(lively music)
-: Just wanted to start off by saying,
I have no financial disclosures related to this presentation
other than the fact that I'm employed
by American Health Network,
which is an Optum company
who asked me to provide this presentation.
Now, of course, that's true at all times
with any medical presentation,
any information that's presented
is not meant to reflect medical recommendations
for you specifically,
of course, consult your own physicians
for personalized recommendations and guidance.
So one would say this is a really important subject
that we have today.
So I'm an osteopathic physician
and an overview of a holistic approach
to any subject is very important and especially this.
So this is the focus here is gonna be
on a patient centered or individualized approach
to mental health and how we can do this naturally.
And I'm really grateful for the subject
and the timeliness of it.
Especially given everything going on in the world.
We have a lot of pressures and stress on us normally,
and of course now is no better time
to focus on things that can keep us healthy
without going out of our house maybe.
So, one of to say,
first off I have experienced with this subject
in my own family, among friends,
of course, among my own patients.
I want to share with you a specific experience
that I had with one of my own patients.
This patient came in during a family members visit,
and this patient came in and took the opportunity
to start asking questions about that mental health,
even though it was the, not this person's visit.
And this person said on our quote said,
"I felt depressed
"and sometimes thinking about killing myself."
I asked,
"Why don't you bring this up during your appointment
"that we had even recently?"
So they said, "I know this is my spouse's appointment.
"So I can just say anything I want without worrying about
"what's going to be recorded or kept record of."
And so this is a good example and a side example
of the stigma that still exists around anxiety
and depression in our society.
There's more awareness in our society,
but still there's a stigma that we need to battle
and overcome.
'Cause this is something that affects more people
and we even realized.
And we need to really create more acceptance
and awareness of this problem.
Remember you're not alone.
So let's go on and look at some statistics here.
I'm gonna see if I can figure out
this screen-sharing thing and move on here.
So the first question is how big is the problem?
So we're gonna just go through this slide.
46.6 million US adults,
which equals 18.1% of the adult population
has a mental illness, at least as recorded in 2017.
Anxiety is the most common of these
with 40 million adults every single year.
Again, this is US adults, which is 19.1% of the population
that they estimate experiencing anxiety.
So again, these statistics are measuring
slightly different volumes if you'll notice,
but in a way it's recorded
through these studies might vary,
but nearly 17.
(radio interference drowns out speaker)
There are 4.3% of those have severe impairment
and less than half of those received mental health care.
We also see that recently,
this has actually been significantly affected
by some things that have been going on.
So, and even adolescents recently
have had increased antidepressant use.
So antidepressant use increased 15% from 2015 to 2019
with adolescents having 38.3% increase.
You can see this is something that,
especially in primary care,
we see possibly more than any other medical condition,
and it affects people and their families,
it affects their health.
It affects risk of other things
like cardiovascular disease and heart attacks and strokes.
And so we really aren't great as a society
about understanding and caring for those
who go through anxiety or depression.
And of course, in this brief overview,
we didn't include a lot of the data about adolescents,
that could be a whole another subject,
but some argue that our current society
in the model that we have is not very good
at providing mental health care for our children
or setting up for mental stability
and emotional stability among our children and adolescents.
The next, I wanted to go through
a couple of different graphs to kind of show this data
so specifically about with, as it relates to anxiety
the past year from this is again, 2001, 2003,
this was some data from the,
that we reviewed that overall females.
I have a little bit of (cracking drowns out speaker) males
but it definitely is spread throughout the age ranges
of 18 to 29, 30 to 44, 45 to 59 as well
and 60 plus also experiences significant amount as well.
(crackling drowns out speaker)
And now, as far as severity goes,
there's most it's split between serious, moderate and mild.
So mild is about 43.5% and moderate is 33.7%
of these experience that level of severity.
The reason why this matters is 'cause
some of the studies are related
to natural approaches,
anxiety and depression show that mild and moderate anxiety
will have better efficacy for these natural remedies, okay.
So these are very effective for the majority of people
that have anxiety or panic attack disorders.
This graphic is showing us that through SAMHSA,
which is a great organization.
You can look those up.
The past year, go back here.
The past year prevalence of major depressive disorder
among US adults.
Again, it's fairly well dispersed.
So again, females more than males,
but still a significant there's 18 through 25.
The young age ranges are having
a lot more of these depressive episodes.
And you can see it split fairly well between all races.
There's some more Caucasians than others.
In terms of severity of depressive disorders,
severe to impairment episodes,
at least in 2017 was more common
than those without severe impairment.
