Back in 2006, when Paul Riedner enlisted in the U.S. Army as a deep-sea diver, he was an idealistic young man looking for adventure. Today, nearly 10 years later, he’s a slightly less young 37, but still idealistic and adventure-seeking, just in a different way. His four years of active duty in the United States and the Middle East changed his perspective on life and his goals for the future.
While Riedner, who holds a degree in economics from Carleton College and an MBA from the University of Minnesota’s Carlson School of Management, left the Army without significant physical injury, he did feel the acute stress of reintegration into the civilian world and the burden of living a life of meaning and character.
“Since being in the military, my conscience weighs on me,” Riedner said. “It allows me or doesn’t allow me to do certain things, and even though I have the education and skill set to go out and get a regular job and make some money, I just can’t do that right now. My conscience tells me I have to have meaning and purpose in everything I do.”
This August, Riedner found both when he accepted the position of executive director of Veteran Resilience Project, a nonprofit dedicated to helping Minnesota veterans get free access to Eye Movement Desensitization and Reprocessing (EMDR) therapy, a treatment that has been shown to be effective in helping veterans recover from the psychological trauma of war.
Access to EMDR therapy is key, Riedner believes, because suicide rates among Minnesota National Guard veterans are among the highest in the nation. He wants to save veterans’ lives.
For the last two months, Riedner has been working without a salary. His focus has been on grant writing, on finding sources of funding for his organization. He’s also been building connections in the veteran community, seeking ways to let veterans around the state know about the benefits of EMDR.
Last week, Riedner launched a crowdfunding campaign for Veteran Resilience Project with the goal of raising $15,000 to fund the organization and his plans to travel the state, meeting veterans and asking them to share their stories to publicize Veteran Resilience Project’s services. The campaign’s deadline is Oct. 9.
I spoke with Riedner earlier this week at Veteran Resilience Project’s headquarters, a shared office space in the Intermedia Arts building on Lyndale Avenue in Minneapolis.
MinnPost: What will the crowdfunding money be used for?
Paul Riedner: The money we collect will pay my salary so I can do the long-term fundraising for Veteran Resilience Project. We are in the process of writing grant proposals to places like Minnesota Veterans 4 Veterans, Minnesota DHS and a number of other funders.
The money will also help fund my travels around the state of Minnesota, where I will interview resilient veterans, meet veteran-service organizations and create audio programs that I will distribute online and to local and statewide radio networks. The idea is that I will interview and highlight stories of thriving veterans. I’ll ask them questions about what’s changed since they reintegrated into civilian life, what struggles they faced in the process and what their service means to them today. I’ll also ask how they find strength and what support organizations they find the most useful.
MP: Have you identified any of the veterans you’ll be interviewing for this project?
PR: In order to find our subjects, we need to earn the trust of the people in the community. I think it will help that Veteran Resilience Project was created by veterans. I’m a veteran, too. I’m hoping that will give us a leg up to making those connections.
I’m still in the early stages of identifying potential interview subjects. There’s this veteran I’d really like to interview. He lives up North. His name is JJ. Every once in a while, he’ll gather up a bunch of veterans, women, men, guys from every era and from all backgrounds. He brings them out to the shooting range. They just get together. He doesn’t have his own organization. It’s not a VFW thing. I’ve been told he’s doing more for veterans in his area than a lot of official veterans’ organizations are. Through the strength of his personality, he’s transcending barriers. I want to tell his story, and I hope it will inspire others to get help.
MP: How will these profiles be distributed?
PR: We’re hoping to share these stories on radio stations around the state. We’re also going to do podcasts. I’m reaching out to radio stations and networks, and I will produce pieces that will fit for them, depending on what sort of programming needs they have. If they have 10 spare minutes, I can do that. If it’s five, I can do that, too.
