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Swami Niranjanananda Saraswati

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Swami Niranjanananda Saraswati

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Sannyasi Karmadhara

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Swami Pragyamurti Saraswati

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Swami Niranjanananda Saraswati

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Phobias: Yoga in the Treatment of Extreme Anxiety
Jigyasu Yogamrit


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Phobias: Yoga in the Treatment of Extreme Anxiety

Jigyasu Yogamrit (Ingrid Fitzgerald, Australia)

“Automatic and involuntary circulation of psychic contents is at the root of all human misery. Automation gives us a sensation of imprisonment in our own mental cages. It robs us of the freedom to think, feel and choose. We feel that we are bound and driven to act.”
Shivaram Karikal

Introduction

Our habitual responses to the world around us are often the source of our suffering; we go through the same reactions time and time again, apparently unable to change. For people who experience extreme anxiety states, such as phobic anxiety, life is indeed a cage; they are unable to act freely, hedged about by terrors which, while they appear to be externally caused, most often come from within the mind. These people often despair, avoiding the situations which trigger the anxiety, and even coming to rely on the anxiety to secure the support and energy of others.

According to western therapists, fear is 'a normal physical response to an external threat', an 'appropriate' response to a really imminent danger, while anxiety is a fear reaction without a clear or 'sensible' cause, an 'inappropriate' response. Anxiety can be 'free-floating' – chronic and not attached to any specific situation or object – or phobic – attached to a particular object or situation. Anxiety states are also related to so called 'neurotic' disorders, psychosis and schizophrenia, and to organic brain syndromes. They are closely related to depression, which is often the 'flip side' of anxiety, a result of the imbalance caused in the endocrine and autonomic nervous system by the overuse and exhaustion of the 'flight' responses.

It can also be argued that most of us live with a degree of anxiety or stress – understood as the overstimulation of the autonomic nervous system, which leads to exhaustion and disease. Sometimes the distinction between the 'real' external cause and the 'irrational' response is difficult to make – which fears are real and reasonable depends on the individual. In fact, a yogic approach would suggest that all fear, hatred, jealousy, anger, etc. are in a sense 'neurotic': our avoidance of or aversion for things or situations is a result of our phobic attitude, and based on the illusion of a separate, egoic 'self'. Anxiety states are, therefore, a matter of degree, ranging from 'normal' stress to abnormal 'neurosis' or 'psychosis' – the extremes of states of ignorance and despair.

Phobias – abnormal anxiety

In our everyday experience, anxiety becomes 'abnormal', or phobic, when it prevents us from functioning fully in the world. A phobia can be defined as a persistent and irrational fear or dread, hatred or aversion for a specific object, activity or situation, resulting in a compelling desire to avoid the anxiety-inducing stimulus. The fear is recognized by the individual as excessive and unreasonable.

There are three broad groups of phobias: (i) simple phobias, in which a situation or object provokes anticipatory anxiety and avoidance, and panic attack if sudden exposure occurs; (ii) social phobias, which develop in adolescence and in which the person is concerned about shameful, stupid or inept acts, and (iii) agoraphobia, the fear of crowds in public places. Each of these phobias is incapacitating to the person, since it prevents them from engaging in ordinary activities, such as shopping, eating in public, etc. In contrast to free-floating or general anxiety, phobias are particularly characterized by a fear of fear: anticipation of the situation as bad as, or worse than, the event.

Symptoms and causes

Physical symptoms of phobic anxiety, which worsen during the acute stages of panic attack, include: chest pain, palpitations, drop beats, flushing, feeling faint, sighing, choking, yawning, dyspnoea, dry mouth, 'butterflies', nausea, abdominal pain, diarrhoea, frequency/hesitancy of urination, sexual dysfunction, tension headaches, blurred vision, sweating, ringing in the ears, shaking, dilated pupils, teeth clenching and chronic jerks. Psychological symptoms include: feelings of impending disaster, worry, inability to relax, not being able to cope, restlessness, sense of 'not being yourself', insomnia, nightmares, depression and panic attack. Some of these symptoms are also experienced in chronic ongoing anxiety or stress. The person often believes they have a physical condition such as heart disease, and this contributes to their anxiety.

