Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 166 | February 28, 2022
Conversations about PTSD
Dr. Deborah Beidel
Professor of Psychology at University of Central Florida
Welcome to Difficult Conversations with Dr. Anthony Orsini. Post-Traumatic Stress Disorder or PTSD is something most people are familiar with but are uncomfortable talking about. As my guest today, I have one of the foremost experts on PTSD who will tell us about the groundbreaking work she’s been doing here in Central Florida. Dr. Deborah Beidel is the Trustee Chair and Pegasus Professor of Psychology at University of Central Florida. She is also the Director of UCF RESTORES program, which is a clinical research center dedicated to changing the way post-traumatic stress disorder is understood, diagnosed, and treated. Her use of virtual reality to treat people suffering from PTSD has led to the development of treatments that are 2 -3X more effective than standard psychological treatments. Dr. Beidel is the author of over 300 scientific publications on the treatment of anxiety disorders and PTSD. Her most recent work involved leading a team of scientists and clinicians develop a new virtual reality system that allows clinicians to use virtual reality to treat veterans, active-duty personnel, first responders, and survivors of mass shootings with PTSD.
Dr. Beidel takes us through her journey, which started in the 1990’s, with her and two colleagues searching for a better way to treat Vietnam Veterans with PTSD. We find out the various historical names for PTSD. She discusses PTSD , the symptoms that develop, and why it’s a conversation people don’t want to have. We hear Dr. Beidel’s thoughts on why there needs to be a change at the administrative level, so PTSD can be recognized earlier. She discusses the need for more therapists who are culturally competent. Dr. Orsini mentions some important points about getting the person to admit to themselves. that they have PTSD. He says "Its a difficult conversations they sometimes need to have with themselves." Dr. Beidel details more about the RESTORES program, which utilizes exposure therapy, virtual reality, and intensive outpatient treatment. We also learn how some of their programs are federally funded, and with the help of the state legislature in Florida, the treatment is provided at no cost to Florida residents who meet the criteria for PTSD. Dr. Beidel tells us where treatments are available, and about a grant she received to do this treatment on 3 military bases around the country. We end with Dr. Beidel sharing with us the most difficult conversation she’s had and how she navigated though it. If you enjoyed this podcast, please go ahead and hit subscribe on your favorite podcast platform.
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Deborah Beidel (1s):
What we do with virtual reality is we’re able to control what it is that you’re being exposed to. Now in exposure therapy, what happens is when that traumatic event occurs, everything that’s in that scene or in that moment becomes part of your trauma memory. So if we take an event like the pulse nightclub shooting, and you’re inside that club, not only are you seeing people who have died, but you’re smelling the alcohol. And in this case in particular, what people said was that cell phones that just kept ringing. And particularly that marimba ring, because people were trying to find out what’s going on with their loved ones.
Deborah Beidel (44s):
And no one was answering the phones because they had died. And the first responders couldn’t answer the phones because they were hunting for the shooter. So that ringing now becomes part of that traumatic event.
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.
Dr. Anthony Orsini (1m 41s):
Well, welcome to another episode of Difficult Conversations: Lessons I Learned as an ICU Physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. PTSD or post-traumatic stress disorder is a term that I believe most people today are very familiar with, but are actually very uncomfortable talking about. Well, today I have one of the foremost experts on PTSD as my guest. She’s going to talk about the groundbreaking work she had been doing right here in central Florida. Dr. Deborah Beidel is the Trustee Chair and Pegasus Professor of Psychology and medical education at University of Central Florida. She is also the Director of UCF RESTORES program. UCF restores is a clinical research center dedicated to changing the way that post-traumatic stress disorder is understood, diagnosed and treated.
Dr. Anthony Orsini (2m 25s):
Internationally recognized as a leader in the area of Traumatic Stress, Her use of virtual reality to treat people suffering from PTSD has led to the development of treatments that are two to three times more effective than standard psychological treatments. Dr. Beidel is the author of over 300 scientific publications, including journal articles and entire books on the treatment of anxiety disorders and post-traumatic stress disorder. She’s received over $31 million in federal research funding throughout her career, developing effective treatments for anxiety and PTSD, and then disseminating them into standard clinical practice.
Dr. Anthony Orsini (3m 7s):
Her most recent work involved leading a team of scientists and clinicians to develop a new virtual reality system that allows clinicians to more easily use virtual reality to treat veterans active duty personnel, first responders and survivors of mass shootings with PTSD. Well, thank you, Deborah. I really appreciated Dr. Beidel for you taking the time out of your busy schedule. I know we just spoke a few minutes ago, and you mentioned that you have a bunch of interviews today, so I really appreciate you giving this hour to my audience.
