“Living Naturally” – Overcoming Depression and Anxiety

“Living Naturally” – Overcoming Depression and Anxiety



Charles Smith, PhD, a clinical supervisor at Bastyr Center for Natural Health and a Bastyr University faculty member, led a discussion recently on ways to overcome anxiety and depression. The discussion was a part of Bastyr Center's free Living Naturally series, in which Bastyr practitioners share their knowledge and expertise in natural health with the public.

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overcoming depression and anxiety depression and anxiety are the two most common issues seen by any psychologist or mental health professionals and when I started doing this stuff over 30 years ago um the most common pres we say presenting issue for psychologists and counselors with depression um that has changed and you're starting to see in many settings like the college setting you're starting to see people coming in more frequently with anxiety than depression or a big combination of both of them put together where you really can't take it apart it's all the above it's both okay that's just kind of the the where we're at right now um here's the agenda for today uh first of all we start with what would you like from today's session so let's stop right there what anybody have anything they would particularly like today or looking for from this session go yeah I'm assuming you're probably going to cover maybe a couple steps that you might have suggestions okay so I was said I'm assuming that you have some steps that you're going to give yes I will so all right okay anybody else anything you're particularly looking for today oh go I'm very interested in the emphasis on on um preventive things behavioral things where you can you can learn how you can how to avoid getting into that okay anxiety head first work yep yep okay I'd be glad to talk about that understanding the body processes that actually Cal symtoms okay that's probably that's kind that will probably not be much of a topic today but maybe afterwards I can s in some directions to look okay um let's say depression I'll just say one thing and kind of covers all the above depression anxiety are heavily related to the What's called the serotonin reuptake system in the body and the brain and do we know why no we don't know why but most of the medications that are given by traditional MDS have to do with what's called serotonin which is a neurotransmitter and actually being able to release more of it because it seems like people with anxiety and depression for whatever reason don't have enough serotonin being absorbed so that's that's what we do know beyond that it's really hard to figure it out so I'll try and address a little bit but I'm not going to get into the biochemistry very much can you talk about Seasonal effective disorder say it again Seasonal effective disorder a little bit I'll talk just a little bit about it thank you that gu it's very helpful there was somebody else I think that had a yeah causes yeah I'll talk a little bit about that I'm going to I'm going to kind of be too directional today um I'm going to give you traditional stuff to start with I'm going to give be traditional psychologist and talk about this in terms of epidemiology and all that kind of stuff then I'm going to be a little more basian a new Agy in the second part of this thing and talk a little more about mindfulness and some other things that I think are the value added in the last 20 years in psychology been around forever but our value added for psychology in the last years I think it's so important and thank God I'm aass year we can actually start talking about some of these things in a more kind of more open way so all right so agenda we just did the first one um what is the experience of depression and anxiety I'm going to come back to that the prevalence of these disorders the causes of these disorders see if this again it's the first time I've used one of these so I hope I do it right um the treatments and question and answer period so that's what we're going to do we'll probably take a potty break in you know about 45 minutes for everybody I heard it call for the first time last week a bio break that's so cool we're going to take a bio break depression vano that fits oops I'll move it up fit better if I move it up and okay so that's a Vango self-portrait depression says it all doesn't it far real serious depression at least is concerned depression okay tell me what is your I'll do that like that when you think of depression what symptoms do you think of as accompanying the word that we use depression what are the symptoms loss of energy loss of energy very good if I move around too much is it going toy you're filming okay all right cuz you know I can't sit still slow movement or less less activity yes yes so less activity less active no pleasure yes that we got a fancy word for that in Psychology anhedonia anhedonia that's another word for loss of pleasure social isolation say it again isolation isolation yeah that's when I got my list negative thoughts yes negative thoughts okay and this where the precursor for or the result of but it's certainly a part of the syndrome all of that anything else when you experience some depression what do you you know motivation yeah definitely go again lack of enthusiasm lack of enthusiasm L of appetite loss of appetite of appetite insomnia insomnia do you get this think about it everything we're saying to D press you push down everything good is lessened correct it's like a damper on all the good stuff the enthusiasm um naturopath might say the vital energy you know everything that seems to be good is depressed by this syndrome and a lot of stuff we don't want like the inability to sleep is increased by this syndrome okay a sense of humor too yes oh I'm going to repeat what you said so everybody here loss a sense of humor that's a real sign of getting better when you start to get your humor back okay no it's a definite sign that you're starting to get better this the humor comes back yes exactly so um so can't sleep want to sleep all the time okay can't concentrate ordinary tasks seem more difficult by the way I have handouts oh can't operate a simple machine no okay thank you ordinary tasks seem more difficult okay is that true yeah mind underwater by the way if you suffer from depression you'll have these underwater or feet in water slow motion can't move dreams you know being almost in in in um in Motion Set Back In Motion overall negative thoughts okay loss of appetite so somebody said or increase of appetite that's true eating to try and overcome it loss of interest in things that would have previously given you pleasure and honia loss of zest and energy for life thank you thank you guys I got a whole crew of helper this my this is a dream I've had I should go through life like this okay it's got to be in this little tiny Zone to be able to get on the screen okay uh drinking or drugging to take take away the bad feelings I've been a therapist for about 35 years and so instantly when I see alcoholism you know I think this probably covering up anxiety or depression one of the other it's covering up bad feelings typically because it's a wonderful drug to take away if you didn't have to live with the consequences to take away bad feelings uh thought this life is not worth living okay let me do a compare and contrast right there just the way a psychologist thinks about it passive suicidal ideation and active suicidal ideation we all have feelings sometimes what the hell's the use and life's not worth living okay we all have that if it's turned into a drive to off yourself to take your own life that's called active suicidal ideation huge red flag for the psychologist or the helping professional this is real serious and you got act you got to do something the mere thought of what the Hecks the use is a passive thought thought about is my life at Value not a big flag unless it turns into the active kind of thought part of it does that make sense to you guys it help you differentiate in yourself and the people around you when you really need to start being concerned about it that this is a huge issue but meaning of life purpose of life is it worth living thoughts a lot of us have those even we're not depressed uh the what's the use feeling Reckless Behavior and you may not think of that going with depression but frequently a person with depression will drive too fast overindulge in sex drink too much so do a lot of stuff that is really designed in a self-destructive capacity there's a self-hatred there that people engage in does that make sense when I see that to you guys okay u p passive ACT versus active suicidal ideation I already said that a withdrawal and isolation as you've already said okay prevalence of the