UCF Podcast: PTSD Treatment That Works for Veterans, First Responders

In episode 12 of Knights Do That, we speak with Deborah Beidel, executive director of UCF RESTORES. The Pegasus Professor and Trustee Chair of Clinical Psychology and Medical Education shares her experience and expertise in PTSD treatment, innovative treatments happening at UCF RESTORES, and how we can better acknowledge and support veterans.

Produced by UCF, the podcast highlights students, faculty, staff, administrators and alumni who do incredible things on campus, in the community and around the globe.

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Transcript

Deborah Beidel: I tell people we don’t need different treatments, we need to do treatment differently. And by doing treatment differently, we found we can be very successful. So the idea is having people give up two or three weeks in order to get a lot better. And we talk about that also as trying to break the stigma. So both for active duty personnel, veterans, and also our first responders, who have always been in the role of being the helper, turning around and asking for help is really different. But if we can start to think about treatment for post-traumatic stress disorder in the same way that we think about physical therapy, then we have a chance of breaking the stigma.

Alex Cumming: As many of you know, November is Veterans’ Month, but what you may not know is that UCF is home to UCF RESTORES a clinical research center here on campus that is dedicated to changing the way that PTSD is understood, diagnosed and treated. In this episode I had the honor of speaking with the center’s Executive Director Debra Beidel. Debra shares her expertise in PTSD treatment, innovative treatments happening at UCF RESTORES, and how we can acknowledge and support veterans.

And before we get to the episode, I do want to share that we touch on topics of traumatic events, which may be triggering to veterans or survivors of sexual assault. Please keep that in mind, as we get into the episode.

Deborah Beidel: So back in the 1990s, I was working with a couple of colleagues and we were trying to figure out how to treat post-traumatic stress disorder for Vietnam veterans. And we’re starting to think about different treatments, but I was always sort of peripherally involved at that point. I was interested, but I was also doing other things. And then on Oct. 2, 2006, Carl Charles Roberts [IV] walked into a one-room school house in that community in [West] Nickel Mines and shot those girls in the head at point-blank range.

I was the psychologist at one of the hospitals where those girls were taken. And after that period of time, it was not only the horror of that but the resilience of that community. Like that night, the women from the community took food to the shooter’s widow and children. And that weekend more than 50% of the people who were at his funeral were from the community of those girls where he had so horribly injured and killed. And it really was that resiliency that was a turning point for me. It was that resiliency in the face of that horrible tragedy that made me decide this was where I was going to spend the rest of my career.

Alex Cumming: How early into your career were you at that point?

Deborah Beidel: I was pretty far along in my career. I got my degree in 1986, so it’s been a long time. I was almost 40, 30 years into it, but I really wanted to do something different and that was a good time. And it really was a motivator to think about how people who were so traumatized, for him to go in there, send all the boys home, line up all the girls and the oldest girl stood up and stood forward and said, “Shoot me first.” She was trying to save time for the younger kids. And I thought that bravery, that courage in the face of that is something that I want to study and I want to be part of.

Alex Cumming: There are moments in your career, at all points it sounds, you never know how one incident can change your career, the trajectory of what you want to do, what you thought you were passionate about.

Deborah Beidel: Absolutely. It really was. If you had asked me when I started my career, was I going to end it running UCF RESTORES or specializing in post-traumatic stress disorder with veterans and first responders? I would’ve said “”No, absolutely not.” But life has a way of showing you what you should do.

Alex Cumming: UCF RESTORES, and from my understanding that UCF RESTORES is a clinical research center here on campus, dedicated to changing the way that PTSD is understood and diagnosed and treated. Currently, you’re the executive director of UCF RESTORES. But how did you get started? How did UCF RESTORES come about?

Deborah Beidel: When I came down here to UCF, I thought that I was probably not going to do any more work with veteran because there wasn’t a hospital here then. There was a small outpatient clinic, but there wasn’t really a hospital and there weren’t a lot of people. So I thought, OK, well I’ll do something else.

