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All across America and around the world, this is Veterans Radio.

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This is Veterans Radio.

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Welcome to Veterans Radio.

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I am Jim Fossone.

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I'm the officer of the deck today.

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We've got some great programs for you.

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We always want to remind you you can find more about Veterans Radio at its Facebook

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site or at the web veteransradio.org where we're on the web 24-7.

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You can find a lot of our podcasts there as well.

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We post new ones every Tuesday so you can get a new story, a new interview, something

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you didn't know before by going to veteransradio.org.

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And before we get started, we want to thank our sponsors.

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Next up we want to thank National Veteran Business Development Council, NVBDC.org.

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It was established to certify both service disabled and veteran owned businesses.

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You'll find out how they can help your business by going to NVBDC.org.

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We want to thank Legal Help for Veterans.

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Legal Help for Veterans fights for veterans disability rights all across the nation.

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You can reach them at 800-693-4800 or on the web at legalhelpforveterans.com.

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And finally, PuroClean.

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PuroClean is the paramedics of property damage.

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It provides water damage remediation, flood water removal, fire and smoke damage remediation,

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mold removal, biohazard cleanup.

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It also has a focus on veteran franchisees.

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You can learn more about them by going to puroclean.com.

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We want to welcome to Veterans Radio today Dr. Helen Burgess and Dr. Allison Zolta.

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We're going to be talking about some research that's being done that is important for veterans

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to know.

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And particularly if they are suffering with post-traumatic stress disorder or some other

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issues like depression.

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Let me start with Dr. Helen Burgess.

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Helen, welcome to Veterans Radio.

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Thank you.

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Thank you very much for having me here.

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She is a professor of psychiatry and you'll might catch a little bit of accents.

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She got her PhD from the University of Melbourne, Australia.

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She is currently at the University of Michigan Medical Center.

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She has had a faculty appointment with Rush University Medical Center previously.

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And that is where she met Dr. Allison Zolta.

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Allison, welcome to Veterans Radio.

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Hi, so happy to be here.

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Thanks for having me.

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Dr. Zolta has a PhD from the University of Pennsylvania clinical internship, I guess.

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So, I got my clinical psychology PhD at University of Pennsylvania and then I did my internship

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at the VA Palo Alto.

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And we'll talk a little bit about that.

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And both of you, as I said, met up at Rush University Medical Center.

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I had some overlapping research areas, which is where you both had some interest in veteran

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related health care issues.

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Dr. Helen, why don't you talk to us a little bit about why your research has gravitated

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into some space that may be of interest to veterans?

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Yes, well, I think this all started several years ago.

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As you mentioned, Allison and I were both working at Rush together.

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And I was funded through Department of Defense and also NIH to start testing morning light

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treatment in veterans with chronic low back pain.

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And at the time, and we still are to some extent also interested in the impact of light

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on pain.

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But as I started to prepare to run the study, I realized that some of the veterans would

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come in with some PTSD symptoms.

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But I really had no idea how to best measure that.

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So at that point, I reached out to Allison for advice on how we could assess that.

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And indeed, at the end of the study, we did find a significant reduction in PTSD symptoms.

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Now, I'm going to make you explain this in fifth grade terms so we veterans can understand

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it.

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What is morning light?

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Yes, so morning light treatment traditionally has been used to treat winter depression.

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So classically, people sit in front of a large light box for about an hour or so shortly

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after they wake up in the morning.

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Some of those light boxes are what we call broad spectrum light.

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So they look like bright white light.

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But more recently, devices that we call wearable light devices have been developed.

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And that is actually what we used in our recent study.

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And they kind of, I guess you could describe them as light glasses.

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So you wear them as if they're glasses and they have some LEDs that shine light just

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underneath your eyes, into your eyes.

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But they're not right in front of your eyes.

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So you can still use your computer.

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You can read.

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And the nice thing is you do not need to sit in front of the light box for the whole hour.

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You can now actually do other things around the house, which we found people really enjoyed

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being able to do.

