All across America and around the world, this is Veterans Radio.
This is Veterans Radio.
Welcome to Veterans Radio.
I am Jim Fossone.
I'm the officer of the deck today.
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We want to welcome to Veterans Radio today Dr. Helen Burgess and Dr. Allison Zolta.
We're going to be talking about some research that's being done that is important for veterans
to know.
And particularly if they are suffering with post-traumatic stress disorder or some other
issues like depression.
Let me start with Dr. Helen Burgess.
Helen, welcome to Veterans Radio.
Thank you.
Thank you very much for having me here.
She is a professor of psychiatry and you'll might catch a little bit of accents.
She got her PhD from the University of Melbourne, Australia.
She is currently at the University of Michigan Medical Center.
She has had a faculty appointment with Rush University Medical Center previously.
And that is where she met Dr. Allison Zolta.
Allison, welcome to Veterans Radio.
Hi, so happy to be here.
Thanks for having me.
Dr. Zolta has a PhD from the University of Pennsylvania clinical internship, I guess.
So, I got my clinical psychology PhD at University of Pennsylvania and then I did my internship
at the VA Palo Alto.
And we'll talk a little bit about that.
And both of you, as I said, met up at Rush University Medical Center.
I had some overlapping research areas, which is where you both had some interest in veteran
related health care issues.
Dr. Helen, why don't you talk to us a little bit about why your research has gravitated
into some space that may be of interest to veterans?
Yes, well, I think this all started several years ago.
As you mentioned, Allison and I were both working at Rush together.
And I was funded through Department of Defense and also NIH to start testing morning light
treatment in veterans with chronic low back pain.
And at the time, and we still are to some extent also interested in the impact of light
on pain.
But as I started to prepare to run the study, I realized that some of the veterans would
come in with some PTSD symptoms.
But I really had no idea how to best measure that.
So at that point, I reached out to Allison for advice on how we could assess that.
And indeed, at the end of the study, we did find a significant reduction in PTSD symptoms.
Now, I'm going to make you explain this in fifth grade terms so we veterans can understand
it.
What is morning light?
Yes, so morning light treatment traditionally has been used to treat winter depression.
So classically, people sit in front of a large light box for about an hour or so shortly
after they wake up in the morning.
Some of those light boxes are what we call broad spectrum light.
So they look like bright white light.
But more recently, devices that we call wearable light devices have been developed.
And that is actually what we used in our recent study.
And they kind of, I guess you could describe them as light glasses.
So you wear them as if they're glasses and they have some LEDs that shine light just
underneath your eyes, into your eyes.
But they're not right in front of your eyes.
So you can still use your computer.
You can read.
And the nice thing is you do not need to sit in front of the light box for the whole hour.
You can now actually do other things around the house, which we found people really enjoyed
being able to do.
So if you're saying that if I'm wearing these morning light glasses for about an hour a day,
at the beginning of the day, it somehow helps lower pain, depression, my post-traumatic
stress disorder symptoms.
Is that what you're saying?
Yes.
And we think there's three different mechanisms by which this might be working.
One is we know morning light treatment helps reduce depression.
And when you reduce depression or depressive symptoms, then things like pain and PTSD symptoms
improve as well.
We also know morning light treatment can help improve sleep.
It's not a huge effect, but there is some improvement in sleep as well.
And there is a connection between sleep and pain, and we know that sleep is often impaired
in association with PTSD as well.
And then the third pathway would be through the circadian system, which is a body clock
in the brain.
And it's driving circadian rhythms in pretty much everything you can think of, both for
our psychological health and our physical health.
And often with our irregular sleep schedules and kind of crazy modern lifestyles, we tend
to have some circadian disruptions.
So when we start following a regular sleep schedule and we get that morning light, and
light is the strongest environmental signal to the circadian clock, then it's a way of
stabilizing the circadian system.
And that leads to a lot of health benefits across a broad spectrum of areas, including
pain, PTSD.
So yeah, we found morning light treatment to be useful across the broad spectrum of
clinical health disorders.
Very interesting.
Now, Dr. Allison, you are a clinical psychologist, and we were talking earlier about your time
at Rush University Medical Center.
But more specifically, you were the research director at the Center for Veteran and Family
Health, I think it was called, which was funded by the Wounded Warrior Project.
Do I have that basically right?
Yep, that's right.
And as a clinical psychologist, when this doctor of psychiatry came in with this crazy
idea on, hey, maybe morning light is helpful, what was your thinking?
