When I had my first panic attack, I thought I was going mad. The feelings were so frightening and intense, I was convinced that my mind had somehow broken and couldn’t be fixed.
Panic attacks feel like the end of the world, and they’re not ‘all in the mind.’ The whole body is affected by the terror, with symptoms ranging from shaking, sweating and nausea through to chest pain, difficulty breathing and a pounding heart that feels like it’s going to explode. While panic attacks don’t actually cause the heart attack that a sufferer may think is imminent, the experience is no less terrifying.
After months of mis-diagnosis and daily anguish, I was very fortunate to meet an experienced yoga teacher who understood what was happening to me. Thanks to his careful support, I began to heal and my lifelong respect and passion for therapeutic yoga began.
What are panic attacks?
Panic attacks are bouts of overwhelming anxiety. They can last anywhere from a few minutes to an hour and can vary in frequency from once every few years to several times per day. At the height of my own panic disorder, I only had a few minutes each day when I wasn't experiencing acute symptoms. Some days, it was truly unbearable.
Panic attacks can strike at any time and while the direct cause of some attacks can be explained by particular circumstances (such as being in a crowded room or driving on unfamiliar streets), others appear to come from nowhere. For me, this apparent randomness generated acute anxiety. I never knew when the next one would hit and so, eventually, I gave up trying to leave the house altogether. Ironically, my panic attacks were being triggered by the fear of having them.
When somebody becomes overwhelmed by the fear of having another panic attack and starts changing their behavior to avoid situations and activities that they fear could trigger an attack, they may be diagnosed with a Panic Disorder. About 5% of Australians experience panic disorder during their lifetime, with slightly more women than men being diagnosed with Panic Disorder.
Treating Panic Attacks with Yoga Therapy
Yoga therapy can be a helpful complementary therapy for students with panic disorder (Vorcapic & Range, 2014; Khalsa et al. 2014). Students can learn simple techniques to stay grounded and connected to their breath and body during a panic attack as well as mindfulness-based practices to manage unwanted thoughts (such as anticipating future panic attacks).
Yoga's emphasis on paying attention to the present moment is particularly helpful for people suffering from a condition that could be characterised as extreme future-mindedness. It's fear of the future that causes panic attacks and, when sufferers can learn to feel safe, comfortable and focused in the present moment, the terror dissipates.
The skilful yoga therapist will work with the individual student to find the best techniques to suit their needs – there is never a one-size-fits-all solution. If a student has symptoms of, or has been diagnosed with panic disorder, a referral to a qualified counsellor or therapist is important.
Yoga techniques for managing acute anxiety and panic disorder
Relaxing muscle tension
Relaxation training is a recognised way of managing panic disorder(Lars-Goran et al. 1995). Teaching students to understand the difference between muscle tension and relaxation through asana can be very useful. For example, working with a posture that requires strength and concentration, such as a balance posture, then relaxing in savasana and noticing the differences in how the body feels. Alternatively, try the ‘clench and release’ process of progressive muscle relaxation (PMR).
Body and Breath
Breathing techniques can be an effective way to enhance relaxation. However, if a student is very anxious, it’s preferable to begin by moving the body and breath together rather than sitting still and focusing on the breath alone as this can increase feelings of agitation. Try sequencing two simple postures together (ie. Cat and Child) and repeating the movements, back and forth with the breath. This combination of rhythmic breathing and moving can be very soothing. Remember, panic attacks are experienced as whole-body events. Teaching students to connect body, breath and mind together in safe and enjoyable ways during yoga may help them manage the symptoms of a panic attack.
Seated pranayama is a very effective way to calm the nervous system, provided that the student is comfortable with the practice. Gentle techniques that emphasise long, smooth exhalation are useful, as well as staggering the inhale and exhale (such as in Viloma Krama). Alternate nostril breathing (Nadi Shodana) can also be helpful, but make sure the student is comfortable breathing through one nostril at a time as this can induce feelings of panic in some people. Chandra Bhedana (left nostril breathing) is another useful pranayama technique for managing panic disorder, stimulating the parasympathetic nervous system (the ‘rest and digest’ response) to help students to feel calmer (Telles et al, 1994).
Mindfulness meditation is often recommended for people with anxiety and panic disorders. While some people may find relief in a short mindfulness practice, others may find sitting in silence overwhelming. It can be helpful to start with guided meditations that are calming and reassuring – stick to ‘concrete’ concepts and imagery such as noticing sounds and sensations that are being experienced in the present moment. Many students enjoy yoga nidra, while others may find lying still with the eyes closed uncomfortable or even frightening. Meditation can be a very effective tool for helping students manage symptoms of anxiety and panic, but it’s important to prepare for meditation and choose techniques that are do-able and comfortable for the individual person.
Download your free Yoga for Panic Disorder practice plan:
Khalsa, M; Greiner-Ferris, J; Hofmann, S; Khalsa, S. (2014). Yoga-Enhanced Cognitive Behavioural Therapy (Y-CBT) for Anxiety Management: A Pilot Study. Clinical Psychology & Psychotherapy (22)4 364-371.DOI: 10.1002/cpp.1902
Lars-GöranÖst (1995). Applied relaxation vs cognitive behavior therapy in the treatment of panic disorder. Behaviour Research and Therapy (33)2 145-158. https://doi.org/10.1016/0005-7967(94)E0026-F
Telles, S; Nagaratha, R; Nagendra, H. (1994) Breathing through a particular nostril can alter metabolism and autonomic activities. Indian J Physiol Pharmacol. 38(2) 133-7.
Vorkapic, C; Range, B. (2014). Reducing the Symptomatology of Panic Disorder: The Effects of a Yoga Program Alone and in Combination with Cognitive-Behavioral Therapy. Frontiers in Psychiatry (5)177. doi: 10.3389/fpsyt.2014.00177