got watch over them and those seeking their return. and with that, mr. speaker, i will yield to the gentlelady from california, the democratic leader. ms. pelosi: thank you, mr. leader, fo >> thank you mr. leader for yielding. for giving us the opportunity to speak about this crime. will thank the distinguished majority leader for his remarks and i associate myself with his remarks and their entirety -- in their entirety. that's how important all of this is. i want to commend congresswoman wilson for her resolution, h.r. 73, which says, condemning the abduction of female students by armed militants from the terrorist group known as boko haram in the federal republic of nye screeria -- nigeria.

mr. speaker, it is clear that what happened in nigeria is outside the circle of civilized human behavior. it is unconscionable and these demissble acts must be condemned -- despicable acts must be condemned in the strongest possible terms. the capture and captivity of these girls challenges the conscience of the world in a very specific, in a very different way. and perhaps that difference can make a difference. i wholeheartedly support the decision by president obama, secretary kerry and the dministration to deploy aid, personnel, law enforcement and military experts to nigeria to partner with local authorities to find these girls and return them home. i commend the women members of , in a bipartisan way,

100% of the women, have signed a letter condemning these actions. i absolute the first lady for her -- salute the first lady for her bring back our girls tweet and hope that members will also be doing that. because the most horrible form of torture for someone who is held by terrorists is when their captors tell them, nobody knows you're here, who you are and is even worried about you. we want to remove all doubt, every minute of every day. , d as we go into mother's day think of those mothers. think of those fathers, think of the siblings of these girls. our thoughts and prayers rest with mothers and fathers and siblings, of each girl kidnapped and separated from

her family and all the victims of human trafficking around the world. as horrible as it is, unthinkable as it is, it's happening all the time, this trafficking issue. so maybe this horrible, heinous rime will give the attention that human trafficking needs in order for us to end it. and so let us all subscribe to #bringbackourgirls. mr. speaker, i thank you again for giving us the opportunity to focus on this despicable action, but to do so prayerfully, hopefully and determined to bring back our girls. with that, mr. speaker, i yield back to the distinguished leader and yield back -- yield back? i yield back our time. thank you, mr. speaker. the speaker: the house will observe a moment of silence for

these young women. the members will rise. >> house speaker john boehner will announce the names of the seven congressmen who will serve in the committee. the members are jim jordan of ohio. mike of kansas. martha of alabama. peter. and lynn westmoreland of georgia. democrats can place five

members of the committee, but nancy pelosi has not made any announcement yet. she plans to meet with john boehner on what role democrats will play in the committee. this is about 20 minutes. >> good morning. sorry to be behind schedule. this is not going to last long. some of the subjects i wanted to , we had ourabout weekly yesterday. credit vote on the tax postponed it -- some change this changes necessitated this. brought a bill on the floor that takes us once --

156 billion dollars in debt. we have all been for making r&d tax credit permanent and monetizing them. -- modernizing them. every district has that entrepreneurial's dear it -- entrepreneurial spirit. yes, it is very appealing. the very wrong the way the republicans brought it to the floor. i am proud that the president has issued a subpoena that there will be a recommendation of a veto. a veto threat. will will be able to sustain the president's veto. the fact is there is an spportunity in the senate i

handle it so much better. our members have included not only the r&d tax credit, but wind and solar. tie it -- child tax credit. in any event, again a political move to bring that to the floor. abouthypocrisy to talk deficit reduction and bring a bill to the floor that takes us 156 billion dollars in debt unpaid for well saying we have to pay for unemployment insurance benefits extension. the extension. as many of you know but none of

you wrote about, they threw us out of the room. we had a room to listen to had beeno had unemployed through no fault of their own, telling their stories about how this extension has hurt their families. we had the room for it for tuesday. we got here to do it. they said, you no longer have the room. . we no longer let you have the room. we took to the steps of the capitol and thought that might provoke some interest. imagine if i had done that to them? what they would be doing if we said, you can't have a room because we don't like the subject matter we are talking about. a matter before the congress that has passed the senate. what thatnt, that is

is. you are interested in the newly committee that the speaker, up until last friday, was rejecting. in his own words saying -- there are four committees that are investigating benghazi. i see no reason to pick up that work and take months to create a select committee. something happened in his caucus. lo and behold, the rumor was talking to spread friday. information until the rule was filed on tuesday night. now the question is, what are the terms under which democrats could participate. ourave made it clear caucuses clearly among those who say don't have anything to do with it. it is a kangaroo court. though dignify what they are doing. others have said, just send one person so we can see what they

are doing to the witnesses and have access to that testimony. the third option is, let's see what they come back with in terms of engagement. -- wee have asked for have rejected an evenly divided committee. we would have liked to have had that. we must have standards for democrats -- a democrat needs to concur in the issuance of subpoenas. the decision to interview witnesses. the decision to release a report document. by the staff of the committee. these are places where in the regular order of the standing committee, we had been led magnificently that these are where we did not get the

respect of the minority. said,eaker called me and i am serious about this. i want this to be no circus. we should sit down and come to terms on it. i said, why don't the stuff go back and forth? so when we sit down, we will see what that is. then we will make a decision as to how we proceed with that. very sad. for stevens. sean smith. tyrone woods. families have called us and say, please don't take us down this path again. it is really hard. it is very sad. that is what that is. upon mother's day. when women succeed, america succeeds.

her -- same as mother's day -- valentine's day. equal pay for equal work. raising the minimum wage. affordable, quality childcare. that is what we want for moms. we want that -- flowers and roses and brunch or whatever. having to do the dishes. but we also want -- to unleash the power of women whether they want to be entrepreneurial and start their business. create jobs. but they want to have a job and be treated fairly. to be able to do so in a way that has a proper balance between telling -- family and work. it is hard to go into mother's day without picking about the little girls in nigeria. how it must be

for those moms? wonderful that the whole ofld has taken up the cause these little girls? bring back her girls. we will do something on the floor in a bipartisan way, i am pleased to say, to take up the resolution passed in the foreign affairs committee this morning by -- submitted by frederick oh. that will come to the floor. what a horrible thing. .t is diabolical we all have to do whatever we can to make sure those little girls are returned home. the idea that these terrorists could go out in say, we will sell them into marriage or whatever. it is a stunning thing. outside the behavior come the human of his -- civilized behavior.

happening at mother's day. it intensifies the concern and love for these girls we have. >> yes -- my favorites are regulars, the ones who are here all the time. if you have full participation -- how you expect the numbers to contort themselves. they call susan rice and there are no democrats there to defend them. can you walk those -- through those mechanization's? >> i thought i just did. the fact is this is a stunt. this is a political stunt. issa just a damaged goods. they had to move from into another venue with another chairman. that is what this is.