Where did it take you?
Yeah, it's a great question.
Because I will say at first I was a little bit skeptical.
And I asked Helen to show me the data that she had collected on veterans with low back
pain, and I was really surprised to see that for the veterans who had PTSD, they had what
we'd call clinically meaningful improvements.
So they had enough of a symptom reduction that we think it would make a meaningful impact
in their lives.
And I was really surprised to see that and also really excited because my experience
working with veterans has shown that as much as I love psychotherapy, and I think psychotherapy
is incredibly valuable in treating PTSD, we know it's effective.
It's often really hard for veterans to get it.
And so having alternative treatments that people can do in their own homes is just a
really exciting possibility.
And that's what really motivated me to start working with Helen on this project.
And I think you hit on a really important point over the years as we've talked to veterans
with PTSD and talked to various healthcare professionals about ways that this can be
worked on and managed.
Veterans are a very proud group.
First off, to go ask for help or even acknowledge the problem is the challenge we wanted to
get over.
But having to go somewhere every three days a week, set times, some of this becomes so
rigid there's not a lot of follow through.
So the idea that this might be a therapy that as you said had clinical meaningful reductions
is kind of exciting, isn't it, Dr. Ellison?
Yeah, absolutely.
I think it's really exciting because we know that we're going to need many different solutions
to tackle the problem of PTSD among veterans.
It's not going to be one thing that's going to kind of address all of the need.
And so the fact that morning light treatment is so accessible to people that they can,
it's commercially available.
People can buy their own devices and use them in their own homes is just really exciting
in terms of potentially getting treatment to a lot more people.
Dr. Helen Burgess, you had mentioned that your research initially was funded by, in
part by DOD.
I'm always curious as to how the, what happens when the funding runs out?
Does the funder simply just put the report on the shelf and we never hear about it again?
Or talk to us a little bit about how your research and work has been maybe accepted
or expanded upon.
Yeah, so I guess the answer is when the funding runs out, you know, hopefully by that point
you've completed the study, you publish it and then you use that as a launch pad to apply
for more funding is really how the cycle continues.
So that veteran study that Alison, that we worked on together and that the chronic pain
study, the results, the changes in the PTSD symptoms, the improvements that we saw, Alison
and I then decided to run a small study, internal pilot study, specifically now testing the
morning light treatment in people with significant PTSD symptoms.
And that also showed some really nice results.
And then we use that study to apply for a much larger NIH grant.
And that is what funded the current publication that is out there in psychiatry research.
But I also want to point out that in science, it's really important that results are reproduced
and ideally you have separate independent groups testing things and finding the same, the same
kind of results.
And we're really excited that there's two other research groups actually that have now
published that morning light treatment can help with PTSD symptoms.
You're absolutely right.
It can't just be a one-off, it's got to be replicable and to prove up that, hey, this
wasn't just a fluke, it really does work.
And the size of the study is always important.
So is this a study Dr. Burgess that has, are we talking 10 people, 100 people, 1,000 people?
It's sort of medium, I guess.
I think that first study, Allison and I, I think there's only 15 people.
This is closer to 50.
And actually, Allison has taken the lead on, I think just last week, submitting a new grant
application to now start testing this in even a larger sample.
I think the largest sample so far in a single study has been around 70 people.
So we're at the stage where I think we need to start moving into logic clinical trials
of at least 100, maybe even a few hundred people.
Dr. Zolta, as you think about this and other groups are beginning to look at this as well,
can you comment about whether or not you've had any interaction with the VA national about,
hey, we're interested, we're going to help, we're going to do more?
What's the, what's the temperature of how VA has looked at this as it might apply to
the patients it treats?
Yeah, I'll say I haven't had direct conversations with folks at the VA.
And at the same time, I will say that colleagues of mine, certainly that work with veterans,
have been interested and excited to try to understand whether we can use this as an alternative
treatment or potentially to help boost the effects of the treatments that we know work.
So I think there is some excitement as Helen said, we're kind of at the stage where we
need some of those larger trials to feel really very, very confident that this is the way
to go.
And I think once we have that then really trying to disseminate this treatment is going
to be a critical next step.
So much of science and medical research is international.
Has this morning light treatment or therapy, is it being used anywhere else in the world
here, Dr. Helen?
Yeah.
Yeah, it's used around the world.
Morning light treatment therapy was first developed, as I mentioned, for winter depression
or what sometimes we call seasonal affective disorder.
