Holistic Treatment for Anxiety and Depression: What Actually Works

What does "holistic" actually mean in mental health treatment?

In this interview Dr. Sultan defines it as additive rather than alternative. The term is often used to mean non-Western or non-medical treatment; his usage is that plus everything else already known to work. The practical version is a multipronged plan: medication where it is genuinely indicated, targeted psychotherapy, and environmental or lifestyle intervention. His argument is that doing all three produces a synergy - people improve faster, improve more, and stay well longer than they would on one or two.

Jump to this part of the interview (8:03)

Can you treat anxiety and depression without medication?

Dr. Sultan's caution in this interview is directed at subtraction. His guidance is to add interventions rather than remove them, and if you do want to come off a medication, to do it deliberately and with support, because the consequences of relapse are serious - a depressive episode can derail a life, and unmanaged anxiety damages relationships and concentration. He is explicit that effective conventional treatments should not be dismissed.

Jump to this part of the interview (14:50)

How much meditation does it take to affect anxiety or depression?

Dr. Sultan cites studies finding that roughly 45 minutes of meditation a day produced symptom reduction comparable to an SSRI - while stressing that 45 minutes daily is a very large commitment, and that this is a comparison drawn from research rather than a recommendation to substitute one for the other. Confirm the specific trials with a clinician before acting on it.

Jump to this part of the interview (10:20)

Why does exercise help depression?

Two mechanisms, on Dr. Sultan's account. Cardiovascular exercise raises dopamine. But exercise is also behavioral activation, which is an established depression treatment - in its simplest form, getting up and doing things, when withdrawal and inactivity deepen depression. Exercising outdoors adds sunlight, which helps reset the reticular activating system and regulate mood; the seasonal pattern in mood as days shorten is the same effect at population scale.

Jump to this part of the interview (11:40)

Why is motivation so hard in depression, and what helps?

Low energy and reduced motivation are core symptoms, not personal failings. Dr. Sultan describes an evolutionary reading: brief withdrawal and rumination after a setback may be adaptive, and the clinical problem is being unable to re-engage. What helps is repeatedly doing things that are hard - which he describes as producing hypertrophy in the mid-cingulate gyrus, strengthening the capacity to act against resistance. He compares it to starting weight training: the difficulty is the signal that there is room to grow, and the gain transfers between activities.

Jump to this part of the interview (25:46)

Can anxiety or depression be mistaken for ADHD?

Often, and Dr. Sultan treats this as a common diagnostic trap. Impaired memory and concentration are part of the criteria for a depressive episode, and persistent anxiety consumes attention - he estimates a substantial share of working capacity going to worry. Patients correctly notice a concentration problem and then incorrectly conclude it is ADHD. His advice is to stop self-diagnosing and work with someone who can tease the causes apart; he notes the distinction confuses clinicians too.

Jump to this part of the interview (15:40)

A note on the discussion of supplements and meditation. In the course of this conversation Dr. Sultan refers to research on a supplement and on meditation compared with SSRIs. Those are remarks in an interview, not treatment recommendations, and nothing here is medical advice or a substitute for evaluation by your own clinician. Do not start, stop or change a medication or supplement on the basis of a podcast.

[0:00] John Cordray, LPC:

You're listening to the mental health today show. My name is John Cordray. I'm a licensed therapist. I am the host of this show. And today I have with me a psychiatrist that he specializes in treating anxiety and depression from a holistic point of view, which is great. I always will like talking to other physicians and other therapists from that perspective, the holistic. And we're going to talk more about that. And if you struggle with anxiety and depression or really, you know, this conversation will probably go to other mental health issues as well. Stay tuned. I, my guest today is Dr. Ryan. So we, we practice this at the beginning. So I'm going to need your help. So I would say Sultan, but how would you say it?

[0:43] Dr. Ryan Sultan:

I mean, that is a totally acceptable answer. But, but like, if my, my Latin grandma was here, it would be Ryan. That's what she would say. Yes.

[0:53] John Cordray, LPC:

I like it. It's very good.

[0:55] Dr. Ryan Sultan:

Accent on the A.

