning for alternate life paths to the complexities of family relationships marked by both love and loss. As she revisited painful memories and sought understanding, K grappled with disillusionment and grief, with the intensity of these emotions at times leading to moments of dissociation. As she processed traumatic memories, the emotional turmoil she experienced shifted to acceptance and strength, culminating in resilience and a deeper appreciation for balanced, supportive relationships within her new family structure. This is reflected in the upbeat repetition of lyrics in her final self-selected high-energy cool-down song, with lines like “It goes on and on.”

Figure 1.

Selection of images used during platform sessions

Figure 2.

Lyric excerpts from selected music

Table 1.

Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation Therapy Treadmill Session Focus and Description

Session	Focus	Description
1	Complex relationship with her father and family of origin	K explored her relationships with her family and father, including her sense of belonging and resilience, amidst her deep longing for emotional connection and safety, and to be seen, heard and valued. K also grappled with the reality that her family was not the safe sanctuary that she had hoped it to be and strived to create.
2	Emotional pain and yearning	K experienced deep disillusionment, feeling that her life’s difficulties were shaped by her father’s decisions. She expressed a longing for an alternate reality where different choices could have led to a better outcome for her and her family. K explored feelings of powerlessness, unresolve, grief, regret, confusion and yearning.
3	Grief, anger, and unmet expectations	K navigated intense emotions of grief and anger over her father’s loss, as well as frustration with circumstances outside her control. She struggled to reconcile her hopes with the reality of her family dynamics. K struggled with the chaotic emotional impact of her father’s death and the gap between her hopes and reality, expressing a desire for a different life outcome.
4	Complexity of family relationships	K reflected on the dual nature of her family relationships, where love, pain and grief coexisted. She mourned her father while simultaneously feeling relief, showcasing the intricate and often contradictory emotions tied to family bonds.
5	Reconstructing family	K explored the process of building a new family with her partner and children, acknowledging both the challenges of past loss and forging of new connections. She emphasized her resilience and self-reliance in having to figure life out “on her own”. This session highlighted K’s process in reconstructing family and balancing her past with the present.
6	Grief, helplessness, and resilience	K delved into the sorrow tied to her father’s mental health struggles, missing both him and an idealized version of him. Despite her pain, her optimism fueled transformation, allowing her to rebuild with strength and hope alongside her partner and children. This session marked a turning point as she used her loss to facilitate growth and looked forward to building a stable life with her partner and children.
7	Personal resilience and family complexity	K reflected on the hardships she faced growing up, balancing love for her family with feelings of disappointment. K recognized her resilience amid complex family dynamics, valuing her perseverance and aspiration for a brighter future despite hardship. This reflection helped her broaden her perspective, reconcile love and disappointment and celebrate her ability to navigate her past and future.
8	Reciprocal relationships	K recognized the importance of balanced relationships, shifting away from one-sided caregiving toward reciprocity. This session underscored her newfound fulfillment in relationships where care is mutual, allowing her to feel seen and valued. She found fulfillment in being loved and cared for by those close to her.

Reconsolidation Sessions 1 and 2

Key themes and supporting quotes from K’s 2 reconsolidation sessions (see Table 2) highlight her transformative process through trauma and grief toward healing. Her trauma processing involved peeling back layers of her traumatic experiences. Each theme described below reflects the complexities of her emotional experiences, the shifts in her understanding of relationships, and her evolving sense of self. K demonstrated remarkable resilience and commitment to rebuilding her life, ultimately fostering deeper connections with her family while navigating the challenges of her past.

Table 2.

Themes and Supporting Quotes from Reconsolidation Sessions 1-2

Theme	Description	Quotes
The Struggle and Triumph: Chaos to Calm	K experienced intense emotional responses tied to her trauma, including panic and self-sabotage. Through 3MDR, she learned to manage her symptoms and emotions better.	“I feel like I’ve been handling [how I feel] better (…) Usually, I would just immediately panic like instantly, but now that’s not happening.”
	She became more capable of regulating her emotional responses, allowing her to engage more openly with her loved ones and her work.	“It still like hurts [to look at photos of her father on Facebook]... It still like makes me upset, but the reaction is far less severe.”
	K’s ability to connect with her partner and children improved as she became more emotionally vulnerable.	“Yesterday was my dad’s birthday, and I felt pretty good all day. And, yeah, I wasn’t like upset or I like put a picture out of them and told [my kids] about like that it was his birthday today.”
Shifting from the Ideal to the Real	K moved from focusing on her dysfunctional familial relationships to building healthier connections with her partner and children.	“There’s been a shift in my relationship with my family. Um like, I am definitely putting more energy and time into like just my family, just [my partner] and my kids, and like [my partner’s] side of the family just because I get it back from them.”
	She began to embrace her past while recognizing the need for reciprocal relationships, shifting her notion of family.	“I want [my kids] to like see real, healthy relationships um between people, between family, between friends. I want them to be around that, to be exposed to that.”
Processing Trauma Work: Overcoming Trauma, Rebuilding One’s Life, and Healing	K’s experiences as a mother became a driving force for processing trauma, motivating her to break the cycle of intergenerational trauma.	“I feel like… I really faced something that I was like really afraid to face and that I just kind of avoided at all costs because I just knew like what kind of reaction I was gonna have to it.”
	Her commitment to the 3MDR process demonstrated her resilience and determination to overcome her past and resolve her grief.	“I really wanted to like give it as much as I could. (...) I don’t want to be stuck in that place anymore you know. So I really just wanted to like just give it my all and I feel like I did.”

