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BETTER THAN PROZAC

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TRANSLATING THE NEW BRAIN SCIENCE INTO GREATER CLINICAL RESULTS Bill O’Hanlon 12.08 NICABM

The New Brain Science

The New Brain Science

Old view: Brain had fixed structure and set number of brain cells, which declined over the aging process and with damage from trauma

which declined over the aging process and with damage from trauma New view: Brain plasticity .The New Brain Science • • Old view: Brain had fixed structure and set number of brain cells.

The New Brain Science • • Old view: Brain had fixed structure and set number of brain cells. which declined over the aging process and with damage from trauma New view: Brain plasticity • Brain can grow new cells and make new connections throughout life .

The New Brain Science • • Old view: Brain had fixed structure and set number of brain cells. strengthening. which declined over the aging process and with damage from trauma New view: Brain plasticity • • Brain can grow new cells and make new connections throughout life Brain and body experience alters the structure and connections in the brain. growing or weakening them and changing structure .

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The mechanisms for brain cell growth (neurogenesis) .

The mechanisms for brain cell growth (neurogenesis) • IGF-1 (insulin-like growth factor) .

The mechanisms for brain cell growth (neurogenesis) • • IGF-1 (insulin-like growth factor) VEGF (vascular endothial growth factor) .

The mechanisms for brain cell growth (neurogenesis) • • • IGF-1 (insulin-like growth factor) VEGF (vascular endothial growth factor) BDNF (brain-derived neurotrophic factor) “Miracle Grow for the brain” .

Neurogenesis and Exercise Sharon Begley .

What affects brain growth and connection? .

What affects brain growth and connection? • Learning new things that stretch your abilities (not too much) and repeating those things through deliberate practice .

What affects brain growth and connection? • • Learning new things that stretch your abilities (not too much) and repeating those things through deliberate practice Top things .

What affects brain growth and connection? • • Learning new things that stretch your abilities (not too much) and repeating those things through deliberate practice Top things • New language .

What affects brain growth and connection? • • Learning new things that stretch your abilities (not too much) and repeating those things through deliberate practice Top things • • New language Music .

What affects brain growth and connection? • • Learning new things that stretch your abilities (not too much) and repeating those things through deliberate practice Top things • • • New language Music New physical abilities (juggling. and so on) . typing.

typing.What affects brain growth and connection? • • Learning new things that stretch your abilities (not too much) and repeating those things through deliberate practice Top things • • • • New language Music New physical abilities (juggling. and so on) Exercise (vigorous aerobic) .

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Exercise and Mood Disorders .

as well as anger .Exercise and Mood Disorders • Growing evidence of strong and lasting effects of exercise on depression and anxiety.

Exercise and Mood Disorders • • Growing evidence of strong and lasting effects of exercise on depression and anxiety. as well as anger Beats medications in some trials for lingering positive effects .

Exercise and Mood Disorders • • • Growing evidence of strong and lasting effects of exercise on depression and anxiety. as well as anger Beats medications in some trials for lingering positive effects Has been shown to work on people who are not responding to medications .

John Ratey on new understandings of depression • From the neurotransmitter theory to brain connectivity and plasticity • • • The brain becomes less plastic.Dr. less able to adapt and learn when the person becomes seriously depressed Brain atrophy/damage can take place with the stress and occurrence of serious and longer-term depression that is untreated Exercise can increase levels of BDNF and other factors that can oppose that atrophy and damage .

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(Standard Medical Intervention and Long Term Exercise) SMILE .

(Standard Medical Intervention and Long Term Exercise) SMILE • 156 adults. diagnosed w/Major Depression .

diagnosed w/Major Depression Randomly assigned to 3 treatment groups .(Standard Medical Intervention and Long Term Exercise) SMILE • • 156 adults.

(Standard Medical Intervention and Long Term Exercise) SMILE • • 156 adults. diagnosed w/Major Depression Randomly assigned to 3 treatment groups 1) Exercise treatment .