Deborah Beidel (3m 37s):
Oh, thank you for inviting me, Tony. I’m happy to be here today.
Dr. Anthony Orsini (3m 40s):
So your work is so fascinating. And I want to just jump into that in a minute. I first heard your name when I moved here to central Florida, about eight years ago and met Dr. Larry Barton. Who’s also at UCF, but I think he was episode 1 0 5. He mentioned your amazing work. And I guess that was like seven years ago and said, oh, you have to meet Dr. Beidel. And then of course, life took over. We got kind of crazy and it just kind of moved through this. We’ve had several other people that have talked about veterans with Dr. David Schulkin was on episode 112, the former secretary of the VA. And then just a few weeks ago, PTSD started to come up again and I said, oh my God, I never contacted her. And so I was so glad when you graciously took my call.
Dr. Anthony Orsini (4m 22s):
And now here we are. So I’m really excited, but let’s get the audience to get to know you a little bit where you’re from, what drew you to psychology and how you ended up working with PTSD.
Deborah Beidel (4m 34s):
I originally started out to think about psychology as a career when I was in high school. As a matter of fact, I was someone who really loved to read. And one summer I ran out of fiction books to read. So my dad had a bookcase and I started going through them and found this introduction to psychology book. And so I pulled it out and started reading through it and just found it to be very fascinating. And for me, it’s never been just about treating patients, although that’s a large part of what I do, but it’s also been the science and the research behind it. And it fits in with the dreams I had when I was a really little kid. I wanted to be a detective. I wanted to be an archeologist.
Deborah Beidel (5m 14s):
And when I realized that all those things had together, it was all about discovering things. And so that’s really been my north star as I’ve gone through my career is how can I discover things? How can I make things better? How can I use science to improve people’s lives? And so that’s where I started in psychology and just decided to keep going. I just wasn’t satisfied with a bachelor’s degree or a master’s degree. I wanted to do my own research, which required getting a doctorate. And that’s the journey of that. And then getting me down to UCF was I was interested in making a move.
Deborah Beidel (5m 54s):
And for me, UCF had this fascinating program in technology and integration of things like VR and artificial intelligence. And I thought, that’s the place I need to be because I’m going to disseminate treatments, I need to understand and use the technology behind it to make things better.
Dr. Anthony Orsini (6m 13s):
Where are you originally from?
Deborah Beidel (6m 14s):
I’m originally from Redding, Pennsylvania.
Dr. Anthony Orsini (6m 17s):
Okay, great. Yeah. Yeah. So UCFF is really a hidden gem that’s starting to explode right now is in general as a major university and a player in so many different areas. My son’s graduating there this year, but I’m so impressed. They started a new medical school. They did it the right way. It’s really very impressive. I find that psychology becomes more and more interesting to me as I started to learn about the psychology of the way humans connect, the way they speak and communicate. Just an interesting story, my very first rotation right after graduation is psychology. And the psychologist takes me over to the inpatient. And there’s a 16-year-old who is a quadriplegic because he dove into a shallow pool.
Dr. Anthony Orsini (7m 1s):
And my job was to visit him every day. And, you know, he had suicidal thoughts and he had all kinds of stuff. And I kind of tell you that was the hardest thing that I ever did. And she would just leave me there, you know, a lot of times and say you visit him and then we’ll come back. So I kind of got nervous about psychology, but now I find myself coming really back in. So now you’re at UCF. And did you get interested in PTSD before UCF or did that happened afterwards?
Deborah Beidel (7m 28s):
Well, I’ve been interested in PTSD since the 1990s. I was at the medical university of South Carolina. I’ve been in three different medical schools as well. So I’ve trained a lot of residents, but I was at the medical university of South Carolina with two colleagues. And we were really searching for a better way to treat Vietnam veterans with post-traumatic stress disorder because we knew that what was out there wasn’t working. And so we developed a treatment program that used exposure therapy, but virtual reality really didn’t exist yet at that time. But it did use exposure therapy and also a group therapy to work on things like anger and social isolation and depression.
Deborah Beidel (8m 8s):
Because if we remember back, when people came back from Vietnam, they weren’t really welcomed home. They were called baby killers. They were spat on. And so there was a lot of anger in this group and a lot of social isolation. So many of the people we saw had been living out in the woods because they didn’t want to be around anyone else, but we started that program and we’re finding it, It was effective, but it was also challenging because people would say to me, doc, I’ve been on disability for 35 years, who is going to hire me if I suddenly get better? I have to be careful about how much better I get. And, you know, legitimately, when you haven’t worked in 35 years, it is going to be difficult for people to give you a job again.