is there at least a level of decency in terms of respect? even in the regular order. does the minority have a right to call witnesses. they try to use the climate and energy select community. it was only established that we can have a couple of bills duns. the record there was there is only one subpoena in four years issued and it was unanimous. it was unanimous. this is a completely different

set up. i think the chairman has already called an investigation. think he called it a trial. a trial. does that tell you everything you need to know? then he says i don't want this to be a circus. i think he is saying something that are looking service -- circus like. i have evidence that not only are they hiding it that there is an intent to hide it. i cannot disclose that yet. there was a decision to withhold certain documents from congress. is that the statement? i have a great respect for the speaker.

to the extent that he is able, i think he was trying to have this. it serves them better than to let them be themselves. they say just let them show who they are with all of this. any of our witnesses can hold their own. there is another school of thought that we are seeing how they operate. >> that was some of today's briefing with the nancy pelosi. you can watch the entire briefing anytime online at c-span.org. >> and sarah of the center for american progress has federal

-- the inference to be drawn from our conversation is we would go to a different place with more clarity about what the rights might be. more specific city. he -- more specificity. but we will see. there, send one person, go if they respect our rights. it doesn't matter what they do. just go in the room. when we see what they have said -- this is interesting. we have our history. we understand what we are dealing with. we don't know yet what the speaker is going to say, so let's find that out. you talked about the spectrum in your caucus. you have good judgment politically and otherwise. what do you think should be done? >> it depends on what the

speaker tell us. i have confidence that we have extraordinary talent to go into the room to get the job done. i worry -- let me read you another quote. pretty well been satisfied that given where the troops were, how quickly the thing happened, the thing off happened, we could not have done more than we did. we have been working on this for a long time. we have issued a preliminary report read at some point, when we run out of people to talk to two or three times, we think we'll have enough of a story as we are going to get and move on. there is that. what is the purpose of this? what is the manner in which they will proceed? in is that manifested respecting the right of the minority? a decision will make

about where we should go. this is brand-new. one week old. with -- wehink the have been talking about this for a long time. cared about the presidential, they would be bill.g an immigration the focus on the affordable care act has run its course. now they have to find some else to talk about that is not about how we create jobs. how we build the infrastructure of america. as simple as abc. let's create jobs, american-made. stop having tax cuts that send jobs overseas. instead, invest in america. e, build the infrastructure. how a sense of community of we educate our children. protect our neighborhoods. part of how we honor

our responsibilities to the american people. they don't want to talk about that. they don't believe in government. they don't believe in science. they want to stop barack obama at every step. i don't think this is about hillary clinton. theink it is about republicans in november, 2014. we would havet -- long ago passed the immigration bill just as the senate did. we had the votes. enda. the votes to pass we have the votes to pass on safety, the brady background check. pass -- wevotes to had bipartisan votes for the voting rights act. what are we doing instead? spending a week getting attention on the subject which, by the way, the american people

care about jobs. their families. the education of their children. the health of their families. as somebody said to me yesterday, it either people have gotten tired of thing does he or they never knew about it in the first place. let's not be accomplices to this diversionary tactic. it is all subterfuge because they do not want to talk about what our responsibility is are here. we have to make a judgment as to whether -- how dangerous we think they can be with their misrepresentation of the facts of the committee. the speaker says he doesn't want to go that place. i hope he -- that is how it will go. when i speak with him, we will see. we have been there, done that. why are we doing this again? why are we doing this again? i have to go to the floor and vote. no, no conversation. [indiscernible]

we have the next row coming up. -- vote coming up. >> we talked with a capitol hill reporter about what is ahead for congress next week. >> timothy cama writes for the hill. the house is out for another week long break, but the senate will be in. the headline says, it is crunch time on energy. what is the status of that measure? >> the status, as you said, they have scheduled a vote for the bill. what is holding things up right now, and what might hold up the bill as a whole, is republicans want to get amendments into

that. the democrats, including senate majority leader reid, have blocked those amendments. one of the amendments would be to force the approval of the keystone pipeline. reid is open to having a vote on a separate bill just for the keystone pipeline. he doesn't want these other five energy related amendments to be considered for this bill. he used a procedure called filling a tree to prevent any amendments from being considered. >> again, senators calling for a vote on the pipeline.

what is the mood of the country on building the pipeline? >> a lot of polls have shown that the country does support this pipeline. for the most part, the polls have shown the possible jobs that are going to come from the construction and operation are outweighing some of the environmental concerns that environmentalists have brought up about the pipeline. it is something that the american people support. >> senators on both sides of the aisle, do they support the separate votes on that? >> all the republicans doing the senate. at last count, about 11 democrats support it. senator mary from louisiana is leading the fight for the democrats. she said that she had 58 votes to approve the pipeline you need 60 votes to get a filibuster proof the geordie she believe she will have that many votes within the next week,

essentially, to pass that. she has 58 now. we will see that actually happens. >> the tax extender was also on the agenda next week. what is in the bill and what senators are leading? >> the tax extender bill -- we expect to see a floor vote. that would extend around tax breaks for two years. for my beat, energy, there are a number of popular tax credits. things that encourage alternative energy and fuel efficiency, they are popular. they expired at the end of last year.

this will extend those for two years. the senate finance committee approved the bill in the beginning of april, i believe it was. there's a lot of bipartisan support for a lot of these tax extenders. we will see where that goes. >> how does the senate's bill on extending tax credits compare with the house's current efforts? >> on the house side, they are taking a different approach. they are doing a few tax breaks at a time. the most recent was at the end of april. that was around -- it was largely -- it was tax breaks including research and development ones that the business community likes.

however, the house republicans and the majority have not shown to be receptive to the senate's strategy of the big tax extender things. at this point, the house's tactic has been smaller bills. >> you can tweet tim cama at timothy_cama and you can read his work in "the hill." >> a discussion about the latest treatment for posttraumatic stress disorder. then president obama talking about solar energy. then the house foreign affairs committee finalizing legislation concerning nigeria and

venezuela. some of the events from this year's conference in los angeles. including federal communications commission tom wheeler on net neutrality rules. cable tv executives discussing how innovation is impacting their industry. when writers talk about their creative process. beginning at noon eastern on c-span. >> let me be clear that i am not defending this -- ms. lerner. i have questions about why she was unaware of the criteria more than a year after they were created. i want to know why she did not mention the criteria in her letters to congress. but i cannot go to violate an individual pot that amendment rights just because i want to hear what she has to say.