In physiological terms, anxiety states are a result of overstimulation of the autonomic nervous system. The limbic and psychic centres in the brain are highly sensitive to emotional states such as fear. They in turn stimulate the hypothalamus which triggers the ANS and endocrine system to respond to the threat. The parasympathetic and sympathetic nervous systems which control the automatic processes of the body, such as digestion, respiration, blood pressure, etc. are thrown into an imbalanced state; the sympathetic nervous system is stimulated and hormones are secreted – thyroxin from the thyroid and adrenaline from the adrenals – resulting in the symptoms listed above. Long term imbalance in the autonomic nervous system and endocrine system caused by high levels of panic and anxiety also leads to exhaustion and depression and can result in lowered immunity as in conditions such as Chronic Fatigue Syndrome.

According to western therapists, certain types of people are more prone to experience phobias. Agoraphobics, for example, tend to be introverted, prone to depression, obssessive, full of self-defeating and self-punishing thoughts, and afraid of loss of control. They have difficulty expressing their feelings and communicating their needs and desires, especially anger and frustration. Agoraphobics, in particular, may tend to be female rather than male, a result, at least in part, of social conditioning which teaches women to be passive, introverted and fearful.

Causes of phobic anxiety are said to include: inherited disposition, childhood experiences and conditioning, and may be related to conditions where the functioning of the brain is in some way impaired. However, phobic anxiety is usually psychogenic; it originates in the mind. A psychoanalytic perspective suggests that the anxiety response in phobias is not to the object or the event itself, but to the possibility that some unacceptable unconscious material is about to erupt into consciousness. Phobias are therefore understood as a result of repression: when the repressed event or content threatens to come to consciousness, the frontal passages of the brain are stimulated – the limbic and psychic centres – and a panic attack results. While the threat begins in the mind, the body responds as if it were real. Phobias thus illustrate the interdependence of the mind, body and the unconscious forces which shape our experience.

Conventional western therapies

Western therapeutic treatment of phobic anxiety comes into three broad categories: psychotherapy, behavioral therapy and medication. Briefly, psychotherapy involves what is known as the 'talking cure', the attempt to bring unconscious material into consciousness through association, and discussion in a supportive environment. Behavioral therapy is aimed not at uncovering the causes of the phobia, but at the person's patterns of thinking and behavior, working to retrain the body and mind. Techniques include: desensitization, where the person works through the fears from least to worst, confronting them in their imagination; flooding, where the worst fear is imaginatively confronted; and exposure, where the person actually enters into the situation or approaches the object so that they can experience the fear lessening and passing away. Relaxation techniques are also taught in this method. Medication involves the short or long term use of drugs, mainly tranquilizers.

Of these three methods, exposure has been found to be very effective. Facing, accepting and moving through the feared situation gives the person confidence and teaches them to live with the fear rather than avoiding it. The least effective of these therapies is medication, which is at best a short term solution, and does not allow the person to solve their own difficulties. Psychotherapy offers mixed results, since it is not always possible to access the repressed material, and it does not address the physical aspects of the phobic anxiety. Finally, another limitation of many western therapeutic approaches is their emphasis on developing a healthy ego, surely a contradictory approach if the ego is seen to contribute to a sense of separateness – the fear of those things 'out there' or 'in here' which are not conscious or amenable to our control.

Holistic approach of yoga

What then can yoga offer the person with phobic anxiety? The advantages of yoga lie in its holistic approach to any so called 'mental' problem, since yoga views and treats the mind, body, emotions and energetic systems as a whole. In the case of phobias, the practices of asana, hatha yoga, pranayama, meditation and yoga nidra work to balance the nervous system and the endocrines, and the prana or energy in the body, bringing greater emotional and mental calm.

