Yoga Heals: Anxiety

It is normal to experience anxiety from time to time when we are in stressful or dangerous situations. But anxiety which is chronic, provoked by seemingly neutral situations, or which interferes with a person's ability to function normally is considered a disorder. Anxiety disorders currently affect about 18% of American adults in a given year, and the World Health Organization has estimated that anxiety disorders will be the second-most prevalent health concern by the year 2020. Although a range of treatment options exist to help those with anxiety, only about a third of those who have it receive treatment.

Symptoms of an anxiety disorder can vary depending on the cause and type of disorder, but can include feelings of panic, fear and uneasiness, problems sleeping, shortness of breath, heart palpitations, inability to be still, nausea, muscle tension, dizziness and numbness or tingling in hands or feet.

Anxiety disorders are a mental illness without known cause. It appears that a combination of factors may play a role in provoking anxiety disorders, including nervous system function and environmental stress or trauma, along with personality and genetic predisposition. There are many types of anxiety disorders

Generalized Anxiety Disorder (GAD)

Generalized anxiety is persistent, excessive and unrealistic worry or tension, even when there is no apparent cause for concern. People with GAD worry about everyday problems or concerns (like money, jobs, family, etc) to the point that it interferes with functioning in their daily lives. It can become an overwhelming challenge to attend social functions, to work, and even to get out of bed in the morning.

Obsessive-Compulsive Disorder (OCD)

People with obsessive-compulsive disorder suffer from intrusive thoughts (obsessions) which often compel them to perform behaviors (compulsions). Most people who have OCD feel powerless to stop the obsessions and compulsions, even though they are aware they are irrational. The obsessions and compulsions may begin to take up so much focus and time that concentration on and completion of daily activities becomes difficult.

Social Anxiety Disorder

Those with social anxiety are overwhelmed with worry and self-consciousness about how others see them, about being judged by others or behaving in a way that will cause embarrassment.

Panic Disorder

Those with panic disorder experience feelings of terror that happen suddenly and without warning. Panic attacks often include feelings of choking, or inability to get a full breath, as well as sweating, chest pain and heart palpitations. Panic attacks happen unexpectedly, sometimes even during sleep, and people who have them are often preoccupied with worry that another will occur.

Posttraumatic Stress Disorder (PTSD)

PTSD is a serious condition that can occur in those who have experienced or witnessed a life-threatening or violent event, such as a natural disaster, a serious accident, a death, personal assault. Most people who experience these events recover, but some continue to be severely affected by depression and anxiety for months or even years after the incident. Often, they will re-experience the trauma through intrusive memories, flashbacks or nightmares which can lead to prolonged distress, irritability or hyper-vigilance, self-destructive behavior, difficulty sleeping or doing other daily tasks, and increasing emotional numbness to or avoidance of social situations or people which remind them of those events.

Anxiety disorder is generally treated with a combination of techniques. In addition to reducing levels of environmental and physiological stress through lifestyle changes, many people take medication and receive psychotherapy, cognitive-behavioral therapy or relaxation therapy.

Yoga practice, with its focus on mind-body balance, has many techniques which can help reduce anxiety. The asana (postures and movements) provide regular exercise which can balance hormones and improve nervous system function. Pranayama, meditation and relaxation techniques calm and focus the mind, cultivating new habits of thought and better nervous system function, which can be a perfect complement to other therapies.

Five Yoga Techniques for Anxiety

The particular asana and pranayama techniques listed below were selected based on their cooling, introspective qualities, and they are most similar to our Gentle Flow class. However, most yoga postures, movements and breathing techniques can be of use to those who are experiencing anxiety. Students are encouraged to try various styles of yoga, even various teachers or studios to help them develop a practice which makes them feel safe, supported, capable and steady.

For many students with anxiety, a style of yoga like Restore, which focuses on relaxation, support and rest, is healing. Some students will find holding postures for a long period of time more stressful, because their minds become more active when their bodies are still.  For these students, a vinyasa-style class like Flow, or a movement-oriented class like Kriya, will do more to calm their minds.