The idea is that we’ll get veterans and their loved ones listening through these stories, and then we’ll let them know about Veteran Resilience Project and what we have to offer. Though the public mostly hears about veterans who are struggling, there are a lot of veterans out there doing amazing things. We want to hold them up and then show the community how post-traumatic stress can be turned into post-traumatic growth.
MP: And you believe that one way to do that is through therapies like EMDR, right?
PR: Yes. Our goal at Veteran Resilience Project is to offer this therapy free of charge to any Minnesota veteran who’s struggling with any re-integration issue. The list of conditions that EMDR helps include PTSD, combat stress, military sexual trauma, moral injury and any of the previous-era definitions of those things. We want to treat and heal the trauma.
MP: Can you tell me more about what the term “moral injury” means?
PR: Moral injury occurs when an individual is forced to make decisions that test their moral code. Going to war can be a moral injury in itself. We teach our kids that killing’s wrong, but then we ask a soldier to go and kill. This breaks down the individual’s sense of self. Moral injury doesn’t only happen in combat. It can come from a shift in perspective. For instance, some guys thought we were in Iraq for one reason and then, through their combat experiences, they came to a different explanation. When that happens in midst of your military brothers and sisters going through hell, that puts a big toll on your sense of the morality of what you are doing. It is an intense realization.
MP: So it’s an injury to a person’s moral code?
PR: Yeah. It’s a sense-of-self thing. Shame is huge in moral injury. An individual soldier may believe that there is something wrong with them because maybe they did or didn’t do something that they now look back at and feel shame about. Guilt is better than shame because guilt is, “I did something wrong,” whereas shame is, “I am wrong.”
EMDR deals with shame in a pretty unique way. It’s one of the therapies I think really does get to the core of the issue. Shame thrives when people are isolated and are not connecting with loved ones and others. It compounds anything a veteran is dealing with, whether it is a physical injury or PTSD. Treating shame can help clear the way for other healing.
MP: Can you tell me a little bit about EMDR and how it works?
PR: It is a therapy developed by psychologist Francine Shapiro. She was on a walk in a park and she was thinking about an upsetting memory. She noticed that the memory became less upsetting when she was walking, through the bilateral stimulation of right foot then left foot then right foot then left foot. That’s a simplified version of what happened, but it really was sort of an accident. Later, she researched the effects and started using EMDR on her patients. That was in the 1980s. The most traditional way doing EMDR is watching a finger from the left side of your field of vision to the right side of your field of vision while you think back on an experience or talk about an upsetting memory. Trauma locks up your brain. EMDR engages a different part of your body while you are observing the experience.
MP: How does this help a person move beyond trauma?
PR: It reprocesses the event, which has become frozen in time. In my understanding, the eye movement is similar to the eye movement we experience in sleep, during REM. During that period of the sleep cycle, the brain integrates information, puts it into the proper place and files it away. But trauma doesn’t get processed and filed away. EMDR creates a space where the brain can process the information, the feelings and the emotions in a healthy way. Then the person can find what’s useful in the experience and discard what’s not. During an EMDR session, the therapist and the client talk through what the body is experiencing when they are in this memory. Then they go through different sets of eye movements, and then the therapist asks the client again, “What did you experience?” And it will bring back insights and thoughts that they didn’t have before. Through this interaction with a therapist, a veteran learns make positive associations with that event and what it means in their life.
MP: So there’s been research backing up the idea that EMDR has been particularly helpful to veterans suffering from PTSD?
PR: There has been a lot of research on EMDR and veterans, but I am not well versed in the results. In 2014, Veteran Resilience Project conducted a pilot study with 27 veterans. We had an effectiveness rating of 73.5 percent.
MP: Does the VA use EMDR for veterans?
PR: There may be isolated instances of EMDR research and treatment among particular VA medical centers around the country, but it is not happening in Minneapolis.
MP: You told me that the Minnesota National Guard has the highest suicide rate in the country of any national guard. Why is that?