And about maybe six, seven months after I was here, I got a call from the Army. They had seen a research study on PTSD with veterans that I had done up in Hershey, Pennsylvania. And they said, “Do you think your treatment program would work with veterans from Iraq and Afghanistan?” And I said, “Well, I think it’ll work better because they’re not 40 years of chronic post-traumatic stress disorder.”

The Vietnam veterans would say to me, “But doc if I get too much better, they might take away my disability payments and I haven’t worked in 40 years. Who’s going to hire me? How am I going to live?” And so I thought, well if you had people who were just coming back who weren’t on disability, didn’t have to worry about being unemployed, we’d have a much better chance. And so the woman from the army said to me, “Put in a project, just put in the same project, but we want you to try it with younger veterans.” And I said, “Sure.” So we did. And that’s how we got started.

And then the first year after we got started, we were doing kind of regular, what you might think of as once a week therapy. And I went back to the army to tell them about the program and the colonel said, “It’s a good program.” He said, “But it’s too long, you’re talking about 17 weeks. I can’t have active duty personnel out of active duty for 17 weeks. I need a shorter program.” So I’m known to have a smart mouth sometime and I said, “Well if you give me more money, I’ll give you a shorter program.” And he said, “OK.” I never got grant money that quickly before, but we did. And that’s how we started our intensive outpatient program, was really to turn the tables on PTSD and try and treat it in a way no one had really thought about.

Alex Cumming: UCF draws so many people from so many backgrounds as has been expressed many times by people outside of myself. Veterans are a big part of UCF’s community and we have a huge ROTC center. So the importance that this means to Central Florida, which has such a huge military presence, to show there’s outreach and there’s possibilities for growth.

Deborah Beidel: I talk about it as hope. When people have experienced these types of traumatic events, they feel changed. And I tell people if there’s one thing I want people to know is that yes, trauma changes you forever. And I say to them, “If anyone tells you they can erase that memory, run in the opposite direction because those types of memories can’t be erased.”

Think about, you’re going along and there’s suddenly something that looked like trash on the side of a road is an IED and people who are with you in a Humvee now are so horribly injured or maybe even killed. There’s no way you’re ever going to forget that but it doesn’t mean that you have to be changed negatively forever. There’s ways of taking on that trauma, ways of learning how to get over it, that then allow you to go on and do something good. If you think about that’s really what we think about when we talk about people who’ve experienced these traumatic events. You take John Walsh, for example, after his son Adam was a horribly killed and what he’s done the rest of his life. You take the Parkland kids, they started a movement. You take the women from the community in [West] Nickle Mines who could go and forgive that man for what he did. It’s those kinds of things that we sometimes talk about as post-traumatic growth. And I think that’s something that we have to hold on to and we have to help people learn that there’s a way of something coming out of a horrible event.

Alex Cumming: Post-traumatic growth. That’s a phrase I’d never heard before, but I think that’s the word I was looking for.

Deborah Beidel: Yeah. We saw it even after Surfside. People who wanted to do something and were looking for a way to take that sort of negative event and do something with it that would be positive. So what they were doing was taking something and saying, “Let me make something good come from this.”

Alex Cumming: Right. Along with being the executive director of UCF RESTORES, you’re also a Trustee C hair and a Pegasus Professor of Psychology and Medical Education. Let me ask you what drives you in your work?

Deborah Beidel: It’s really the need to discover and try and make positive change in some way. Throughout my career, whether it’s been with post-traumatic stress disorder or social anxiety disorder in children, it’s always been about what can I discover? What can I learn? And then what can I do with what I’ve learned to make the world a better place? And if we can make the world a better place in the community where we live, then that has ripples. And those kids can go out — I had one little boy I worked with a long time ago who developed asthma, but no one told him he had asthma. But he would be short of breath and he thought he was going to die and no one would tell him what was going on at first. And so he started refusing to go to school. He started refusing to a lot of things cause he didn’t want to be away from his mom in case he started to die. And so, we worked with him and I always say that’s the only kid that ever worked with that wanted to go to school rather than skip school and come see me. And he ended up going through the military academy at West Point. He’s had a career in government. And, I’m thinking from a little boy who may never have graduated from school because he would not go to someone who now is making such a big impact in the world and the fact that I could help him, I don’t take full credit for it, but the fact that I could help him do what he always wanted to do is what keeps me going.

