There are many ways to help people who are in psychotherapy. Sometimes talk alone works fine. Other times a more multidisciplinary approach is called for, especially with someone who is very anxious, someone who could benefit from calming methods that may include yoga, breathwork, and meditation. Paying attention to the breath calms the body and provides a focus for meditation.
One such person was Julie—not her real name—who came to my office for help with chronic anxiety and anxiety attacks. I’m both a psychotherapist and a yoga therapist, and she liked that combination of Eastern and Western techniques. I know from experience that practicing yoga and meditation can naturally reduce stress and anxiety in a person’s life. These simple, proven relaxation techniques can help you feel better.
Chronic anxiety is a fearsome state that feels like second nature to some. You wake up in the morning and there it is—shallow, fast breathing accompanied by a clenching, jumping stomach or a pit of emptiness. You want to pull the covers over your head and hide, or, worse yet, you can’t fall asleep in the first place. You’re frightened all the time, simply not at home in your own skin. You might even feel like you have no skin; your nerves are just exposed, reactive, and painful.
Anxiety attacks are even worse. They strike suddenly, seemingly without warning. You might faint. You might feel like you are going to die. Julie was having frequent attacks on the subway, and was afraid to go to work or out to meet with friends. She was becoming a recluse.
As part of treatment, I often employ a positive health approach including, when appropriate, an introduction to yoga breathing techniques, which synchronize body and breath, calling up the relaxation response.
People who are anxious breathe from the chest—it’s part of the fight-or-flight mechanism, which is useful in an emergency. Anxious individuals always feel like they are in an emergency, and chest breathing creates a body that is ready to react to danger all the time; the body becomes habituated to taking quick, short breaths, a vicious loop begins, and soon the body is in a continually stressed state, ready for fight or flight. Clearly, my first step with Julie was ending this vicious cycle, so I decided to teach her the three-part breath, which involves breathing from the diaphragm instead of the chest.
We are born breathing from the diaphragm. Anyone who has ever watched an infant, dressed only in a diaper and lying on his or her back, can see the process very clearly. Belly goes out, ribs expand, collarbone goes up—that’s an inhale. Collarbone goes down, ribs go in, belly goes in—that’s an exhale. You can see the diaphragm move. This is not part of the repertoire for people with chronic anxiety, and what was once natural, diaphragmatic breathing must be consciously practiced and learned—a chore, yes, but valuable because it reduces body stress and anxiety.
The three-part breath, or, as yogis say in Sanskrit, deergha swasam, stills the mind, creating a feeling of peace and spaciousness, providing a perspective from which to view, experience, and investigate thoughts, feelings, time, and space in the moment. Anxiety can be worked with as an entity with boundaries. Shaping anxiety makes it more approachable; it has a beginning and an end, a handle to grasp, and the person becomes less reactive.
Breath is both automatically and consciously controlled, a bridge between mind and body, as both ancient yoga teachings and current research affirm. As you know if you go to yoga classes, we consciously use the inhales and exhales while we go through a series of asanas, or postures. We inhale when we do an expansive, opening movement, and we exhale when we do a closing movement. If you want to try it, inhale your arms up over your head; exhale as you bring them down. That’s a simple yoga way to move, riding the breath.
Julie knew a little about yoga, and she was willing to attend gentle classes at a well-known school that emphasizes calming breaths and helps people learn to be centered and quiet. This studio offers classes in gentle yoga, restorative yoga, and deep relaxation, as well as more vigorous classes. Julie enjoyed the gentle yoga classes and found the calm atmosphere of the school helped her to feel less nervous. She was too antsy for deep relaxation, but enjoyed restorative yoga. Once she learned the different yoga postures, she started taking vinyasa, which links the breath with a series of movements in flowing sequences, almost like a dance.
Meanwhile, we continued to meet for talk therapy and meditation. We began our sessions with breathwork, a brief meditation which helped her center, and with time she learned to use her breath and the memory of the peaceful feelings she enjoyed when doing yoga, breathwork, and meditation, and she calmed down considerably. Her anxiety attacks stopped, and she might have stopped treatment then and there, but she decided that she had another big problem that she wanted to resolve. She was in a relationship, and she was pushing her partner away. Her severe anxiety issues had taken up all her attention, and now she knew there was more to deal with. Julie is a determined and persistent woman.
We continued to work using yoga, meditation, and talk therapy to bring Julie closer to her body and more aware of her emotional life. Guided meditations helped Julie to feel safe and grateful. This combination of safe feelings and self-acceptance helped her develop a more empathic, positive response to herself and to others. Julie is a good example of what can happen when you combine talk and body work.
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