disorder let's put that down there okay let's make sure I get this right on the screen estimated that 20% of us will report at least one symptom of depression in a given year so that's a lot okay 20% of us with at least one of the symptoms of depression in a given year surveys have found that 5% of us report major depression major depression is reoccurring depression of a very serious nature that's where I can't get out of bed I can't perform normal task um the criteria for psychologist of when you're moving into the danger zone with depression or anxiety is can you perform your daily functioning if you can perform your daily functioning sounds cruel but you may be suffering but you're not at a level where we say this is really serious when you're unable to perform daily functions you can't go to work uh you've you've lost passion for living you can't take care of the kids etc etc that's where depression and or anxiety has reached a level of where it's really critical okay all right um 10% of us 10 over 10% of us will have significant depression in a lifetime that's a huge number more than 10% of the American society will have major depression in a lifetime wow that's a lot H their entire life yeah in other words they have a major depressive episode basically a serious depressive episode okay uh 15 to 30% of people have major depression uh who have major depression also suffer from panic attacks remember I said they tend to overlap and they tend to come together which also alludes maybe the same excuse me brain functions are involved in both of them the same neurological functions may be involved okay would a panic attack be considered like extreme anxiety yes um and again we don't know we literally don't know the mechanisms involved in this stuff we're just kind of guessing at what the mechanisms involved um I'll get i'll get back to the panic attack so yeah we'll make you panicky a little later um uh types of depression major depression symptoms of depression are ongoing and relatively constant the episodes are typically 6 months or more um there is a huge difference between the onwe kind of feeling that many people have of kind of a lowgrade ongoing what the hell's a use feeling as opposed to major depression which interferes with functions of daily life the capacity to do things in daily life and just sucks all the life and energy out of the person who suffers from major depression um these tend to be ongoing I I debated as to whether I should mention this to you because the research is indicating that um it may be a fact that people who suffer from recurrent major depressive episodes actually have neurological changes of a negative nature over time in other words uh after one or two serious depressive episodes it may actually have an impact on the neurological system and their functioning okay and uh almost wish I had a natural path standing right next to me right now I can kind of talk about what some of the natural treatments for that that's outside of my scope of practice but it'd be nice to think that we can repair some of those neurological damages from that you know what occurs um second kind of depression is uh atypical depression it's the most common subtype um anytime a psychologist or counselor says atypical that that also means that they can't stick it in the other category so that's a leftover category a typical not your typical okay um perhaps not as deep or longlasting as major depressive episodes lot of people suffer from one variation or another in atypical depression so that becomes kind of a catchall category yeah all right sad Seasonal effective disorder I have no numbers for prevalence I should have looked that up but I didn't um it is uh it seems to be by the way this is a controversy in Psychology uh I tend to think such an animal as said exist there are a lot of psychologists that don't believe it they just think it's Garden variety depression and does not exist I tend to think it does um a lot of people on our campus in kinmore have light boxes right on their desk and actually give themselves treatment every day a lot of naturopaths use light boxes with people and they seems to be good results as far as I know there's not a lot of good research you know on the effect of light boxes it tends to be a northern climate disorder where we live in places that are cold and wet I don't know if any place like that you might but and I moved here from Minnesota originally so God I can't get enough so all right just s a fancy word for kind of mild depression but of a very long-term nature okay last a long time but you hardly miss a day of work when you talk to somebody when I talk to somebody as a psychologist and I said how long have you been depressed and they say my whole life that's usually this time in and that you know and then I start you I'm jumping way ahead to treatment but I start looking there for the kind of family they grew up in what you know Mom and Dad's mental health history alcohol and that you know the home of origin and all that kind of stuff to try and figure out what would make a person depressed for much of their life you know so and okay um just to mention it is not grief or Sadness by itself grief is a reaction to a major loss and grief is the correct reaction to a major loss sadness is the reaction to the stuff that goes on in daily life you may turn in the news tonight and see some awful story and you feel sad because you're a human being okay that's just normal kind of stuff if that grief grief loss or sadness starts to linger for a long time and again the criteria starts to interfere with your functioning keep throwing that in there then there's a problem and that really is diagnosable depression let's pause for questions right here for just a minute so I just don't jabber away any questions about anything we've talked about thus far any comment oops oops start in the back and I'll come back up here I have comment yes research at lately suggest the hampa shrinks yeah I saw one study Rec the mdala yeah mdala seems to be related to all kinds of emotional functioning and um and a lack of emotional control in many kinds of ways what's going on with the igal so yes exactly exactly so so I'm not a I'm not a neuros psychologist so I'm very reticent to get into the neuro piece of it so just not what I I think up here oh I was I was just going to say about major depression where it says typically six months or more of course that's true but a lot of times when people are that bad off they go they get medication after a few weeks and then so yeah the duration doesn't get a chance to yeah so in other words the medications masks the effects a lot of those folks unfortunately I'm biased towards Psychotherapy to some extent because it tends it tends to work I mean there's great great amount of evidence that Psychotherapy tends to work um however I wouldn't hesitate to send somebody to get psychotropic medications if they need it particularly a psychologist friend in Minnesota and you know that becomes a good first choice but you try and wean people off the psychotropics and see if you can get at getting at what's underlying if you can unless it's truly biochemical and you don't seem to be able to get at it so you know distracted that's right that's right you have you watched the um the DVD called the marketing of Madness yes I've seen it yeah the question was about the DVD have you seen it the marketing of Madness and have you seen the DVD um it's it's pretty anti Psychiatry and the only thing is yeah the only thing for me having worked on inpatients and work with really seriously mle El people for a lot of my life uh some people it's a miracle that they can get un psychotropics it just changes their lives and they found no relief from anything else it doesn't sometimes sometimes cool do you think there's a common connection between brain injury and depression yes but I Can't Tell You What mechanisms are involved and it be yes absolutely so um brain injury and depression even concussion personality change I'm sorry I'll get off on preaching and I don't want to preach I just seen too many because I work with young people for a lot of my life in college age and having relatively minor head injuries uh Falls or football or sports or stuff like that and having personality change following and having their MDS and neurologist not take it seriously and it's just I mean it just absolutely breaks my heart when that happens cuz there this a sensitive mechanism anytime it gets rattled you know what I'm saying there there are changes sometimes and you've been rattled and uh you got to take it really seriously a young woman in class the other day I was teaching a class over at Bast year and she said I it was in a car accident it wasn't serious but she said I can't concentrate to read and I said that's