Alex Cumming: That reemphasizes your point of hope, what you were saying there. So many of these people that have served overseas to keep ourselves safe, they can come back here and have these experiences that they might not recognize are affecting them so deeply. They help us so much and what their service means to us. What we can do is to make sure that their life back here in the states is the easiest transition?

Deborah Beidel: I think it’s that. I think it’s also valued. I’m old enough to remember how veterans were treated after the Vietnam War and the difference between that and the way we treat veterans now is really very stark, and thankfully much, much better. I think the fact that we now value what they do and what they did and keeping us safe — I always say to veterans, “You took an oath that you would lay down your life so that I could live back here, do whatever I want to do.” To me, that’s the most amazing thing about this, is that someone that I don’t even know will put his life on the line for me and for us. And I don’t think we can ever forget that nor should we.

Alex Cumming: No. Speaking of the work that you do, I read that 66% of participants with combat-related PTSD and 76% of first responders no longer meet the diagnostic criteria for PTSD following treatment at UCF RESTORES. Those are some pretty impressive statistics. And that’s a real testament to you and the work that your team does here. What do you think has made UCF RESTORES so successful in helping the individuals in this community?

Deborah Beidel: I think it’s really a testament to my staff. I often say I’m the one that talks about UCF RESTORES, but they’re the ones that really make it happen. They’re the ones that do the work every day. I think a couple of reasons is that UCF is a place where you can do lots of things. We’re such a young university that we can come up with these ideas and nobody says,”Well Deborah, we didn’t do it that way in 1865.” So we can come up with new thoughts and new ideas. And I think that’s the first thing that we can do that we do here.

I think the second thing is that we’re all driven in my clinic by science and by evidence. So we never want to say, “Well, you’ve been coming here for 12 weeks, so you should be better.” And because we are committed to measuring success, and when I say measuring success it’s really the success that the patient has. But we also look at it, if things aren’t going well, what are we doing wrong? Not the patient is guilty of transference or resisting treatment. We think about why isn’t this working? What are we doing wrong and how do we need to change? And I think that’s really some of the success we have. What I tell people is when the statistician ran the data for the first time and told me that number, I made him go run it again because I didn’t believe it myself.

But I think the fact that we can do things because my treatment program would not work in the VA, I don’t believe, because the VA would not allow me to see a smaller number of patients for two sessions a day for three weeks straight. Because they would say, “Well you know, you’re not treating enough people, we’ve got to get all these other people in for a session as well.” Rather than taking a chance on doing something differently. So I tell people we don’t need different treatments, we need to do treatment differently. And by doing treatment differently, we found we can be very successful. So the idea is having people give up two or three weeks in order to get a lot better.

And we talk about that also as trying to break the stigma, both for active duty personnel veterans, and also our first responders, who have always been in the role of being the helper, turning around and asking for help is really different. But if we can start to think about treatment for post-traumatic stress disorder in the same way that we think about physical therapy, then we have a chance of breaking the stigma.

If your leg is broken, you have to go to physical therapy after you get out of the cast. Right? So if you have a stress injury, which is what we think of as post-traumatic stress disorder, if you have that stress injury, you need to go get it taken care of soon, go back and do it. And if we can change that stigma, I think then we can give people more help.

Alex Cumming: I’d like to ask. What types of treatments are you doing differently? I heard mentioned about some virtual reality treatments.