a much greater principle is at stake here today. the sanctity of the fifth amendment rights for all citizens of the united states of america. >> i have never alleged it goes to the president. i have said that the tea party would clearly and fairly be described as enemies to the president's policies. they were targeted by somebody thewas trying to overturn -- supreme court decision in inizens united and sip -- support of the president's position. >> this weekend, house debate on holding former irs official lois lerner in contempt of congress. saturday morning at 10:00 eastern. attack,tv, in point of

john yoo argues the obama administration's's foreign policy will harm the country. of a look at the restoration george washington's no burn in dining room. -- mount vernon dining room. >> the american association for the advancement of science treated -- discussed treating posttraumatic stress disorder. the panel included peter. whoennsylvania congressman is a ranking member of the appropriations subcommittee on science. this is 1.5 hours. >> i walked up to the front and everybody was quiet. good afternoon. >> good afternoon. >> that wasn't too bad. has just turned

afternoon, that was good. and the chief executive executive publisher of the journal science. i get to welcome you to the first of our series of neuroscience and society briefings for this year. this one is focusing on the treatment of posttraumatic stress. interest. increasing if phenomena that has been around for decades. which was ignored for decades and has received more and more attention over time. it is a major public health issue. about which there is much needed good policy. you will hear from a variety of speakers with expertise, identification and sort of epidemiology of

posttraumatic stress. then focusing on treatment as well. we will be joined by congressman todd -- fatah. we will posit when he appears so we will have the opportunity -- he will have the opportunity to say some things. he is one of the best supporters of science and a narrow science in the u.s. congress. -- and in rural science and the u.s. congress -- and neuroscience in the u.s. congress. date iswe will work to each of the three speakers will speak for about 15 minutes. i apologize for the fact we do not have a giant screen. hopefully you can strain your neck. we will have a panel discussion. likepical fashion, i would

-- for those of you who have not been to our events -- repeat what a question is. question is short, it does not have a preamble. up at the end. when it gets too long, i guy that looks like me will make noises and embarrass you. as you are thinking about your questions, please try to keep that in mind. ok. let's start, the first of today's speakers is general peter caroli. a retired general with the u.s. army. he is the chief executive officer of one mind for research. one of the most important focusing organizations on ptsd and traumatic brain injury. it will be interesting to get his perspective to general,

please. [applause] you who assume that because we have a slight projector and slides, it is because they generally speaking. generals can't speak without a lot of powerpoint. i have no slights -- slides. therefore, the clinicians who will speak to you about therapy for genetic brain injury. as for me, no slides at all. i want to put this in context for you. i served 40 years in the military. you have to remember that everything you hear come out of my mouth today is from a liberal arts major. i'm not a neuroscientist. i'm not a psychiatrist or psychologist. this is all homeschooling on my part. it started when i became the

vice chief of staff in the army. i spent two tours in iraq in 2004-2005, and all of 2006. on the fourth day as vice chief of staff -- for those of you who do not know what that is, the armyis the coo out the chief operating officer. the one who is to come up to this building area that is why am shaking. i had to testify 21 times one the chief is flying around pontificating and doing the fun things. i would fill in for him for the things he did not want to do. on the fourth day in that general, my surgeon the head of army medical command came in and did a reprieve for me.

at that time we were fighting istan andin afghan iraq. he put a chart in front of me and it showed the most prolific wounds. i was sure what i would see were the soldiers who had lost arms and legs and had been shot to read soldiers with physical injuries. two percent had spinal cord injuries. arm leg ort an multiple limbs. -- withination of 36% traumatic brain injury and posttraumatic stress. i had no idea what pds was. i had spent two tours downrange.

i knew that i had combat stress teams. that somebody somewhere in my career had told me the importance of getting combat stress teams to men in combat who had gone through traumatic events. for some reason, i gave them a priority of aviation assets. they were always there when i had a platoon that had a bad day and lost comrades in battle. bi, for myut t football coach had told me. shake it off and get back in the game. we had more soldiers wounded, 36%, with dramatic brain injury and posttraumatic stress than the physical wounds i had seen in my two towards an iraq. tours in iraq. forward, that number increased to 67%.

traumatic rain injury and posttraumatic stress. i don't trust those numbers. i don't trust those numbers for a number of reasons. i have learned that the estimates -- instruments to diagnose, i would call them blunt instruments. i would say you need to transport yourself around two years into the past three that is where we are today. think what we knew 50 years ago, that is where we are. we don't understand the biology of it. we do not have markers from blood. you think you have posttraumatic stress, you see a professional, depending on what kind of professional you see, they are supposed to go to the american psychiatric association 5.s m five -- esm it used to be for.

it had 17 questions. five came out in 2013. it has 20 questions i look at that and say, that is what research has got us. three more questions. spending $500 million of dod money. we have three more questions. a better test, because if you don't have any the symptoms come you get a score of zero. before coming to cut 17, which i never understood. if you fall down or getting a when he -- accident received a head,, you would be given what is called a, test. coma test. when we look at the mild to moderate people, summer told -- severee told they have brain injury. they are back at work on monday

and do not have problems. there are others that they -- are told they have mild injury and have cognitive issues and are never able to go back to work. i call these blood interest -- blunt is tremendous. b's blunt instrument -s. i went to close by telling you the things i have learned. posttraumatic stress is treatable. to is difficult for me me mention it without mentioning posttraumatic stress. they share the shame -- same symptoms during we have people that have accommodation of both conditions. for me, it is a complex problem. it is not as simple as a sports concussion or posttraumatic

stress. these things are combined and that makes it difficult. it is treatable. you will hear two of the evidenced-based treatment today. we have young warriors going all over the country on the claims of some that there are other ways to treat this. aboutf you may have heard hyperbaric oxygen. push by certain individuals who showed up in my office when i was vice. making a the army was mistake by not putting everybody into a tube and giving them 1.5 atmospheres oxygen. you care a lot about service dogs. i think dogs are great. we need to do the research necessary so they become evidence-based. they are covered. all the organizations that are training them and providing

comfort, 10 years ago -- from now the dog will be dead and the organization will be disbanded. i wonder what would happen then. vice not know what i was and i was handling the suicide issue that all the drugs we prescribed for posttraumatic brought tone were not market to treat posttraumatic stress. .hey are off label that is a doctor making a determination that they will repurpose that drug based on their professional experience that they believe it will help control your symptoms. is a good thing in many cases, but a bad thing in others. many of these drugs affect people in different ways. one of the biggest issues i had in the military was -- i think you will hear about two

treatments that quite frankly take the dedication of time. they are not easy to do. they take time. u says to clear somebody out of your office, we are finding in the military -- when you go to the doctor, they have a business case that says based on me having high cholesterol, the doctor's have a period of time to clear me out of his office. if he tells me about all the things i can do to lower my cholesterol and takes up 20 minutes. explains lifestyle changes. come back in 90 days and we will see if it is down. somebody else goes into the doctor and the doctor says, you have high cholesterol, i will write you a prescription.

