Anxiety: Definitions, Symptoms, Conventional Treatments

One may say that our mind creates our world. Thus our reactional patterns often become the source of suffering. A person in an anxious state of mind has readily created barriers around her own life thus impeding a free and creative unfolding.

In this context, anxiety can be defined as a psychological and physiological state consisting of cognitive, somatic, emotional and behavioral components. These elements jointly give rise to an unpleasant feeling that is typically associated with general uneasiness and worry, as well as apprehension and fear. Fear, however, is commonly related to specific behaviors of escape and avoidance and occurs in the presence of an observed threat. Anxiety, on the other hand, originates from threats that are perceived to be uncontrollable or unavoidable. If anxieties become abnormal or phobic, the individual will be unable to function in the society and world.

Anxiety can be highly vague, but this unpleasant feeling of fear of something can be categorized into at least five distinctive types as follows:
1: Panic – an extreme momentary fear without any obvious external cause.
2: Phobias – irrational fear resulting in conscious and forceful avoidance of particular objects, anticipated situations, people and other things. A phobia’s main symptom is the excessive and unreasonable desire to avoid the thing associated with the mentioned fear.
3: Obsessive-compulsive disorder (OCD) – a reiteration of thoughts (obsession) for something that has to do with a certain fear, like the fear of getting robbed, fear of acquiring a certain disease or fear of uncleanliness. Obsessive-compulsive disorders can virtually extend to anything or phenomena. OCD sufferers often perform different tasks which may seem abnormal to other people to relieve them of their particular fears.
4: Post-traumatic stress disorder (PTSD) – mainly brought about by excessive negative past experiences rendering one feel helpless and / or fearful. People suffering from PTSD often also are affected by insomnia, nightmares, flashbacks of particular events, and depression.
5: Generalized Anxiety Disorder – a general feeling of ‘angst’ or aroused fear of anxiousness of being in this world and living in a society without a clear object of anxiety projection.

In 1959 M. Hamilton developed the widely used interview scale called the HAM-A (Hamilton Anxiety Scale) that measures the severity of a person’s anxiety. It is based on 14 parameters which include anxious mood, tension, fears, insomnia, somatic complaints and behavior.

Physical symptoms of anxiety can consist of heart palpitations, muscle weakness and tension, fatigue, nausea, chest pain, shortness of breath, stomach aches, headaches or any combination thereof. In general, the body gets into an alarm mode to respond to a threat: Heart rate and blood pressure are increased, sweating is initiated, major muscle groups are activated, and at the same time the immune and digestive functions are inhibited – this is the common fight or flight response. External signs in a patient with anxiety may include papillary dilation, sweating, trembling and pale skin. A quite common symptom can also be a sense of dread or panic. Panic attacks may even be confused with heart attacks.

Symptoms of anxiety are also emotional in addition to the physical ones:  Feelings of apprehension or dread, difficulty concentrating, feeling tense or jumpy, irritability, restlessness, nightmares, déjà vu or a general feeling of being trapped. Cognitive symptoms of anxiety can include intense thoughts about suspected dangers, such as the fear of dying.
While anxiety is commonly psychogenic, i.e. its origins are in the mind, there are also indications that an inherited disposition may exist, that childhood experiences and conditioning can be causative or that it may even be related to impairments in the functioning of the brain. Generally speaking, anxiety disorders are driven by tension and a weak mind. From a psychoanalytical perspective, acute anxiousness is not a response to the object itself, but to the possibility that some unacceptable unconscious material may be about to become conscious. The main moment here is that of repression and anxiety thus elucidates the interdependence of our mind and body.

There are three broad categories of conventional western therapies for anxieties: Psychotherapy, behavioral therapy, and medication.

Psychotherapy involves a psychotherapist talking to the person suffering from anxiety attempting to make unconscious material conscious. A therapist would commonly apply associations, discussions and a generally supportive environment.  Psychotherapy usually offers mixed results since unconscious material cannot always be disclosed. Also, the physical effects are not addressed in this approach.

Behavioral therapy aims at the patient’s patterns of thinking and acting to retrain behavioral patterns. There are techniques like desensitization which gets patients to work from the least to the worst fear in their imagination and exposure where the patient actually is put into the situation or approaches the object with the purpose of experiencing the decrease and passing away of the fear.  This method may also apply relaxation techniques prior to exposure. Exposure has proven to be effective as moving through the fear situation acquaints patients to living with the fear rather than avoiding it. At times, however, exposure results in detrimental effects as it tends to put patients into a ‘do-or-die situation’. Also, it aims at developing a healthy ego, which is a somewhat contradictory approach if the ego is perceived to foster a sense of separateness.