that's a hit injury following a minor concussion but it's a hit injury and I've been trying to get her books on tape because she somehow the auditory channel is working better than the visual Channel and that's you know so it'll help her she can more easily learn through her ears at this point than through her eyeballs so yeah related question so if someone had a brain injury and a year later had the um there's some sort of evaluation neur psychologic yeah neuros psychological evaluation um how for lack of a better word accurate how much is how good is that see what you don't know about anything that follows after an accident or so on what we call in the trade premorbid you don't know what they look like before you don't have a measurement of that necessarily but you can measure functioning and all kinds of levels from memory to you know all kinds of stuff you can measure measure and it's it is fairly accurate I think having you know but you don't know what they were like before and if you had a hit injury you don't know like what you were like before necessarily you're again that's kind affect to being rattled you know so you don't it's it's hard to tell sometimes when you're this is getting off the subject but sometimes when you're dealing with this stuff even depression the partner or the parents will be better reporters than the person themselves you you follow and they'll say you're just not the person I married or you're just not the the boy or girl you used to be that's much more accurate in a sense in saying how have you changed do you follow what I'm saying to you so you got the people around you to give you feedback lots of times when I'm working with bipolar disorder uh you know um I'll say you need people around you to give you feedback as to how you're doing because you're not going to know when you're manck you're not going to know it it's going to feel real good but the fact is your behavior is not normal at those points and you need somebody who's courageous enough to step up to the plate and say you're you're you're going toward that extreme that you get to you know so you can start to monitor it and do something about it I don't mean to offend anybody uh in my talk I'm just trying to be honest with you so okay all right causes okay these are old terms but I still think they're of value endogenous versus situational depression um endogenous depression seems to be something that's much more biochemical or brain mechanism based it tends to be long-term it's kind of this permanent press you know effect in depression very very long-going you know ongoing kind of depression okay that's endogenous um situational depression by when you say to a person is there a causal factor that you're aware of with your depression and they say no I going to have always been this way or it seems like it's been forever they can't point to anything okay I'm going to repeat this with anxiety in a few minutes because there's a similar phenomena with anxiety um then you're dealing with something it seems like it's much more biochemically based I firmly believe personally that a lot of depression is in fact chemical and there's a whole lot of research that points toward anxiety and depression you know having a uh heritability factor to use fancy word heritability means you inherit the gene or the potentiality for it uh lots of times when you talk you'll find other kinds of mental illness so you find depression in that family now can is it an absolute Smoking Gun no it's the chicken or the egg and you don't know if it's the family programming or if in fact it's genetic it's really hard to tell the difference in twin studies at the University of Minnesota people raised apart but in families that have a large genetic component for depression or anxiety the CIB is actually much more likely to have it too that points to the Smoking Gun the genetic Smoking Gun so um okay uh if they can point toward circumstances uh yes my wife and I broke up a year ago or I flunked out of school or you know disappointed in a relation whatever then that tends to be more situational depression today what you see all the time is we're living in tough Economic Times and you see a whole okay whole other causal Factor uh work is so important to self-esteem life meaning who you are how you identify yourself what you say when you meet somebody what do you do for a living well I'm chronically unemployed those kind of factors are situational but they tend to result in a kind of an ongoing depression for a lot of folks because they don't have the self steam goodies the point to those are environmental situational kinds of things lower our thoughts do all the stuff you know like depression does any questions or comments at that point another time to take a breath okay I'll check in every now and then so I don't just rattle away last overall sense of Life disappointment self-judgment lack of self-acceptance and self-worth some people seem to emerge out of childhood with all the above uh they tend to be more likely in my book to suffer from anxiety and depression it's how they were raised how they felt about themsel as the result of childhood does that make sense when I say that to you guys okay that's not necessarily anything chemical but it's the factors of environment other possible causes anybody ever heard of learned helplessness other than we got a professional in the room yeah uh yes what is it do you know what it is uh helpless is yes I went to a a seminar recently with CLA Warden who started the nature kindergartens in Scotland great and she talked about learn helplessness in children and I know you know yeah there's a lot of you know research behind that about you do things for them when they can do them for themselves and they learn that that's how things operate I'm going to tell you the origin oh go ahead please um originally is actually they use the uh I mean the Sal i s experiment with the dog basally yeah the dog is very active but they fix dog I say on the table then give you the dog electric shock and then the dog struggle but the US it this okay later on they remove all the strain but then the dog free to go when they give electric shock the dog still stay there so that's a original idea then they so I'm going I'm going to repeat that so everybody hears all the way through the auditorium the original experiment with learned helplessness is really interesting and it seems to apply um definitely applies to depression and maybe anxiety you take a dog and you put him in a cage that's not a nice scenario anyway and you put a minor electrical charge in the bottom of the cage not enough to fry them but enough to disturb them you turn the electricity and what the dog does is what any rational being would do it tries to escape it Yelps it bounces around the cage um and it tries to escape from this unescapable electric shock stage two of this is the dog starts to surrender to the circumstances starts not jumping all over the cage not barking and results in laying in the bottom of the cage uh you know peeing and pooping and not trying to escape from the electrical charge going through the cage stage three as you alluded to is the experimenters opened the door and what happened when the electrical shock was administered it stay it stay the dog stays in the cage and does not try to escape the cage yeah and it's not nice experiments and I would never do that in a million years but it's really instructive when you take a look at it does this generalize to humans a lot of people believe it does that when humans are raised in environments or in circumstances where they cannot escape the negative consequences the result result is that they tend to stay in the Box stay they stay in the Box exactly right they stay in the cage and they don't try to escape anymore they give up trying to think of Creative Solutions and get out of it so it's really important and I would say to you A lot of people that I've worked with historically over the last 35 years or so our classic cases of learned helplessness you know where they that's the environment they grew up in and environments in which alcohol child abuse sexual abuse physical abuse were there in the environment frequently result in that lack of sense of I can escape life and then very easily reinfected with the same thing and a sense um marrying the wrong person lots of stuff that happens a job that's abusive or you know all that kind of stuff and that whole thing comes flooding back in again comes back again so that's to learn helplessness phenomena okay just adding just for most of us um we can only take so much most of us as human beings repeated Hard Knocks disappointments dead ends losses they all Ed up over time it's not one thing it's a 10 things that have happened to me in the last two years you know and that's