PR: Nobody knows. This is a large group of Minnesotans who have been in service over the last 15 years. Since 2001, our National Guard has sent nearly 50,000 National Guardsmen to Iraq and Afghanistan. It has taken a toll.
MP: 50,000 soldiers just from Minnesota?
PR: Yes, just from Minnesota. The Minnesota National Guard has one of the highest rates of deployment of all National Guards in the country.
MP: So you are saying the higher suicide rate among Minnesota National Guard members may be partially because so many Minnesotans have been deployed?
PR: They’ve really been put to task. They had one of the longest deployments on record when their tour got extended while they were in Iraq. So many Minnesotans have served in this war.
MP: You’re inching in on your crowdfunding goal. You’re not asking for that much money, just $15,000. That seems totally achievable.
PR: Money is only part of our goal. What we really need to do most of all is to reach the veterans who need us. We need to identify veterans to interview, and we need to let them know that help is available in the form of EMDR therapy. We need to get to the eyes and ears of people who know a veteran who is struggling. We need to connect with veterans so we can help them. We need to save lives.
A few things to consider
This is an important and potentially very beneficial program. At the same time, there are a few things to keep in mind.
First, the link between deployment and risk of suicide in military veterans does not have a lot of research support. It makes sense, but has not really worked out in terms of the data. A recent paper in JAMA Psychiatry by Reger and colleagues suggests other factors may be at work.
Second, while EMDR does seem to work in general, the research support for use in Military veterans is lacking. For example a recent meta-analysis in Military Behavioral Health (Verstrael et al., 2013) found limited support for EMDR in this population. Thus, while it may be useful for many people, it is also important to consider why organizations, like the VA, may not be using fully. We should expect the VA to use the best, most empirically supported treatments for veterans. As more evidence for EMDR in the veteran population is published, I am guessing we will see changes in rates of usage.
Support for the Veterans Resilience project and reply to Steven
Steven,
There is much we still do not understand about what increases the risk of suicide for our veterans.In the Reger study they cautioned they did not have data on combat exposure for those deployed. The authors speculate, based on previous research on why people commit suicide, that problems such as injury, a legal issue or mental health conditions that lead to a soldier being forced out of the military could contribute to suicidal behavior.
What we are coming to understand is that resiliency and post traumatic growth can be targeted and fostered in therapies for PTSD. They show promise as protective factors for reducing suicide risk. They are related to yet not directly the result of PTSD symptom reduction and often precede the symptom resolution.
Frankly your statements about EMDR lacking research support for use with military veterans represent a selective bias in reporting the research of PTSD treatments. EMDR is included as a first line treatment for PTSD in numerous national and international practice guidelines as well as in the Veterans Administration/Department of Defense’s (VA/DoD) own Clinical Practice Guideline for the Management of Post-Traumatic Stress (2010). Are these guidelines in error?
Although a growing body of evidence over the last twenty years has shown that EMDR is an effective trauma treatment for civilians, the VA and Department of Defense has funded no studies that evaluate the effectiveness of EMDR for treating PTSD among military personnel and veterans. The Department of Defense and VA has, however, has funded millions of dollars of research on Cognitive Processing Therapy and Prolonged Exposure Therapy (also identified as first line treatments for PTSD) . VA mental health clinics are mandated to provide CPT and PE (not EMDR) for PTSD.
This would be all well and good IF CPT and PE were effective therapies for our veterans and military personnel when implemented in clinical settings. Maria Steenkamp at her colleagues published this summer in JAMA a thorough review of the research with CPT and PE titled Psychotherapy for Military-Related PTSD; A Review of Randomized Clinical Trials. There conclusion ought to give us pause. They state; ” In military and veteran populations, trials of the first-line trauma-focused interventions CPT and prolonged exposure have shown clinically meaningful improvements for many patients with PTSD. However, nonresponse rates have been high, many patients continue to have symptoms, and trauma-focused interventions show marginally superior results compared with active control conditions”. They site a study by Watts in which of 1924 veterans in a VA PTSD clinic who started CPT and PE only 2% completed an “adequate dose” which they defined as 8 or more sessions!