And certainly here in Michigan, we tend to experience higher rates of that than in California.
But yes, I think after those initial trials, then most of the work has been done in what
we call non-seasonal depression.
So depression that is sort of year round and doesn't just pick up in the fall and in winter.
And there's now what we call meta-analyses, which are these publications in which they
go around and they combine the results of many, many, many different studies to kind
of help create a sort of global or average effect.
And there's been at least three of those now looking at morning light treatment for non-seasonal
depression and finding medium effect sizes, which means that morning light therapy is
as effective as pharmaceutical antidepressants.
But interestingly, the side effects of morning light therapy, they're really quite reduced
compared to these pharmacological treatments.
And the most significant one for morning light therapy would be headaches.
And the literature suggests, and it has certainly been, matches what we've experienced in our
trials, is that new headaches can start typically in the first week with the morning light therapy.
And some people say, that's enough for me.
This isn't for me.
And that's, of course, totally fine.
Other people say, well, the literature suggests if I stick it out, these headaches will disappear.
And certainly that is what they experience.
So that is the number one side effect that we've noticed in our studies and fits the
rest of the literature.
But yeah, morning light therapy is used around the world.
Mostly I would say for depression.
The PTSD work, to our knowledge, has really been here within the US.
And we, as I mentioned, have also started to explore it in terms of the area of pain
as well.
Yeah, that's what I was going to ask.
Is it being used elsewhere for the low back pain, which is kind of where you started?
And did your research on low back pain and morning light therapy result in clinically
meaningful reduction in pain?
Yeah, we did see that with chronic low back pain.
That veteran study, as we described, kind of spun off into the work with Allison, looking
specifically at PTSD.
It was also a second spin off from that study, which was to focus more on people with chronic
pain conditions.
And the one that we really ended up focusing on was fibromyalgia, which is a chronic widespread
pain condition.
And we were funded to run a small pilot study.
And that went quite well.
And then that moved on to a more medium sized study similar to this PTSD study that we've
just published.
And then going back and again requesting for more funding, now we're at the stage where
we've just launched a clinical trial and it will be in 400 people with fibromyalgia.
And it's a fully remote trial, so we're enrolling people across the country.
And yeah, that will be our largest clinical trial to date testing morning light treatment
for a chronic pain condition.
And if people wanted to register for that study, is that something that they could do?
And if so, how?
Yes.
Yeah, so a really useful resource for people if they interested in participating in what
we call clinical research studies is you can go to clinicaltrials.gov, which is a website
run by NIH, the National Institutes of Health.
And you can enter in different search terms for different illnesses or studies that are
out there.
And you will find our studies registered there and there's contact information on there.
I guess another website being in Michigan that I would plug is the University of Michigan
also has what we call a research registry where people can sign up again interested
in participating in all kinds of different research.
And the website for that is umhealthresearch.org.
And they already have over about 80,000 people who have signed up on that.
And that is a huge help for all of the researchers at University of Michigan that are trying to
recruit participants for this study.
So certainly if anyone is interested in participating, that is also a great place to register at.
Well, let me back up to something like, because I don't think we've fully explored this.
When I wear my morning light glasses, if that's what I'm wearing, I think you said I wear
them for like an hour a day.
But do I have to do that for the rest of my life?
What's the process here for how long I'm in using the therapy?
And then how long does the results of less pain or less depression or less PTSD symptoms,
can you talk to us about how long that lasts, I suppose?
Yeah.
Now those are great questions.
In the original Veteran's study, we did track people for 30 days after the end of the light
treatment.
And I will say to my surprise, we still found some benefits in mood and pain and sleep 30
days later.
But you raise a really good question, which is, is this the therapy people need to do
every day once they're feeling better?
Can they maybe do it every second day or third day?
And this is exactly one of the questions that Allison is trying to answer in her new grant
submission to help us get a better handle on as this treatment starts to be disseminated
into the real world and we're all dealing with all these other things going on in our
everyday life.
What should this long-term maintenance treatment start to look like after perhaps an acute treatment
period of every day once people improve?
How can we maintain those benefits without necessarily having to do the treatment every
day?
The answer right now is we just don't know.
But I just knew.
I just knew, Dr. Zolta.
I'd get to a point where you all said, we just need more research.
And that's what you're doing.
I will add just to Helen's other prior response that, so different folks have tested different
lengths of treatment.
We've been testing for weeks every day.