typically what you hear and then there's that that's the Learned helplessness phenomena too I you know just no matter how hard I try and for some people's lives that is so accurate and so true and you know as a helper you listen to the scenarios and the stories and it's like what more can go wrong I can't make my appointment today the car won't start or is one of my students last week I can't come to class today somebody stole my car last night and it's just like I'm only paying a fortune to go to school and now somebody stole my car and I can't go there that's that's the real life stuff that a lot of us do in fact live with you know so okay um I'm going to mention something else and this is kind of my thing but it's not my thing it's kind of written between the lines in a lot of psychology people suffering from depression and anxiety have this long-term feeling of not enoughness that they are simply not enough okay that they don't have whatever they're supposed to have inside of them that should make them able to cope with life jump over tall buildings with a single bound do all the expectancies and I would say for many people that's how they come out of childhood with that feeling of not enoughness another word for that would be the phenomena of Shame the phenomena of Shame Shame is the it's not conscious in a sense it comes out as not enoughness shame is having felt that you did not meet parents or others expectations and it's because it was something intrinsically the matter with you that you could not fulfill expectations okay that results in this not enough or as we used to say in the 60s I'm not okay you know uh kind of a feeling that you're just not enough to the the world around you by the way that's that's work horable that's stuff that you can't get at and work at I can see how that can come from your there also seems like in some job situations oh God that is put on people and it's not doesn't come from within it's like yeah no matter how much you do the expectations just keep counting yeah this one time I was I was flying from Minnesota somewhere and I sat next to a stock broker we got started to talk and at that point this before the market crashed this guy is making $350,000 a year as a stock broker now most of us could live on 350 a year if if we had to I mean if we downscale and you know we probably do it and but he had been called in the boss's office and he was one of these big flying you know stock broker firms the boss said you're not aiming high enough you know you're not ambitious enough had he was a very good Catholic gent and he said no I have a family and I have kids I don't want to do more I'm already consumed by this job but all this pressure is being put on him because the more he earned the more the company earned but he was a top producer already I'm just saying there are many environments and that's an extreme example in which no matter what you do you're going to be told what you didn't do um Okay show of hands if you're willing how many of you your parents in a sense raised the bar any of you am I the only one sometimes parents keep raising the bar to a higher level of okay yes um that's great that you got a B you could have gotten an a though okay that's just a common experience for people learned helplessness it's demoralizing to be told constantly and reinforced for what you didn't do rather than the the recognition there's a new book called the Buddhist brain have any of you seen the book called the Buddhist brain it's also on a on a CD uh yeah it's great and one of the things they talk about same thing that Steven cvy talks about um that you need to give 10 positive Strokes okay for every withdrawal for every negative because negatives the brain is built the brain is built to have when you hear a negative it's really big in your brain because you're you're built you're wired in to avoid dangerous situations it's you're wiring comes from being an animal and the old days you know we avoid yes it's survival mechanism so we're very alert to what might threaten us that's negativity too emotionally and what people say to us okay so that's huge people a lot of us probably me too you get positives and you don't even know where to put them you have nowhere to stick the positive there's no SEC between yeah there it's like there's no hook that it can hook onto and you get a positive so not only with kids but with employees 10 positives for any negative you know and how you you build people up but you're right organizations typically don't do that particularly when they're in the driver's seat and they can find a lot of employees okay yeah go when you talk about the point there that says repeat Hard Knocks yeah um I think all of us have known a personality in our lifetime where it seemed like so many things happen to a particular person and that particular person is always full of drama and they're real things yes but you wonder how does this person attract all of those things an interesting conversation in my class the other day yes you're talking about what's what's the karma if you want to put it that way yeah I I had one small class that I'm teaching on group Psychotherapy and it's almost what is all women in that class and they had an interesting discussion that most of them didn't want to talk to their mothers these are women in their 30s and 40s they're not real young I mean in a sense but and they said cuz every time I talk to my mom I just get an earful of everything that's wrong back home and with my brother my sister and it's like this kind of you know it's just I mean it's just really interesting to me there's another concept and I'll just throw it out there and we don't know why we don't have the vaguest idea something called resil resiliency it seems like a lot of people some people are just inherently resilient you know they're like those little toys that we had that came back up every time you'd hit them you know the yeah exactly yeah and they tend to be like that as people other people it takes much less to just knock them over and you see that as a therapist you'll talk to somebody they're they're absolutely decimated by what to anybody else will be small somebody else just had the whole world come to an end and they're relatively buoyant about it I guess it's programming you know maybe it's maybe it's genetic I don't know but you just see this difference in people of buoyancy and and you know the ability to bounce back fixable H is it fixable I think all of this is fixable I mean that's my optimistic Viewpoint um I had a client a few years ago that had been to the mental hospital every year and had ECT electr convulsive therapy uh every year since she was a child and year after year and uh I can say I work with her for 3 years we broke that cycle she stopped having to go to the mental hospital was she totally UND depressed no okay but okay I'm going to jump to the end in a sense let me whine back and I'll whine forward there there were in California there was a psychotherapist who was a Sufi uh extraction uh did did work based on Sufi uh teachings and in a book that he wrote he said one of his clients gave one of the big secrets uh to to everything and the client said you know I have all the same problems I did when I came into therapy they just don't matter so much anymore that's a funny little subtle thing but it's like right sizing downsizing something about because I don't want to give the impression that anxiety and depression totally go away I don't see that that often they totally gone whoe I'm a different person no I still have a tendency toward but I manage it better I deal with it better and that seems like a rational outcome come for me in terms of therapy and counseling and so on okay cogn cognitive therapy and the purpose today is not to go into a big thing about cognitive therapy but this is a new kid on the Block in the last 20 years straightforwardly looking about how your mind influences your mood okay and that how changes in your underlying belief systems and your thought systems tend to have an an effect an effect upon your your mood um lot of evidence that it works that it helps okay and today Miss almost everybody coming out of any psychology school is coming out trained in cognitive therapy that's how they're being trained today um natural methods I love uras here maybe sending somebody for homeopath homeopathic cure and seeing some remarkable things happen I came here a skeptic and you know if any of those little little little globules under your T like right you know um I've seen it work I've seen it help without a doubt in the world um so all kinds of Natural Things changes in diet uh we've got a remarkable new staff member um Dr rmer Who's come to us Katherine uh she's the one only in America she's an MD medical doctor ND nutritional I mean