he first gets paid less than the second, even though the second review out in two minutes, giving you your prescription. he performed another service. he charges more. the system charges more. we were seeing that any military. military. polypharmacyg because that was easier than in every instance to do the treatments you will hear about today. ad with that is kind of introduction to the two speakers. i want to close by telling you the following. anybody who believes it is just this generation of warriors that has this problem is really mistaken. posttraumatic stress and dramatic brain injury have been around since mankind created war.

i often recommend to audiences, if you have not seen the hbo special called war-torn, i recommend you see it. about an hour and 10 minutes long. watch the opening. they reconstruct the life of a several -- civil war veteran from pennsylvania. he went into the army and killed himself after three years in the union army. he went hunting with himself and killed -- his friends and killed himself. he had what every would agree as posttraumatic stress. he told the story in c sent home. -- letters he sent home. the other thing i would tell you is to take a look at the interview they do with the 14 world war ii veterans. they explain how they came back from world war ii with poster medic stress. they were afraid to tell anybody about it.

they lived with this their entire lives. ever.as been around for we are now shining a light on it. which is good. in a lot of ways, is it that. the general perception of the public is anyone who is deployed has posttraumatic stress. the majority of those do not. don't leave here with the misconception that this is because of this generation of warriors. as long--this has been around forever. we are shining a light on it. we will call with better diagnoses and treatment soon. i will stop right here because i see the congressmen is in here. i know when it is my time. thank you very much. [applause] >> thank you.

actually, i wasn't quite ready to get the hook out. you could have had a couple more minutes. before i go on, i went to a knowledge partner -- i want t oacknowledge our partner. they are one of the most enlightened private philanthropic foundations. with influence from the world. among other things, they not only fund neuroscience activities. public understanding. they are responsible for the core of something called brain awareness week. dana alliance on brain initiatives. very wonderful partner for us. not only in this activity, but in some neuroscience and society presentations we do.

thank you. with that, it is my great pleasure to introduce our other partner in these activities. one of my favorite neuroscientists. almost neuroscientists by now. a member of the house of .epresentatives read one of the most important places to be from rick he is among other things the ranking is -- theember -- he department of energy. the national institute of science and technology. an array of other important science activities. he is among other things one of the greatest supporters of science in this country. idea the guy who had the

for a brain initiative. i love that about him. with great leisure, i give you chuck. [applause] >> first of all, let me thank each of you for coming. this is an important -- and i hope you will find it enlightening -- briefing on one of the major challenges we face. there are hundreds, well over andrelated diseases disorders. but posttraumatic stress is a challenge that is at the forefront of the issues. i know you have heard from the general. a significant percentage. soldiers overured this period our nation has been at war. these injuries are posttraumatic

stress. turn on thes in work one mind has focused on. i know you have heard a little bit about it today. i want to make room for our other guest. i just want to say a few things. one is, i want to thank the dana foundation and alan for that induction. -- introduction. these briefings have helped build the kind of consensus we need in the congress. we had the largest increase of any of the science accounts in the neuroscience space. taking the national science foundation investment in this year,or the next fiscal it will be over $500 million. weeks, alast couple

lot has happened. i met with the president of the european union. interact with the head of the israeli brain technology effort to read a lot of international activity in the space. country, we are starting to find our footing on the fact that we have to make spending and investment decisions that are going to advance the science. in part, in boulder -- in order to do this, congress has to understand the state of the science. that is what the working group is about. the brain initiative has the important -- it is part and parcel of what we need to do. this briefing, like the others, is about having us build a currency for knowledge. move this can help bipartisan consensus forward in

a way in which we can make a contribution. i will stop there. i visited the national intrepid center. i have been around the country looking at the activities in a variety of labs. i am convinced we are at a tipping point and we can make progress. what we need to do is to understand that. allen said in his editorial, we need to seize the neuroscience moment. i will stop there and let you continue. [applause] >> as a neuroscientist, i have to make the, and that the -- iessman had the insight have to make the comment that men had thes

insight that the brain initiatives are being coordinated around the world. it is an important milestone for narrow science that it would be corrugated. the next speaker is dr. kathleen. from the university of cincinnati. she is a professor of psychiatry and behavioral neuroscience. i hope you got programs because the programs are there. -- the files are there. -- the bios are there. >> good afternoon. thank you very much for letting me give an overview. this is one of the two therapies that the institute of medicine and international guidelines have given to as being best practices for the treatment of ptsd. i think is important we dispel myths thate mets -- they are not treatable and it is a lifetime disorder.

a lot of us go through, throughout our lives, whether it be car accidents, the sudden death of a loved one. we don't expect to be miserable for our lives. that there's something about being a warrior that makes people think this is something they were suffer with permanently. dramatic stress is true medic stress. once it rises to a significant level that the person is impaired by it, we have to understand we can then treat them and help them get better. with cognitive processing therapy, we have one of the treatments. this therapy is quite old. which is scary, thinking how little we know about it in society at large. it was created in 1888 with survivors of sexual assault. it as time went by. it we began comparing it to the other tree meant, which you'll hear about any minute. -- in a minute. we marked it into a veteran

military manual which we have in use today. , no a treatment designed matter what the trauma was. we have used it in china for victims of the earthquake. we used it in the world trade center for the survivors who did the cleanup after 9/11. dispelling the myth this is just about warriors. i want to take a second to talk behindthe seriousness it. we all organize our thoughts. we governing usable of how interact with the world. your schema guides what you do. it guided whether you chose to drink water or diet coke. those were rules. where did they come from? did they come from your doctor or nutritionist? you have schemas and rules that

guide what you're doing in your lives. those are developed through interactions with your peers, your parents come your religion. the military. function -- if i go out and do good, good will come towards me. but there is a small problem for -- with that. a bad event when happens to someone who thinks they have been good? what happens when you are the officer and the unit in your breast friend has been killed? -- and your best friend has been killed? what do i do? i must have done something wrong. i doing that something wrong, caused his death. now i will suffer for it. what we find as they completely change their schemas about the world. it becomes not just, i did something wrong about johnny.