Deborah Beidel: We do. The treatment that works the best for post-traumatic stress disorder is called exposure therapy. And basically you can think about exposure therapy as if you are afraid of a dog. How would you get over your fear of a dog? Most people would say, “Well, I’ve got to be around a dog.” Yes. But if your post-traumatic stress disorder has resulted from an IED explosion, for example, I can’t set off an IED explosion here, nor would I want to. So the only other way I might be able to do exposure therapy is I could ask you to imagine it. But I can’t control what your imagined because I could be telling you to think about this horrific thing and you could be thinking about puppies for all I know. With virtual reality, we can bridge that gap. I can expose you to the sights, the sounds, and even the smells that were part of that event that has now created your fear. And by doing that, I can get you in touch with what we call triggers, those things that reactivate your anxiety. One example is, you can think about diesel fuel. A lot of veterans who came back said that anytime they would smell diesel fuel to gas station, they would then have this flashback to this IED explosion that happened in Iraq or Afghanistan and their buddies who were horribly injured or killed. So what we need to do is teach your brain that just because you’re smelling diesel fuel, it doesn’t mean that your buddies have again been injured or killed. That happened once, but it doesn’t happen every time. So I like to explain it to people by telling them to think about a really scary movie that you saw. For me, it was The Exorcist. You may go see it again and it still scares you. But then by about the 10^th  time you’ve seen it, which would be like your 10^th  exposure therapy session, you go yeah, “Yeah, yeah Linda Blair’s head’s going to spin around.” The bad thing, the thing that scared you at first, it’s still happening, but you’re not scared anymore because you’ve learned that it’s not going to happen. And this is what we do in exposure therapy. And the virtual reality helps us get there because smells in particular, smells are hard to imagine, but smells and the memories that go with them are very powerful and very emotional memories. It’s a short run, here’s the neuroscience part. It’s a short run from the olfactory bulb in your nose to what’s called the hippocampus and the limbic center in your brain. It goes straight there. There’s no rerouting through the cortex or anything like that. And it makes those memories extremely powerful and therefore they’re extremely traumatic.

Alex Cumming: I haven’t even thought about it that way. That’s super interesting. This technology that’s so new and on the cusp of developing in such grand ways to assist in the wellbeing of these veterans, it’s lovely to hear.

Deborah Beidel: It’s really good. We find it’s not the only thing that’s really helpful though. We also have a group therapy. That’s part of this whole treatment package that we do. And that works on things like sleep hygiene because veterans and even first responders who are suffering from post-traumatic stress disorder sometimes only sleep two or three hours a night. So helping them get better sleep, helping them decrease their anger, helping them think about the horrible things that happen, the traumas. And a lot of times veterans will say, “It was all my fault.” They’ll say, “I had to shoot that little girl.” And when you talk to them about why, “Well because that little girl was loaded with explosives and some adult way out of range sent that little girl toward our troops with the idea of killing and maiming our troops and that little girl.” And so shooting that little girl, you saved everyone else, and it wasn’t your fault she was sent that way.

So helping people process through these traumatic events and how much they’re really responsible for is a big part of what we do. It’s a part that exposure therapy doesn’t take care of. And that’s what I mean when I said always looking at the treatment and looking at the outcome and how can we make it better?

For me, 66% of veterans no longer meeting diagnostic criteria is good. The rest are better, but they’re still struggling. And so my mind always goes to that other 34%. What is it? What am I not doing right? What’s not going right there that we need to be able to help them?

Alex Cumming: One thing to think about that gives me a lot of optimism is there are people who are working on those niche details with organizations, like UCF RESTORES, and continuing to do such amazing work. As long as the amazing work continues, more people are going to come that want to do more amazing work to focus in on those niche aspects of life that an individual suffering with PTSD might have, such a difficult time expressing or overcoming. And there could be somebody who, if everybody’s working on these small parts that come together to make the 66% even better.

