Anxiety disorders are one of the most prevalent mental health conditions, affecting a third of the U.S. population. They impact social, occupational, or other important areas of functioning; people with anxiety disorders experience significant distress or dysfunction in their daily lives.
Those with anxiety disorders will often experience increased muscle tension, extreme
cautiousness, and hypervigilance in preparation for a perceived threat and may go to extreme lengths to avoid the situation that is perceived as threatening. Anxiety disorders commonly begin in childhood and, without treatment, may become chronic conditions lasting into adulthood. Two of the most common anxiety disorders seen by primary care providers are generalized anxiety disorder and panic disorder.
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is characterized by excessive anxiety and uncontrollable worry regarding multiple life events or activities, such as school or work performance. It causes significant distress or impairment in function. Excessive worry may occur over minor issues, manifest somatically, and result in pathological behaviors. For a GAD diagnosis, symptoms will occur on most days for at least six months and include feelings of restlessness, being keyed up or on edge; easily fatigued; difficulty concentrating or mind going blank; irritability; muscle tension; or sleep disturbance.
Panic Disorder
Panic disorder (PD) is the experience of recurrent panic attacks – the sudden onset of intense fear or discomfort – without an obvious trigger, and persistent worry about having another panic attack or a maladaptive change in behavior to avoid a panic attack. Panic attacks peak within minutes and are accompanied by at least four of these symptoms: palpitations or rapid heartbeat; sweating; trembling or shaking; shortness of breath or feeling smothered; choking sensation; chest pain; nausea or abdominal discomfort; feeling faint or lightheaded; chills or hot flashes; numbness or tingling; feeling detached from one’s body; feelings of being in a dreamlike state; fear of going crazy or losing control; or fear of dying. PD is diagnosed if these symptoms persist for at least one month after an initial panic attack.
Yogic Remedies
Pranayama and Mudra
Pranayama is the yogic practice of breath regulation. Breathing into a specific area of the body enhances the flow of energy. Diaphragmatic and slow-paced breathing may be effective techniques for reducing anxiety and stress.
Mudras are intentional movements of the body, hands, and face that may be used for psychological balancing, directing awareness to specific areas of the body and supporting optimal breathing. There are four Sharira mudras, listed below, that bring awareness to the torso and the movement of the breath.
- Kanishtha Sharira mudra helps to direct the breath to the lowest portion of the lungs, engaging the pelvis, abdomen, solar plexus, and mid back regions, promoting abdominal breathing. By bringing the hands to the lower rib cage, we become aware of the rhythmic movement of our breath, promoting a sense of calm.
- Madhyama Sharira mudra directs the breath into the mid-chest, ribcage, and upper back, promoting thoracic breathing. With this mudra, the thumbs are in the armpit region, and the palms face downward, helping release tension in the chest.
- Jyeshtha Sharira mudra helps direct the breath by engaging the muscles of the upper chest, collarbones, neck, and cervical spine, bringing the breath into the upper lobes of the lungs. To engage this mudra, the elbows bend, and the palms of the hands rest on either side of the upper thoracic spine. Holding this mudra while directing our breath to the area beneath our palms helps us release limiting beliefs about ourselves.
- Purna Svara mudra helps us engage in full yogic breathing and incorporates the entire thoracic region. To hold this mudra, place the little finger of each hand to the base of the thumb, the ring finger touches the mid-thumb, the middle finger touches the tip of the thumb, and the back of the hands rest on the knees or thighs. The breath is directed to the abdomen, rib cage, and shoulder region, helping release tension from the thorax.
Two additional mudras help reduce anxiety by decreasing the sympathetic nervous system (SNS) response, slowing respirations, and supporting abdominal breathing.
- Dvimukham mudra helps reduce stress and promote deep relaxation in individuals whose stress is a contributing factor to their anxiety. Holding this mudra reduces the respiratory rate and promotes abdominal breathing.
- Pala mudra helps to relax the body, slow the breath, and direct energy to the abdominal region, creating a state of peacefulness.
Asana
Experts suggest that yoga asanas that incorporate diaphragmatic breathing are beneficial for reducing SNS activation. Because some people may become more tense with a pranayama practice as a stand-alone practice, focusing on doing it “just right,” the following asana practice with breath awareness may help to reduce that focus:
- Makrasana: Lying on the abdomen, resting the forehead on folded arms, toes may be facing in toward each other or away from each other, pointing toward the edges of the mat. Bring awareness to the breath, and after several breaths, exhale completely.
- Parsva Urdhva Hastasana: Bend to one side from the waist with the opposite arm raised overhead and the other arm resting along the side body. Start by moving from side to side with corresponding arm movements. After three or four side bends, pause in the bend and focus the breath to the expanded area of the ribs and intercostal spaces between the ribs. Hold the side bend for three to five breaths on each side.
- Salama Sarvangasana: Stand with feet on the wall. Move in close toward the wall and place a folded blanket underneath the shoulders. Bring the feet to the wall with the soles of the feet resting flat on the wall, with the knees bent. The focus is on the breath in this asana.
Other asanas that have been shown to reduce anxiety include:
- Setu Bandhasana (bridge pose) modified for pelvic tilt: Start with an inhale, press the tailbone down, and extend the lower back off the mat. On the exhale, lift the tailbone and press the lower back toward the mat. It is useful to link one’s breath with this movement to enhance the engagement of the parasympathetic nervous system (PNS) and reduce SNS activity.
- Kumbakasana (plank pose): Kumbakasana may be held with the arms fully extended, keeping the hips in a straight line from the shoulders to the ankles. Consistent practice of this asana helps tone abdominal muscles and increase respiratory capacity, thereby decreasing SNS activity.
- Tadasana (mountain pose): This asana promotes optimal breathing by aligning both the physical and energetic bodies. The soles of the feet provide grounding and connection to the earth, while the crown of the head lifts toward the sky. Tadasana helps balance the nervous system while creating a stable foundation.
Yoga practices date back almost 5000 years and may be considered an integrative therapy for the management of mental health conditions, including anxiety. Yoga practices are holistic, encompassing mind, body, and spirit. Yoga has a rich history and offers a holistic approach for individuals who seek to maintain physical and mental well-being.
Nanci Kaczegowicz, MSN, APRN, FNP-C, PMHNP-BC, APHN- BC, is an advanced practice registered nurse with over twenty-seven years of experience. She is nationally certified as both a family and psychiatric mental health nurse practitioner. Her training in holistic nursing and yoga helps her promote spiritual, mental, emotional, and physical well-being. She is passionate about helping teens and adults experiencing depression, anxiety, insomnia, and chronic stress understand the root cause of psychological distress impacting their lives. Services may include medication, psychotherapy, therapeutic yoga, mindfulness, stress reduction, and relaxation techniques.