Steven I agree with your statement we should expect the VA to use the best, most empirically supported treatments for veterans.This is not happening today. Continuing to rely on therapies that have such high drop out rates are not justified clinically.
Regarding the lack of research support for EMDR compared to PE and CPT with veterans and military personnel this is basically a catch 22. Studies of EMDR have not and are not being funded by the VA and DoD since the landmark study by Dr. Carlson in 1998 showing the promise of EMDR for our veterans. Steven you state that as more evidence for EMDR in the veteran population is published we may see changes in rates of usage. This position will result in business as usual and will not serve our veterans.
The Veterans Resilience Project project which Paul notes had a 73% completion rate is needed and necessary. There are a small yet growing group of clinicians in the VA and DoD who are proficient in EMDR. Supporting there work and expanding the training in EMDR is what we should expect of VA leadership. It is my hope not that such initiatives like the Veterans Resilience Project is no longer needed. Rather that such projects are welcomed by the VA to work together to serve our veterans.
I agree, and…
Joseph,
I agree with much of what you say. At the same time, I strongly disagree with your statement that my description of the research “represent[s] a selective bias in reporting the research of PTSD treatments:” I, like you, cite a meta-analysis which is specifically designed to examine the comprehensive research in a given topic. Further, in the JAMA paper you reference the authors state “In sum, the efficacy of EMDR remains largely based on civilian studies; additional studies in military populations are needed.” Further, they note that many studies of EMDR in military populations “involved small samples, tested only brief interventions (1-3 sessions),or involved dismantling comparisons (eliminating eye movements). They also generally did not use methodology consistent with modern trials.” So again, the paper you cite calls into question the research base for EMDR in military populations.
Again, I strongly agree with much of what you say. Psychology is replete with examples in which culture or social factors play a bigger role in decisions than science. This certainly is likely one of those situations. At the same time, I think recognizing the limited support for EMDR in this population (for whatever reason) is still fair.
more about EMDR therapy
As a recently retired psychologist, I used EMDR therapy as my primary psychotherapy treatment and I’ve also personally had EMDR therapy for anxiety, panic, grief, and “small t” trauma. As a client, EMDR worked extremely well and also really fast. As an EMDR therapist, and in my (now retired) role as a facilitator who trained other therapists in EMDR therapy (certified by the EMDR International Association and trained by the EMDR Institute, both of which I strongly recommend in an EMDR therapist) I have used EMDR therapy successfully with panic disorders, PTSD, anxiety, depression, grief, body image, phobias, distressing memories, bad dreams, and many other problems. It’s a very gentle method with no significant “down-side” so that in the hands of a professional EMDR therapist, there should be no freak-outs or worsening of day-to-day functioning.
One of the initial phases (Phase 2) in EMDR therapy involves preparing for memory processing or desensitization (memory processing or desensitization – phases 3-6 – is often what is referred to as “EMDR” which is actually an 8-phase method of psychotherapy). In this phase resources are “front-loaded” so that you have a “floor” or “container” to help with processing the really hard stuff, as well as creating strategies if you’re triggered in everyday life. In Phase 2 you learn a lot of great coping strategies and self-soothing techniques which you can use during EMDR processing or anytime you feel the need.