Deborah Beidel (8m 52s):
So I got interested in what we were doing and having some effect. And at that time, then I was recruited down to UCF and that’s where we started working with younger veterans and including virtual reality
Dr. Anthony Orsini (9m 6s):
PTSD. I was doing a little research before this PTSD, although I think was first made an official diagnosis in the eighties, but it goes back centuries, right? I mean, I think I re shell shock. There’s a whole bunch of battle fatigue, I guess it was called by many different things, correct?
Deborah Beidel (9m 22s):
Yes. It goes all the way back to writings of Ulysses and people along that line who were just having some kind of reaction. And as far back in the United States, we can trace it back to the civil war where they talked about something called soldier’s heart, but the symptoms were very much the same. And then it was shell shock, war neurosis. We didn’t get a diagnosis of PTSD until in the 1980s, but it was always with us as long as there have been human beings on this planet. It’s just, we keep refining how we think about it.
Dr. Anthony Orsini (9m 56s):
And then for the people out there, give us a definition of PTSD. And why do you think is one of these conversations that people don’t want to have? It’s almost like they want to ignore it.
Deborah Beidel (10m 4s):
Well, we talked about PTSD. The first thing that has to happen is there has to be a traumatic event. So something has to happen. And the way we talk about it, it’s not just said something happened and you think, wow, that was awful. It has to be something that either results in death, results in you witnessing someone else’s death, results in the threat of your own life being taken, or some kind of serious physical injury. So it’s a little different than when people say, oh, you know, I was traumatized by that test. I took last week, this is something that really has the threat to your physical integrity. And so then after that people develop these symptoms because what’s happened is with that kind of traumatic event, lots of things get connected that we might want to talk about that a little bit later, but as to why people are afraid to talk about it.
Deborah Beidel (10m 55s):
When you think about some of the groups who are most likely to develop PTSD, we’re talking about our service men and women, whether they’re veterans or still active duty and our first responders. These are the people that we think are going to save us. They’re supposed to be the tough men and women. And the idea is they get a lot of messages until very recently that they should just suck it up. Buttercup is the phrase that’s often used or you’d do what you were getting into way you joined the military, or you knew what you were getting into when you decided to be a cop. I challenge anyone. As I say to go into something like the pulse nightclub, see 49 people dead, 53 people injured and be able to say, oh yeah, this is what I signed up for.
Deborah Beidel (11m 40s):
And this doesn’t bother me. That’s someone who I always say, doesn’t have a heart because to see that we’re fellow human beings and not be affected by it. That’s not the kind of person we want helping us.
Dr. Anthony Orsini (11m 52s):
Really, for some reason, I guess, because so many years that we weren’t able to discuss with successfully treated that the community at large just decided let’s pretend it’s not there. Is that why? I mean, that’s why this turns into a difficult conversation episode perfectly.
Deborah Beidel (12m 7s):
Yeah, it does. Because the military people were always afraid. If I admit to that, my career is over. And even though people would say, no, your career is not over. If you admit to it, every individual person would say, that’s not true. I know my career is over. I’ve seen it happen to someone else. If I tell you that I’m having trouble, I’m never going to get promoted. You’re going to find a way to get me out of the military. Same thing with our first responders. This is why the rates of suicide are so high, particularly among our first responders and also our military. This untreated post-traumatic stress disorder. Now it’s not the only reason, but it’s one of the reasons. And in part it’s because people have been unable to come forward is a very well-known case in the Indian river area of this state.
Deborah Beidel (12m 54s):
Where a Captain in the fire department left note saying 29 years of PTSD has taken its toll on me. I love you all very much. Take care of each other, went out in his dress uniform into a field and shot itself. And it’s because he couldn’t find a way to get the help he needed. The other thing is there are not a lot of therapists who really understand the culture of these groups and how to approach treatment. And that’s another reason why there’s this stigma that if you have PTSD, you’re broken, you can’t be fixed. So don’t talk about it. Law enforcement officers say, if I tell you you’re going to take away my gun, I can’t work if I don’t have my weapon.
Dr. Anthony Orsini (13m 38s):
Yeah. This series is really home for me. I mean, I come from a whole family of police officers and not suburban police officers, Newark, New Jersey police officers. I’ve seen a lot. And my father was in the riots of 68 and you know, had bombs thrown on him, et cetera. So, but what I’m seeing in medicine, you mentioned first responders, but physicians have the highest rate of suicide of any profession. Now I know the doctors, we, it’s a very hot topic. We’ve got several episodes on whether you call it moral injury or burnout, but there is that for police officers, doctors. And I’m sure veterans that I feel like I have to have this S on my chest and say, I’m Superman.