[0:58] John Cordray, LPC:

Yeah. That, yeah. I need your accident for that. So that helps. Well, I want to welcome you to the show and I'm really looking forward to getting to know you a little bit, but tell us a little bit of a story. What's something about you that would be, you know, an interesting backstory.

[1:15] Dr. Ryan Sultan:

Yeah. I mean, I actually have been in our world of like the mental health space a long time. My, my dad is a psychiatrist. And my, my brother, sister and I all had and still do struggled with, with ADHD as a kid. And I, I had a lot of treatment when I was younger and it made a big difference for me and my, my brother and my sister in our lives. And that's one of the things that drew me into the field was, was the idea that even though, you know, particularly when I was going into it, the stigma around mental health was more significant within the field. I can remember being in medical school. I'm like, the things people would say, like, like I'd be in medical school, I'd be considering going into psychiatry. Like someone would know that, or they would say that. They'd be like, this is like another medical student. They'd be like, you know, I went to medical school, I did all that work and I became a psychiatrist. I just feel like it would have been a whole waste. And I was like, okay. Because, you know, historically maybe not as much right now, but historically the medical field has been very dismissive and snooty towards psychiatry. We have definitely been the, the like bastard stepchild and, and seen as like the least legitimate aspect of the, of the medical field. And interesting for me, I think that's because our field is so, the whole field of mental health is, is, is not, it's not as clearly grounded in science and mechanisms. Right. So like the heart, like, I could just draw the heart and it's a pump and it's moving stuff around like it's really clear what it is like, like, you know, the, the kidney is like a filter system basically. The liver is a combination of a filter system and like kind of a gland that produces stuff. You know, your lungs are basically something that has air going in and out of it. You know, your brain, you know, from a neurology point of view, people kind of can understand that. But the mind, like, what's the mind? Like, I don't know. It's like this emergent property thing. And so, you know, psychiatry and mental health and, and, and our whole field is, is this dynamic interdisciplinary world. So from my point of view, that pulls from like psychology, that pulls from my philosophy, certainly like neuroscience, sociology, even anthropology. And, and, and so for me it was like, I remember thinking like I was thinking ER, like emergency medicine, emergency room medicine. And, and for me, I was like, deciding what to do to decide, you know, your fourth year. And I was like, every time I would think about something else, even though the, everyone thought it was sort of like Wayne that I was going to psychiatry. I was like,

[4:21] John Cordray, LPC:

If I go into these other things,

[4:22] Dr. Ryan Sultan:

I won't be able to do, I can't do psychotherapy. I can't, I was so sad. And that's how I was like, nope, that's it. That's what I'm doing. That's what I'm doing. Nice.

[4:33] John Cordray, LPC:

You know, I always think that's interesting. I talked to other psychiatrists as well. And they would say the same thing in med school that is almost the feeling of psychiatry is at the bottom of the list. It's

[4:47] Dr. Ryan Sultan:

Almost a feeling like that was the thing. That's changing, by the way. That's significantly changed. Psychiatry has become much more competitive for a variety of reasons. Much more competitive. I'm not that old. Maybe I transitioned like 14 years ago, but it's changed a lot. But yes, that's a common thing that, and I'm excited that it's more competitive, because our field should be competitive. Our field is on the precipice of so much change, right? Like our understanding of the mind and how we help people is behind the rest of the ways that we help people from an understanding in a science point of view and an effectiveness of treatment point of view. But we are making a lot of progress, a lot of progress. And for me, that's very exciting. The ADHD boy in me that's still here, that loves the new thing, that gets excited. I'm just so happy about that. When we talk about depression and anxiety, we're doing so much. One of the main things that I'm always preaching is probably the appropriate word. How do you do a multipronged approach? At our clinic, at our practice here at Integrative Psych, we think about always like, you got to hit this thing from multiple levels. Yes, meds are great, and they're super effective when used appropriately and targeted appropriately. Often we use medications inappropriately because we don't know what else to do. But when they're being used for the thing that they actually work at, they're great. And we have psychotherapies, and they're targeted psychotherapies that are useful for certain things, and if you use them, they're great. And then we have like environmental lifestyle interventions, and those are great too. But you know what actually the best way to help someone is, is to do all three of those things, right? If you do all three of those things, people get better faster, they get more better than they would have had they already done one or two, and they stay better longer. Because there's a synergy that starts to happen, right? Like where one is sort of ticking off the other, and you make a much more of a difference for someone. And that's one of my big, I don't know, shticks that I have around this.