In phase 2 you learn how to access a “Safe or Calm Place” which you can use at ANY TIME during EMDR processing (or on your own) if it feels scary, or too emotional, too intense. One of the key assets of EMDR therapy is that YOU, the client, are in control NOW, even though you weren’t in the past, during traumatic events and/or panic/anxiety, or whatever disturbance(s) on which you’re working. You NEVER need re-live an experience or go into great detail, ever! You NEVER need to go through the entire memory. YOU can decide to keep the lights (or the alternating sounds and/or tactile pulsars, or the waving hand, or any method of bilateral stimulation that feels okay to you) going, or stop them, whichever helps titrate – measure and adjust the balance or “dose“ of the processing. During EMDR processing there are regular “breaks” and you can control when and how many but the therapist should be stopping the bilateral stimulation every 25-50 passes of the lights to ask you to take a deep breath and say just a bit of what you’re noticing, anything different, any changes. (The stimulation should not be kept on continuously, because there are specific procedures that need to be followed to process the memory). The breaks help keep a “foot in the present” while you’re processing the past. Again, and I can’t say this enough, YOU ARE IN CHARGE so YOU can make the process tolerable. And your therapist should be experienced in the EMDR therapy techniques that help make it the gentlest and safest way to detoxify bad life experiences and build resources.
Grounding exercises are essential. You can use some of the techniques in Dr. Shapiro’s new book “Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR.” Dr. Shapiro is the founder/creator of EMDR but all the proceeds from the book go to two charities: the EMDR Humanitarian Assistance Program and the EMDR Research Foundation). The book is an easy read, helps you understand what’s “pushing” your feelings and behavior, helps you connect the dots from past experiences to current life. Also gives lots of really helpful ways that are used during EMDR therapy to calm disturbing thoughts and feelings.
Pacing and dosing are critically important. So if you ever feel that EMDR processing is too intense then it might be time to go back over all the resources that should be used both IN session and BETWEEN sessions.
Many organizations, professional associations, departments of health of many countries, have given their “stamp of approval” to EMDR therapy. There are 35 randomized controlled (and 20 nonrandomized) studies that have been conducted on EMDR therapy in the treatment of trauma, and many more on other psychological and physical conditions.
importance of EMDR
Riedner’s project is ambitious, and I greatly admire him for taking it on. I also think his focus on giving veterans more access to EMDR therapy has great potential for healing, especially among those afflicted with PTSD.
Thank you, Andy Steiner!
We agree and yet…
Steven,
We are in agreement that there is a limited research on EMDR with veterans. Yet to only state this and leave out any mention that the extensive research base on PTSD treatments clearly shows that PE and CPT, the PTSD treatments utilized by the VA have limited efficacy is to give an incomplete picture of EMDR.
The next sentence after your quote of Steenkamp and her colleagues they stated; ” In the 2 trials testing adequate doses of EMDR there were large symptom reductions,58 and 78% of completers no longer met criteria for PTSD.” These are very positive findings with EMDR yet the VA and DoD has not followed up with further research of EMDR.
I apologize if I inferred you are biased. It was my intent to point out that there is more to be said about the research on EMDR and other PTSD treatments than to point out there is limited research on EMDR with veterans. Do you agree that the fact research on EMDR with veterans is limited this is not a statement about its effectiveness?
Steven can you expand on your statement that while it(EMDR) may be useful for many people, it is also important to consider why organizations, like the VA, may not be using fully. I would appreciate hearing your perspective on this by back channel or in this forum.
Some more thoughts
John,
A couple things:
1. I think we will have to agree to disagree on PE and CPT as effective. A number of studies have shown PE to be effective in veterans (Tuerk et al., 2011; Thorp et al., 2012; Yoder et al., 2012).
2. Studies which have compared PE and EMDR head-to-head have found comparable results (Taylor et al., 2003; Rothbaum et al., 2005). Thus, to claim that EMDR is effective while PE is not requires strong evidence as the previous work shows similar levels of efficacy.
3. I believe the reputation of EMDR has been harmed by many of its advocates, including Shapiro. This is covered in great detail by Herbert et al., (2000) and a chapter in Lilienfeld, Lynn, and Lohr (2015). For example, when research came out showing that finger tapping worked as well as eye movement, proponents claimed that both were viable treatment options. Furthermore, little evidence has supported any of the presumed mechanisms by which eye movement is beneficial. As a result the APA treatment guidelines for PTSD state that dismantling studies “show no incremental effect from the use of eye movement or other proxies during treatment sessions.” The DOD/VA guidelines include similar language. Thus, the research support for a key element of the treatment (it is in the name…) seems to be lacking. Yet, supporters of EMDR have often turned the tables on critics/skeptics and argued that the burden of proof is on the skeptic to disprove EMDR.