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So if you're saying that if I'm wearing these morning light glasses for about an hour a day,

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at the beginning of the day, it somehow helps lower pain, depression, my post-traumatic

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stress disorder symptoms.

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Is that what you're saying?

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Yes.

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And we think there's three different mechanisms by which this might be working.

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One is we know morning light treatment helps reduce depression.

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And when you reduce depression or depressive symptoms, then things like pain and PTSD symptoms

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improve as well.

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We also know morning light treatment can help improve sleep.

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It's not a huge effect, but there is some improvement in sleep as well.

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And there is a connection between sleep and pain, and we know that sleep is often impaired

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in association with PTSD as well.

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And then the third pathway would be through the circadian system, which is a body clock

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in the brain.

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And it's driving circadian rhythms in pretty much everything you can think of, both for

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our psychological health and our physical health.

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And often with our irregular sleep schedules and kind of crazy modern lifestyles, we tend

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to have some circadian disruptions.

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So when we start following a regular sleep schedule and we get that morning light, and

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light is the strongest environmental signal to the circadian clock, then it's a way of

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stabilizing the circadian system.

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And that leads to a lot of health benefits across a broad spectrum of areas, including

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pain, PTSD.

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So yeah, we found morning light treatment to be useful across the broad spectrum of

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clinical health disorders.

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Very interesting.

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Now, Dr. Allison, you are a clinical psychologist, and we were talking earlier about your time

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at Rush University Medical Center.

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But more specifically, you were the research director at the Center for Veteran and Family

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Health, I think it was called, which was funded by the Wounded Warrior Project.

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Do I have that basically right?

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Yep, that's right.

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And as a clinical psychologist, when this doctor of psychiatry came in with this crazy

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idea on, hey, maybe morning light is helpful, what was your thinking?

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Where did it take you?

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Yeah, it's a great question.

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Because I will say at first I was a little bit skeptical.

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And I asked Helen to show me the data that she had collected on veterans with low back

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pain, and I was really surprised to see that for the veterans who had PTSD, they had what

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we'd call clinically meaningful improvements.

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So they had enough of a symptom reduction that we think it would make a meaningful impact

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in their lives.

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And I was really surprised to see that and also really excited because my experience

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working with veterans has shown that as much as I love psychotherapy, and I think psychotherapy

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is incredibly valuable in treating PTSD, we know it's effective.

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It's often really hard for veterans to get it.

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And so having alternative treatments that people can do in their own homes is just a

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really exciting possibility.

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And that's what really motivated me to start working with Helen on this project.

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And I think you hit on a really important point over the years as we've talked to veterans

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with PTSD and talked to various healthcare professionals about ways that this can be

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worked on and managed.

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Veterans are a very proud group.

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First off, to go ask for help or even acknowledge the problem is the challenge we wanted to

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get over.

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But having to go somewhere every three days a week, set times, some of this becomes so

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rigid there's not a lot of follow through.

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So the idea that this might be a therapy that as you said had clinical meaningful reductions

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is kind of exciting, isn't it, Dr. Ellison?

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Yeah, absolutely.

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I think it's really exciting because we know that we're going to need many different solutions

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to tackle the problem of PTSD among veterans.

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It's not going to be one thing that's going to kind of address all of the need.

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And so the fact that morning light treatment is so accessible to people that they can,

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it's commercially available.

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People can buy their own devices and use them in their own homes is just really exciting

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in terms of potentially getting treatment to a lot more people.

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Dr. Helen Burgess, you had mentioned that your research initially was funded by, in

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part by DOD.

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I'm always curious as to how the, what happens when the funding runs out?

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Does the funder simply just put the report on the shelf and we never hear about it again?

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Or talk to us a little bit about how your research and work has been maybe accepted

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or expanded upon.

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Yeah, so I guess the answer is when the funding runs out, you know, hopefully by that point

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you've completed the study, you publish it and then you use that as a launch pad to apply

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for more funding is really how the cycle continues.