(Standard Medical Intervention and Long Term Exercise) SMILE • • 156 adults. jogging or stationary bicycle riding 3x/week . diagnosed w/Major Depression Randomly assigned to 3 treatment groups 1) Exercise treatment • Exercise consisted of brisk walking.

jogging or stationary bicycle riding 3x/week 10 min. diagnosed w/Major Depression Randomly assigned to 3 treatment groups 1) Exercise treatment • • Exercise consisted of brisk walking.(Standard Medical Intervention and Long Term Exercise) SMILE • • 156 adults. warm-up. exercise. 30-min. 5-minute cool down .

diagnosed w/Major Depression Randomly assigned to 3 treatment groups 1) Exercise treatment • • Exercise consisted of brisk walking. warm-up. 30-min.(Standard Medical Intervention and Long Term Exercise) SMILE • • 156 adults. exercise. 5-minute cool down 2) Zoloft treatment . jogging or stationary bicycle riding 3x/week 10 min.

diagnosed w/Major Depression Randomly assigned to 3 treatment groups 1) Exercise treatment • • Exercise consisted of brisk walking. 30-min. exercise.(Standard Medical Intervention and Long Term Exercise) SMILE • • 156 adults. warm-up. 5-minute cool down 2) Zoloft treatment 3) Combined treatment . jogging or stationary bicycle riding 3x/week 10 min.

5-minute cool down 2) Zoloft treatment 3) Combined treatment “Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder.(Standard Medical Intervention and Long Term Exercise) SMILE • • 156 adults. al. diagnosed w/Major Depression Randomly assigned to 3 treatment groups 1) Exercise treatment • • Exercise consisted of brisk walking. Psychosomatic Medicine. Blumenthal. jogging or stationary bicycle riding 3x/week 10 min. exercise. . 69:587-596 (2007). PhD et. warm-up.” James A. 30-min.

(Standard Medical Intervention and Long Term Exercise) SMILE .

(Standard Medical Intervention and Long Term Exercise) SMILE • At the end of 4 months. 60-70% of the participants were “vastly improved” or “symptom-free” in all 3 conditions .

(Standard Medical Intervention and Long Term Exercise) SMILE • • At the end of 4 months. 60-70% of the participants were “vastly improved” or “symptom-free” in all 3 conditions On 10-month follow-up: .

(Standard Medical Intervention and Long Term Exercise) SMILE • • • At the end of 4 months. 60-70% of the participants were “vastly improved” or “symptom-free” in all 3 conditions On 10-month follow-up: 38% of Zoloft condition subjects had recurrence .

(Standard Medical Intervention and Long Term Exercise) SMILE • • • • At the end of 4 months. 60-70% of the participants were “vastly improved” or “symptom-free” in all 3 conditions On 10-month follow-up: 38% of Zoloft condition subjects had recurrence 31% of the combined condition had recurrence .

(Standard Medical Intervention and Long Term Exercise) SMILE • • • • • At the end of 4 months. 60-70% of the participants were “vastly improved” or “symptom-free” in all 3 conditions On 10-month follow-up: 38% of Zoloft condition subjects had recurrence 31% of the combined condition had recurrence 8% of the exercise only had recurrence (and people who continued to exercise were less likely as a group to have recurrence) .

(Standard Medical Intervention and Long Term Exercise) SMILE • • • • • At the end of 4 months. 60-70% of the participants were “vastly improved” or “symptom-free” in all 3 conditions On 10-month follow-up: 38% of Zoloft condition subjects had recurrence 31% of the combined condition had recurrence 8% of the exercise only had recurrence (and people who continued to exercise were less likely as a group to have recurrence) Hypothesis: Self-efficacy .

(Standard Medical Intervention and Long Term Exercise) SMILE .

(Standard Medical Intervention and Long Term Exercise) SMILE How much exercise matters: .

(Standard Medical Intervention and Long Term Exercise) SMILE How much exercise matters: Every 50 minutes of exercise per week correlated with a 50% drop in depression levels .

(Standard Medical Intervention and Long Term Exercise) SMILE How much exercise matters: Every 50 minutes of exercise per week correlated with a 50% drop in depression levels .

Psychosomatic Medicine.(Standard Medical Intervention and Long Term Exercise) SMILE How much exercise matters: Every 50 minutes of exercise per week correlated with a 50% drop in depression levels “Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder. PhD et. Blumenthal.” James A. al. . 69:587-596 (2007).

Exercise and Mood: Depression research .

Exercise and Mood: Depression research Two studies found: .

experienced a decline in depressive symptoms by an average of 47% after 12 weeks .whether it was for three or five days per week . such as exercising on a treadmill or stationary bicycle .Exercise and Mood: Depression research Two studies found: • People who participated in moderately intense aerobics.