So depression definitely can cause severe impairment,
job functionality, problems with family.
There's lots of things that come from this
and any of us that have had this
has either within our family or ourselves,
they're all heard it can be
Now I wanted to briefly to hit on a current subject.
So some of you may have seen some news articles
saying about COVID
and how some of the other things going on,
including social unrest of increased stress
and anxiety and depression.
That's a real statistic
and we definitely see that in primary care
that there's a lot of more people feeling that
and having these worsenings of their anxiety or depression.
There's actually a recent study that was put out
by Express Scripts that was reported by Medscape.
I wanted to share,
to show that the number of weekly prescriptions
for antidepressants and anxiety medications,
and anti insomnia medications
jumped nearly 21% during February and March of this year.
And it peaked in the week of March 15th,
when the World Health Organization
declared COVID-19 a pandemic.
And then the US also declared
a national emergency that week.
So the important thing about this
is that more than 3/4 of those prescriptions,
that means 78% of them were in the week of March 15th
were from new prescriptions.
And so that's not refills or people saying,
"I need to go back on them."
But this is new people experiencing new symptoms.
I think new stress, having new disability in their life
because of anxiety or depression.
So I think that's significant.
Again, you're not alone, your family is not alone,
and it's important to remember that
and to be kind to yourself
and we can get through all this together.
So let's move on.
I wanted to talk first about treatments.
So I wouldn't be, of course I am a physician,
so medicines do have their place.
And while this talk is about natural remedies,
we'll briefly go through medication.
So many think that medications are the answer,
and they look for a simple solution that they can take
that will fix it all.
And that definitely is vital.
So medications definitely have their place,
especially it's effect.
Those are they're effective for anxiety, PTSD disorders,
panic disorders first-line.
There's no question in data about that.
And then, the reason why this matters
is as the way this works is that serotonin
in the brain becomes low when you're undergoing
stress or pressure.
The brain actually can stop producing as much serotonin,
norepinephrine, oxytocin and some others,
including dopamine.
And so those levels, they don't bounce back quickly.
And so medications can help the brain naturally
restore those levels of serotonin,
which gives us the ability to cope,
maybe with the stress that we have,
again, in a natural way, it's a normal hormone
that we're supposed to have.
But there are bad treatments for anxiety
that a lot of people may have heard about.
And so just to review some of those,
I definitely feel that the evidence is strong
in the literature about benzodiazepines
that are used longterm.
These include things like Xanax or Ativan.
You know, they're fine in short term
for brief episodes of panic attacks or other things,
but there's lots and lots of side effects.
Definitely happens more so in older population,
but we see drowsiness increased reaction time,
ataxia, motor incoordination, anterograde amnesia.
We have cognitive decline,
that actually according to the studies,
there's actually a great meta-analysis,
which is a conglomeration of studies
that looked at withdraw from people that were going off
of higher doses of benzodiazepines
an average of 17 milligrams per day of diazepam
found that the longterm use led to substantial decline
that didn't resolve three months after discontinuation.
So this can continue to have a negative effect
on our brains for long after we take the medicine.
And that's a different than other classes like SSRI or SNRI,
or even things like Wellbutrin
that don't have that same effect.
Now, motor vehicle crashes that the risk of driving
with benzodiazepines is about the same as a blood alcohol
of about .05 to .079,
so above .08 is the level that's considered illegal
in all states in the United States.
Interestingly enough, also, you see the slide
that hip fracture is increased by at least 50% in elderly
when they take benzodiazepines,
whether acutely or on a longterm basis.
And then Zolpidem, which is sleep medicine
also has been shown to increase hip fractures by 2.55 times,
that of those who are 65 and older.
So that's a significant thing.
We wanna keep that in mind when you talk about medicine.
So there's good medicines.
And then some of these aren't the best
to rely on as primary treatment.
So let's define natural approaches.
We're gonna talk about this
and they're essentially defined
for the purpose of this talk as non medicinal, okay.
So things that we are not using a prescription
for a pharmaceutical for,
things that even though they may be a natural supplement,
they're not given through a pharmacy.
And so I think that's why we're all here today.
This is, so first, many of us have heard about therapy,
cognitive behavioral therapy
is the reason that we have psychologists
that do great jobs working through some of our,
the things that we have
exploring why we respond to things in certain ways.
There's two different theories here.
One is that we have preconceived notions
or things in our brain
that lead us to act certain ways from birth.
And then there's another that says
that there's things called life traps
that we learn or develop as we're growing.