naturopathic doctor and she's a psychiatrist okay boy yeah all three in one person but she's not doing a lot of strict psychiatric stuff she's doing a broader treatment because she wants to do the whole person kind of stuff but that's an amazing thing and a lot of stuff possible here cures not cures but at least improvements through diet dietary changes um Katherine is a u molecular U psychiatrist so she literally looks at diet and you know that kind of stuff so this is a wonderful place to get treatment and more than one modality at the same time louder please rmer R hope I don't say it wrong r a y m r is how I think it is I'm not the world's greatest speller so yeah but um she's amazing she's hard to get into when you come here for treatment you're not going to see them you're going to see the students on Clinic because that's the way we work so she or I will be the supervisor of those students so we be the person that's watching the work you're not going to get us doing the treatment because that's not the way it works here oh we do have a we do have a private practice setup with in the clinic she's not in it right now and nether am I yet but we do have that setup okay I say perhaps medication that's just I'm at this place in life where I'd like to try natural things unless it's really serious before we go with the psychotropics the hardcore stuff but if we need to we need to I've asked Katherine too do you do you go to into your tool bag and and use typical you know anti-depressant sh absolutely you know whatever we need to do go would you consider do you recomend recommend volunteering a form of method for trying to deal with depression having the depressed person go and volunteer give give their time to help somebody else to improve their own sure why not why not yeah yep let's move on to the topic of depression I mean of anxiety I should say I've been told I need to speak louder if I speak too much louder my voice will go so I got I got to figure out the golden mean with that so um this is that famous painting that everybody has seen the scream okay as an illustration of what anxiety feels like this is a modern version of the painting The Scream for for those of you who are Fox TV fans and The Simpsons as I am and this is another version of it so there you go all right okay I'm going to need to move quicker so we get everything in a lot actually of what I've said about the treatment of anxiety or depression will will be for anxiety quickly what are the symptoms of anxiety as you experience as you experience anxiety what are some of the symptoms racing thoughts who said that say it loud racing thoughts racing thoughts say that really fast Okay no Okay sometimes uh audio seems noises seem louder smell seem Stronger Yeah Yeah Yeah Yeah I want to come back to that in a few minutes because I I think for some people anxiety is what they're calling the highly sensitive person and being overstimulated by environmental kinds of stuff for someone who is neurologically also very sensitive does that make sense okay um It's a Wonderful read by the way the book The highly sensitive person it's very helpful for depression and anxiety I think somebody are just going like cued I don't know if that's maybe they're born with a highly sensitive nervous system go um shortness of breath shortness of breath yes what else good can't sit still yeah ex some people seem to be wired that way but they're not anxious it's just you know yeah but but for some of us yeah that's a good symptom raing heart yes heart palpitations uh am I the only one that's felt like they're having a heart attack sometimes and it's just not just anxiety it's anxiety but you're not having a heart attack it's usually thinking about an event that is going to happen in the future and you don't want to confront or you're afraid or thinking about a future event being afraid of it running it through your mind anticipating uh Freud called this anticipatory anxiety where we're afraid of something that might happen um panic attack panic attacks yeah that's the heart pounding the wanting to run outside your whole life passing in front of you no miserable it's probably okay and what goes with a panic attack is a certain feeling I feel like I'm losing my mind you feel like you're going nuts and it doesn't last but for about five minutes or however long the short now take everything you got and put it together and you have a panic attack all the above in one person in one short period of time and you have your panic attack I've had them before I have truth and advertising I've been working my whole life on the issue of anxiety I'm not by Nature a depressive type but I've always been an anxious type and that's why I also got interested in the you know the highly sensitive person because I think that is true of a lot of us who suffer from anxiety um it is very treatable uh I'll have this on a slide in a minute the danger danger danger warning okay danger with anxiety is you can management manage it through drugs and alcohol danger you can management through an addiction to anti-anxiety medications but they don't do anything about the underlying structure they just mask all of those symptoms so long as you are taking the anti- you know anxiety medication dangerous um if you see people well I have I worked in psychiatric hospitals and patient people are begging for their anti- anxiety medication because when they go off they just have all that stuff flooding in because nothing's been treated at a deeper level does that make sense you guys so that's really scary part question are you saying that like on the medications cortisol still affecting people or do you think it's an alleviating I don't know I don't know I didn't know you no no I'm just saying by underlying I don't mean that they're having a panic attack every moment the thing we didn't say is what do you also feel you feel the Jitters all the time you feel jittery yes the tingly jittery you know like an ongoing I have no idea what the cortisol levels look like during the Jitters certainly they're crazy during a panic attack but that's like everything that's perfect storm all of these physiological symptoms you know yeah something else that goes with that that's really kind of dangerous for all of us that have anxiety then we start paying so much attention to our bodies that it's just simply hard to live because we're so focused on every little palpitation every little agitation in the stomach or anything we feel so we start getting I'm sorry I'm say this out loud we start becoming very self-focused because so much energy is going on trying to keep it all copasetic so we don't have those horrible feelings you know what I'm talking about and then that becomes an Obsession almost or you know a pression of everything that we're so focused on those feelings all the time okay we'll talk about Solutions as we move along okay well done constant sense of dread okay being on the edge negative anticipation and worry about the future just like you said I'm going to make that thing go right excessive fear and worry anxiety interferes with the functioning of daily life and may may may result and avoiding somebody mentioned I didn't spell check right at a wrong word that's that's typical me so but I'm not going to let it make me anxious uh plagued by fears and uh that seem irrational uh fear that something bad will happen if things are not done in a particular way what is that alluding to OCD obsessive compulsive disorder U the the fear of that if I don't do everything just right in a particular order yeah so that results in OCD that's anxiety just simply you know serious case of anxiety uh okay panic attacks heart pounding shaky sweaty dizzy short of breath talking real fast in front of a group uh insomnia fatigue and headache okay feeling of being in danger irritability um and trouble concentrating restlessness okay we've alluded to all of those the painting called anxiety you probably can't see it in the back it's AAS locomotive with a huge wave behind it going to sweep it away all right causes of anxiety disorders I want to compare and contrast again old terms but I think they're still good trait anxiety versus State anxiety trait anxiety means some of us who have the ongoing permanent press trait to get anxious okay it seems wired in kind of stuff State anxiety has to do with um we lost our job or losing a relationship or about to get evicted there's something going on and we feel really anxious about it and it's not an ongoing state but it's about it okay that's that's TR that's State anxiety it's a now kind of thing I really believe having seen hundreds of clients with the anxiety stuff and again it's that piling up kind of effect if enough things happen in a short period of time anybody can kind of go over the deep edge as far as anxiety