Exercise and Mood: Depression research Two studies found: • • People who participated in moderately intense aerobics.whether it was for three or five days per week .experienced a decline in depressive symptoms by an average of 47% after 12 weeks Those in the low-intensity exercise groups showed a 30% reduction in symptoms . such as exercising on a treadmill or stationary bicycle .

Exercise and Mood: Depression research Two studies found: • • • People who participated in moderately intense aerobics. such as exercising on a treadmill or stationary bicycle .experienced a decline in depressive symptoms by an average of 47% after 12 weeks Those in the low-intensity exercise groups showed a 30% reduction in symptoms Exercise also helped people who were unresponsive to medications .whether it was for three or five days per week .

Jordan. such as exercising on a treadmill or stationary bicycle . Greer.experienced a decline in depressive symptoms by an average of 47% after 12 weeks Those in the low-intensity exercise groups showed a 30% reduction in symptoms Exercise also helped people who were unresponsive to medications Trivedi. Chambliss..D. T.Exercise and Mood: Depression research Two studies found: • • • People who participated in moderately intense aerobics.whether it was for three or five days per week . A. “Exercise as an Augmentation Strategy for Treatment of Major Depression.. H. 12(4):205-13. M..H.” Journal of Psychiatric Practice.. 2006 . B.N.O. Grannemann.L.

Madhukar H. such as exercising on a treadmill or stationary bicycle . Issue 1. T. M. Kampert. Chambliss.experienced a decline in depressive symptoms by an average of 47% after 12 weeks Those in the low-intensity exercise groups showed a 30% reduction in symptoms Exercise also helped people who were unresponsive to medications Trivedi.H. 12(4):205-13. “Exercise treatment for depression: Efficacy and dose response. Chambliss. Clark and Heather O. A. B. Grannemann. Volume 28. “Exercise as an Augmentation Strategy for Treatment of Major Depression. Dunn.L.. January 2005. 2006 Andrea L.D.whether it was for three or five days per week .. Trivedi.. H.” Journal of Psychiatric Practice.. Greer.N.O. Camillia G. Jordan. James B. Pages 1-8 .” American Journal of Preventive Medicine.Exercise and Mood: Depression research Two studies found: • • • People who participated in moderately intense aerobics.

Exercise and Mood: Depression research .

Exercise and Mood: Depression research A Purdue University study found: .

Exercise and Mood: Depression research A Purdue University study found: Middle-aged runners who had been running 3-5 times/week for 3-10 years were markedly less depressed than a matched comparison group. .

.Exercise and Mood: Depression research A Purdue University study found: Middle-aged runners who had been running 3-5 times/week for 3-10 years were markedly less depressed than a matched comparison group.

D.Exercise and Mood: Depression research A Purdue University study found: Middle-aged runners who had been running 3-5 times/week for 3-10 years were markedly less depressed than a matched comparison group. “Depression as a Powerful Discriminator Between Physically Active and Sedentary Middle-Aged Men..” Journal of Psychosomatic Medicine. Lobstein et al. . 27 (1983):69-76.

Exercise and Mood: Depression research .

Exercise and Mood: Depression research A University of Virginia study found: .

Exercise and Mood: Depression research A University of Virginia study found: • Exercise had the most profound mood-lifting effect on people who were depressed .

Exercise and Mood: Depression research A University of Virginia study found: • • Exercise had the most profound mood-lifting effect on people who were depressed The effect increased with the amount of exercise .

Exercise and Mood: Depression research A University of Virginia study found: • • • Exercise had the most profound mood-lifting effect on people who were depressed The effect increased with the amount of exercise The study also found reductions in anger and anxiety through exercise .

. al (1978). 6:34-49. “The Prescription of Exercise for Depression.” Physician and Sportsmedicine. Brown et.Exercise and Mood: Depression research A University of Virginia study found: • • • Exercise had the most profound mood-lifting effect on people who were depressed The effect increased with the amount of exercise The study also found reductions in anger and anxiety through exercise R.

Exercise and Moods: Depression research .

Exercise and Moods: Depression research Beware of “overtraining.” or exercising too much (as in anorexia and other compulsive problems) .