Medication involves the short or long-term use of drugs, above all tranquilizers. This can only be useful short-term, as it does not give patients the opportunity to solve their own difficulties if this method is applied solely.

Treating Anxiety with Yoga Therapy

The advantages of treating anxiety with yoga are grounded in its holistic approach to any mental and psychosomatic ailments. The mind, body, emotions are addressed as a whole in yoga. For this reason, yoga therapy is very suitable to remove the root cause of anxieties through the application of Yoga Nidra (= yogic sleep) and meditation, asana, cleansing techniques, pranayama, mudras, and bandhas. Naturopathy practices like hot foot bath, steam bath, and mudpack may well enhance the positive effects of yoga therapy. This anxiety is not only corrected on the egoic behavioral level as in conventional western therapies, but the nervous and endocrine system, as well as the prana or energy in the body, are balanced, resulting in overall greater mental and emotional equilibrium.

In this context, it is an important contribution of yoga to assert that body, mind, and emotions are sustained by ‘prana’, the subtle force creating all life. In fact, our whole existence is understood as vibrational energy in yogic terms. This energy vibrates at different levels of intensity making up solids such as bones, liquids like blood and urine and gases like the air we breathe are all at the gross level, while emotions and thoughts are at the subtle level. The seven chakras, which correspond with nerve plexi in the gross physical body, link these energies and the nadis – energetic currents, throughout their extensions in the body.  If anxiety disorders arise from suppressed material in the subconscious mind, a yogic approach would assert that these complications are stored in the chakras and in the flow respectively blockages in the nadis. These so-called samskaras are the impressions, in this case – tensions, from our karma from past lives. Imbalances or blockages in the chakras or nadis cause disease. Without further elaborating on the chakras here, it may be assumed that anxiety involves at least Mooladhara – fear, and Manipura – the need to control that characterizes states of anxiety. Also involved would be Ajna, the location of mental worry and anxiety, the heart center or Anahata and the throat center – Vishuddi, inability to speak.

In relation to the nadis Ida and Pingala are the most relevant here. Ida is linked to the left side of the body and the right side of the brain, moving in the left nostril, while Pingala controls the right side of the body and the left side of the brain and moves in the right nostril. Ida and Pingala meet and cross at each of the chakras which are linked by Sushumna moving in the central spinal column. Unbalanced ida is thought to make a personality introvert, depressed and paranoid, while unhealthy pingala is related to a too sedentary lifestyle. Hence the personality type of an anxious person appears to be overactive ida. Yoga as a therapy would need to address the outlined imbalances from the unconscious mind, conscious mind, to the emotions and physical body involved in anxiety disorders.

Here are some yogic practices that would be helpful in dealing with anxiety. It is assumed that the person, apart from suffering from at least one of the types of anxiety is of good health and that there are no further complicating ailments, like for example high blood pressure, heart diseases, slipped disk or the like.

Asanas: Pawanmuktasana and Surya Namaskara offer great benefits as they work to balance the entire body and endocrine system. The speed at which they are performed should be rather slow though as an anxious person generally needs to calm down. It goes without saying that the speed and intensity of each asana would need to be adjusted to the overall capability of the person. Shaschankasana, marjariasana, ushtrasana, the trikonasana series, chkrasana and dhamvasana work on the adrenals. The shakti bandha series, spinal twists, paschimottanasanaand and bhujangasana are also recommended. Inversions may be practicedby the more experienced student, as they can be very beneficial for the troubled mind by stimulating the pituitary gland and supplying the brain with fresh blood carrying oxygen and nutrients. Inversions may include sarvangasana, halasana and sirshasana. Advanced postures may also include garbasana and koormasana, both poses that strongly induce mental relaxation.

Pranayama: Pranayama is extremely important and beneficial in yoga therapy as it balances the nadis and chakras and therefore the gross physical body. Khumbakh (breath retention) should be generally avoided for patients of anxiety as this would require a stable mind and can create tension for the nervous system. Nadi shodana is especially beneficial as it directly balances the nadis, thus purifying the pranic system and bringing the whole body into balance. Ujjayi, the ‘victorious’ or ‘psychic’ breath, is useful to induce stillness, clarity, and calm. Bhramari, the humming breath, is useful to alleviate mental tensions and worries. Bhastrika revitalizes the sympathetic nervous system and Kapalbhati tones the parasympathetic nervous system. These two pranayamas hence can be regarded as complementary practices if they are not contraindicated due to hypertension in the anxiety patient.