and have it become kind of this ongoing state that they can't escape because so much crap has happened to them in a short period of time can you repeat what you said about trait trait is this kind of ongoing anxiety that may be genetically driven maybe neurologically driven okay because there is a genetic component here a heritability as we say there definitely there so may just be that may be the oversensitive person that we've talked about no and I really relate personally to that so it may be that as a trait as a personality trait is that clear to people what I'm saying go yeah can we say that uh um State anxiety actually may I mean sorry uh uh yeah State anxiety may actually uh may become tra anxiety just because it's become chronical longlasting this kind of anxiety situation yes can we say that a state anxiety becomes a trait anxiety I think so and again I think us humans can only bear so much and we snap we just can only take so much I've seen very successful relatively normal people take that one knock after another and they can no longer it just results in this ongoing state of panic and fear it's conditioning we're waiting for the next bad thing to happen we've been conditioned by the environment and circumstances okay go um one of your points there was irritability what about what about a tendency to to blow up or have uh um anger anger oh yeah episod but also know here's where it gets really dicey that's also one of the symptoms of depression is irritability and irritated depression okay and this tendency to explode that's why rather than thinking of these like this I think of them as being maybe overlapping or very similar to each other probably very similar mechanisms between anxiety and depression so absolutely it is one of the characteristics explosiveness is that part of just the fact that you feel like can't getable I can't get out of this I should be getting out of this what the heck is wrong and then the first person that you talk to they the front of your frustration exactly that's just a hypothetical situation it's not true at all no what's it mean when you look at this no I'm teasing okay U various causes ranging from specific trauma uh parents fearful attitudes and the over sensitive temperament as I mentioned before um one of the first things I ask when I get somebody coming in with anxiety obviously how long and were your parents anxious and did they communicate worry to you because many people as adults who have this pattern of anxiety they had a worried parent who gave him all kinds of messages about it's a Scary World out there honey did you honey did you honey did you did you remember to so like this constant kind of on ongoing message it's hard to grow up feeling confident in your decisions and your capacities when you get a constant kind of dose of that kind of stuff so that's a nurturing thing rather than nature or could both well that's interesting question that you you ask we don't know because it's probably some of all the above you know you learn Behavior yeah is it learned or inherited I mean or yeah inherited heritability maybe both I don't know again all this stuff and I want to sound negative about it all the stuff has a big heritability factor genetic Factor so let's say you got a mom I'll pick on mom she's nervous and a worrier and maybe you got it from her both genetically and as a behavioral kind of a condition so it could be both so reinforcing each other double whamming double whamming as we say in Psychology okay um alcohol abuse in the home or anything that produced a home in which you didn't know how dad and mom were going to be today do you understand what I'm saying to you if parents' mood varies a lot if you were raised by an anxious and or depressed parent or parents parents who are fighting all the time your experience of childhood is just to feel like the rug could be pulled out of you at any out from under you at any moment do you see that and as an adult that's what you tend to be like as an adult You're Expecting the other shoe to drop something really nice happens yeah but you better exactly you better not trust it because it's probably going to be followed by something bad inevitably you know I certainly grew up in a home like that where parents were constantly anticipating the next bad thing that was going to happen not that much really did that was bad but they're always on edge for the bad thing well they're raised during the Great Depression and maybe some of your parents you're of an age where your parents are raised during the Depression or the Vietnam era or whatever the contributing thing to the psychology of the parents during the time and that's what you experienced I think kids sidebar I think kids are psychic sponges and what I mean by that is they unconsciously absolutely suck up all of the energy in that environment without being able to identify necessarily my parents were depressed my parents were were anxious but they just suck it all in they're like sponges for it it's written in them in their unconscious minds as a rule of thumb the earlier stuff happens to you the bad stuff or the not so good stuff the harder it is to work at because you can't put words to it does that make sense so the earlier stuff have so if you were raised people don't know this by the way the mom is depressed for the she had posted part in depression was depressed for the first two years of your life she never told you dad never said anything or these mysterious things just mother was gone for several weeks at a time but nobody would talk about where she went the mental hospital is where she went and families don't have a discussion they don't know what to do with this stuff so the kid winds up just having this sense of distrust and weirdness and not knowing what to do with it does that make make sense what I'm saying to you guys and so that this happens a whole lot you know and maybe as an adult you figure out geez Mama's depressed or Mama's suicidal or you know Mama's anxious all the time that's why she never went outside she was agoraphobic you know boing okay got to move fast um mention the family genetic components generalized anxiety disorder seems more a lifelong pattern and may be physically based perhaps um people having a natural tendency toward fear and anxiety uh cannot be traced to a specific problem is it's there all the time it's an underlying thing we could call it as constitutional by temperament it's constitutional okay I'm going to do this really quickly because of time I'm very aware of our time uh six major types of anxiety disorders um the first is not stated is running late when you're doing a presentation followed by generalized anxiety disorder Gad okay chronic worry and anxiety that generalized over many life situations results in many physical symptoms G generalized anxiety disorder so you get a person it isn't one thing it's like all kinds of things make them anxious and Trigger the anxiety response obsessive compulsive disorder by the way don't think that you just have many people have one of these many times they'll have all the above um obsessive compulsive disorder OCD unwanted of compulsive thoughts that drive people toward behaviors that they really at some level no this is pretty wacky people don't do this all the time you know um every every book must be arranged in a particular order colors must be done this way got to check the door five times you know uh you got to do this you got to do that in a driven sort of a way um it is maybe sometimes it doesn't affect other people hardly at all the person suffering from it it's really it's hard and they can't stop doing it because they're compuls to do it they have to do it so it's all kinds of rituals that are trying to take away bad things from happening and control the environment panic disorder we've already talked about it a lot of you understand it oh to well and specific phobias fear of flying spiders snakes and all of that kind of stuff so those and PTSD post-traumatic stress disorder um anybody that's uh had this helpless phenomena in the face of something terrible happening to two them are in their environment they witnessed a car accident something was killed somebody was killed they're in it they're in the war and they intend to have flashbacks and it tends to make their life miserable okay it's becoming much more treatable though that's the good news there a lot of treatments going on social anxiety disorder fear of social situations fear of being judged and evaluated socially social anxiety tends to be about the fear of the social situation is the fear of judgment largely speaking you follow that it's not agoraphobia is not about the old word is is the fear of the fear of the marketplace I mean literally no it's the fear of being evaluated by people in that Marketplace