” or exercising too much (as in anorexia and other compulsive problems) • The evidence shows that over-exercising (exercising several times a day at training levels that are at or near maximal) is correlated with depressed moods .Exercise and Moods: Depression research Beware of “overtraining.

12:146-59. . Morgan et. al (1991).” British Journal of Sports Medicine. “Psychological Monitoring of Overtraining and Staleness.Exercise and Moods: Depression research Beware of “overtraining.” or exercising too much (as in anorexia and other compulsive problems) • The evidence shows that over-exercising (exercising several times a day at training levels that are at or near maximal) is correlated with depressed moods W.

Morgan et. 12:146-59. “Psychological Monitoring of Overtraining and Staleness.Exercise and Moods: Depression research Beware of “overtraining. .” or exercising too much (as in anorexia and other compulsive problems) • The evidence shows that over-exercising (exercising several times a day at training levels that are at or near maximal) is correlated with depressed moods W.” British Journal of Sports Medicine. al (1991).

norepinephrine levels and regulation affected by exercise . dopamine.Dr. John Ratey on exercise and mood disorders • Serotonin.

Exercise and Mood: Anxiety research .

Exercise and Mood: Anxiety research A review of 56 empirical studies found: .

Exercise and Mood: Anxiety research A review of 56 empirical studies found: 73% of those studies showed significant reductions of anxiety following exercise .

Exercise and Mood: Anxiety research A review of 56 empirical studies found: 73% of those studies showed significant reductions of anxiety following exercise Single bouts of exercise associated with decreased state anxiety .

Exercise and Mood: Anxiety research A review of 56 empirical studies found: 73% of those studies showed significant reductions of anxiety following exercise Single bouts of exercise associated with decreased state anxiety Extended programs of regular exercise associated with reduced trait anxiety .

(1994). Morgantown. WV: Fitness Information Technology. Foundations of Exercise and Mental Health. . L.Exercise and Mood: Anxiety research A review of 56 empirical studies found: 73% of those studies showed significant reductions of anxiety following exercise Single bouts of exercise associated with decreased state anxiety Extended programs of regular exercise associated with reduced trait anxiety Leith.

Exercise and Mood: Anxiety research

Exercise and Mood: Anxiety research
A study compared the effects of aerobic cycling to weight training:

Exercise and Mood: Anxiety research
A study compared the effects of aerobic cycling to weight training: Blood pressure and state anxiety fell significantly after cycling

Exercise and Mood: Anxiety research A study compared the effects of aerobic cycling to weight training: Blood pressure and state anxiety fell significantly after cycling Blood pressure and state anxiety increased significantly after weight training .

W. J. DC: Taylor and Francis). 113.Exercise and Mood: Anxiety research A study compared the effects of aerobic cycling to weight training: Blood pressure and state anxiety fell significantly after cycling Blood pressure and state anxiety increased significantly after weight training Raglin. ed. p.” in Physical Activity and Mental Health. (1997). “Anxiolytic Effects of Physical Activity. Morgan (Washington. .

Exercise and Mood: Anxiety research .

Exercise and Mood: Anxiety research A study compared the effects of exercising at 60% of maximum heart rate to 70-75% (3x/week) over 10 weeks: .

Exercise and Mood: Anxiety research A study compared the effects of exercising at 60% of maximum heart rate to 70-75% (3x/week) over 10 weeks: • Significant reductions in trait anxiety for the 60% group .

Exercise and Mood: Anxiety research A study compared the effects of exercising at 60% of maximum heart rate to 70-75% (3x/week) over 10 weeks: • • Significant reductions in trait anxiety for the 60% group No reductions for the 70-75% group .

Exercise and Mood: Anxiety research A study compared the effects of exercising at 60% of maximum heart rate to 70-75% (3x/week) over 10 weeks: • • Significant reductions in trait anxiety for the 60% group No reductions for the 70-75% group Moses.” Journal of Psychosomatic Research. et. 33:47-61. al (1989). . J. “The Effects of Exercise Training on Mental Well Being in the Normal Population.

Exercise and Mood: Anxiety research .

Exercise and Mood: Anxiety research Norwegian psychiatrist Egil Martinsen did a study: .

Exercise and Mood: Anxiety research • Norwegian psychiatrist Egil Martinsen did a study: 92 patients voluntarily committed themselves to a hospital for 8 weeks. variety of diagnoses but had failed to benefit from outpatient treatment .

