PROVIDING EMDR THERAPY TO VETERANS IN

MINNESOTA

Paul Riedner, MBAiraq veteran, us army dive company,

executive director of veteran resilience project

Joseph Graca PhD retired department of veteran affairs

Licensed clinical psychologist

BACKGROUNDThe Veteran Resilience Project (VRP) offers veterans (or active military) 10 EMDR therapy sessions with two more sessions available for family visits. As in many other regions of the United States EMDR therapy is not readily provided in the VA to veterans in Minnesota. VRP has successfully reached out and engaged veterans in Minnesota in EMDR therapy and retained them to completion. The EMDR therapy provided by VRP significantly reduced PTSD on multiple clinical measures.

METRICSVRP has been successful in four important ways. 1) VRP has effectively reached out and

connected veterans with PTSD with EMDR therapists.

2) Veterans in VRP have a very high rate of

completing EMDR therapy 77%3) The outcomes data collected by VRP shows

the EMDR therapy was highly effective 4) VRP developed a robust data

collection/outcome management system to monitor

1) EFFECTIVENESS2) EFFICIENCY3) SATISFACTION

METHODIn its outreach efforts and program design, VRP thoughtfully followed “design thinking” best practices to ensure that veterans, community leaders, and veteran service providers would be listened to and engaged in the process.

1. Create Veteran Advisory Committee2. Recruit EMDR therapists across MN3. Provide “Cultural Competency” training, ie. Advanced Military Training4. Invite veterans, thought leaders, social workers, mental health

professionals, VA employees, city/county/state officials to “Get Out of Our Silos” to discuss veteran needs, challenges, and opportunities

5. Incorporate learning, insights, and takeaways into VRP’s program

OUTREACHVRP has developed a new media campaign to generate even stronger connections with the veteran community and the public at large. Using a weekly internet radio program (podcast) called ResilienceMN, VRP is interviewing thriving, resilient veterans in Minnesota. We believe a great way to reach struggling, isolated veterans is to build trusted relationships with the veterans and veteran service organizations in their community. Through this interview series, VRP is addressing what ‘Moral Injury’ is and how the community is connected with both the decisions that led to war and veterans having the support they need when they return from war.

OUTREACH PHILOSOPHY

We are one of many in a complex tapestry of individuals and organizations that have unsuccessfully dealt with veteran recovery from war. We believe by helping others to tell their truth we can inspire the community to rally around effective programs and services.

VRP has sought to directly address the cultural differences, power imbalances and other social driven barriers that have hampered past efforts to reach out to our veterans. VRP has developed strategies that address engagement, therapeutic rapport, and retention. VRP has been successful in getting the word out to veterans about the effectiveness and availability of EMDR therapy. VRP has succeeded in building working relationships with the diverse community of veterans. VRP has even earned the ear of the VA’s central office leadership.

RESULTSVRP retention rate to date is 77%

Veterans who did not complete were contacted to link them with other services if needed and to gain input on what factors led to their dropping out.

27 veterans participated in the data collection

21 completed EMDR therapy

6 did not

20 veterans were men

7 veterans were women

17 of the 27 participants completed “Client Evaluation of

EMDR Therapy.”

RESULTSThe most exciting finding was the clinically and statistically significant improvement in the effectiveness measures (IES and PCLM) resulting from the EMDR therapy.

The AVERAGE decrease in Impact of Events

scale was 37 points! Pre avg 46.9 – Post avg 9.9

The MEAN pre PCLM was 57The MEAN post PCLM was 32The significance of this data proves that considerable gains were made by these Veterans in the reduction of their trauma related distress.

CONCLUSIONSVRP and other similar programs are often the primary source of access to EMDR therapy for our veterans and military personnel in many areas of the country. Cognitive Processing Therapy and Prolonged Exposure therapy are the primary PTSD therapies provided to our veterans in the VA and military yet recent research shows they are of limited effectiveness. Lisa Najavits (2015) in her review of the research findings with the “gold standard” PTSD therapies, stated:

“The highest standard for gold-standard therapies would thus be strong performance in RCTs plus evidence of ability to

retain patients, and their clinicians, under real-world conditions. In this framework, performance in RCTs alone

would be bronze, performance in real-world conditions would be silver and the gold—the true EBT champions—would have

to evidence success at both.”

CONCLUSIONSHoge, et al. stated in relation to the problem of PTSD patients dropping out of therapy; “Dropping out of care is clearly the most important predictor of treatment failure; therefore the most promising strategies

to improve efficacy of evidence-based treatments will be those that address engagement, therapeutic rapport, and

retention.”

The success of the Veterans Resilience Project and similar clinical programs and projects that provide EMDR supports that EMDR is worthy of Gold. The lessons learned from the VRP can benefit other programs/projects to successfully provide EMDR therapy to our veterans and military personnel.

REFERENCESPTSD Treatment for Soldiers After Combat Deployment: Low Utilization of Mental Health Care and Reasons for Dropout. Psychiatry Services. 2014; 65 (8): 997-1000. Charles W. Hoge, M.D., Sasha H. Grossman, B.A., Jennifer L. Auchterlonie, M.S., Lyndon A. Riviere, Ph.D., Charles Milliken, M.D., Joshua E. Wilk, Ph.D.

The problem of dropout from “gold standard” PTSD therapies. F1000Prime Reports 2015, 7:43 (doi: 10.12703/P7-43) Lisa M. Najavits, The electronic version of this article can be found at: http://f1000.com/prime/reports/m/7/43

Psychotherapy for Military-Related PTSD; A Review of Randomized Clinical Trials JAMA. 2015; 314 (5):489-500.Maria M. Steenkamp, Ph.D.; Brett T. Litz, Ph.D.; Charles W. Hoge, M.D.; Charles R. Marmar, M.D.