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So that veteran study that Alison, that we worked on together and that the chronic pain

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study, the results, the changes in the PTSD symptoms, the improvements that we saw, Alison

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and I then decided to run a small study, internal pilot study, specifically now testing the

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morning light treatment in people with significant PTSD symptoms.

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And that also showed some really nice results.

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And then we use that study to apply for a much larger NIH grant.

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And that is what funded the current publication that is out there in psychiatry research.

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But I also want to point out that in science, it's really important that results are reproduced

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and ideally you have separate independent groups testing things and finding the same, the same

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kind of results.

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And we're really excited that there's two other research groups actually that have now

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published that morning light treatment can help with PTSD symptoms.

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You're absolutely right.

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It can't just be a one-off, it's got to be replicable and to prove up that, hey, this

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wasn't just a fluke, it really does work.

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And the size of the study is always important.

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So is this a study Dr. Burgess that has, are we talking 10 people, 100 people, 1,000 people?

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It's sort of medium, I guess.

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I think that first study, Allison and I, I think there's only 15 people.

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This is closer to 50.

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And actually, Allison has taken the lead on, I think just last week, submitting a new grant

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application to now start testing this in even a larger sample.

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I think the largest sample so far in a single study has been around 70 people.

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So we're at the stage where I think we need to start moving into logic clinical trials

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of at least 100, maybe even a few hundred people.

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Dr. Zolta, as you think about this and other groups are beginning to look at this as well,

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can you comment about whether or not you've had any interaction with the VA national about,

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hey, we're interested, we're going to help, we're going to do more?

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What's the, what's the temperature of how VA has looked at this as it might apply to

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the patients it treats?

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Yeah, I'll say I haven't had direct conversations with folks at the VA.

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And at the same time, I will say that colleagues of mine, certainly that work with veterans,

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have been interested and excited to try to understand whether we can use this as an alternative

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treatment or potentially to help boost the effects of the treatments that we know work.

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So I think there is some excitement as Helen said, we're kind of at the stage where we

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need some of those larger trials to feel really very, very confident that this is the way

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to go.

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And I think once we have that then really trying to disseminate this treatment is going

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to be a critical next step.

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So much of science and medical research is international.

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Has this morning light treatment or therapy, is it being used anywhere else in the world

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here, Dr. Helen?

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Yeah.

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Yeah, it's used around the world.

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Morning light treatment therapy was first developed, as I mentioned, for winter depression

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or what sometimes we call seasonal affective disorder.

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And certainly here in Michigan, we tend to experience higher rates of that than in California.

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But yes, I think after those initial trials, then most of the work has been done in what

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we call non-seasonal depression.

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So depression that is sort of year round and doesn't just pick up in the fall and in winter.

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And there's now what we call meta-analyses, which are these publications in which they

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go around and they combine the results of many, many, many different studies to kind

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of help create a sort of global or average effect.

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And there's been at least three of those now looking at morning light treatment for non-seasonal

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depression and finding medium effect sizes, which means that morning light therapy is

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as effective as pharmaceutical antidepressants.

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But interestingly, the side effects of morning light therapy, they're really quite reduced

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compared to these pharmacological treatments.

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And the most significant one for morning light therapy would be headaches.

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And the literature suggests, and it has certainly been, matches what we've experienced in our

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trials, is that new headaches can start typically in the first week with the morning light therapy.

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And some people say, that's enough for me.

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This isn't for me.

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And that's, of course, totally fine.

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Other people say, well, the literature suggests if I stick it out, these headaches will disappear.

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And certainly that is what they experience.

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So that is the number one side effect that we've noticed in our studies and fits the

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rest of the literature.

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But yeah, morning light therapy is used around the world.

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Mostly I would say for depression.

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The PTSD work, to our knowledge, has really been here within the US.

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And we, as I mentioned, have also started to explore it in terms of the area of pain

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as well.

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Yeah, that's what I was going to ask.

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Is it being used elsewhere for the low back pain, which is kind of where you started?

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And did your research on low back pain and morning light therapy result in clinically

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meaningful reduction in pain?