[7:08] John Cordray, LPC:

Well, I think you bring up a really good point, and I love the kind of transition into this idea of holistic approach, and you know, that's been thrown around a lot, functional medicine integrative approach. And I want to talk about that because I have had a lot of clients and a lot of my listeners who are struggling with whether it's anxiety, depression, bipolar, whatever type of mental health issue. And the last thing they want to do is use medication if at all possible. And they want to know what are some things that they can do to help feel better without going to or eventually weaning off medication. So can you tell us a little bit about what is exactly holistic medicine or a holistic practice when it comes to mental health? Yeah,

[8:03] Dr. Ryan Sultan:

You know, for me holistic is being holistic, right? I think sometimes the term is used to refer to the idea of non-Western treatments or the idea of like non-medical interventions. To me, it's actually that plus all the other things that we know, right? And so one of the things that I'm really excited about now is particularly in individuals that are in their mid 20s or late mid 30s is like, let's think about hormones. We know hormones have a lot to do with mood and anxiety and attention. And something that I've been very excited about is this root that's from Malaysia, Tongkat Ali, sometimes it's called Longjack. And you can use this root. And there have been studies like somehow someone got this funded because it's very hard to get studies funded for things that are not patentable drugs. That's just how the system is set up. It's not a conspiracy. It's just like no one's going to make any money off it. And it's very expensive to run a study. And what we find is that, you know, people that are on this compound that we see normalizations around a number of different hormones, like cortisol goes down. It's like a stress hormone that you definitely chronically don't want to be too high. You get sort of a normalization around testosterone and estradiol, which are important hormones as well. And one of the things I see clinically, right, is people that have had like really bad depression or anxiety have like meaningful improvement. So we can see that on scales. And that's a thing that like Western mental health treatment doesn't even think about at all. So that's something that I think a lot about. Another thing that I think a lot about that we should all be doing, myself included, and I fail at this all the time, is regular meditation. So mindfulness is so powerful, right? Like so, so, so, so, so powerful. It's a huge commitment. But it's so powerful that there have been studies that show that if you do 45 minutes of meditation a day, which by the way is a lot of meditation. Okay, that's, that's a huge commitment. But, but, but in studies, again, that somehow got funded, that they are as effective as an SSRI, which is our most common medication that we would use for anxiety or depression in reducing symptoms. Whoa, whoa, like, that's huge. That is huge. And there are some more studies around exercise, right? And we know that like particularly cardiovascular exercise gets your dopamine up, right? Like, you know, and, and, and how do we find these ways to get our dopamine up? I mean, I hate to use the word naturally. It's like one of these words that's getting you the uses like a lot to the point where you're like, I don't even know what that means anymore. But, but, but in a way that, that you're, you're able to produce this internally and feel good about that. People often are anxiety, anxious about like being dependent on something and, you know, okay, well, if you, if you want to be dependent on something, like exercise sounds like a great thing to be dependent on. And, and, and, and they make meaningful changes and it's not surprising because they overlap, right? So one of the treatments we have for depression is behavior activation. Behavior activation in its simplest form is get your ass up and do things, right? Like, you know, what you shouldn't do when you're depressed, lay around and do nothing. That will make you more depressed, like guaranteed hundred percent. I'll bet on that over and over again. And I will, I want to be very validating