For most students, working with a qualified teacher in private sessions for a more personalized therapeutic approach will yield the most success. Anxiety is a complex mind-body symptom, and responds best to individualized care for the whole person.

Asana

Cat/cow

Moving with the breath in this spinal flexion/extension set of postures can be very useful in focusing and calming the mind. Begin on hands and knees. With the inhale, bring the chest forward as the belly drops (cow pose). On the exhale, round the spine as the belly lifts upward and head drops (cat pose). Continue moving back and forth for several repetitions, letting each movement last the full length of each breath.

Setu bandha sarvangasana

Bridge pose is a cooling back-bending pose and inversion, and can be done either in a more restful way with a block under the sacrum, or more actively. For the active, movement and breath-oriented version, begin lying on the back with knees bent and heels close to sit bones. On the inhale, press into the feet to lift the hips and lengthen the front of the body. On the exhale, gently lower.

Supta Matsyendrasana

The one-legged reclined twist lengthens the sides of the body and gently twists the spine. On an exhale, lie on the back and bring one knee in toward the chest, then roll toward the opposite hip, bringing the body into a twist. Pause for several breaths, then release and repeat on the opposite side.

Apanasana

Knees-to-chest (wind-relieving) pose is a cooling position that relieves tension in the back and hips. Lie on the back and draw both knees in toward the chest. Pause, breathing slowly and completely for several breaths.

Pranayama

Simple Breath Awareness

Rest in a comfortable variation of savasana. Close your eyes and relax your face, shoulders and any other place that may hold tension. Begin to focus on your breath, following the length of each inhale and exhale. It may help to focus on the sensation of movement in your chest, ribs and belly as you breathe. Or to imagine you can see the breath move in and out. There is no need to change the breath, or for the breath to be any particular way. This is a practice of simply observing and letting things be as they are. When you notice your mind is actively engaged with a thought other than the pattern of breath, gently bring it back to the breath, coming back as many times as needed.

Tips, Considerations and Contraindications

It may take time to find a teacher and class situation which fits the student's needs. For some students, a particular yoga class might increase anxiety, instead of helping them feel more calm. If a student has social anxiety, for example, trying to meet other's expectations and avoid embarrassment might make the entire practice stressful and potentially harmful if they overextend themselves to perform an advanced posture. A private session might be more beneficial. For those with generalized anxiety disorder, the stillness of a restorative yoga practice might be an ill fit for their first class.

Whether teaching a group class or a private session, yoga teachers should always be sensitive to the needs of their students. It is best not to make assumptions about what a student is feeling or thinking during class and to encourage open communication. Not all students who experience anxiety will tell their teachers, even if they complete an intake form which requests information about current health. Teachers cannot control the student's experience, but if their intention is kindness, perhaps they can guide the student toward more peace and calm.

Research

Studies indicate that yoga reduces symptoms and perception of anxiety. In a 2005 study of women who described themselves as "emotionally distressed," the group which attended yoga classes twice per week for a period of three months reported their depression improved by 50%, anxiety by 30% and overall well-being by 65%. In other studies, self-reported levels of tension, anxiety, depression and anger drop significantly, even after a single class.

A 2004 review of research on the efficacy of yoga as treatment for anxiety disorders show encouraging results, although most research published prior to 2004 

Anxiety was significantly reduced for participants in a comprehensive 10-day yoga program which included daily asana, pranayama and relaxation (meditation and savasana) practice as well as lectures about yoga philosophy, stress management and healthy lifestyle modifications. Interestingly, participants with hypertension, coronary heart disease, obesity, cervical spondylitis, and psychiatric disorders showed the more improvement for anxiety in the ten days of the program, and those with the most anxiety (as scored on the State Trait Anxiety Inventory questionnaire) showed greatest improvement.

Additional Resources

Integrating Yoga and Meditation with Anxiety Treatment - Social Work Today

Nine Yoga Tips to Overcome Anxiety Disorder - Art of Living

Relaxation to Calm Anxiety - Yoga International

Understanding Anxiety - Anxiety and Depression Association of America

Yoga for Anxiety: Meditations and Practices for Calming the Body and Mind
By Mary NurrieStearns LCSW RYT, Rick NurrieStearns