Yoga, stress and anxiety.

In the first year of the COVID-19 pandemic, global prevalence of anxiety and depression increased by a massive 25% according to the WHO.  That's a whacking estimated 264 million people who have anxiety or anxiety disorder.  We've now lived through years of a pandemic. Covid 19 infections have left a mark on our brains and nervous systems. As if that wasn't traumatic enough, we've got a cost of living crisis, climate change, world politics, war, food shortages and the worry of heating our homes over winter. Work pressures, family and relationships, money, covid's still out there, when you put it all together it's no wonder so many are struggling to cope. It's enough to make you want to curl up and hide.

We all know how it feels to be anxious every now and again because it's a natural human experience and an important defensive and protective mechanism. But when that occasional anxious feeing becomes persistent it can be extremely challenging and seriously affect quality of life.

I see it everywhere. Currently within my own family we are using yoga to try to help manage the overwhelming anxiety of school life, exams and social pressures.   The course of yoga therapy that I'm studying is a far more fascinating, rewarding and yet stressful, anxiety inducing experience than I could ever have imagined.  I regularly work on a one to one basis with people who feel too anxious to come to a group yoga class.

Stress or anxiety?

Some people use the word stress rather than anxiety to express their feeling and this is due in part to the cultural acceptance of stress, and the judgement towards outright anxiety. Often people say they're stressed rather than expressing they feel anxious although it may be they don't know the difference.

Anxiety and stress are similar but they aren't the same thing.  Generally, stress is the response your body produces to an external cause or threat such as a deadline at work or an argument with a friend.  It subsides when the situation has been resolved.  People under stress experience mental and physical symptoms such as irritability, anger, fatigue, muscle pain, digestive troubles, and difficulty sleeping. 

Anxiety, on the other hand, is a person's specific response to stress as well as a myriad of other factors  (to name a few: trauma, brain chemistry, environmental influences, genetics, use or withdrawal from substances, etc.)  It is defined by persistent, excessive worries that don't go away even in the absence of a stressor. It's origin is internal and can be characterised by a persistent feeling of dread in situations that are not actually threatening.  Unlike stress, anxiety persists even after the the concern has passed. 

Research looking at the effect of anxiety on the systems of the body usually looks at the effects of stress. The physiological responses associated with anxiety are called the stress response and not the anxiety response even though these responses are part of the feeling of anxiety. In addition to increasing risk factors for many diseases, an overactive stress response can result in emotional ill health. In particular an overactive stress response is associated with and can be the root cause of anxiety disorders.

Anxiety exists on a spectrum from mild to severe. The most common psychological features include racing thoughts and an inability to focus on anything else, but also may include shakiness, palpitations, hyperventilation, dizziness, digestive issues and frequent urination. It can exist as a stand alone condition and often presents alongside other health issues, eg menopause, cancer, heart disease, Parkinsons, autoimmune conditions, GI issues, hypertension, asthma.

Yoga and anxiety research

The most common forms of treatment recommended are psychotherapy and medication. A meta analysis of interventions for anxiety found the greatest efficacy for medication, followed by mindfulness based psychotherapies, CBT, relaxation techniques and exercise (Bandelow et al.2015)

Partly because of the diversity of yoga and the lack of a standardised practice, research into the effectiveness of yoga as a treatment strategy is still limited.

However what we do know from the scientific evidence available is that yoga does have significant therapeutic value in the management of anxiety.

One study showed that a yoga intervention significantly decreased anxiety and depression amongst high risk pregnant women hospitalised for bed rest compared with those not receiving yoga therapy. (Gallagher et al)

Another study studied the impact of yoga combined with information support methods on anxiety, depression and sleep quality among menopausal women.  Significant improvement in anxiety, depression and sleep quality was observed in the yoga group compared with the control group. (Lu et al)

It should be noted that some yoga styles and practices are contraindicated because of their extremely challenging and stimulating effects which may worsen symptoms. For someone in a hyper alert state, it may be challenging to be still, relax or even close their eyes. It is important that if you do have anxiety, you find a teacher who is suitably qualified and who understands the complexities of working with the condition.

What we do know about yoga and its effects on anxiety:

• Yoga has been proven to be an effective long term strategy for relief from symptoms of anxiety.
• Yoga works well alongside other medical interventions including medications and CBT.
• Anxiety populations have dysregulated and high levels of the stress hormone cortisol. Chronically high levels of this hormone can have particularly damaging effects on the body.
• Yoga down regulates the stress response via the HPA axis which reduces the amount of cortisol in the body and brain.
• Yoga increases the neurotransmitter GABA which is low in anxiety individuals.
• Yoga is a natural way to increase the 'happiness hormones' dopamine, serotonin, oxytocin and endorphins which can boost happiness and mood.
• Yoga increases vagal tone which allows greater control of the autonomic nervous system.
• Yoga supports self regulation of the autonomic nervous system and so increases physiological resilience to anxiety.
• Yoga practices can increase heart rate variability which is a measure of resilience and flexibility in the autonomic nervous system.
• The act of stretching helps with relaxing and activates the relaxation response.
• Yoga philosophy provides an effective framework for establishing a worldview that supports confidence and may ease anxiousness.
• The mind-body connection developed through yoga supports improved self awareness and may facilitate diet & lifestyle changes that reduce anxiety.
• The journey to health through yoga is a multidimensional experience that is not restricted to merely the presentation and treatment of one's physical or psychological symptoms.
• Not all types of yoga support anxiety reduction as the nervous system requires an approach that appreciates how to work with it intelligently.
• While those with mild anxiety may tolerate general yoga classes well, those with anxiety disorder and severe anxiety would be best served within specialist classes or working with a yoga therapist.
• Yogic practices which do support anxiety reduction include, certain breathing practices, grounding practices, mindfulness, mental noting, intelligent use of asana and guided relaxation that is tailored to the needs of someone with high sympathetic drive.