people that are very depressed, particularly if you are profoundly depressed and you meet the criteria for major depressive disorder. It's really hard to get yourself out there and do things. That said, doing, it's going to make a difference in exercise is, is, is a behavior activation. So not only is it bumping the dopamine probably because of the cardiovascular effects, but you're also getting out there and doing things. Oh, and if you do it outside, you're getting sunlight. Oh, guess what? Like sunlight is magical. Like, I mean, it does a lot. It resets your reticular activating system so that you are awake more appropriate times. It appears to energize you. It has to do with mood regulation. Like you can look at large scale studies and we know that when the days get shorter, everyone gets some depression. That's what seasonal affective disorder is describing. It's a, it's a phenomenon that is probably biologically built into us. That happens related to hibernation and there's a whole area of evolutionary psychiatry that's like very interested in talking about this and thinking about it. So there's a lot of interventions you can be doing. I do want to say, I mean, I'm a psychiatrist, like I'm supposed to be the drug dealer, right? That's what we were accused of. By the way, I entered psychiatry after psychiatry had already like withdrawn itself from that. So I'm safe, but like, you know, people older than me, older than me were involved in this more. The bottom line is though, that I really want to caution people like, you know, you want to be careful about like not taking a medication or stopping a medication. You know, you want to add stuff on, you want to do it in a synergistic way. Please do that. I want you to do that. But that we do have effective classical Western treatments for stuff and that they shouldn't be dismissed. And that if you want to try to get yourself to stop you taking those medications, that you can do that, but you want to do that in a really thoughtful way because the consequences are enormous, right? Like falling back into a depressive episode can ruin your life, okay? Having worsening anxiety, again, ruins your life. If you can't manage your own anxiety and you are now spewing your anxiety everywhere, which that's one version of anxiety that people have is their right. They need to be contained by other people and they're overwhelmed. That affects your relationships. That's tiring for other people, you know, that's many cases that kind of cause other people to sort of withdraw from you because there's a lot that you're asking. You may get stuck on things like a classic idea around generalized anxiety is like, you just keep thinking about it over and over and over and you don't actually do anything, right? And you are paralyzed by that. That is problematic, right? It is hard to do things in your life if that's how you're doing it. Not to mention you're running this program in your brain all the time. Like 15, 20% of your brain is being used to worry about this if your head space is taking up on that and it makes it hard to concentrate. I do a lot of ADHD treatment and one of the first things we do when people come in for ADHD treatment is like, whoa, hold on. Can we just confirm that we think you even have ADHD? Because there are lots of things that can cause concentration problems. Lots of depression, by the way, like memory and concentration is literally in the criteria for a depressive episode. And getting back to the anxiety thing, like you're anxious all the time. If you're thinking about this stuff all the time, it's really hard to concentrate on stuff and people perceive that as a concentration problem, which it is. But then they incorrectly link that and say, oh, this means I have ADHD, which is a huge problem, by the way. Guys, please stop self-diagnosing. I know our field is a little hand-wavy sometimes, but I swear, I swear we're thoughtful about this most of the time. Be thoughtful about what your diagnosis is and really consulting with someone that can help you actually sort through that and tease that out. Because it's confusing. It's confusing to us. I still get confused about people's diagnoses sometimes when I'm working with them. I'm like, what do I really think is going on here?