And as we're developing
throughout our childhood and adolescents.
If we experience trauma or abuse
or any kind of loss during our childhood or adolescence
that can lead us to develop traps
or ways of thinking or coping
that aren't healthy and long run.
So when we become an adult,
maybe that way that we coped as a child,
leads us to abandon relationships
or leads us to isolate ourselves
in a way that isn't healthy.
And so cognitive behavioral therapy
can help us work through some of those life traps.
And so the negative sides to therapy
is that it can cost more than medication.
It can take time, but then on the other side,
it can also lead to positive coping skills
that we may have not have had before.
And that's very valuable
'cause it can lead to doing things without medicines.
And all the studies show that that CBT,
which is cognitive behavioral therapy or general therapy
worked very well for anxiety and depression.
And of course, there's the problem with therapy as well,
that with insurance coverage, we all know that challenge.
But one other challenge that we see quite often
in primary care is that it's can be difficult
to find a therapist, sometimes that you can connect with.
So sometimes it takes one or two or three times
to find the right person.
If you've been searching for the right person,
just keep searching because a good therapist
can make a big difference in your life.
So onto my favorite subject in this talk is exercise.
Now this is underestimated treatment,
and we don't hear a lot about it,
at least in the media and from doctors even.
So exercise is consistently shown as one of the best ways
to treat and manage anxiety and depression.
It's a great choice, it's cost effective.
It can help anxiety disorders, panic disorders
that are resistant to other treatments
and also unipolar depression.
It also is really good for PTSD.
Now this is maybe if I can be a little bit theoretical here.
If we look where we came as a species
and where we've been for centuries, we were meant to move.
So the human body was meant as a long distance animal,
we were meant, a lot of cultures were hunters and gatherers.
We would chase herds of animals across long distances.
And our bodies were designed for that.
We're able to do that better than almost any other species
that's on this earth.
And so in our modern society,
we do so much less activity, less work.
And so that might be one reason
that we see a lot more anxiety and depression
coming in our society.
So remembering that if we can include exercise in our life,
it can unlock parts of our body and our mind
that we haven't experienced for decades if not centuries.
Now there's no true guidelines in the studies,
as far as what level of exercise helps
and how much you need to do to get that benefit.
My general recommendation is that 30 minutes a day
for five days a week gives us cardiovascular outcomes
and also can lead to maybe the earliest parts
of weight loss.
So in the studies though,
they just showed that aerobic and resistance training
can give us benefits naturally, which is good to know.
It's not just walking,
it can also be resistance training bands or weights.
So there's much more we can talk about there,
but in interest of time, let's go on to,
so yoga there's actually good data on yoga.
It's helpful for very specific things with depression,
it can be useful alone.
Without medicines, it can actually help
and improve things for a fair amount of time.
If some studies show that if you did yoga
60 minutes per week, for one session each time
it can help for six weeks or more and that's very effective.
And then it also, as an adjunctive treatment
can work for anxiety and depression,
I'm sorry, anxiety and panic disorders.
So knowing what we struggle with is important.
I'll take this brief moment to say,
if you have any questions about which you struggle with
or what your family members struggle with,
there are some scales that you can look up
to kind of grade yourself and see where you are.
One of them is the PHQ-9.
That's a good screening tool.
We use that a lot in the medical field
and it has essentially nine questions that we'll ask you.
And you can rate where you scale on depression.
And then for anxiety,
something called the GAD-7, G-A-D-7 is another good option.
And then you can scale that to determine
which one would be better for you.
And you can help choose between some of these methods,
depending on which one you feel as primary.
You may have noticed in some of the news there,
they periodically report,
a study comes out about gardening and that is true.
So gardening helps wellbeing overall.
There's great scales shown the overall sense of wellbeing
can be improved with gardening.
And also depression can be effective.
Partially, this may be because we're getting out in the sun
and we're moving.
So we're going back to the exercise component,
but if it can be therapeutic as well,
just to get out and get your hands
into something that you're building and growing.
There's meditation is different than mindfulness strategies.
And so if this, both of these work best for depression,
this can be effective for six months
or more even doing them once per day or once per week
can help center us and help lead to
more of a centered strategy where you're able to cope
with some of those depressive thoughts,
improved sleep, feelings of that you have
greater ability to cope.
And so again, works for anxiety and panic disorders
when you're on medicines as well.
That's what the studies have shown,
but really for depression, this is excellent.
And then if you're taking, if you're on medicines as well,
this can be a great strategy.