According to a yogic understanding, the body, mind and emotions are comprised of and sustained by 'prana', the subtle energy or force that creates all life. Our whole being is understood as energy vibrating at different levels of intensity. Solids such as the bones, liquids such as urine and blood, and gases such as wind and the oxygen we breathe are the more gross levels, while the more subtle levels include emotions, thoughts and the energy we experience in the body in practices such as acupuncture, healing with reiki and so on. The energy bodies are linked in and through the seven chakras, which correspond with nerve plexuses, and the nadis, currents of energy – meridians – which link the chakras and extend throughout the body.

Role of the chakras and nadis

If phobias are a product of repressed material, yoga suggests that the combination of genetic and environmental impressions is stored in the chakras, and in the flow or blockage of the nadis. These impressions form our karma, our emotional, mental and physical inheritance from past lifetimes, and samskaras, the knots or tensions in our unconscious mind. Overactivity or underactivity in the chakras or nadis causes disease. Mooladhara chakra, at the perineum or cervix, is the site of these karmas and knots, and is also the location of our primal energy. When unbalanced, fear, insecurity, low vitality and self-esteem, depression and fear of the future result. Swadhisthana, at the coccyx/pubic bone, is related to the subconscious mind, pleasure and the repression of pleasure. Manipura, at the navel, is the site of all power, the desire to control, and self-assertion, and is related to the stomach and the adrenals. Anahata, the heart centre, and vishuddhi, the throat centre, are related to love and communication respectively. Ajna chakra, the eyebrow centre, controls the activity of the brain.

Speculating, we can say that a phobia probably involves at least mooladhara – fear, anxiety, and manipura – the desire to control the anxiety, the fear of fear and need to control that characterizes panic and anxiety states. Ajna chakra, the site of mental worry and anxiety, is also involved, as are the heart centre – palpitations, and the throat centre – inability to speak. The unconscious fears at mooladhara may be related to repression of primal energy, or sexuality, as Freud suggested.

Of 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 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. Unhealthy ida is said to result in introversion, depression and paranoia, and ongoing mental tensions, while unhealthy pingala is related to lack of exercise, sedentary lifestyle and overeating. Since ida relates to the parasympathetic nervous system and pingala to the sympathetic nervous system, an imbalance in these nadis will reflect an imbalance in the systems, as in panic attack. The 'personality type' of a phobic person seems to be overactive ida.

Asanas and pranayama in yoga therapy

This brief analysis shows that the whole system from the unconscious mind, conscious mind, to the emotions and physical body is involved in phobic anxiety. Yoga treats each of these levels and the subtle interrelationships between them. Asanas are important in balancing the physical body, the endocrine system, and on a more subtle level, the chakras and prana in the body. Surya namaskara is of great benefit for all anxiety states because it works to balance the entire body and endocrine system. Shashankasana, marjariasana, ushtrasana, the trikonasana series, chakrasana and dhanurasana work on the adrenals. The shakti bandha series, spinal twists, paschimottanasana and bhujangasana are also recommended. The inverted poses: sarvangasana, vipareeta karani mudra, halasana and sirshasana can be practised by the more experienced student. The hatha yoga cleansing techniques are also advised. Kunjal is especially beneficial for releasing tensions held in the manipura area. Neti and shankhaprakshalana are soothing and work to tone and balance the body. Kapalbhati works to remove impurities and makes the mind calm, while trataka, working on ajna chakra, influences the pineal gland, the hypothalamus and the sympathetic nervous system.

Pranayama is an extremely important aspect of yoga therapy because it works to balance the nadis and chakras and, therefore, the physical body. Ujjayi, the 'psychic' breath, brings stillness, clarity and calm. Bhramari, the humming breath, is useful to alleviate mental tensions and worries. Nadi shodhana is especially beneficial because it works directly on the nadis, purifying the pranic system and bringing the whole body into balance. Since bhastrika revitalizes the sympathetic nervous system while kapalbhati tones the parasympathetic nervous system, these practices are complementary. People with anxiety will benefit from using these practices and determining which ones are most effective for general relaxation, and which, such as nadi shodhana, are suitable for use during a panic attack.