[16:31] John Cordray, LPC:

Yeah, it's not necessarily a cut and dry all the time. And you bring up a really good point where a lot of people self-diagnose and they just Google it and they say, well, this is it. I have this. And it's not necessarily the case. And I also like how you connected the holistic is not the absence of medication. It is the addition. If you need medication, you need it. But don't leave out all the other things that you can do to really can work together. And so this is not about anti-medication at all. It's about promoting good mental health, working on regulating your emotions. And maybe your diagnosis requires that medication, but also what else can you do to enhance it? And so I like that distinction that you made earlier. So that is really important. So don't self-diagnose and what are some things that you can do right now at home to improve your mental health? Maybe it's going, getting exercise. Maybe it's eating a healthy diet or maybe it's getting enough sleep. That's one of the things that I have seen in my practice that people are not getting enough sleep and that can really interfere with mental health. So what would you say? We're

[17:56] Dr. Ryan Sultan:

Touching on something very important, which I think is a general description of self-care. We live in a modern world that is conspiring to make our mental health bad. I was on a podcast yesterday and one of the things we were talking about was social media. The social media algorithm is set up in a way to send you things that are going to make you feel crazy. And also a narrow, micro curated reality that you're seeing and all these sort of problems that we think about. You have to protect yourself from a system that is not going to naturally want to take care of you. So whether that is monitoring your own screen time, monitoring your own social media time, valuing interpersonal relationships. We are social creatures. You need close interpersonal relationships. All of us do. I don't care if you're an introvert. That is a classification that was created recently and is a false dichotomy. We all need that. We all need these social relations. We are social creatures. We are primates. All of our relatives in this realm are like this as well. Having contact with each other, which I think is one of the unfortunate unintended consequences of what I go through from the pandemic is that a lot of us don't spend as much time with other people in person as we probably should. That is restorative and healing for all mental health. Pick your diagnosis. I don't care if you have schizophrenia. It is healing for you. So how are we creating those close relationships? How are we fostering those relationships? That community, right? So that is a huge thing that people don't think enough about. And it doesn't really fall into any specific thing. It falls into maybe sociology or something like that. But that is something that I think we don't think enough about. Your sleep. I mean, like, where do we even start with sleep? I mean, you need to be in bed. You want to get eight hours? You need to be in bed more than eight hours. Okay? Like, you really need more than that. You need a routine before you go to bed to get yourself ready for sleep. Like, think about what that routine is and describing that for yourself. Like, how do I get myself ready to go to bed in a way that I'm starting to calm myself down, settle myself in? You know, think about what that routine is. And think about the routine in the morning, too. How do I integrate something? So ideas to integrate would be, like, meditation. I love – there's, like, a zillion guided meditation apps now. I personally use Headspace, but there's many of them. You know, that's a great thing to be integrating into that. You know, what is my consistency of my diet? Not just the quality of the food, which is super important. God knows what processed food is. Like, I mean, like, really sort of thinking about that from a quality point of view. But also, like, the consistency of your eating. I can't tell you how often people's self-care around food is just bad. Like, they eat in this inconsistent matter. They eat large amounts of food. Then they don't eat anything for a while. You know, how are you structuring your food in a way that, look, food is delicious. I love to eat. But food is also fuel. And so making sure you're thinking about, like, that you are structuring your eating in a way that you are consistently getting that and you're not going up and down. Because the changes in your symptomology, your mood, your anxiety, can be related to not eating properly or not eating enough or not eating at the right times. That's another thing that I think a lot about, you know, how do I get a regular exercise routine, which is so hard, guys. Like, so hard. Like, it took me years to figure out how to do this for myself. So doing all that stuff that helps you take this modern life that is not really taking care of you. And, you know, you're an adult now, so your parents are not doing this for you. And actually create a self-care that protects you because no one else is going to do it for you, right? No one is really going to do this for you. Your gut is your job is not going to do it for you. Your job of anything just wants you to work more. So, you know, like, that's all they're going to want from you. And, you know, how do you create that for yourself and thinking about that?

[22:51] John Cordray, LPC:

Well, that's exactly right. And taking ownership of your life is so important and making it a priority. You mentioned this or alluded to this earlier that there are times that people can get so caught up in doing other things that they don't really pay attention to their own self. And developing those routines, bedtime routines, morning routines, eating healthy, drinking plenty of water, making sure you get enough sleep. All of that is so important, but yet so many people neglect it. They don't realize how that is connected. It's happening, right?

[23:28] Dr. Ryan Sultan:

We're talking, you know, with the exception of maybe the community discussion, which that's an old thing people used to talk about, like nothing we're saying is groundbreaking right now. But I think the thing to point out is most of us, not most of us, but a lot of us are failing at it, right? And you actually need to ask yourself, am I really doing that? That's a foundational thing that you need to be doing for yourself, even if you don't have like a diagnosed mental health condition, right? Like that is a thing that you need to be thinking about at a really, really, really, really foundational level. And just, you know, life is a DIY project. It's a do-it-yourself project. It's one of these things that's taken me a long time to realize, like, you are in charge of your own life. Like, you know, no one is looking out for you more than you are, and you need to remind yourself of that.