Deborah Beidel: Yeah. We had a World War II veteran who came to us and asked for treatment and our grant funding at that time didn’t allow for that. And I’m like, I don’t care. We’ll treat them anyway, we’ll figure it out later. And we talked to him and he’s like, “I still think there’s things I can do, but this is getting in the way.” And so we treated him and he got a lot better, and again it’s that hope that people have.

Alex Cumming: And you find that the sooner you can work with somebody the better you have of assisting their livelihood?

Deborah Beidel: I think so because their daily functioning hasn’t been so impaired and people get to the point where they really think they aren’t useful anymore. We had one woman who was sexually assaulted in the military 30 some years ago. She really hadn;t been able to find treatment that worked and wasn’t able to hold a job because of the trauma. And when people come to our clinic, even though I don’t do the treatment anymore, I always introduce myself to the people who are waiting in the lobby because I want them to know who’s in charge. And I want them to know if they’re struggling, if something’s going wrong in my clinic, I want to know about it. Not to blame people, but to fix it. And so on her last day of treatment, she saw me and she grabbed my arm and she said, “Dr. Beidel, I just want to tell you one thing.” And I said, “What?” She said, “You gave me my life back.” And I said, “I am so sorry it took 30 years.” And she said, “Don’t you be sorry, you gave me the rest of my life.”

And that’s why my staff and I get up every single morning.

Alex Cumming: That’s beautiful. And I want to talk about that. You and your team work so hard to bring in as many people as possible. You have veterans active duty, military personnel, first responders, as you said, survivors of sexual assault and survivors of mass shooter.

I want to hear some more about the fulfillment those efforts bring to you and the UCF RESTORES team.

Deborah Beidel: I think we celebrate with the people that we work with. We celebrate their triumphs and we know they do the hard work, right? Because they’re the ones that have to go back into that trauma. They’re the ones that have to experience it. They’re the ones that have to leave their families for three weeks and come for treatment. But the fact they can improve and we can send them home different than they came is what makes all of us get up in the morning. And it’s funny because sometimes when we have new therapists come, they don’t know the treatments that we do. And they’re a little suspicious at times because they don’t think this is gonna really work. And time and again I’ve seen clinicians who started off very skeptical, where I’ll ask them to do a visit because we have lots of people who want to come and see the clinic and want to see the VR. I’ve heard them go, “I didn’t believe this at first, but this treatment really works.” And we can see the change and I think that’s what it is that as a team we know we’re making an impact and I think that is so important. And we just keep going. When the first grant was ending we didn’t know what we were going to do because there we were running out of money and we just looked at each other. We put this whole thing together. We started this, we just have to keep going, we just got to do it. And so we let people know what was going on. We’d let them know the success we had. And we’ve been able through state funding and through very generous donors to keep this going.

It’s amazing the number of people who will give money. And there are some people who get big amounts, but it’s the people who give us $5, $10. I’m so thankful for those people as well, who believe in us and who give what they can so we can continue to help others.

Alex Cumming: That’s fantastic. And all I have to say about that is how wonderful. I want to ask you now, what’s something that you would like veterans or people who know veterans to be aware of about PTSD and receiving treatment?

Deborah Beidel: The one thing I want them to know is that it takes a lot of courage to face your fears. Doing this type of therapy is not always the easiest thing, as I said, going back there. And when we do the therapy we go back to everything that happened. So we don’t gloss it over. We don’t say, “And then it was an IED explosion and people died.” Yeah, no. We have to go back and talk about what it is exactly that they saw and who that was and what it looked like.

So it takes a lot of courage to do that. But it’s, like I said before, trauma changes you forever. There are traumas that you should not just be able to walk away from. First responders will often say well, “The old guys say, ‘Suck it up, buttercup,’ or ‘Just stuff it.’ ” But a lifetime of witnessing those types of traumatic events, both for our veterans and also for our first responders — think about it, a first responders job is to respond to trauma, right? We don’t call them when we’re having a good day. We call them when something really bad is going on. So that’s what they see every single day. And so it’s time that we all stop thinking that you should just be able to shrug it off. And it’s time that we all just acknowledged that people who have post-traumatic stress disorder are not faking it. The things that they’ve seen that, going inside a school where people have been killed, elementary school students at Sandy Hook, teenagers down at Parkland. All the people who were shot and killed at the Pulse nightclub, no one should be able to just look at that and go, “Well, just another Thursday.”