So that's been kind of the dose that we've been, we looked at in one of our most recent
trials.
And Helen, I don't know if you can speak to what the range of studies has tested and
why we think four weeks might be a good first try to see how that helps.
Yeah.
There's one other study that did six weeks.
We ended up choosing four weeks and we sort of consistently done that actually in a lot
of our studies.
And that was mostly informed by those meta-analyses I referred to on non-seasonal depression, where
they do show people start improving in the first week.
But in studies that had a placebo, they find that the significant difference between a
placebo and morning light therapy doesn't, on average, doesn't start to emerge until
around weeks three and four.
So that was the reason why we said, okay, we're going to do four weeks.
And so far that has worked pretty well for us.
Now you said earlier, Dr. Burgess, that this is commercially available equipment, I suppose,
for morning light therapy.
And I guess if I went on my search engine or my favorite shopping site, I could find
somebody promoting some sort of glasses or a screen or something for morning light therapy
for seasonal depression.
I got the term wrong there.
But is there something you should put a asterisk on here and say, it's this wavelength, it's
this type, it's this, because I suspect there's a lot of hucksters out there?
Yeah.
No, that is a good question.
And it turns out that the circadian system is most sensitive to blue wavelengths of light.
So blue light in the morning is great.
We don't love blue light in the evening, which a lot of us get from our cell phones, because
in the evening we're trying to wind down for sleep.
And having a lot of blue light in the evening is making our brains think that it's morning
time or at least daytime.
But I will say when the light gets bright enough and often light boxes, the intensity
is enough.
You wouldn't necessarily see any larger effect compared to the blue light, for example, versus
a really bright white light.
So recommendations would be, you know, some people actually really enjoy sitting in front
of a light box and our recommendations there go for something that's quite bright.
The companies will often market themselves as being around 10,000 lux.
They are bright.
They're not 10,000 lux at the level of the eye.
They're 10,000 lux at the level of the box.
But those marketed devices will work.
And we encourage large light boxes, not small ones, because a large light box means you
can move around a little bit in front of it and still get the light.
And it's also going to appear less glary, whereas if you have this smaller focal point
coming from a smaller light box, that sometimes can be a bit more unpleasant.
In terms of the wearable, I think it's fine to mention the device that we've used, because
we have no financial connection with the company at all.
It's actually a company originally coming out of Australia, believe it or not.
And it's called the Retimer Device.
There are other wearable light treatment devices out there, and people should feel free to
take a look at those.
We kind of tested them all on ourselves, and we felt that the Retimer was the most comfortable
one.
And the Retimer Company has recently come out with version three.
We use version two, which we like because it has an adjustable nose piece, which just
means if people wear glasses or they have different shaped heads, that there is a way
to move these glasses around a little bit and really look for the perfect fit.
But we always explain to participants in our studies that with the Retimer Device, if it's
positioned correctly, you'll essentially see a lot of blue-green light when you look in
the mirror around your eyes, under your eyebrows, almost sort of an oval circle around your
eyes.
And if you see that, then for sure you know that you're getting the light.
So there are a variety of options out there for people.
I think the main devices are available on Amazon, so that's usually a good place to
go and at least take a look.
And people obviously can look at readings and things in prices, things like that.
Well, this has been an interesting conversation.
And when you kind of explain how it moved from seasonal defective disorder and depression
into the areas that may be of interest and help to veterans, it kind of all makes sense.
But unless you guys tied it together, I would never have thought of it.
And I'm not surprised more research is needed, right, Dr. Zalta?
Absolutely.
Well, we thank both of you, Dr. Allison Zalta and Dr. Helen Burgess, for spending some time
with Veterans Radio today to explain this interesting research and hopefully a new at-home therapy
that may be helpful to veterans on a number of fronts, from pain to better sleep to PTSD
symptoms.
It's all pretty exciting stuff.
And we look forward to hearing more as your research develops.
Thank you so much for having us.
Thank you very much, Jim.
Yeah.
Thank you, ladies.
And I want to thank everybody for listening to Veterans Radio today.
I am Jim Fawcone.
It's been a pleasure to be your host.
I'm a Veterans Disability lawyer at Legal Help for Veterans.
And you can reach us at 800-693-4800 or legalhelpforveterans.com on the web.
You can follow Veterans Radio on Facebook and listen to its podcasts and internet radio
shows by visiting us at veteransradio.org.
And until next time, you are dismissed.
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