Dr. Anthony Orsini (14m 19s):
And I remember trainings, you sit at a cafeteria and you hear a bunch of doctors going, I haven’t slept in one night. I I’ve been up 36 hours and the next doctor goes, oh, I’ve been sleeping for three days. And they’ll, you know, 40, it’s like walking back up, but it’s this whole mentality of, and then I guess I saw in medicine very early on, when you see these horrible things coming to the emergency room, you see them almost have humor, I guess, to deal with that, I guess, is that something that happens in all of it or is that just a medicine thing where they try to deal with it with humor? I
Deborah Beidel (14m 49s):
Think that happens in all of that, that as well. So people try to find something to call it gallows humor or whatever it might be that people try to use to just get themselves through that particular situation. I mean, it’s interesting too, because sometimes it’s not the most horrific event that has driven people into treatment. It’s this idea. It’s just been one more, it’s almost like this cumulative effect. So we sometimes there is a big of it like a mass violence event. But the other times when we’ve looked at what has served people into our clinic, and we’ve seen over 600 1st responders now in the past five years, the number one event is a pediatric death.
Deborah Beidel (15m 31s):
And it’s typically a pediatric drowning and people will come in and they’ll say, if I have to pull one more kid, dead kid out of a swimming pool in one of the counties right around here last year, they had, I mean, almost a hundred pediatric drownings in one county. How do you keep doing that without that affecting you in some ways? So we can think about these very large events, but we also have to think in terms of this cumulative effect. And I think for our medical personnel, that’s also what we see. It’s not just one big thing. It’s all the things that are layered together that then people do burn out or say, I just can’t do this anymore.
Deborah Beidel (16m 15s):
There’s typically one that haunts them at night,
Dr. Anthony Orsini (16m 17s):
Susan Wilson was on our podcast. She does a work with second victim syndrome of doctors. Who’ve had medical malpractice against them and you know, real medical errors that were just innocent errors. But then it just had PTSD for that afterwards. But it’s been said that every critical moment starts with a difficult conversation. Every critical moment in our lives starts with difficult conversation, but that conversation has to be one with yourself, right? So first you have to admit it that you have this issue. And I find that the leaders, and I really want your opinion on this, that the leaders who may or may not see this choose to ignore it, like Johnny has PTSD or he’s not himself, but gee, I’m really short firefighters.
Dr. Anthony Orsini (16m 59s):
Aren’t really short paramedics. So I can’t really afford to give him some leave. And how do we change that? And how much of a problem do you think that is?
Deborah Beidel (17m 8s):
Well, I think it’s a problem. I think what we have to do is change at the administrative level. I think it’s starting to change, but as people retire and younger people live into those administrative positions, but we have a retired fire chief who works with us. And when we go to do presentations someplace, she’s always part of our presentation lists. And she says, her job is to talk to the white shirts, the people who are in charge. And she’ll say, I’m talking to you white shirts out there about how to handle this, how to have an administration that recognizes that people are suffering and that they need to get help. Now I think the other thing is that we have to come up with treatment programs that don’t take years.
Deborah Beidel (17m 50s):
The idea that PTSD takes you years to recover from it is just not correct. And so we have to have people understand that it doesn’t mean that you’re broken forever. That just like if you have a leg injury and you go to physical therapy, if you have a stress injury, you’ll have to go for therapy, get it taken care of. And there are now we’re finding these intensive programs that I’m hoping are going to help change the stigma so that people don’t think, oh my God, if he’s got PTSD, I’m not going to see them for three or four years that it’s not going to be that way. But that’s part of the difficult conversations is having it with the people in charge. The other thing is to have therapists who are really culturally competent.
Deborah Beidel (18m 35s):
And what I mean by that is who understand these different cultures of the military and the cultures of first responders with the cultures of fire and law enforcement being very different. Florida is lucky in that the fire service in Florida is very forward thinking and there’s a lot of support for that. And we’re hoping that we’re going to be able to make it a model for the nation as how you’ve been come up with these programs and an intensive program that starts from the first day you’re in the fire academy or the police academy through retirement. Because just as you leave the service, does it mean you lose your PTSD? But I’ve had so many calls from patients who have said to me, my therapist just fired me because she says, I’m traumatizing her more than she’s able to help me.
Deborah Beidel (19m 24s):
And then they go see I’m broken. Nobody can fix me. And then I have to convince them, come see us because we could work with you. But it’s this idea that people think they know how to treat trauma, but they’ve never treated traumas like this. And that’s a huge difference. And without changing that part of the whole equation, it doesn’t matter because even if you decide to go to treatment and your EAP gives you a therapist who’s around the corner, if they don’t know and understand your culture and what you’re going through, it’s not going to be effective.