3MDR, multimodal motion-assisted memory desensitization and reconsolidation therapy.

Theme 1: The Struggle and Triumph: Chaos to Calm

Prior to 3MDR, K experienced strong emotional and physiological responses to trauma- and grief-related memories, including shutting down, self-sabotage, and substance use. While symptoms of PTSD remained, they became more manageable. K reported improved emotional regulation, communication about her experiences, and reduced avoidance of triggering situations. She gained strength to confront chaos, developed coping skills, and gained confidence in managing challenges. Her relationships deepened as she became more open and vulnerable, particularly with her children, partner, and work colleagues.

Theme 2: Shifting from the Ideal to the Real

K’s trauma and grief processing involved reconciling her feelings toward dysfunctional family dynamics and shifting from prioritizing unhealthy relationships to focusing on reciprocal connections with her partner and children. She recognized her parents’ limitations and began to embrace her past while letting go of her caregiving role for her siblings. K expressed a desire for her own children to witness healthy relationships, accepting that she might not receive support from her biological family. This realization led her to invest in her present family life and foster an environment of empathy and compassion while processing her anger and sadness.

Theme 3: Processing Trauma Work of Overcoming, Trauma, Rebuilding One’s Life, and Healing

K’s motivation for change stemmed from her commitment to being a better mother and breaking intergenerational trauma. She steadily engaged in confronting her past and demonstrated resilience in facing her fears and loss. K worked with increasing resolve to unstick herself from her traumatic past and rebuild her life. Her process highlighted her determination to create a positive future for herself and her children, showcasing her growth and willingness to embrace healing. Processing the crippling grief she experienced with the loss of her father made way for healthy remembrance, acceptance of him, and celebration of his life.

Follow-Up Sessions

In her efforts to address PTSD and complex grief, K found 3MDR uniquely impactful in ways that previous treatments had not been. Unlike traditional TFTs, which felt passive to her, 3MDR provided a transformative, immersive, embodied approach that engaged her in a focused, undistracted manner both emotionally and physically. The walking component paired with personalized trauma cues enabled K to actively reconnect with painful memories, fostering a deeper level of trauma and grief processing than static, purely verbal TFTs could achieve. She was able to confront specific trauma-related triggers through tailored visual cues, gradually reducing their emotional intensity. This structured yet patient-led approach empowered her to process her experiences at her own pace, giving her a sense of control over her recovery.

The therapist’s role was integral to the success of the intervention. Extending far beyond facilitating the procedural aspects of 3MDR, the therapists were actively involved in creating a secure, trusting environment where K felt supported enough to confront distressing memories and challenging emotions. Attunement to K’s emotional needs, validation of her experiences, reinforcement of her autonomy, and pacing of sessions to match her comfort level were integral to the treatment. The supportive and trusting therapeutic relationship enabled her to stay engaged in the process. Establishing and maintaining rapport and strengthening the therapeutic alliance were essential to the intervention and played a significant role in the positive outcomes K experienced.

In follow-up interviews after 10 months, K shared the lasting impact of the therapy. She described how the personalized, focused environment of 3MDR—combined with the physical engagement of treadmill-walking and consistent therapeutic support—allowed her to process traumatic experiences that were otherwise challenging to focus on due to ADHD. She reported visible improvements in emotional stability, regulation, and relationships, including a marked decrease in reactivity to triggers and a greater ability to manage her emotions. This progress extended into her work life, where she excelled and actively engaged in trauma-informed care training, even discussing sensitive topics like suicide.

K also reported positive changes in her personal life. While remaining close to her biological family, she established healthier boundaries, allowing her to prioritize her relationships with her partner and children. Driven by a commitment to her family’s well-being and personal growth, K expressed determination to sustain her progress. Multi-modal motion-assisted memory desensitization and reconsolidation therapy’s immersive engagement, tailored trauma cues, strong therapeutic alliance, and physically dynamic approach were essential to K’s successful trauma processing, helping her advance in ways that prior TFTs had not.