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Yeah, we did see that with chronic low back pain.

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That veteran study, as we described, kind of spun off into the work with Allison, looking

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specifically at PTSD.

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It was also a second spin off from that study, which was to focus more on people with chronic

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pain conditions.

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And the one that we really ended up focusing on was fibromyalgia, which is a chronic widespread

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pain condition.

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And we were funded to run a small pilot study.

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And that went quite well.

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And then that moved on to a more medium sized study similar to this PTSD study that we've

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just published.

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And then going back and again requesting for more funding, now we're at the stage where

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we've just launched a clinical trial and it will be in 400 people with fibromyalgia.

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And it's a fully remote trial, so we're enrolling people across the country.

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And yeah, that will be our largest clinical trial to date testing morning light treatment

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for a chronic pain condition.

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And if people wanted to register for that study, is that something that they could do?

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And if so, how?

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Yes.

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Yeah, so a really useful resource for people if they interested in participating in what

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we call clinical research studies is you can go to clinicaltrials.gov, which is a website

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run by NIH, the National Institutes of Health.

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And you can enter in different search terms for different illnesses or studies that are

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out there.

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And you will find our studies registered there and there's contact information on there.

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I guess another website being in Michigan that I would plug is the University of Michigan

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also has what we call a research registry where people can sign up again interested

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in participating in all kinds of different research.

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And the website for that is umhealthresearch.org.

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And they already have over about 80,000 people who have signed up on that.

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And that is a huge help for all of the researchers at University of Michigan that are trying to

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recruit participants for this study.

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So certainly if anyone is interested in participating, that is also a great place to register at.

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Well, let me back up to something like, because I don't think we've fully explored this.

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When I wear my morning light glasses, if that's what I'm wearing, I think you said I wear

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them for like an hour a day.

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But do I have to do that for the rest of my life?

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What's the process here for how long I'm in using the therapy?

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And then how long does the results of less pain or less depression or less PTSD symptoms,

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can you talk to us about how long that lasts, I suppose?

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Yeah.

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Now those are great questions.

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In the original Veteran's study, we did track people for 30 days after the end of the light

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treatment.

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And I will say to my surprise, we still found some benefits in mood and pain and sleep 30

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days later.

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But you raise a really good question, which is, is this the therapy people need to do

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every day once they're feeling better?

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Can they maybe do it every second day or third day?

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And this is exactly one of the questions that Allison is trying to answer in her new grant

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submission to help us get a better handle on as this treatment starts to be disseminated

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into the real world and we're all dealing with all these other things going on in our

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everyday life.

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What should this long-term maintenance treatment start to look like after perhaps an acute treatment

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period of every day once people improve?

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How can we maintain those benefits without necessarily having to do the treatment every

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day?

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The answer right now is we just don't know.

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But I just knew.

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I just knew, Dr. Zolta.

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I'd get to a point where you all said, we just need more research.

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And that's what you're doing.

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I will add just to Helen's other prior response that, so different folks have tested different

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lengths of treatment.

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We've been testing for weeks every day.

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So that's been kind of the dose that we've been, we looked at in one of our most recent

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trials.

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And Helen, I don't know if you can speak to what the range of studies has tested and

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why we think four weeks might be a good first try to see how that helps.

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Yeah.

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There's one other study that did six weeks.

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We ended up choosing four weeks and we sort of consistently done that actually in a lot

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of our studies.

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And that was mostly informed by those meta-analyses I referred to on non-seasonal depression, where

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they do show people start improving in the first week.

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But in studies that had a placebo, they find that the significant difference between a

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placebo and morning light therapy doesn't, on average, doesn't start to emerge until

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around weeks three and four.

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So that was the reason why we said, okay, we're going to do four weeks.

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And so far that has worked pretty well for us.

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Now you said earlier, Dr. Burgess, that this is commercially available equipment, I suppose,

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for morning light therapy.

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And I guess if I went on my search engine or my favorite shopping site, I could find

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somebody promoting some sort of glasses or a screen or something for morning light therapy

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for seasonal depression.