Dr. Anthony Orsini (20m 0s):
And so there’s somebody, as we say, choke points here. So first you have to get the person to admit that they have PTSD. And I think what I see around the hospital all the time after we have a terrible death or something like that. And I’ve mentioned this in a previous podcast that administration will say to the nurse who just experienced that maybe in my field babies that they’ve been taking care of for months, that just died. And I could see it happening in the fire department, et cetera, is where the leader says, Tony, you look like you’re really upset. Do you need to get some help? And that tells me immediately, if I say yes, that means I’m weak. So we have to change the narrative to there’s really no choice.
Dr. Anthony Orsini (20m 41s):
Okay? Like I’m referring you, you’re going to go get your leg x-rayed right. And you come back. And I think the police officers have done that for awhile. Like after shootings, et cetera, they have to talk to someone. And I think that really frees you into not being embarrassed because well, I have to go, I don’t have a choice. That’s the rules. So you have that choke point and then you have the choke point where, okay, now you’d go and you’d go to someone who’s not culturally sensitive is not good with PTSD. And so now it’s a big failure. And then the person comes back and says, see, that was a whole waste of time. So, but thanks to people like you, things are going in the right direction. So tell me about the restores, because this is, I think the most fascinating thing that I really want my audience to hear about this and tell us what that is about the virtual reality and why it’s so successful.
Deborah Beidel (21m 30s):
So our treatment program works with something that’s called exposure therapy. And if you were afraid of a dog and I asked you, how do you get over your fear of a dog? You’d say, well, it gotta be around a dog. Yeah, that’s correct. But I can’t make you be around IED explosions or children who just died in your arms or gunshot victims. I can’t manipulate those. So the only other way of the past that we’ve done, this is to have you imagine it in your head while we do therapy. And I’ll talk about therapy just a second, but I can’t control what’s in your brain. You could be telling me, you’re thinking about this horrific event.
Deborah Beidel (22m 13s):
And you could be thinking of puppies for all I know. What we do with virtual reality is we’re able to control what it is that you’re being exposed to. Now in exposure therapy what happens is when that traumatic event occurs, everything that’s in that scene or in that moment becomes part of your trauma memory. So if we take an event like the pulse nightclub shooting and you’re inside that club, not only are you seeing people who have died, but you’re smelling the alcohol. And in this case in particular, what people said was that cell phones that just kept ringing. And particularly that marimba ring, cause people were trying to find out what’s going on with their loved ones.
Deborah Beidel (22m 58s):
And no one was answering the phones because they had died. And the first responders couldn’t answer the phones because they were hunting for the shooter. So that ringing now becomes part of that traumatic event. So what happens afterwards is every time someone hears that ring, no matter where they are, they could be at a shopping mall, restaurant, they have an immediate reaction. They have a flashback. As we call it to that night, they get very anxious. They might find themselves for a few minutes, be in that events again. And so what we do with exposure therapy is we have to retrain the brain and we know that the therapy actually makes new neuronal connections inside your brain.
Deborah Beidel (23m 39s):
You’re learning something new. And what you’re learning is that now every time that phone rings, the bad thing doesn’t happen, right? You’re not back inside that club. Once that ring was associated with something terrible. But now in exposure therapy, you learn that ring does not signal danger. Every single time the phone rings. We do this over a series of days and what we can do with virtual reality, not only can we give you a visual of what the nightclub looks like we can put in those sounds, we can also put in those smells and smells are really important because smells, we find often trigger the memory of the trauma.
Deborah Beidel (24m 22s):
So for example, our servicemen and women will talk about the smell of diesel fuel. When they go to the gas station, they have a flashback to that explosion. Again, people will talk about the smell of tequila after the pulse nightclub shooting. Cause it was last night and there was a lot to keep up so we can put the smells. And why are smells important? I’m telling the physician about brain anatomy, but from your olfactory bulb to your amygdala and hippocampus the memory center of your brain, the emotional center of your brain, it’s a straight run. It doesn’t cross through the thalamus or go through the forebrain and then down into the midbrain, it goes straight there and it makes those memories, very emotional memories, and very powerful memories.
Deborah Beidel (25m 6s):
So by adding in all those cues into the therapy that we’re doing, we’re able to create a much more powerful treatment and exposure therapy works best when you do it in rapid succession. So it’s kind of like when you tell someone to take a medication, you say, take this for 10 days. You don’t treat an infection by saying, take a pill once a month for 10 months. So we’re doing the same thing here. We’re saying, take this treatment. The treatment is 10 to 14 days, depending on the severity of the trauma. And by repeating it over and over your brain learns that phone is not going to cause shooter to occur.