Since engaging in 3MDR, K has experienced meaningful personal changes that have allowed her to better manage the loss of her father and improve her emotional resilience. She now feels more comfortable talking about her father, and her memories of him are no longer as overwhelming, which has reduced her tendency to avoid situations that previously triggered her grief. K reported being less reactive to stressors and finding everyday challenges more manageable, as her responses have become more stable and less emotionally intense. This has reportedly made it easier for her to navigate her daily life and allowed her to face difficult situations with a newfound sense of control and calm. K’s overall experience reflects a significant shift in her ability to constructively process her emotions, leading to greater stability and well-being. Upon K’s review of these results, she confirmed that the representation in this case report accurately represents her experiences with her stating, “I feel like this report captures my experience well. I felt happy, sad, comfortable, and had an overwhelming feeling of accomplishment. It was quite the experience and I’m glad I did it!”

Discussion

This case report highlights the application of 3MDR with a postpartum mother experiencing treatment-resistant PTSD, complex grief, a history of adverse childhood events, and ADHD. After 8 sessions of 3MDR, K exhibited significant PTSD symptom reduction despite previous limited progress with TFTs. Following 3MDR, K is better able to manage the loss of her father, feeling comfortable talking about and recalling memories of him without becoming overwhelmed. She is less reactive to stressors and more willing to face situations she once avoided, as they are no longer as triggering. With more stable emotions and greater resilience, K experiences her daily life as more manageable and feels a stronger sense of control.

Multi-modal motion-assisted memory desensitization and reconsolidation therapy’s immersive, motion-assisted, multi-sensory approach within a trusting therapeutic relationship set 3MDR apart and allowed K to focus and engage with her trauma and grief—a key benefit given her ADHD. Unlike static talk therapies, 3MDR’s combination of movement with personal trauma cues and the use of self-selected music and images as K walked towards symbolic reminders of her trauma fostered a non-avoidant mindset. The physically dynamic and multi-sensory nature of the therapy helped maintain her engagement and regulate emotions in ways traditional TFTs had not.

A safe and trusting therapeutic relationship was central to K’s willingness to confront distressing memories, further enhancing her emotional regulation and strengthening her relationships. The intensity of the 3MDR protocol yielded favorable outcomes, potentially requiring less overall therapy time. K noted, however, that individuals without prior therapy experience might find the intensity challenging. Recommendations for future sessions/clients include reducing the frequency of changing participant-selected photos to allow for deeper trauma processing and extending the number of intervention sessions to enhance immersion in therapy.

Strengths and Limitations

This study possessed several significant strengths. It is situated within a larger mixed-methods investigation focused on the use of 3MDR in real-world contexts. Novel insights into working with a perinatal population experiencing PTSD and comorbid complex grief were gained and further research with this population is encouraged. Arms-length researchers reduced study bias, while access to clinicians who developed and delivered the treatment, along with the rigorous data collection and analysis process, enhanced the reliability of the findings and informed subsequent clinical applications and research.

Several limitations also warrant consideration. A case study prevents any generalizability of the results, making it challenging to determine whether 3MDR would be helpful for a broader population. Yet, the report demonstrated the feasibility and effect in this subject.

Conclusion

This case report involving a 35-year-old postpartum mother suffering from PTSD and complex grief provides compelling evidence for the use of 3MDR as a potential trauma treatment for this demographic. Key components of 3MDR—such as the integration of walking, along with personalized, self-selected imagery and music, as well as the therapeutic relationship—appear to have significantly enhanced K’s engagement and adherence to therapy when addressing PTSD and grief. Processing trauma through 3MDR enabled her to navigate through and regulate her emotions as well as manage the loss of her father and difficult relationships with her family of origin. This led her to focus on relationships that were reciprocal, nurturing, and supportive, and challenge patterns related to intergenerational trauma. She experienced improved coping skills and emotional regulation, freeing her up to more effectively reflect and respond in personal and work situations. These findings underscore the promise of 3MDR for integration into standard clinical practice. To fully ascertain the use of 3MDR, further research involving larger cohorts of perinatal women experiencing PTSD and complex grief is essential.

Funding Statement

The authors declared that this studywas supported by funding from the Department of National Defence, Innovation for Defence Excellence and Security Program Phases 1(RES0052019) and 2 (RES0057347), Royal Canadian Legion AB/NWT Command & First Response to Fashion (RES0046384); and Government of Alberta (RES0063326). In-kind support was provided by Alberta Health Services, Covenant Health, Veterans Affairs Canada, and the University of Alberta.

Data Availability Statement:

The data that support the findings of this study are available on request from the corresponding author.