if i am in charge of things, i will make mistakes. things will always go wrong. i can't trust my gut. the world is not safe anymore. i can't even trust other people. i can get close to people can'te they will die -- get close to people because they will die. we see these alterations in people's cognitions. the circle of light get smaller. they don't go out. what happens? depression. often we seek substance abuse. now we have people with multiple until health disorders. if we treated the initial posttraumatic stress, the rest of it would not have happened. you see the risks for suicide and other things going up. what does ctp look like? it is simple. it started out of the -- as a therapy.

slow them down enough to understand what is ptsd and what does it look like? talk about how you have been impacted. what are you telling yourself about this event having happened to you? then we asked them to write about the trauma. people said, i am not going to therapy because you will make me talk about the trauma. how many times do i go to the general saying, special forces will come into my office and say, i cannot talk about the trauma because i signed a statement saying i would not. in cognitive processing therapy, we have shown it works well without ever telling the full, story. -- telling the full trauma story. there is no reason for not getting help if you feel you cannot tell your story. you can get better without it by focusing on what it means to you . not what happened. that's the critical difference. we begin to go to challenging

these assumptions. let's look at whatever you are telling yourself. challenge yourself. i teach you to be a better therapist for you than i could ever be. we move them forward into the last phase. we talk about the five areas that are critical in terms of post traumatic stress. control, self-esteem, and intimacy. we asked them to revisit the impact. without this was a nice, perfect package. what we begin to see is, maybe not. some people may be needled less. some people need a little more. prove that it worked overtime. people would say, that therapy works but for how long. we did it in five plus years. can -- on any mental health issue. by the looking at these two

therapies, and i don't mean to steal your thunder, but we have looked at these treatments five plus years later. they got that are and stated better. stayed got better and better. let's talk about, how much do they need. it is not even 12 sessions. the majority of people, when we look at who got better when and stop forcing them, because it was a research's teddy and you will do 12 sessions, let's look at how soon you will get better. guess what? people were getting better in eight-nine sessions. that is all we are asking. if you need a few more, ok. let's take it up to 15 or 17 sessions. 18 sessions of therapy compared to a lifetime of distress could mean it is worth it.

be hard part is they have to willing to do the work. let me mention veterans. can it work for veterans? tenet work in vietnam veterans? -- can it work in vietnam veterans? there's nothing to suggest we can use these therapies to make them better. this is treatment as usual and non-evidence-based. it is compared with using this treatment. look at it. to do this,them they did much better. i would like to talk about treating folks with tbi. they cannot do posttraumatic stress were. to write method.

we admitted patients into the program with both mild and severe tbi. they did fantastically well. those with low and severe tbi did better in cognitive therapy than those who were martyred. these gentlemen knew that they had a problem and were invested in working through their problems and getting matter -- better in their therapy. he a penetrating blast injury that really shredded most of his face and also took his legs from him. he was addicted to pain pills. the time he was done with the therapist, he no longer had ptsd. he lost his leg seven months later and still do not have ptsd. we have been in contact with him two years since. even after everything this guy

went through. you have got a severe tbi in his history. the last thing i look to talk about is because i know we need time for the presentation, what are we doing about it? we have a therapy that works. what are we going to get it out there? we are rolling it out. creating trainers so we have for people who are absolutely skilled in their therapies and looking at having them go out and train multiple and how to use the staircase. they're making sure that they are trained to the ongoing consultations. the worst thing you can do is train someone and expect them to go out and remember how to do it for five or six months later. monthly to give them a recent consultation with an expert who can help them when those difficulties walked into the door, how do i work with the individual and stay true to the

this model. we are doing this ongoing training of trainers in this ongoing training of your to make sure we can provide this in lots of settings. we are going to do an online at onlineo look training. we can create more trainers very quickly and have them continue online and interactive ways to maintain their training capacity so we can have more people out there making sure therapists are available at all times to anyone in the va the department of defense. we do need to address ptsd there as well. does it work? i want to point out these scores. these are the first two cases that there is ever saw. these are looking at people who are vietnam veterans, and people who are young.

the improvements are the same as .hat we saw in the trials it shows is that if you teach a therapist have to do it well and give them good consultation, out anthe gate, they can be effective therapist for treating posttraumatic stress in a multitude of settings where there be an inpatient or an out patient. i trained numerous dod clinicians to use this downrange. have used this and afghanistan and iraq and in five sessions in the span of about two weeks to get someone functioning. one of my favorite stories of a marine who spoke to me in my program, he wanted to stay in the military, they're able to get him out to me that we

treated his posttraumatic stress and sign the worn affidavit saying he did not have ptsd. they took it. he was at home for a long weekend and spent three days back to germany. he is still in the marines today and functioning fully as a warrior. that is the clear he wanted and he did not have ptsd. it is a life debilitating event only if we allow it to be. we could get them to continue on the left projector they want. whether that is the military or any other avenue. equity like to close out on the final figures of comparing the different types of clinicians who went through that treatment.

men and women can be treated equally well. all of them fight effectively in terms of the outcome. again, we took inventory because we know depression is high with stress and to treat it equally well along with the posttraumatic stress. where are we going? we need to keep doing work on group and individual hairpiece. therapies. we are also doing a lot of work comparing the therapy of prolonged exposure. studies.7 sites persony we can get specific item recommendation when someone is coming in. based on who you are what you are saying, and this is the best fit for you. we're are looking at severe mental illness.

some are schizophrenic. some are bipolar and manic. when they need extra help, we're looking at that. it is beginning to show that they did well. they are doing really well in those studies. we are also looking at other countries. we have there suspected not even have a college degree learn how to do the therapy and doing quite effectively by giving the training and consultation. going to people's home and meeting with their iphones and ipods and being able to work with them instead of dragging them into a clinic somewhere where they feel very underserved or perhaps isolated but looking at all of these people that do not look like them.

i will be ready for questions later. thank you. [applause] that data is tremendously impressive. i hope everyone is storing those up. there are programs and studies [indiscernible] .> thank you i'm delighted to be here today come especially since i started as a young person on capitol hill as an interim and then legislative assistant before decided to go to grad school. be careful. [laughter] ok. let's see. i'm going to start by providing you with context. we have to evidence-based treatments. how do we get here?

why wasn't it used for vietnam's? i think it is important to understand the context that it will inform how we go forward treatments, but it is not disseminated and used as white as they could be. studentas a graduate about 25 years ago, there were no evidence these treatments. i was handed a file about that patient, it was a ptsd a woman with a horrible experience of witnessing her former husband murder her boyfriend. we didn't know how to treat her. i happen be doing a rotation on the burn center where there are high rates. i agreed to take the patient. i can tell you she would be treated much differently today than she was then. i happened to be lucky because i had a supervisor that was sort of on the right track.