Exercise and Mood: Anxiety research • • Norwegian psychiatrist Egil Martinsen did a study: 92 patients voluntarily committed themselves to a hospital for 8 weeks. variety of diagnoses but had failed to benefit from outpatient treatment 36 had anxiety disorders. stopped all meds during this hospital stay .

variety of diagnoses but had failed to benefit from outpatient treatment 36 had anxiety disorders. stopped all meds during this hospital stay Hour of aerobic exercise 5 days/week for 8 weeks .Exercise and Mood: Anxiety research • • • Norwegian psychiatrist Egil Martinsen did a study: 92 patients voluntarily committed themselves to a hospital for 8 weeks.

Exercise and Mood: Anxiety research • • • • Norwegian psychiatrist Egil Martinsen did a study: 92 patients voluntarily committed themselves to a hospital for 8 weeks. variety of diagnoses but had failed to benefit from outpatient treatment 36 had anxiety disorders. stopped all meds during this hospital stay Hour of aerobic exercise 5 days/week for 8 weeks Anxiety scores decreased in all patients except those with social anxiety .

variety of diagnoses but had failed to benefit from outpatient treatment 36 had anxiety disorders. stopped all meds during this hospital stay Hour of aerobic exercise 5 days/week for 8 weeks Anxiety scores decreased in all patients except those with social anxiety One-year follow-up showed those with GAD and agoraphobia w/o panic attacks maintained treatment gains .Exercise and Mood: Anxiety research • • • • • Norwegian psychiatrist Egil Martinsen did a study: 92 patients voluntarily committed themselves to a hospital for 8 weeks.

Exercise and Mood: Anxiety research • • • • • Norwegian psychiatrist Egil Martinsen did a study: 92 patients voluntarily committed themselves to a hospital for 8 weeks. stopped all meds during this hospital stay Hour of aerobic exercise 5 days/week for 8 weeks Anxiety scores decreased in all patients except those with social anxiety One-year follow-up showed those with GAD and agoraphobia w/o panic attacks maintained treatment gains . variety of diagnoses but had failed to benefit from outpatient treatment 36 had anxiety disorders.

et. stopped all meds during this hospital stay Hour of aerobic exercise 5 days/week for 8 weeks Anxiety scores decreased in all patients except those with social anxiety One-year follow-up showed those with GAD and agoraphobia w/o panic attacks maintained treatment gains Martinsen. 43:411-415. al (1989). E.” Nordic Journal of Psychiatry. “Aerobic and non-aerobic forms of exercise in the treatment of anxiety disorders.Exercise and Mood: Anxiety research • • • • • Norwegian psychiatrist Egil Martinsen did a study: 92 patients voluntarily committed themselves to a hospital for 8 weeks. variety of diagnoses but had failed to benefit from outpatient treatment 36 had anxiety disorders. .

Exercise and ADHD .

as well as increase dopamine storage .Exercise and ADHD • Exercise has been shown to elevate dopamine levels in the brain.

Exercise and ADHD • • Exercise has been shown to elevate dopamine levels in the brain. as well as increase dopamine storage Exercise also increases the production of enzymes that create dopamine receptors in the reward centers of the brain .

as well as increase dopamine storage Exercise also increases the production of enzymes that create dopamine receptors in the reward centers of the brain Dopamine improves mood and motivation and increases attentional abilities .Exercise and ADHD • • • Exercise has been shown to elevate dopamine levels in the brain.

as well as increase dopamine storage Exercise also increases the production of enzymes that create dopamine receptors in the reward centers of the brain Dopamine improves mood and motivation and increases attentional abilities Serotonin. impulse control and self-esteem.Exercise and ADHD • • • • Exercise has been shown to elevate dopamine levels in the brain. which can help moods. is also affected positively by exercise .

Exercise and ADHD .

Exercise and ADHD Hofstra University study found: .

Exercise and ADHD Hofstra University study found: • ADHD boys who engaged in martial arts training 2x/week improved their behavior and performance more compared to ADHD boys who exercised 2x/week (both improved) .

jumped out of their seats less often • . improved their grades. broke fewer rules. were better prepared for class.Exercise and ADHD Hofstra University study found: • ADHD boys who engaged in martial arts training 2x/week improved their behavior and performance more compared to ADHD boys who exercised 2x/week (both improved) They finished their homework more.