Deborah Beidel (25m 46s):
That it doesn’t signal danger, whatever else it might be fireworks do not mean that you’re under fire. And we are able to do that. Now in our therapy. We know that as good as exposure therapy is, and because we’re a science-based and we measure everything, exposure therapy doesn’t really work all that well immediately for things like sleep problems or for depression, moral injury, anger. So we’ve added in a group treatment that deals with all those. And we’ve packaged this as an intensive outpatient program. We do this treatment for three weeks. Exposure therapy in the morning group therapy in the afternoon. Our success rate at the end of three weeks is 66% of veterans and 76% of first responders no longer meet the criteria for PTSD.
Deborah Beidel (26m 35s):
After the three week program, our dropout rate is 2%. We’d done almost a thousand people now. And our relapse rate at least at six months is 1%. When we started this, people told me, oh, aren’t you afraid people are going to commit suicide because you’re stressing them out. No one has completed suicide. Abel said, well, people will be drinking a lot more because you’re having so stressed. We’ve measured that people are not drinking more. Even though they’re staying at a hotel because we offer housing to people from out of the city where they get two hours of free beer and wine and happy hour every day, they’re not doing it. I think the key is we’re giving them hope.
Deborah Beidel (27m 16s):
And I think for any kind of medical treatment, whether it’s psychological or physical, you have to have hope. I mean, you have to believe that the people who are treating you are going to make you better. And when our people come in after the first week, and they’re saying, I’m sleeping just a little bit better. I’m sleeping five hours now, not three. They have hope and they’re willing to stick out what can be for the first week, a pretty distressing kind of treatment, but they do it because they know they’re going to get better. So we’re very proud of this program.
Dr. Anthony Orsini (27m 49s):
Really is amazing results. And you get people from all over the country. And how did they find you?
Deborah Beidel (27m 54s):
They find us in various ways, we’ve had a lot of referrals from people, a lot of word of mouth from people who have been in our program and counsel others to do that. We’ve had some good publicity about what we’re doing. We get a lot of referrals through Facebook, patients who have been through our program, we’ll post on there. This is a good program. This is the real deal. And we also use outreach workers. So in addition to our former fire chief, we have a former nine 11 New York city police Sergeant who does outreach to law enforcement. We work with the national police foundation. So they refer people to us. We’ve just hired or office of hiring a medical outreach person who is a former nurse.
Deborah Beidel (28m 38s):
Well, she’s still a nurse, but she works in one of the local hospitals that she’s now going to work with us, reaching out to other people. And you talk about stigma. And I think this is part of the stigma that we faced being in the college of sciences at UCF is people immediately think, oh, well, they just have students doing that work. That’s not true. We have licensed clinicians. So we’re also trying to overcome this stigma of, you know, oh, it’s just students. And also that all we want to do is measure things because people say, oh, well, if it’s a research project, they don’t really care about me. I’m just a lab rat, which is not true, but we have to have people who can speak out on our behalf and we’re getting
Dr. Anthony Orsini (29m 17s):
You are federally funded, so there’s no cost?
Deborah Beidel (29m 20s):
Some of our programs are federally funded. So there’s no costs. We’ve also been very fortunate that the state has seen the work that we’re doing. And we have been funded in the past four or five years by the state legislature here in Florida to provide this treatment at no cost to Florida residents. So anyone in the state of Florida, who meets the criteria for post-traumatic stress disorder and wants to participate in our program, we are available to them for this. And like I said, we’ve been lucky enough that both the programs, federal and state level also include money for housing. So people stay at a local hotel, if they’re out of the area, so we’re not asking people to drive from Naples every day to come to the program, we can house them there at no cost to them.
Deborah Beidel (30m 5s):
And the hotel has free breakfast and dinner some nights a week, so they can do pretty well.
Dr. Anthony Orsini (30m 11s):
Now to be clear, when you say virtual reality, this is one of those goggles that we put over the head that you see on TV or with sniffing and other things like that.
Deborah Beidel (30m 18s):
Yes. So during COVID we did some work via telehealth, but we couldn’t do the virtual reality. I’m still working on how to get it over the internet, but it’s the goggles. And we have a machine that will emit the smells and our new system. The old system that existed when we first started only had military combat scenes on them. So we were not satisfied with that because we were starting to see first responders and the military scenarios didn’t really fit. So we’ve developed a new virtual reality system that we’re testing right now that does include scenarios that are relevant to first responders that are relevant to survivors of mass violence events. We even just modeled in the virtual reality, the Surfside building collapsed down in Miami, so that we’re now able, cause we are getting some calls from some of the people who were working on that pile for 12 hours a day for three to four weeks who are now coming in asking to be part of the program that we have.
Dr. Anthony Orsini (31m 16s):
A lot of what I do is as simulation with the breaking bad news program and the patient experience program. And I’m just a fleeting thought. Does this help in a preventative measure? In other words, if we’re training a police department or we’re training doctors during their training to be exposed as virtual reality, is there any data that that helps at all?