[24:23] John Cordray, LPC:

That's right. And sometimes we're talking about anxiety and depression, and so often that robs you of motivation, that robs you of interest, that robs you of wanting to do anything. And so I was just talking to a client this morning about this very thing, and you mentioned it earlier about behavioral activation. And there are times where you just, you have to do something in order, then maybe the motivation comes later. But so often we just sit around and wanting the motivation to just magically come up, and then we'll get things done. But no, you have to look at it as a priority, whether you feel like it or not, and move forward, have something that you do, even if it's a little thing, but you accomplish it. And it's important to think about how you're going to cultivate and nourish your body, mind, body, and soul. And that is going to, it will, it'll increase your joy levels, your interest, your motivation. And like you said, whether you have an official mental health diagnosis or not, if you're just feeling blah, yuck, right? And so you have this low mood, integrate these things into your life, and you will feel better. So

[25:46] Dr. Ryan Sultan:

Let's talk about that motivation thing. That's a huge barrier for all of us, particularly the depressed people, right? So low energy, motivation, lack of it rather, these are core symptoms of depression. And from an evolutionary point of view, low energy and reduced motivation for a brief period of time in a depressive, let's say like, I don't want to call it an episode, because that's what we mean, I don't know, maybe like an event, depressive event that you have is actually thought to be helpful. The idea is that like, you know, depression is this thing that yes, some of us are more predisposed to it than others, that, you know, it's this, you're walking through life and you get kicked in the face and you get knocked down. And how do you handle that knockdown? And the idea of depression from an adaptive point of view would be that you withdraw, you maybe ruminate about it a little bit. You think about it and then you re-engage, right? So how do we re-engage, as opposed to the clinical problem of depression where someone gets knocked down and they cannot get back up, right? And they just feel like they keep getting knocked down. And modern life makes it harder to re-engage, by the way. But the more you try, the more you do things that are hard for you, either not do things that you want to do that you know you shouldn't do or do things that are challenging for you. And I'm not talking about like torturous, traumatic things. I'm talking about like things, you know, like getting out of bed and doing stuff that you don't want to do. What it actually does is it causes a hypertrophy, a growing, a part of your brain, I think it's the mid-cingulate gyrus, which is this part of the brain that we can actually measure in your brain, it gets bigger. And the bigger it gets, the stronger your ability is to do things that are hard for you, that are difficult, that you don't want to do. And it's transferable, meaning like if you do it for one specific activity, that strength transfers to another activity. And think of it just like going to the gym, like it is really hard at the beginning to start doing any kind of weightlifting. Good, that's good that it's hard. That means you've got a lot of growth in front of you. And good, that means there's a lot you can do. That's exciting, right? And so it's the same thing, like how are we going to build this area up for you, which is actually going to be protective? It's not only just going to help you get out of the depressive episode, hopefully, but hopefully it's going to – more like it's going to help you not get into another episode.

[28:36] John Cordray, LPC:

Yeah, the proactive approach as well. Not only that it will help you in immediately right now, but it could help you prevent it at least getting worse in the future. And taking that as a priority, it goes right back to that. Are you taking your life, how you're feeling, just your old lifestyle, is that a priority for you? And hopefully you're listening to this and you say, well, maybe it hasn't been, but it's going to now be a priority. And if you are struggling with mental health, you have to take it a priority. You can't look at your life and say, my life is miserable, I can't do anything about it. And I think that's where the anxiety and depression try to convince you is that you can't do anything about it. And that is part

[29:27] Dr. Ryan Sultan:

Of depression, is the idea that it changes your thinking, right? It changes your thinking in a way where you – Aaron Beck, the guy who designed CBT, used to talk about this idea of these glasses that you would wear. Maybe it was actually his daughter, Anna, the doctor. But the glasses that you would wear that filter out certain things and all you do is see the negative. It's this attitude. It's this mindset. And it's hard. It's sneaky. It's really freaking sneaky. And it changes your ability to think about it. So it's really, like, messed up in that way. So it is a battle that you have to wage. And I encourage people to try to actually separate their – particularly for depression. I think of their depression as, like, an entity that is coming after them that they are mad at and that they are not going to allow to do this to them as a way to help them with that. You know, getting back to your idea of, like, you know, doing something even small, that's a way to start. You know, you want to set yourself up to win. What is a small, achievable goal? Whenever I do a goal setting with people, people always come up with these, like, ridiculous, grandi – whoa, whoa, whoa. I'm going to get a new job. Hold on. Like, literally, you have no job right now and you're, like, running out of money and you're, like, out on unemployment. Like, let's start with something smaller. Like, okay, so what's the small thing we're going to do? Okay, we're going to imagine what our job might be and we're going to take some notes on that. We're going to open up, you know, LinkedIn and update our LinkedIn profile and write it out. And when you – you know, the first step might just be writing down what you need to do. You don't need to do it yet. Just write it down. Just write it down. Just log into your LinkedIn profile and then feel good about what you did. And each day over weeks, over months, like, pushing yourself further and further, if you set yourself up for unrealistic goals – you're going to get discouraged. You're totally going to get – of course you're going to get discouraged because it was never realistic that you were going to achieve this in the first place. And it becomes a self-fulfilling prophecy and then you convince yourself of that situation. With anxiety, you know, people say, well, I can't go talk to this person. I have social anxiety. Okay, do you know what the treatment for social anxiety is? It's exposure to social situations. That is actually the best treatment for social anxiety. And yes, it's going to be super stressful for you. Good. I'm glad it's stressful for you because you know what? It'll be fine. And you realize it'll be fine and it'll be easier to do it a little bit the next time. You know, the example that I would give, if you have a fear of heights, ideally, you know what I want you to be able to do? I want you to jump out of a plane. Like ideally, if you can jump out of a plane, I mean, we might have cured – and it's like flooding is what I'm describing. I mean, I'm being like a little facetious here. But, you know, I want you to be able to – yeah, I'm in New York City. I want you to get into New York City, go to the top of the rock in the Empire State Building and take the elevator all the way up and look over the edge. That's what I want you to be able to do. And so getting this idea of holistic, like there are supplements that are super helpful. There are Eastern, like non-traditional medicine treatments. And there's also like a whole bunch of other stuff that we've been studying for a really long time – CBT, cognitive behavioral therapy, which is a lot of what we're talking about today – that we know is actually super helpful, but it's hard. This is something that I spend a lot of time with when I start with someone, particularly someone who's not in a good place, is not to discourage them, but to set up the point of view that this is a challenging road, and there's lots of support along the way, but that you're going to have setbacks. And two steps forward, one step back is still one step forward. There is a net gain. And so when you get kicked in the face again, how do I remind myself that, look, hey, I was listening to that podcast, those guys were talking about this, and they told me that I was going to maybe make some progress, but then I was going to fall backwards. And how do I not allow my mind, in this case maybe the depression, to deceive me and to trick me into thinking that's it, screw it, I'm worthless, I got no value, nobody likes me, never going to do anything, it's never going to get better.

[34:26] John Cordray, LPC:

Yeah, and that's right. I mean, it's a mindset, it's being willing to get out of your comfort zone, being willing to do hard things. And I know you and I both know it's hard to do that when you're feeling as depressed and anxious as a lot of people are. Well, Dr. Reiner, our time has come to an end here, but I just really appreciate you coming on and sharing your expertise and encouragement. This is hard stuff, this is hard work, and we both acknowledge that. And yeah, it is possible to feel better. And that's the silver lining in this. That's why you and I both got into the mental health field. It is possible to feel better. You can get through this.

[35:09] Dr. Ryan Sultan:

Everyone can feel better.

[35:11] John Cordray, LPC:

Yeah, that's exciting. It really is. And I know some people are not there yet, but don't lose hope. There is light at the end of the tunnel, and there are things that you can do right now that we just talked about in this episode. Well, Dr. Reiner, again, thank you for coming on. I appreciate you. And yeah, it's been great to talk with you, and thanks for coming on and talking to my audience today.

[35:41] Dr. Ryan Sultan:

My pleasure. Good luck, everyone.

[35:44] John Cordray, LPC:

Well, thank you, everybody, for listening to this episode of The Mental Health Today show. I want to encourage you to continue to work on, just like we talked about today in this episode, keep working on your mental health. It's one step at a time. It's trying to remain as hopeful as you can and realize that, yes, you're going through a dark time now, but it doesn't mean it's going to be dark forever. All right, friends, take care. Until next time. Bye-bye. Thank you.

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