Exercise and ADHD
Hofstra University study found:

ADHD boys who engaged in martial arts training 2x/week improved their behavior and performance more compared to ADHD boys who exercised 2x/week (both improved) They finished their homework more; were better prepared for class; improved their grades; broke fewer rules; jumped out of their seats less often Hypothesis: More structured exercise better

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Exercise and ADHD
Hofstra University study found:

ADHD boys who engaged in martial arts training 2x/week improved their behavior and performance more compared to ADHD boys who exercised 2x/week (both improved) They finished their homework more; were better prepared for class; improved their grades; broke fewer rules; jumped out of their seats less often Hypothesis: More structured exercise better
Morand, Matthew (2004) “The Effects of Mixed Martial Arts on Behavior of Male Children with Attention,” Unpublished doctoral dissertation. Hoftsra University: Hempstead, NY.

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Exercise and ADHD

ADHD children between the ages of 5 and 12 participated in 40 minutes of intense exercise five days per week .Exercise and ADHD • A 2001 SUNY Buffalo study showed the positive benefits of exercise on ADHD children.

Exercise and ADHD • A 2001 SUNY Buffalo study showed the positive benefits of exercise on ADHD children. ADHD children between the ages of 5 and 12 participated in 40 minutes of intense exercise five days per week Children involved in this study showed a significant improvement in behavior over the six-week duration of the study • .

• • . ADHD children between the ages of 5 and 12 participated in 40 minutes of intense exercise five days per week Children involved in this study showed a significant improvement in behavior over the six-week duration of the study Behavior changes were generally noticeable two to four weeks after beginning the exercise program.Exercise and ADHD • A 2001 SUNY Buffalo study showed the positive benefits of exercise on ADHD children.

ADHD children between the ages of 5 and 12 participated in 40 minutes of intense exercise five days per week Children involved in this study showed a significant improvement in behavior over the six-week duration of the study Behavior changes were generally noticeable two to four weeks after beginning the exercise program. Children with oppositional behaviors made the greatest improvements with exercise • • • .Exercise and ADHD • A 2001 SUNY Buffalo study showed the positive benefits of exercise on ADHD children.

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Getting people to exercise .

Getting people to exercise

Baby steps

Getting people to exercise
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Baby steps The solution-oriented method

Getting people to exercise
• • •
Baby steps The solution-oriented method The buddy system

Getting people to exercise • • • • Baby steps The solution-oriented method The buddy system Linking to motivation .

Getting people to exercise • • • • Baby steps The solution-oriented method The buddy system Linking to motivation • Away from/toward .

Recommendations for amount of exercise .

Recommendations for amount of exercise • For anxiety. maybe as little as 10-15 mins. can reduce anxiety .

can reduce anxiety 3x/week for at least 20 mins. aerobic exercise at 50-70% of maximum heart rate for relief of depression .Recommendations for amount of exercise • • For anxiety. maybe as little as 10-15 mins.

Recommendations for amount of exercise • • • For anxiety. can reduce anxiety 3x/week for at least 20 mins. aerobic exercise at 50-70% of maximum heart rate for relief of depression For maximum brain growth and learning: 6x/week for 50 minutes at 50-70% of maximum heart rate . maybe as little as 10-15 mins.

Recommendations for amount of exercise • • • For anxiety. maybe as little as 10-15 mins. can reduce anxiety 3x/week for at least 20 mins. aerobic exercise at 50-70% of maximum heart rate for relief of depression For maximum brain growth and learning: 6x/week for 50 minutes at 50-70% of maximum heart rate • And then learn something new in the next 24 hours .

Recommendations for amount of exercise • • • For anxiety. can reduce anxiety 3x/week for at least 20 mins. aerobic exercise at 50-70% of maximum heart rate for relief of depression For maximum brain growth and learning: 6x/week for 50 minutes at 50-70% of maximum heart rate • • And then learn something new in the next 24 hours Stretch yourself by doing/learning something slightly beyond your comfort zone . maybe as little as 10-15 mins.

com www. NM 87501 PossiBill@aol. Guadalupe #278.getyourbookwritten. Santa Fe.thewebwhisperers.paidpublicspeaker.com www.com www.com www.com .com 223 N.getovertrauma.billohanlon.Bill O’Hanlon www.