Deborah Beidel (31m 39s):
There’s a little bit of data. I mean, I still don’t think that you could go to one of these vast violence events and not be affected, but there’s a little bit of data. I was working with someone over in research park who was doing a study on people who, you know, everyone out in the field now in the military is a sort of first day person. They all carried kits and all of that. And so he was doing an interesting study. He found that people trying to put a tourniquet on something were having difficulty because of the smell of blood, the smell of urine and feces and all those things that happen when you get injured. So he did a study where he was seeing if he could have people learned to put a tourniquet on in the presence of those smells with the idea that if they smelled them now and could put the tourniquet on in real life then, or in his case, in his testing scenario, they would be able to do a better job.
Deborah Beidel (32m 32s):
And he did find that there was evidence. Blood is hard to make a smell. People haven’t been very good at getting the smell of blood, right. But he did find that people were more effective. They could put a tourniquet on faster and more correctly if they had been exposed to those spells ahead of time than if they first got the, the actual test. So I think there are some things that we can do.
Dr. Anthony Orsini (32m 53s):
What made me think of that is that the Orsini Way has been working with Eastern Virginia medical school for a long time, which is located in Norfolk, Virginia. And we’ve done some work with them and their residency programs there. And they took me around their simulation lab. I’ve seen a lot of simulation labs and I can tell you this one is impressive. It, I always say, it looks like Trump towers. I mean, it’s got bronze. It’s just a beautiful building. They have really dedicated. And I think part of that is they do a lot of simulation for the Navy there it’s right next door. And they did take me to a room where the Navy surgeons have to do surgery, where they’re piping in these super loud speakers, bombs, and guns and things like that, which I thought was really cool.
Dr. Anthony Orsini (33m 34s):
And I think that’s probably the same concept, right? That maybe they’re getting used to doing this. And so, so your program is so successful, but you’ve said you treated it like a thousand people.
Deborah Beidel (33m 44s):
We put the first responders and the veterans and a mass violence events. Yes.
Dr. Anthony Orsini (33m 50s):
So wonderful, amazing results. But compared to how many PTSD people are out there, that’s a drop in the bucket and is anyone else doing this and is this catching on? And how can we get this everywhere?
Deborah Beidel (34m 1s):
Well, there are other people who are doing intensive outpatient programs. It’s not the same as ours. So I don’t know what their success rates are. We do have some of my former students who are now working at VA’s are pushing this in the VA’s, where they are working. We’re doing a, we have a federally funded grant right now to do this treatment on three military installations. So we’re actually at Portsmith, right near Norfolk, Portsmouth hospital Camp Lejune hospital, and also Eisenhower army medical center to see if this program is going to be as effective with all active duty personnel, as it was with war veterans and active duty personnel in our first study. And also an interesting thing is to see if it’s as effective.
Deborah Beidel (34m 42s):
If people go home at night, rather than going back to a hotel, the advantage of being in a hotel is if you’re there by yourself, you don’t have to worry about the water heater broke, or, you know, you may have a little more time to just work on your PTSD, but we are trying to get the program out. We recently developed a web-based training course in the therapy. That’s now online that people could go and take the course. It’s a six hour course and they can get CE credits for taking it. And so we’re trying to push it out right now in that way. We know that everybody isn’t going to be able to come to central Florida. And so really my goal throughout my career has always been disseminating treatments that we know are effective.
Deborah Beidel (35m 23s):
And so this is our way of trying to push them out. And I’m also happy to consult with anyone who wants to have treatment programs like this set up in their area, because we’ve learned some things the hard way about bringing people in and housing them, all of those things that, that are part of it, the logistics that you don’t often think of when you want to just give a good treatment.
Dr. Anthony Orsini (35m 43s):
Yeah. Once you have a model that works, I think you’ve proven that it works. And even as you said, ironed out the wrinkles, it’s easy now to set up satellite places all over the country and help these people. But if there’s someone in central Florida or someone listening who says, gee, I really need this. Is there a waiting list for restores? How hard is it to get it?
Deborah Beidel (36m 1s):
It’s not hard because since the treatment is so short, we don’t have the waiting lists that other programs have. So they can call our clinic. It’s (407) 823-3910. And we’ll take the information. One of our therapists will give them a call and talk about what they’re experiencing to make sure that we’re the right place for them. Because substance use, for example is often part of PTSD because people have difficulty going to sleep. So they think, well, I’ll just drink some alcohol. And don’t realize that passing out is not sleeping, but for people who might need detox, for example, we’re not the right place because we don’t have a physician on our staff. So we’ll work with someone to make sure they get to the right place.