Mudra: Vipareeta Karani, Pashinee mudra, Shambavi mudra, Prana and Yoni mudra – these mudras or psychic gestures focus the mind and concentrate the flow of energy in the body.  Shambavi Mudra, for example, is an excellent method of introspection, stimulates Ajna chakra and generally strengthens vision, all highly beneficial effects for a person in a state of anxiety. These Mudras, as well as the application of Bandhas (body locks), will help the patient to focus, balance energies in the body and prepare for meditation, a very effective practice against all states of anxiety.
Bandhas: Bandhas – (Jalandhara, Moola and Uddiyana Bandha) should be carefully chosen based on the patient’s progress and the overall state of mind as they can initially arouse people with high blood pressure and heart ailments as well as colitis or ulcers (uddiyana) should avoid these bandhas. If they can be applied with comfort, however, they have a very beneficial effect on the flow of prana: Moola Bandha directly stimulates Mooladhara Chakra and Jalandhara Bandha works on Vishuddi.

Yoga Nidra: The most effective, especially if the patient is just starting with yoga practices, are meditation, yoga nidra and Omkar chanting, while the practice of meditation usually requires prior practice of yoga nidra and Omkar chanting to quieten the mind. Both these practices will have an immediate calming effect on the patient. In fact, they can be practiced almost non-stop for initially to days to remove acute anxiety. As there are no contra indications these are fabulous tools.  Yoga Nidra is psychic sleep working with visualization techniques bringing greater awareness and calm. The vibrational energy of the primordial ‘Om’ (Omkar chanting – A-U-M) is tremendously healing vibrational energy for the whole body and mind and should be part of any asana practice as well. This practice can bring some spaciousness into the inner cage of anxiety and foster self-acceptance, a key element in overcoming anxiety. Once the patient becomes proficient in yoga nidra, the practice of inner silence (antar mona) allows the anxious person to watch the mind without judgment, allowing all thoughts to come to the mind and accepting all experience as internally caused. Ajapa Ja is also recommended for anxiety. This practice involves the repetition of a mantra and effectively takes away the attention from the situation which has triggered anxiety.

Shatkarma: These are various cleansing techniques greatly helping an anxious mind. The cleansing techniques don’t only remove waste products from the body, but above all strengthen the mind and increase the resistance of the nervous system. These techniques include Agnisar (the fire breath – practice 100 strokes total in 3 to 4 rounds), Uddiyana Bandha (5 rounds of each 30 seconds), Jalan Neti (once a week) and Laghoo Shankaprakshalana (once per week). Also, Trataka (candle gazing) and Kunjal offer great benefits.

Diet: The diet for a patient of anxiety should be normal food with fewer fats and carbohydrates but with high fibers. The best food, in fact, is fresh fruits and vegetables, replenishing the body with plenty of prana. Avoided should be any non-vegetarian food, oily and spicy food, any refined food, fast food, and preserved food as well as too much salt. A healthy diet should support a well-balanced lifestyle aiming at overall body-mind harmony avoiding unnecessary stress.

Naturopath Practicals: The aforementioned naturopathy practicals hot foot bath, steam bath and mud back can enhance the recovery for a patient suffering from acute anxiety. These practicals are calming, alleviate stress and help introspection, apart from the benefits, apart from the benefits for the gross physical body.

Yoga therapy offers tangible benefits for all types of anxiety. A yogic approach shifts mental emphasis from the external environment to the inner attitude and from having a fixated egoic perception to a systematic transformation. In April 2009 the Harvard Medical School published an article called ‘Yoga for Anxiety and Depression’ by and large supporting the claims for the beneficial application of yoga therapy to anxiety disorders. The article cites studies from the University of Utah where researchers showed that yoga significantly modulates the stress response system and increases pain tolerance in patients.  A German study from 2005 showed that 24 women decreased their anxiety scores by 30% over a period of 3 months. And in Australia, one randomized controlled study examined the effects of yoga and a breathing program in disabled Australian Vietnam veterans diagnosed with severe PTSD. After a five day course, their PTSD scores came down from moderate to severe symptoms to mild and moderate. So, there are strong indications that yoga therapy relieves anxiety disorders and while it may be valid to consider that pharmaceutical lobbies in major industrial countries don’t necessarily favor yoga therapy as it would mean a loss in business. In this context, a compelling argument for yoga therapy may be that it empowers the individual to become her own healer, an underlying requirement for self-actualized people faced with the environmental and social challenges of the earth in the year 2010 and beyond.