However, this is not how science or medicine works. Instead, the burden is always on the advocate and always should be. I could create a theory that broccoli treats cancer. If I insist that you prove me wrong, you would call me a fool. The same processes should be at work when it comes to mental health. The burden is always on the advocate and always should be.
Now, I want to be clear that I am not in any way referencing our current discussion. Rather, this has been the history of EMDR in the field. Advocates have made bold claims and then attacked those who were skeptical. As a result, many got turned off from EMDR as it seemed to be pseudoscientific in its approach. I think many have lumped it in with TFT at this point and dismissed it. Thus, the reason it has a hard time gaining traction is that many got turned off and it will require some very thoughtful and very strong research to change minds.
All of this is to say, that while there may be growing support for EMDR in the literature – it might take a while for the treatment to overcome its past.
Let science speak for itself
Steven,
This is not about degrading CPT and PE to make EMDR stand out. If advocacy is about being skeptical and making statements that have research support then I am an advocate for not only EMDR but for getting the best possible PTSD treatment for our veterans.
Lets take a broader look at the history of EMDR. It has taken years for the academic research field to take EMDR seriously. Critics have labeled EMDR as pseudoscience directly or by association. “The finger movements of the EMDR therapist bear an intriguing resemblance to those used in some early forms of Mesmerism.” Does this statement by Lilienfield suggest he has an unbiased view of EMDR? In the article by him about EMDR he states; “Eye movement desensitization and reprocessing (EMDR) was developed in the late 1980s as a treatment for posttraumatic stress disorder. Since then the therapy has been shown to be efficacious for this and other disorders.”
Knowing EMDR works has presented the skeptics of EMDR with a new challenge. This has led to an effort to discredit the “mechanism of action” meaning the eye movements as being nothing more than a distraction or as Lilienfield percieves a form of mesmerism.. There are dozens of recent studies that have tested specific hypotheses regarding mechanism of action and found a direct effect on emotional arousal, imagery vividness, attentional flexibility, retrieval, distancing and memory association. These studies have been done by academic researches with no allegiance to EMDR. Below are just a few references.
Lee, C.W. & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy & Experimental Psychiatry, 44, 231-239.
Lee, C.W., Taylor, G., & Drummond, P.D. (2006). The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clinical Psychology and Psychotherapy, 13, 97-107. This study tested whether the content of participants’ responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing which would be expected given Shapiro’s proposal of dual focus of attention. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner, which indicates the underlying mechanisms of EMDR and exposure therapy are different.
Leer, A., Engelhard, I. M., & van den Hout, M. A. (2014). How eye movements in EMDR work: changes in memory vividness and emotionality. Journal of behavior therapy and experimental psychiatry, 45, 396-401. This study provides corroborating evidence that EM during recall causes reductions in memory vividness and emotionality at a delayed post-test and that the magnitude of these effects is related to intervention duration.”
Steven,
With due respect I encourage you to take to heart what you said about while there may be growing support for EMDR in the literature, it might take a while for the treatment to overcome its past. As a clinical psychologist I too was trained to be a skeptic and researcher first. While working in a VA PTSD clinic I heard the skepticism about EMDR yet wanted to know more about what EMDR was about. Taking our field to task for not giving EMDR a fair shake is not easy and can lead to scorn. Again all this would be academic and just posturing if the current PTSD treatment system was meeting the needs of our veterans. It is not hence the need for grass roots veteran driven programs like the Veterans Resilience Project. I suspect you have heard of the past with EMDR and the criticism of EMDR from your colleagues. Speak to a colleague who is doing EMDR and ask about their experience. If you already have great. If not I am willing to speak to you any time.