Yoga nidra and meditation

Meditation and yoga nidra are key practices in the management of phobic anxiety. Yoga is not designed primarily as a therapy, but to bring us to greater awareness and calm, even to transformation. Yoga teaches us to change the inner environment so that all our fears, anxieties and miseries will gradually lessen. Meditation can bring some spaciousness into that inner cage. An important aspect of the practices of yoga is self-acceptance. Phobic anxiety is characterized by fear of one's own nature and by a denial of what we are actually feeling, in other words, by aversion. Phobics often go to great lengths to hide their fears from others, and indeed, many phobias are related to anxiety about how others will perceive us, reflecting our self-hatred.

The practice of antar mouna, 'inner silence', allows us to watch the mind without judgement, allowing all thoughts to come to the mind and accepting all our experience as internally caused. 'External' conditions, such as sounds, are brought into the inner experience and we learn to observe our habitual reactions. Antar mouna is a beneficial technique to use when the mind becomes disturbed by a situation, since the reaction, rather than being pushed away or avoided 'with fear, dread, hatred or aversion' is steadily observed: we face the fear. Ajapa japa is also recommended for anxiety. This practice, which involves the repetition of a mantra so that it becomes spontaneous, effectively takes the attention from the situation which has triggered the anxiety. It may be more effective than antar mouna when the feeling of aversion is overwhelming, since it distracts the mind from the situation – a technique also used by therapists in anxiety management.

People experiencing phobias are often at a loss to explain why they are afraid of that object or situation. They know the anxiety is 'irrational', but cannot access the original causer, which may be deeply repressed. In my view, yoga nidra is probably the most powerful practice in the long term treatment of phobias and extreme anxiety. Not only does it provide the relaxation skills which are so helpful to the phobic person, it can also be used in the processes of exposure, desensitization and flooding. Once they are familiar with the yoga nidra state, the person visualizes going through the feared experience in the imagination, while remaining in the relaxed state: either beginning with the easiest situation (desensitization), or the most frightening one (flooding). Similarly, when in the actual situation, the person can use yoga nidra techniques to relax and 'stay with' the fear. Yoga nidra also acts as a 'tranquilizer' to balance the hypothalamus and relieve anxiety states.

Most importantly, the regular practice of yoga nidra gives access to the deep unconscious and subconscious forces which are the basis for the phobia and allows them to be released. In the advanced stages of yoga nidra, practitioners are asked to submit voluntarily to threatening emotions while preserving a state of deep relaxation and 'witness awareness' to the whole process. A specific program of yoga nidra, beginning with the basic technique and continuing into specific guided visualizations, should be constructed, with a teacher who can guide the person through this process. Therapy and yoga can work together well in this context.

Conclusion

A yogic approach to therapy for phobias and related anxiety states offers real benefits to the sufferer. Yoga shifts the emphasis from the external environment to the inner attitude, and from 'fixing' the mind or ego to a systemic transformation. Finally, it empowers the person to become their own healer, teacher and psychoanalyst!

Bibliography

Saraswati, Swami Suryamani, Yogic Management of Stress, Bihar School of Yoga, Munger, Bihar, 1990.
Saraswati, Swami Satyananda, Kundalini Tantra, Bihar School of Yoga, Munger, Bihar, 1984.
Saraswati, Swami Satyananda, Asana Pranayama Mudra Bandha, Bihar School of Yoga, Munger, Bihar, 1993.
Saraswati, Swami Satyananda, Yoga Nidra, Bihar School of Yoga, Munger, Bihar, 1984.
Karikal, S., Vedic Thought and Western Psychology, Arathi Publications, Mangalore, 1994.
Williams, W., The Current Management of Anxiety States, Modern Medicine of Australia, August, 1976.
Molnar, B. & Evans, L., The Management of Phobias, Patient Management, February, 1983.
Williams, W., Understanding Sexual Phobias, Modern Medicine of Australia, July, 1984.

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