Deborah Beidel (36m 42s):
And then if they are, for example, we’ve had number of people who were detox successfully, and then they come to our program and we can take care of the PTSD. But typically people will say, well, I can’t come for three weeks. Cause I’ve got to find somebody to take care of the kids. I got to work a job. So the waiting list is usually on their side, not on our side. We can usually get people in within a week of when they call.
Dr. Anthony Orsini (37m 3s):
Wow, that’s amazing. And it sounds like there’s probably a lot of detox. And I have a few friends in the detox business that after they get treated, it’s probably pretty obvious to the doctors who are treating them, that this is PTSD related and that they’d be able to have and refer them to use so that they don’t get back into the drugs after they get done would be a perfect synergy.
Deborah Beidel (37m 22s):
That would be wonderful.
Dr. Anthony Orsini (37m 24s):
This is an amazing program. Deborah, I don’t know when we spoke last week, if I gave you the heads up that I usually give to my guests, sometimes I forget, but the you’re looking at me right now. I finish every episode with the same question because it says Difficult Conversations. And I promised my audience two things that there’ll be inspired, what you’ve already done, and that they’ll learn something about communication, which you’ve already done. But the last question I ask, every guest is in your life, what is the most difficult conversation or type of conversation that you’ve ever had to face and tell us how you were able to navigate and get through that.
Deborah Beidel (38m 4s):
I did a lot of work with kids at one point. And the most difficult conversation was really to talk to some of the kids after the Parkland shooting that we talked to and to talk to kids who had witnessed that event firsthand, who were in those classrooms. One of the kids was one of the ones who was severely injured and the conversation was difficult for me because I saw what an AR 15 did to the arm of a teenager. And that’s an image that frankly doesn’t leave my brain.
Deborah Beidel (38m 45s):
And the most difficult conversation I’ve ever had with them was when they asked me is when does this stop? When do we stop having to be afraid to go to school? And it was difficult to navigate because part of me wants to fix everything like physicians. I want to just fix it. I want to make it better. And just say that I didn’t know what things would change, but that I pledged to them that I would not let what happened in that school be in vain.
Deborah Beidel (39m 25s):
That part of my career from that point on would be being behind them would be raising my boys and would be trying to make sure that other kids didn’t experience what they had to experience. So part of the difficulty for me was needing to admit to myself that I couldn’t change the world. But part of it was resolving to them that even though I had only known them an hour or two, that they were now part of my life and I would be there for them in whatever way occurred, going forward.
Dr. Anthony Orsini (40m 1s):
That’s beautiful. And that means a lot. And as we say, when we teach physicians how to break bad news is your goal is not about information, your goals about the show, compassion. It’s about being the expert in the room that they can put their arms around you and you’ll lead them to the next step. And it’s about letting them know you’re not going to leave them. And I think that’s all you really can do in these tragic situations. And I can tell your facial expression that you still kind of get choked up. When you think about that,
Deborah Beidel (40m 27s):
That shouldn’t be part of anybody’s adolescence.
Dr. Anthony Orsini (40m 28s):
No, it should be nothing but enjoyment and fun and playing in the playground. And for that to happen, it’s just inexcusable. And I’m glad they had an opportunity to speak with you. Deborah, thank you so much for the work that you’re doing. I don’t know why I didn’t, couldn’t get you on earlier that want my audience to hear about this so much. If there’s anything that I can do with promoting restores and getting people to you, please let me know. This is something that I think having a cops is my entire family were cops, to be honest with you. It’s, I’m the only one that my family that hasn’t become a cop and they asked me why? And I just tell them I became a doctor because I’m afraid of guns, but this is something that’s near and dear to my heart.
Dr. Anthony Orsini (41m 12s):
I did speak with Dr. Barton after the pulse nightclub. They had a UCF kind of day seminar for the first responders that were there. I got to meet some of those amazing people and I was just honored to be in the same room with them. But thank you so much for taking the time. I know you have a really busy day. You mentioned how to get in touch with your program. We’ll put all your information up on the notes. So anybody who’s listening to this in the car, all you have to do is go back to my website, the Orsini Way dot com or go back to apple or Spotify, and they’ll get all your contact information. If there’s anything I can do for you, please don’t hesitate to ask.
Deborah Beidel (41m 47s):
It’s been a real privilege to be here today to talk to you, thanks so much for reaching out.
Dr. Anthony Orsini (41m 52s):
Thank you so much, Dr. Beidel and thank you for everything that you do is if you enjoy this podcast, please go ahead and hit follow on your favorite podcast platform. If you like to get in touch with me, you can reach me at TheOrsini Way.Com or my email is Dr. Orsini @ TheOrsiniWay.com. Thank you again, everybody for listening.
Announcer (42m 10s):
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