Now, someone that you may have not heard of.
So Tai Chi or Qi Gong is a strategy
that comes from the Middle Eastern
or Eastern cultures.
And it's similar to yoga as well
has some very slow movements.
So this is different in some ways,
not so much strong movements as gentle movements
has to do with body position in space
and combines postures and gentle movements
with focus and breathing and relaxation.
So this one in the studies,
it did show some positive results in some small studies,
but inconsistent when you look at larger studies
or combining those results.
So for this, it's not as good
as some of those other strategies.
So for medications,
there are supplements that actually do work very well.
So one of those is St. Johns Wart.
This is probably one of the oldest that's been reported.
St. John's Wart is actually very similar
to antidepressant therapy,
especially a lot of some studies have shown
that it's equivalent to tricyclic antidepressants.
As a result, it also has side effects to antidepressants
that are the same as antidepressants.
So some tiredness, maybe some lethargy initially,
and then you can have some other things that come on.
So it's not without side effect.
I wouldn't recommend taking it without knowing that
and looking at what those side effects are,
but it is an effective method, that's natural.
Now it's not regulated by the FDA.
So any of these supplements,
they're not regulated by the FDA.
So we don't truly know the consistency in dosing
or the correct dosing for any of these
because the FDA allows natural supplements to exist
and rightfully so.
So just be aware of that with any of these,
but especially the St. John's Wart,
because it does have
some active pharmaceutical properties to it.
Folic acid is an area of study right now.
It may help boost antidepressant therapy in men,
more than women.
There's theoretical risks
with more than one gram of folic acid per day.
So there's maybe some studies
that suggested an association with breast cancer.
I believe that's an association
and not a causation that has not been proven,
but there is some benefit to taking that,
especially if you're already taking an antidepressant.
So this is s-adenosyl-LL-methionine.
So something that you may have heard SAMEe
is the abbreviation.
This is actually a natural substance.
It exists in our body and it helps neurotransmitters
like serotonin, norepinephrine or oxytocin.
It helps them work better, including dopamine.
And so in the studies,
it was more effective than placebo
was similar to St.John's Wart,
it was equivalent to TCAs in some studies,
but because it does have this pharmaceutical action,
serotonin syndrome is a caution.
So again, these don't come without warning.
Another one is Omega-3.
So there's a lot of news right now on Omega-3s.
EPA specifically have been shown
to help decrease cardiovascular disease, heart attacks.
And then also some strokes,
it can lower triglycerides,
but it can also possibly boost response
to an antidepressant therapies.
So if you're on another medicine already,
this actually may help.
If we got an EPA only supplement,
this does not apply to DHA.
So those two types of Omega-3s
and EPA can help more specifically.
So there's lots more here to come again.
This is an area new that's burgeoning and coming out.
So hopefully we hear more about this
in coming months and years.
With any fish oil,
there is a small risk to increased bleeding.
You have to mention about.
So things that you can do there are plenty of apps
in our society that can help,
there's different reasons for each of these.
So I'm gonna go through some of these
and you can record these, maybe jot them down,
download them and play with them to see
if which one gives you some benefit.
The first one is called 7-Cups.
So that's a great overall depression tool.
It helps with anxiety as well.
Helps you quantify what your symptoms are.
There's one called ModTool.
This helps depression and then FearTools,
they're both made by the similar,
the same company that helps with anxiety.
So those are our good.
BoosterBuddy is another one.
SleepBot is one that helps monitor your sleep.
So a lot of us have smartwatches
that help record sleep sometimes,
but this is just on your phone
and it helps report how you're doing
that can help improve your overall sense of wellness.
Sleep, of course, is improving the quality of our sleep
is of course a great natural way
to help with anxiety and depression.
The next app is called What's Up?
What's Up, this helps with uses CBT,
which is going back to our therapy slide
and also acceptance commitment theory.
So these are strategies that therapists will use.
And so this is a way to use that in an app,
if you don't want to,
or not ready to go see a therapist right now,
it is a good useful app
and recommended by some good professional organizations.
The last one, I use a whole lot and recommend a lot,
it's called Virtual Hope Box.
This has some guided meditation, relaxation
and controlled breathing exercises.
It helps to, it gives you an ability to within five minutes,
maybe at work or at home, take a brief break,
and to recenter yourself
and to have an ability to put yourself in a different spot.
It also has some quotes
and things from famous people over time,
as well as some brain games that can get your brain working
on a different level.
So that can help if our brain is constantly firing
in the anxiety and depression center.