you see he's wearing a display. i will and by talking about using technology in virtual reality forms and show you a couple of videos. so, why did it work for you and not me? >> [no audio] >> i'm pressing the arrow. huh? , they're fixing it. maybe someone can come up and show me. is talk going to do about like exposure therapy and who it is for and what system of care is delivered in an why more people are not getting it. >> [no audio] >> yes, that is what i am doing. ok. i'll keep talking. ok.

there we go. well, they are figuring that out. i will fast forward and start this story. september 10, 2001. where were we? that, ayear before major component of exposure therapy -- ok. yeah? ok. fast forward. we can skip that. there we go. where were we then? there was plenty may evidence for one evidence-based treatment was prolonged exposure therapy and one fda approved medication of zoloft. the expert consensus guidelines had first been published a year and a half before recommending this treatment. can we go back once like?

slide? who is very new and psychiatry. our education for the point has been pretty much dominated by theory and other theories, that there wasn't an ethicist. when i started using the term that i wanted to start an evidence-based, treatment, people kind of looked at me like i had three heads. you go forward. what is this evidence-based mean? and science in general, we're talking about treatment that has been steady and is the gold standard. it would be a randomized controlled trial comparing different treatments with different trauma populations and showing that they are effect to. the results are assessed by reliable and valid measures. the point is that there is very strong science underpinning these treatments. i'm sorry.

i was expecting to be able to just go through my slides. i apologize for having to slow you down here. keep going. keep going. to 2008.orward they were looking at that evidence. they precluded that there was one psychotherapy and there are two forms of it. the cognitive process and prolonged exposure therapy or various exposure therapies that i will talk about. the evidence was sufficient to preclude that these treatments were hit in treating patients. have it in the back of your mind . why are we not using it more? keep going. the evidence is a cross. we have at least 27 randomized

trials across multiple trauma populations. seven veterans, six female assault survivors, refugees, earthquake, and the world trade center. next slide. again, i do not want to belabor the point too much. i have one example here of the also concluded that exposure therapy were in effect it treatment. there is a laundry list of organizations around the world that have drawn this conclusion and are respected. ok. i will talk a little bit about what exposure therapy is delivered in a virtual reality and i will talk a little bit about -- i will show you a video and talk about what i think some of the obstacles are.

that is fairly important in your role as public policy here on the hill. this is also a very old treatment. goes back to at least freud if not before. and guessing most everyone in sight -- psych 101. talk about your feelings and thoughts and situations related to the event. we have a schematic of a person. they are going to be chocked. -- shocked. they will also be shown a light bulb at the same time. it is a neutral stimulus. they shouldn't be scared when around my balls. certainly it is adversative. is. happens

have a paradigm. care -- pair the blast with the light and you take away the aversive stimuli. there is a conditioned cue to fear. when you see the light, you will jump. next slide. keep going. what do we do in exposure therapy? it sounds like the treatment is unpleasant. you probably need to rename that treatment. it is extension training. we will take our patients and asked them to come in. we do need to talk about the trauma.

we asked them to go over our trauma as if it were happening again. over and over again until they have habituated to it. until all of those cues no longer create fear. it doesn't take as long as one might think. a typical trial isabel 12-15 sessions. a study showing that people get better but many fewer exceptions. having, because part of trauma, aoiding your lot of people have difficulty engaging in it. i think we can probably skip this. you can make the point that neutral situations in real life become associated with fear. most of us are not fearing about walking down a stairwell unless

you were escaping at the world trade center not knowing what was at the bottom or whether you'd be able to get out and where your loved ones were good stairwells are no longer neutral . psychologist and psychiatrist would often use a technique for relaxing patients in which they have the walk on the stairs and close their eyes and gradually imagine at the end of that walk there will be more relaxed and going to a happy place. you cannot do that in new york without asking some if they were at the world trade center. they might be introducing their fear. the way we think about is that itic stress is a disorder of fear. learned avoidance is a big part

of it. a cousin of ptsd is phobia. whether you are at the world trade center were served as a warrior or in a car accident, there is a common set of features. we learn to fear what the traumatic event was and unlike -- you generalize it. it means that we come back from whatever the situation was ever likely to be afraid of flying and going into bridges and tunnels. we are likely to not want to listen about bad things. there are a few cues and it leads to what the doctor is talking earlier that the patient site -- start to narrow the world more and more. they do not want to go out to dinner with their wives because they are afraid that the noise

rockers them. they are hyper aroused. there weren't something bad will happen. they feel like they're back is against the wall. what is happening there is a their brain is still processing their trauma and telling them something bad is going to happen. they are in this mode and are looking for something bad to happen. next slide. go back really quick. you were going to see a slide that said that the fear response is hardwired. much of what happens with ptsd is the amygdala -- we don't have time to go into that. i want to make the point that there is a lot of preclinical evidence from neuroscience outlining the fiercer country in the brain. it helps us with available treatment, but will also help us cure.forward to develop a

it is not a word used in psychiatry much, that we have changed the thinking there to be more hopeful. as i said, there is a lot of evidence emerging from -- that would suggest that would be sooner than we think. let me see if i can remember what the next slide is. it is still going back to the way we do mental illness or psychiatry. there are a lot of people who think that they can bootstrap themselves that they can get every -- over on their own and what have you. they talk about how this is a fear related condition. it would lead us to understand that you could be surprised that it is not a lack of will or a sign of weakness.

it is not a sign of a character failing. it is a condition that is eminently treatable. ok. what does exposure therapy accomplish? we help the patient process the memory in such a way that they it and understand it is something that happened in the past that is not happening again and then we treat them to go forward and have dinner with their spouse or significant other or whomever on a saturday night. over what happened as if it were happening again. this is the hard part for patients. let me get them to engage, based a.

they get better and very -- and better. i was treating a high level member of the nypd not long ago. because 10t out years after the fact, the are policeether they officers or firefighters or , we had a site at cornell and they came down to see us because we're not related to the occupational department. where i'm going with this is this man was very involved in the world trade center effort and coordinated things that they are keeping the city safe after. divorced.p he left the police department. this is a common story. i'm not saying this about any

one particular individual. the point is that he got better. but he said to me afterwards was, ge, i wish i knew about this sooner. why wasn't this offered to me didn't think i could get better 10 years later, but i did. ok. that is the emotional processing. i will make this point and i will show you the video. .xposure therapy is to --re is across, population there is a trauma population. 9/11 is still a public health problem. stub posttraumatic stress disorder. it is treatable, but it doesn't go away unless you get treatment. ok.