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I got the term wrong there.

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But is there something you should put a asterisk on here and say, it's this wavelength, it's

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this type, it's this, because I suspect there's a lot of hucksters out there?

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Yeah.

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No, that is a good question.

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And it turns out that the circadian system is most sensitive to blue wavelengths of light.

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So blue light in the morning is great.

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We don't love blue light in the evening, which a lot of us get from our cell phones, because

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in the evening we're trying to wind down for sleep.

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And having a lot of blue light in the evening is making our brains think that it's morning

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time or at least daytime.

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But I will say when the light gets bright enough and often light boxes, the intensity

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is enough.

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You wouldn't necessarily see any larger effect compared to the blue light, for example, versus

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a really bright white light.

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So recommendations would be, you know, some people actually really enjoy sitting in front

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of a light box and our recommendations there go for something that's quite bright.

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The companies will often market themselves as being around 10,000 lux.

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They are bright.

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They're not 10,000 lux at the level of the eye.

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They're 10,000 lux at the level of the box.

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But those marketed devices will work.

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And we encourage large light boxes, not small ones, because a large light box means you

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can move around a little bit in front of it and still get the light.

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And it's also going to appear less glary, whereas if you have this smaller focal point

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coming from a smaller light box, that sometimes can be a bit more unpleasant.

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In terms of the wearable, I think it's fine to mention the device that we've used, because

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we have no financial connection with the company at all.

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It's actually a company originally coming out of Australia, believe it or not.

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And it's called the Retimer Device.

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There are other wearable light treatment devices out there, and people should feel free to

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take a look at those.

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We kind of tested them all on ourselves, and we felt that the Retimer was the most comfortable

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one.

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And the Retimer Company has recently come out with version three.

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We use version two, which we like because it has an adjustable nose piece, which just

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means if people wear glasses or they have different shaped heads, that there is a way

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to move these glasses around a little bit and really look for the perfect fit.

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But we always explain to participants in our studies that with the Retimer Device, if it's

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positioned correctly, you'll essentially see a lot of blue-green light when you look in

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the mirror around your eyes, under your eyebrows, almost sort of an oval circle around your

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eyes.

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And if you see that, then for sure you know that you're getting the light.

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So there are a variety of options out there for people.

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I think the main devices are available on Amazon, so that's usually a good place to

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go and at least take a look.

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And people obviously can look at readings and things in prices, things like that.

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Well, this has been an interesting conversation.

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And when you kind of explain how it moved from seasonal defective disorder and depression

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into the areas that may be of interest and help to veterans, it kind of all makes sense.

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But unless you guys tied it together, I would never have thought of it.

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And I'm not surprised more research is needed, right, Dr. Zalta?

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Absolutely.

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Well, we thank both of you, Dr. Allison Zalta and Dr. Helen Burgess, for spending some time

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with Veterans Radio today to explain this interesting research and hopefully a new at-home therapy

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that may be helpful to veterans on a number of fronts, from pain to better sleep to PTSD

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symptoms.

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It's all pretty exciting stuff.

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And we look forward to hearing more as your research develops.

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Thank you so much for having us.

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Thank you very much, Jim.

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Yeah.

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Thank you, ladies.

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And I want to thank everybody for listening to Veterans Radio today.

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I am Jim Fawcone.

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It's been a pleasure to be your host.

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I'm a Veterans Disability lawyer at Legal Help for Veterans.

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And you can reach us at 800-693-4800 or legalhelpforveterans.com on the web.

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00:28:57,400 --> 00:29:02,280
You can follow Veterans Radio on Facebook and listen to its podcasts and internet radio

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00:29:02,280 --> 00:29:06,920
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00:29:06,920 --> 00:29:10,280
And until next time, you are dismissed.

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00:29:14,560 --> 00:29:15,560
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00:29:15,560 --> 00:29:19,160
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00:29:19,160 --> 00:29:23,160
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00:29:23,160 --> 00:29:28,680
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