So getting another part of the brain to fire
can offset that a bit and do some distraction,
which can help, which gives you an opportunity
to maybe do some of those controlled breathing
or relaxation programs.
And so that is again in the time that we had
was some of the results on
and the best studied evidence
on natural approaches to anxiety and depression.
So see if we have any questions here.
(faintly speaking)
That's a great question.
So part of the problems with finding a therapist
is just finding one that your insurance will cover.
You know, I have a selection of therapy sites
that I like that I refer people to.
It's not right for everyone.
Some site locations will have websites
that give biographies of therapists.
That is a great way to do it.
These therapists will post about their specialties
and about their focuses.
And you can tell a lot from looking at their picture
and seeing if they focus on trauma, sexual trauma,
abuse, neglect or family issues,
which one would be right for you.
So I'd recommend going onto their websites,
doing some of that.
And then not being afraid to try it or a therapist out.
And after three or so sessions,
you just feel like they're not in the way
or communicating in the way that you would understand,
don't feel ashamed, say I'm gonna try to see someone else.
Woman: Next question (faintly speaking)
what does serotonin syndrome mean?
-: So serotonin syndrome is a rare condition.
It really does not happen very much.
It happens more when you're on an older antidepressant
that is not used very much all in combination
with other medicines like nausea medicines.
And it essentially can give you a lightheadedness nausea.
There's a whole list of the syndromes
that you have flushing feeling weak, and it can be serious.
Usually it is seen more with tricyclic antidepressants
or things like that, that are not prescribed,
except with certain people that have not done well
on other medicines.
Now these TCAs are very effective,
but they do have that as a side effect.
So we monitor those very carefully.
And if a doctor does prescribe that,
you want to make sure that you're asking,
enough about that medicine, okay.
(faintly speaking)
Sertraline?
Woman: Yes.
-: No, sertraline does not.
So sertraline is a very safe SSRI.
It's actually one of the safest that's been studied.
It's safe in pregnancy.
It's a very gentle medicine that you typically go on.
Now, some people still have problems with sertraline,
which is used very commonly,
but usually if we start very slowly on that,
people do not have any side effects.
Tiredness is the most common side effect in the SSRI class.
Again, we're not talking about
maybe all those medicines with the subject,
but yeah, sertraline does not have the same side effects.
It's considered a good class of medicine,
your body doesn't develop tolerance to it.
You can wean off relatively quickly with your doctor.
So yeah, not the same as benzodiazepine side effects.
Good question.
Woman: (faintly speaking) question (faintly speaking)
I'll have to say this, but what do you think 5-HTP
are released in these (indistinct)?
-: Yeah, so that's actually another good one.
So, you know, so again, so 5-HTP,
there are several medicines that work off of that receptor.
Okay, and so you may be able to find some supplements
it's called 5-Hydroxytryptophan.
So it's actually an amino acid that can boost serotonin.
The science behind is that it can boost serotonin
in the natural way.
It's one that we didn't cover on this presentation,
because I don't believe that the evidence on it
is as strong as some of the other ones,
but it does actually have some science based on it.
It can help with some weight loss
just by feeling like there's increased feelings of fullness.
But that happens with a lot of SSRIs.
The principal there is the same as
serotonin producing medications
that as far as the science behind it.
Yes, it probably would fall right in there
in line with probably compare it to
(indistinct) so in that same range.
Woman: Okay, another question
you're likely to repeat the question
that (faintly speaking) hear anything.
-: Sure.
Woman: And then what is that Lexapro?
-: So what about Lexapro?
Woman: What's your question?
Is what about Lexapro,
why do you call (faintly speaking) Lexapro?
-: Sure, so the question was, what about Lexapro?
Lexapro is a good SSRI.
So again, it's a selective serotonin reuptake inhibitor.
This is a good class in medicine,
as it does not have significant side effects
or longterm dependence like benzodiazepine do.
It also does not cause,
well, it does list serotonin syndrome
and QT prolongation as a side effect.
It doesn't have that as a major problem.
And so very effective.
It comes on a little stronger than the sertraline
that we just talked about.
So some people, it comes on a little faster,
maybe have some more side effects in the beginning stages,
a little more tiredness,
but it also takes effect faster than a sertraline would.
So sertraline usually takes about four to six weeks,
whereas Lexapro, my experience is about two to four weeks.
Lexapro will take an effect.
Some of these supplements that we've talked about
will be in the four to six week range.
So St. Johns Wart the same, you know,
any of those will have a little longer
of a initiation phase.