i'm going to move sideways just a little bit. therapythe exposure requires you be telling your trauma as if it were happening again and generating it from your imagination. we have sort of a conundrum. how to get people to engage? following 9/11, we understood that people -- we would offer therapy ande medication as necessary, but we also knew it wasn't perfect. at that point we had much less knowledge. we asked, what could we do to enhance the experience in such a way that people could engage in the treatment more easily? you think about the day-to-day experience. is the new date thinking, but you are also apprehending the world in a multi sensory dimension. your things and you smell them and you feel them. why not try to create virtual

reality simulation? there had been a case published by some unknowns of taking vietnam vets who had failed if you will ultimately treatments over many years and showing that they could accretive reduction -- achieve reduction. i will jump forward now. feeding backing -- piggybacking on her work and my work to get the forms of treatment, we now have a multi site clinical trial going on in comparing the virtual reality. next slide please. you can see at this point we now have -- when i started with the world trade center, it cost about three $5,000 when he had a running on a workstation.

it was a limited program. i think we are all more haveested in -- today we two scenarios. there was a city seen. we could only have one on patrol and one convoy. ago, myple of days colleagues launched a version with 14 different scenarios, including scenarios which is a highly specific form of trauma. in what we dore is we don't use all of the available elements. undergo trauma, we learn cues to the fear. a common one would be a flyover. driving in a convoy. if you go to the next slide this

makes the point where users virtual reality. keep going. that is the virtual world. keep going. there we are. this is going to show a young man coming back from iraq in 2009. he received virtual reality tree and. go to the next one please. there we go. they talk about the treatment and shows how they used it. and i'll talk about some of the obstacles. would you like me to help you?

>> [indiscernible]

as showed a boy and his father. i have a son that age. it struck home. home and i do not think i noticed i had a problem. my wife would tell you that you never smiled or talk as much. we were at walmart. can you hold this for me? there are like 50 kinds of toilet paper. i couldn't make a decision. i almost had a nervous breakdown at walmart.

it frazzled me. .t is so simple it was a hard decision to make. i talked to psychiatrist. . do not want to hear that the classic symptoms. these guys are kidding me. it is the last thing i wanted to hear. put the goggles on or the headphones are. i grabbed the controller and would go on patrol. doctor, but can hear him. intervals,ittent you'll hear explosions and

gunfire. it is tough. you spend so much time trying to avoid thinking about your deployment and they're dredging up memories that you try to avoid at all costs. it is difficult. idea fort was a great them to put it in that format. >> [inaudible] this shows you what we do is for patients who are reluctant to engage in treatment and it is still an empirical question. ours is one of the major ones

and there's another one up in pacific west. ours involves a side of new york where veterans of the national guard and active duty can go. -- in d.c. --al we can see how the treatments do with active duty as well as veterans. you can keep going. there is an evidence base for the treatment for both forms of exposure therapy. it is not clear you have the treatment will fare with different trauma populations. when guests would be this form of treatment homework well. you can sort of bypass or willful avoidance of your problems and all of the stimuli that you need to call off your cues to fear and process your

experience and get better mastered and move on. it is available in the virtual world. i do not have much time left. i started out by showing you that there is pervasive evidence of multiple governor bodies governmental organizations that have precluded that these treatments are affect did. -- affective. why don't more people get them? i want to point out that there are myths. memory ishem with the cruel. we shouldn't do it. people are living with this symptom. it, you least expect have something pop into your mind that is related to your trauma. we're not asking people to do something that the brain is not already doing. we are introducing -- it could

be done across all trauma said not just some that are like a car accident. they continue to confront traumas right here and are warriors and veterans. keep going. .k here is the one i want to and on. i think some of the major problems we're having have to do with our systems of health care delivery. there are multiple in prejudice. -- thereographical aren't geographical impediments. i cannot practice in new jersey because i don't have a license. we could deliver the treatment using skype or other forms of technology, but you can. informedmissed consumers and health care providers and the stigma and the

prejudice -- keep going. ok. it shows is i happen to be here in town about four or five years ago. there is a huge pink ribbon hanging from the back of the white house. if we hadt be great something similar for ptsd? breast cancer. years ago that was not the case. do it for our warriors. i think my point is that i think it will take embracing by our leadership that there is stigma. i know we are at the tipping point. we have to keep pushing that method. i think that will make a huge

difference. make sure another veteran doesn't lose his family. thank you. [applause] >> if the panels -- timeless would take a seat, use the microphones. say what you are. -- who you are. >> [inaudible] >> we all do. >> [inaudible] i have a greater appreciation. there has been this range of studies that have come out beingg that young people

raised in some of the more challenging communities in our -- as if they lived in a war zone. gunshots and all of that at tidbit he and witnessing that gunshots and all of that and witnessing that violence. we have seen a number of studies have ads in our cities higher stress and kids tested in war zones in terms of their sense of trauma. thousands of soldiers have been diagnosed with traumatic ring injury since the beginning of the third team year war. traumatic ring injury every single year.

3.4 million. estimate. to as much as a percent will suffer from posttraumatic stress at some time in their life. these are huge problems not just for the military, but civilian society as a whole. show that in urban areas there is often people introduced to multiple traumas before reaching adulthood. >> 8% of all individuals living in the u.s. will have posttraumatic stress to sort at some point. we know one in five women will be subject to to sexual abuse. one in seven boys will be abuse.ed to sex one in five women will be subjected to subjected to or completed rape. black and abuse children result in over $20 billion in the u.s.

and about $40 million in indirect costs every year due to the problems that once someone is abused, you have the welfare system and the adult court system, all of these things happen due to that assault. when you add in all of the other types of trauma, you are talking about hundreds of billions of dollars every year due to traumatic stress. it is nothing to do with the military. >> one other point. i do not have the d. that upsets a lot of people. there are two stories told. and tryals who waited to handle it with drugs or alcohol, that is what we see. .hey don't want to be told

it is the people that are not --ting help that we continue we will be able to understand the biology of what happens in the brain and will no longer be disorder, but injury that occurs in the brain. injuries can be healed. this desire to continue to call it a disorder that is -- >> good question. these are rather different treat. -- treatments. how do you know which one to use? you pick one? there is some kind of marker you can use? patient informed choice. he gave them an informed choice. one head-to-head study is only once in. it is one minor thing that

hired on people were guilt and self blame did better than more cognitive therapy. we wanted to answer that. . love feedback >> ok. another one. ready? how much better is better? study three and post treatment. he didn't go to zero. how much better it better? what can we hope for? a using virtual reality. another words, the medication. it enhances learning. >> as in zero?