okay go what about a person who doesn't have a social anxiety disorder but they're a performer and every time they have an audition yeah it's yeah being judged it's that's a specific phobia performance anxiety and um I'll cut to the chase in case you're R out of time the treatment for all of that this tend to be fairly effective is is actually exposure therapies uh they tend to work quite well and that is and you can use visualization and guided imagery they also tend to work hand inand but exposure means they put you in the situation and you experience it incrementally a little bit sing for one person deliver a speech for one person then two then a small group and take and work your way up huh over yes until you overcome it exactly so okay treatment of anxiety disorders cognitive behavioral therapy cognitive therapies as with depression exposure therapies a bit of the hair of the dog that bit you proven proven quite effective um um yeah the mayale clinic I was I went through their their training and anxiet treating anxiety disorders whole program is based on exposure therapy you know overwhelmingly guided imagery and visualization where you imagine doing the task and you imagine yourself being comfortable with it you know etc etc a PTSD treatments are now including um EMDR and desensitization therapies there's a lot of people that do that work now there's an accumulating body of evidence that those kind of therapies work I don't know how they work but they tend to work so very EMDR and as it's called if you guys Google just Google EMDR and you'll get this on it and you can you can see what it is but the V there various forms of New Body Mind therapies that are developing in the last 20 years or so that and uh even the VA has been using these newer techniques for working with PTSD with with veterans so they're pretty conservative about what they allow other stuff to follow and that's going to happen in just a moment here we go other treatments and thoughts okay one one rather than trying to take all the symptoms away first of all trying to learn if there's something the symptoms can teach you or tell you about yourself about your condition about your past about what it is you need to learn okay there are a variety of techniques for using mental imagery to talk to your symptoms to actually have a conversation with them to figure out what they need to teach you for some people they're extraordinarily helpful okay to find out how to it's a more psychospiritual way to engage this stuff but to actually dialogue with symptoms you know to image it to visualize it see where it is in the body go to it in the body you know and sit with it the Buddhist way of dealing with both depression and anxiety or any strong feeling is in fact to sit with it and to be with it not run from it not deny it sit in it and be with it okay there's a remarkable thing about anxiety in particular when you sit with it you first will feel more anxious over time you start feeling less anxious it's like you've accepted it that it's there and then somehow you're you're free to kind of move to somewhere else by virtue of it okay number two for the over sensitive person phenomena um I think it really is a highly tuned uh an emotional system or nervous system relaxation okay fight ORF flight syndrome and anxiety and relaxation are diametrical opposites you literally cannot induce the body into a deeply relaxed State and be anxious at the same moment they cannot co-occur okay so if you can induce deep relaxation at will how long do it take to do that a lot of practice eight six times eight times a day of practice deep relaxation until through your breathing and through a little bit of relaxation work you can exper erence the body chilling out calming down right in front of you there's a program you can find it on the internet for treating anxiety called the change program got two a c h a a n g e it is entirely based not entirely cognitive behavioral techniques combined with really deep relaxation okay now they're going to charge a couple of thousand dollars for that you didn't have to pay anything for today so um you can learn to deeply relax there all these tapes out there you know a lot of stuff you can do deep deep relaxation work very very helpful okay number three that okay not enoughness feeling um I think therapy is the best way to get at that to be very honest with you to go and work with somebody to find out the roots for the non- enoughness the shame feeling the not okay feelings you really it's really helpful to have somebody work with you to be able to to actually get into it with you so it's worth the price of admission to pay somebody to get at it okay uh number four learn to be this is I believe this with all my heart learn to live in the now and the present moment okay mindfulness meditation uh everything you do go get all of echo eart toes tapes and books and indulge in all of them until you can do it start to do it anyway you're not going to become a Buddha immediately but you can start to get there some Buddha hood you know Americans we want instant booty hood okay um if you can start to develop the capacity to control the mind at will um I use Raji yoga which is more based on pranama which is breathing and following my breathing and it's very very very effective okay so that's that's that's stuff that you didn't used to hear at all from a person like me okay it's very hard to live in the now and not either in the past if you're like me you run those old failures and the stuff you did wrong and the embarrassing moments over and over and over again and then have negative anticipations toward the future of the same stuff nness is the opposite of that to learn to be now you know okay train yourself to do it the Apostle Paul instructed I'm out of a Christian background whatever is true whatever is Noble whatsoever is right whatever is pure whatsoever is lovely whatever is admirable if anything is excellent or worthy of Praise think about these things okay so to try and program yourself as positively as you possibly can or as the Greeks of old said dwell in the good the true and the Beautiful In other words try and really make it the pre you're going to preoccupy your mind with all the bad stuff why don't you preoccupy it with good stuff you know and stay away from those folks who infect you withad Madness the negative folks if you need not to watch the news don't watch it be ignorant but be happier okay if they say the end of the world is coming what you need to do about that anyway why bother okay um I've had really remarkable results in my own life as a chronic anxiety suffer ER of doing heart centered meditation work um so I can feel an outgoing sense of love and compassion for myself and other people and not be preoccupied with poor me and all of my anxiety feelings that makes sense and it's a real discipline and you got to work with it it's not an overnight fix it's a long-term these are longer term kinds of things um but to learn to to learn to meditate to learn to watch your breathing and to go inside and to come from your heart toward other people and yourself it really is is effective in the yoga all this emotional C C is seen in the solar plexus and part of the pathway in the yoga is to raise it to the heart because in the heart it becomes love here it's agitation and emotion here it's Love self-acceptance and Other acceptance and a feeling of being connected with everybody in a nice way in a good way okay so that's going out in the limb for you guys all right all right um cultivate a life purpose believe it or not most people don't know what their life purpose purposes and they haven't annunciated and they don't have a personal mission statement these things kind of Recession Proof us so in the bad times come we have a sense of what we're about even your life lesson for those of you who are spiritually into that what are you here to learn why those parents what are you supposed to learn from those parents what your Early Childhood wherever you grew up I grew up in South Central LA and in the hood it was a tough growing up but why that lesson why' they do that what was that about for me why if you believe that why'd you choose it what is that for you all of that stuff is Mission and purpose stuff do you see what I'm saying to you the more you have of that the more Recession Proof because you feel like you're bigger the you is bigger and you're here with the purpose even when bad things happen you're here with a purpose okay learn to practice Detachment and that's a certain don't care attitude as they say in the yoga that Detachment is not a negative surrender detach attachment is I'm going to stand back from it emotionally because all my emotional intensity is not going to make it one bit better not one bit you know it doesn't help at