So I want people to know that we understand what it is they’ve been through. And we’re here to help and we’re not going to be afraid. I get calls sometimes from first responders who say, “My therapist fired me.” What do you mean? She said, “I’m traumatizing her more than she’s able to help me and she fired me. See, I’m broken.” And I say, “Come to us because we’re not afraid. We’ll hear those things and we’ll work with you.” And we do.

Alex Cumming: The bravery abroad coming to the bravery at home to face what you’ve experienced and that people like yourself and your team are here to work with these people and not show them to the door. To keep them and to work with them. It’s outstanding. What’s some advice you would give to somebody who wants to do what you do?

Deborah Beidel: I think do what you love and love what you do. I think that I couldn’t do this if I wasn’t part of a team too, because we all have days where we’re like, “You got to take care of this. I got to step back for a few minutes and take care of myself.” But I think if you do what you love, then it’s not work.

People often say to me, “When are you going to slow down now? When are you going to retire?” And I say, “When it stops being something that’s fun, it’s something that I love. When coming to UCF campus becomes a chore and not the beginning of my day then it’s time to move on and do something else.”

So find what it is that makes your heart sing and do that.

Alex Cumming: I love the sound of that. I mean, how could you get tired of UCF’s beautiful campus?

Deborah Beidel: It’s amazing here. It’s true.

Alex Cumming: It’s beautiful here. And what’s one thing that you’re still hoping to do both on a personal and a professional level?

Deborah Beidel: On a professional level, what I want to do is to make sure that UCF RESTORES will be self-sustaining because right now we’re still in the position of crossing our fingers and hoping that the state legislature is going to see what we’re doing and keep funding us to keep doing it. So my goal is I want us to not have to cross our fingers every year. I want us to have a base that’s self-sustaining so that we’ll be able to continue to do the work and focus our attention. New and better treatments rather than making sure that there’s enough money to pay next month bills.

On a personal note, I’m also sort of looking for what I call my third chapter in life. My first chapter was getting ready to do my career. My second chapter has been my career. And then the third chapter, what comes after that when they finally make me retire because I’m doddering around or something. When they finally make me leave, what is it I’m going to do with that part?

So that’s what I’m thinking about.

Alex Cumming: Well, I’m so excited to see in here what that third chapter becomes for yourself. I’ll conclude with this. How can people inside and outside the UCF community help support UCF RESTORES?

Deborah Beidel: They can go to our website and donate. They can even more than that, tell other people about what they’ve heard here today and what we’re doing and make sure that anyone they know who’s suffering from PTSD gives us a call.

We do have resources. People often think we just treat students at UCF. And we don’t. We don’t even just treat people in Central Florida or Florida. We treat people throughout the nation who come to us. I just want people to know that our doors are open, that they’re going to stay open. And that we’re here.

Alex Cumming: Well Deborah, I want to say thank you so much for this super insightful conversation. I learned a lot about what goes on for those who have served and how we can at home help serve them. So thank you for this conversation. I really enjoyed it.

Deborah Beidel: Thank you for the opportunity. I enjoyed it as well.

Alex Cumming: Hey everybody. Thanks for listening. I’ll see you on the next episode of Kights Do That, where I’ll be speaking with epidemiologist Elena Cyrus from UCF College of Medicine to discuss public health and COVID-19 vaccines. As we approach the one-year mark since the vaccines were granted emergency approval.

If you’re doing something cool, whether that’s at UCF or somewhere you took UCF that we should know about, send us an email@socialmediaatucf.edu, and maybe we’ll see you on an episode in the future. Go Knights and Charge On.