much no symptons. socialient showed no funct effectsions. functions.d l behavior.s socia we showed 80% got better. we have a lot more to do. we are reaching the point where we can talk about people going into a very long-term remission. but itbe able to talk -- does work. >> you have to understand the couple of things. time.things take when you look at the billet to

do this, you have to look at him couple of things. second, are they given the time to do it? and execute a protocol the way it is supposed to be executed. that wea huge issue really need to keep the spotlight on. if we do not, we get ourselves in a situation that's very poor. that is when we get into other things i have seen. >> people lump things quickly and it does indeed take time. quickly and it does indeed take time. your further answer question, we know 70-80% will get better and stay better. that is what the study show over and over again. what does it mean?

they don't have symptoms enough for it to be significant for the distorted. well they have some symptoms? absolutely. you will feel sad. you will have problems he. -- sleeping. a cure just means it doesn't control your life on its terms. >> okay. you have these policy types. seize the moment. anything you would recommend they think about doing? >> you have got to ask the question. if you have it. p, why isn't it better known? -- if you have the therapy, why isn't it better known? i think there are obvious reasons. i think part of it is the medical profession.

the mostelieve that efficient way of getting that information. war zone, if i didn't have the information in a nanosecond, you would come down on me. if any of them were hurt because we didn't publish information, we ought to ask ourselves -- why didn't take so long to take therapies like this to ensure they would be used to treat all of these veterans we have got from the rest of the population? if you go to see a physician for a heart transplant and they give you [no audio] doctor would be held for malpractice. a standard ofve care current with the research. why is mental health not given the same standard of care by the

state and their like to practice using tech nixed that were created 100 years ago? -- techniques that were created 100 years ago? >> mental health is still undervalued by our society. don't -- they don't have medicare or medicaid. their reimbursement makes it so that that they were works of man -- surmounts them amount of payment they will get. it is a pervasive issue. >> a question in the back. a [indiscernible]

they haven't had treatment before? haven't had evaluation's before? you are guessing to getting them back to normal here and you do not know what that was. there's a bill that could introduce mental health evaluation as part of joining the service. now. isn't one right would it be helpful thing? what is that like? willthink it is help definitely to get more context about that individual. would measure, a you base it on people who are healthy dose who are not so you know what it should look like across a very large norms sample. use samples people like to

capture us at a small norm sample.-- norm it is critical we didn't have to do assessments. if i go to the doctor after having chest pains, he will take might be dead. -- my blood. he will say you had a bad sandwich or you are having a heart attack. we do not have any blood biomarkers. -- yetot even have been mri's are constantly being used, but not accepted by the fda. you got fresh it did in 2007. he said anyone who gets a va diagnosis of ptsd gets 50% disability. it all you have to is 20

questions and you look at what disability means from the va, you have created my numbers that i show you some times that i think are inflated. there are some who don't know how to answer those questions and they want the disability more than they want other things. it's a small percentage. it is a real frustration. manders have a rough time knowing who is really -- commanders have a rough time knowing who is really say and who is trying to play the game. >> we have a minute and half left. this don't have a one and a half minute question? does someone have a one and a half minute question? >> the question -- culture is changing. it is ok to get help and talk about it before the problem

becomes exasperated to the point -- let's go to therapy right away and start talking about what our issues were. .stead of feeling like that -- that. >> i believe they have made great strides in the stigma. there are many times that to testify and i was over military suicide. doublethe suicide rate from 2001-2000 and eight. it doubled, no doubt. it doubled from being half the civilian average. about 349lking suicides in 2012. 30,000 americans created soon -- committed suicide. if that isn't a national health

problem, i don't know what case. 170,000 were hospitalized. they failed at a suicide attempt . it's a huge dollars. we look at how things are moved by dollars. we'd start to look at that for the general population. >> we have thousands of therapists who have been trained to provide treatments both at home and at the place. i cannot tell you when the number one cricket there's -- one of the number one predictors is positive social support. someone with non-judging and non-blaming and non-shaming. they will actually listen to you. it we can provide that environment, you are right. on that optimistic note,

let's thank the panel. [applause] thank you and thank you again to our partners and the foundation. thank you. [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute] >> next come obama talking about solar energy. in making energy more efficient. later a discussion about the treatment for posttraumatic stress disorder. on the next "washington journal" guerie on the tea

party influence. and sarah jane and high school teachers talk about the advanced placement u.s. government exam and what will be on the test. e-mail, facebook problems, and tweets. "washington journal" live at 7 a.m. eastern on c-span. the president of the united states. [applause] >> hello. hello, everybody. hello, mountain view. [cheers] it is good to be in california. this is actually my third day on the west coast.

on wednesday, we went to l.a. we went to san diego. we are here in the bay area. i have to get back because sunday is what? >> mother's day! >> mother's day. that is a public service announcement. do not forget. [laughter] i told michelle one time, how come people put so much emphasis on mother's day and father's day not so much? [laughter] she said, every day other than mother's day is father's day. [laughter] [applause] which i thought kind of quieted me down. i want to think your mayor for hosting us. [applause] i want to thank the folks at walmart. i know this looks like a typical walmart, but it is different. that is why i am here.

a few years ago, you decided to put solar panels on the roof of the store. you replaced some traditional light bulbs with led's. you made refrigerated cases more efficient. you even put in a charging station for electric vehicles. those upgrades created dozens of construction jobs. they helped the store save money on energy bills. that's why i am here today. more and more companies like walmart are realizing that wasting less energy isn't just good for the planet, it is good for the business. bottom line. [applause] it means jobs. changing the way we use energy is just one of the ways americans have been working so hard to move this country forward. in the wake of the worst financial and economic crisis in generations, our businesses

created over 9.2 million new jobs. the housing market that was reeling is rebounding. you have a manufacturing sector that is adding jobs for the first time. more than 8 million americans have signed up for health care coverage through the affordable care act. [applause] troops that were fighting two wars are coming home. president create jobs in other countries, more countries -- companies are choosing to invest right here in the united states. we have a long way to go before we get to where we need to be. an economy where everybody who works hard, who takes responsibility has the chance to get ahead.

we have a chance to build an economy that works, not just for a few at the top, but for everybody. that is our goal. the idea that no matter who you are, what you look like, where you come from, what your last name is, if you work hard and take responsibility, you can make it in america. that starts with helping businesses create more good jobs. one of the biggest factors in bringing jobs back to america has been our commitment to american energy over the last five years. when i took office, we set out to break our dependence on foreign oil. today, america's closer to energy independence than we have been in decades. we generate more renewable energy than ever with tens of thousands of jobs to show for it. we produce more natural gas than anyone. nerly everybody's energy bill is lower because of it.