all I'm going to stop my spinning and detach okay and radical self-acceptance and self forgiveness and it's also a heart-c centered practice and it comes out of Buddhism and it's the practice of learning to accept self and others and to forgive you no matter what you've done or you know what your bobles are shortcoming sorry you can learn to and whatever that no good guy did to you whenever they did it you learn to forgive it and let go of it and accept it questions comments anything did my battery expire yet no so came up to me such a nice man such a totally nice man during the break and said your battery will expire soon I didn't know it was my pacemaker he was talking about or this you know I my my anxiety no yes exactly you know go and your comments on the the correlation maybe a strong correlation between anxiety disorder and depression I don't know it statistically we have another therapist I don't know statistically what it is all I can see is what I see in an ongoing basis in practice is they're just twins they they co-occur more and more I said the beginning of my practice it was depression without anxxiety is s often today it's kind of it's both presented simultaneously pick one what I did at the end are techniques that work for both mindfulness yoga breathing guided imagery relaxation they work for both okay they they generalize uh let's go here first like you were first is there a particular breathing exercise that you find is very simple that you would be open to sharing to much time yeah all the most the most simple of all the most possible simple of all um it'll come back to me in a minute the guy the guy that taught all of the stuff to business people and he's teaching this like one minute stuff of breathing it'll come back to me just a second it's right H not Anthony Robin no no um it amuses me as a psychiatrist and he wound up just creating it's a simple breathing of when you breathe in you count one and when you breathe out you count two and he charges like $110,000 to go to his Clinic to learn one two and learn it that the relaxation response the relaxation response is the book it's about 25 years old that's just based on the simplest yogic breathing practice known demand just simple breathing Bon Herbert Benson Bingo you get the price is there a price no all the way in the back and then we'll come forward can you describe the services here at and the different shifts that might be helpful to someone yeah what you want to what you want to do you get to go one or two ways to get your foot in the door when you come into best here I don't have the number in front of me do we have the number to we can make sure you get it11 say it loud 834 4101 is that good is that good can you even pay for that kind decide whether you're going to come in through the counseling track or whether you're going to basically come in uh through the natural medicine track and that's up to you that's really up to you where you want to start either way we can refer by track I mean when you come in you going to say I'd like to Comm in and see somebody to counsel as a counselor okay mental health provider or you're going to come through naturopathic medicine the third alternative which I don't know really well would be Oriental medicine including acupuncture and that I don't know as much about you describe modalities in the naturopathic medicine track you want to talk um stand up just if you can or loud okay go um Homeopathy is that what you're going for well stand up you do it then come on that was like okay that's like baiting the witness or something okay question it was a total one to go Fe and a lot of talking about meditation and the Pama and the breathing exercises is amazingly is amazingly cheap and requires practicing diligence to generalize into your daily life so the bio feedback Shi wonderful my family has benefit from it I've benefited from it but the Homeopathy too more and more my are yeah as to that and then um yeah so like my question really actually was more around how do you coordinate care and is there a lot of communication between counseling about feedback Homeopathy sometimes yes sometimes absolutely not just depends on the provider and how aware they are when they're doing it on my shift I can speak for my shift in counseling we entertain a fairly Lively debate of whether the services this person could benefit for at lots of times now I'm a supervisor so I'm the doctoral supervisor for a group of of natural naturopathic doctors and training and there's typically six on a shift and we'll have a Roundtable discussion about and it's fairly Lively no I think uh this is cranial sacral work I think this is and it's a different kind of a modality this looks like Homeopathy and you know um here's a great thing about natural medicine it has multiple modalities to choose from that's also good if if a doesn't work let's try B you know and I didn't mention bio feedback thank you for doing that absolutely absolutely cool so all of these modalities are possible probably that I would say I want your input you guys are in the indd program I would say the best thing might be to start um with what's called a patient care shift here we Comm in kind of and have an initial assessment because they're going to look at your whole self and because what you're what you're calling an anxiety issue might wind up being dietary or it might wind up something else you know an allergy of some kind even a medication allergy and so they're going to do the basic overview workup thing they very willingly and eagerly refer to counseling if they think it's going to help that's my experience here and then off of counseling we refer the other direction if it would you agree with that you guys okay all right thank you cool so has depression but also has an addiction um how do how are those two co-occurring Disorders Treatment plan integrated that's a really good question TP here's how I was trained but this is less this is less so anymore we used to try and treat the addiction first that's the way I was trained so we could get at the psychological issue now they're treated at the same time and so what you would have to do if you get if a person were being treated for an addiction off campus or somewhere else that we need communication and medical records exchang between us and the provider off campus if it's on campus it' be someone you know maybe between counseling and one of the other one of the other modalities for the treatment so um I've been here one year at this point I've not had a client yet that was kind of had that co-occurring disorder in that way so that's the best I can do it that anybody else no no go all the way in the back we have a counselor in the room well train coun somebody the connection between aniy please model model is that it's it's stress connect excess stress connected get that either cortis P without that's pretty good yep yep how could you be in this society and not be honest to God you know how could we be in this Society not be to some degree stressed and some of us are more susceptible than others to the effects of that Bingo you know back there loud how do you feel that caffine inters with aniet still treat anxiety a lot of people in whole okay there's also a paradoxical effect for some people too but um for for most natural people are going to tell you to give up the the caffeine or really limit your caffeine intake to really get it down it makes no just what happens when you drink coffee even if you're normal quote unquote your heart pounds and your blood pressure goes up slightly for anybody for anybody so to switch to herbal teas and I've recently switched to green tea for that very reason I don't need the extra Jag I like it but don't need it so the paradoxical effect is in some people with hyperactivity disorder that it actually has the opposite has the opposite effect and when they take the coffee it makes them calm down go figure got to be one in every crowd you got to do the opposite we're just we have like one minute left and I want to honor the time where are the handouts before we way in the back okay so we can do that on the way out ask you a question can we email you or contact you C E Smith or cith it is here cith my home one of C cith at best b.edu cith Bas here.edu sure you can now I can't do any treatment or anything like that that'd be unethical but yeah but if I can help send you to a resource or something I'd be glad to do that and you everybody is always welcome to come to the clinic and again patient care shift or if you want to start with counseling you could do that um we have shifts pretty much every day and day and night so yeah so thank you everybody Namaste and thank you thank you

#Living #Naturally #Overcoming #Depression #Anxiety

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