And so I would like Lexapro a little faster
than some of those, but in a good class of medicine.
(faintly speaking)
So Heather has added the link to a PHQ-9
and GAD-7 in the chat box down at the bottom.
So if you want to find that and click on that
and take the scale yourself, feel free to do that.
Woman: Is aerobic exercise (indistinct)
better than strength training?
-: Is the, I'm sorry.
Woman: Is aerobic exercise better than strength training?
-: Yeah, that's a great question.
So the question was,
is aerobic exercise better than strength training
for relief of anxiety or depression
or other mental illnesses?
The studies do not show that there's a benefit
to one over the other.
I definitely promote aerobic exercise
because I think it has benefits
that strength training does not.
I think that adding on strength training
is good for other reasons,
increasing the muscle mass and stability,
strengthening pelvic girdle and core strength,
all those decrease falls.
And there's lots of medical reasons for that.
But as far as anxiety and depression goes,
the studies show that there's no difference
between whether it's resistance training
or aerobic training and the benefits that come from that.
So, yeah, choose which one you'd prefer and go at it.
I think the key to either of them is consistency.
If we're able to do anything consistently,
we will have to get the physical and mental benefits.
There are good pheromones and hormones
that come from aerobic exercise.
I think that's been proven
from running studies that have been done.
But that being said,
not everybody gets the same level of,
we'll say it a runner's high as others do.
And so many of you probably know that where you say,
I feel terrible when I run and I don't enjoy it.
And that's a fact.
Some people genetically release more of these hormones
doing aerobic activity versus resistance training,
but one or the other does provide good benefit.
Woman: Next question.
Is magnesium or magnesium supplements beneficial?
Repeat the question (faintly speaking)
-: Okay, so again, magnesium.
The question was are magnesium supplements beneficial?
There has been some study on that.
It's been inconsistent in the research
and if any researchers out there are listening,
they might debate on that.
I think from my analysis
that the evidence is not solid to support
that magnesium supplements will statistically prove benefit
to a population as a whole.
If someone has a deficiency,
I think that it does, probably have some benefit,
but generally, no.
There's also some questions about vitamin D therapy,
especially with this COVID era,
or we're thinking about immuno competency
and boosting our immune systems.
There is some evidence that vitamin C and vitamin D
can boost immune systems
and that can lead to healthier overall feeling.
But as far as what we see in the major studies
know that none of those actually help with depression,
although vitamin D might be on that
another one of those cusp nutrient supplements, it can help.
Woman: (faintly speaking) chat box.
-: Okay, so listen, I just wanted to say,
again, if anyone has questions, feel free to add them on.
We'll stay on for just a second,
but I wanna say thank you to everyone for being here.
This is again, such an important subject.
We really value your time and hope that you appreciate,
glad that you're able to spend this time with
and hope you found it valuable.
Of course, if you have any questions, see your physician.
We're all here to support you.
There's gonna be several presentations
coming over the next several months.
And I hope that you enjoy those as well.
I think there's one last question.
Woman: Yes, so the question is
are there breathing exercises
that you can recommend beside (faintly speaking)?
-: Yeah, that is a great question.
So going back to what we talked about Tai Chi and Qi Gong,
those ones can help.
I'm sorry, the question was,
are there any other breathing exercises
other than yoga that we might recommend?
Woman: In the middle of (faintly speaking)
or anxiety attack?
-: In the middle of a heightened panic or anxiety attack?
Absolutely, I really love this Virtual Hope Box App.
There's some guided breathing exercises in there.
There are ways to breathe
that other ways that therapists will guide you in.
I don't think that it's easy to describe those,
right in this presentation, in this format,
but definitely therapists could guide you through
alternative methods that are out there.
I think I like this Virtual Hop Box.
It gives you some structure
and you can do it at home at any point in time, okay.
Okay, this information in the presentation
will be on the website if you have
and you wanted refer to it later.
All right, thank you so much.
-: Again, we'd like to thank Dr. Murphy
for our first in a series
of our Wellness Starts Within Program.
And this is our first topic.
You will be able to access this
on our WellnessStartsWithin.com.
On the website, you will be able to access the presentation
it is being recorded.
Again, we wanna thank Dr. Murphy.
He is one of our physicians at our Marsh Road practice
in Indianapolis.
And there on the WellnessStartsWithin.com website.
We will also have links to the GAD-7 for anxiety
and the PHQ-9 for depression.
We appreciate you joining us
and look forward to providing you many more topics
for overall health and wellness.
Thank you very much.
(lively music)