Pranayama and its Effects
on Anxiety
Helen Manzella
Yoga: Theory, Culture
and Practice
Professor Laura
Douglas
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Anxiety in its purest form is our body’s
natural way of telling us to prepare ourselves for impending danger. Anxiety is
a physiological adaptation to help us mechanize quickly against threat. The
response of our body allows us to function at a high level of performance in a
situation that requires our most needed energy. Anxiety only becomes dangerous
when that response starts to trigger all the time, even when there is no actual
danger present. When one becomes anxious in an unhealthful way the person
afflicted tends to feel distress and fear that interferes with their ability to
function normally. In effect, the sufferer is not equipped to deal with the
everyday challenges and motions of life.
In biological terms this response is
called “fight-or-flight” which is an evolutionary adaptation that once in
prehistoric times helped us defend against predators, or quickly beckoned us to
grab our young and retreat to a safe cave when our tribe was under attack. The
[fight-or flight] “response occurs to any perceived threat, whether it is
physically real, psychologically upsetting, or even imaginary” (Khalsa, 256).
This response occurs in our Central Nervous System. The nervous system is
linked to our brain, spinal cord and peripheral nerves, which are divided into
two separate parts: the voluntary nervous system and the involuntary (or
autonomic) nervous system. The voluntary nervous system controls your immediate
reactions to sensory stimuli, such as the action of touching a hot stove, and
quickly removing your hand once the pain fibers are engaged and sent to your
brain. All of this happens quickly, without one having to “think” about it. The
autonomic nervous system on the other hand, controls the functions unbeknown to
us during our daily functioning such as: muscle tension, pulse rate,
respiration, glandular function and the circulation of the blood.
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The autonomic
nervous system is divided into two separate parts as well which are called the
sympathetic and parasympathetic nervous systems. These two system’s jobs are to
balance and regulate the body. If we become frightened and our heart starts
pumping incredibly hard the parasympathetic nervous system will intervene and
slow down the heart rate. If the heart rate then drops too dramatically the
sympathetic nervous system then will begin to speed up the heart rate to keep
the body functioning on a sustainable level. Inside the body when
our sympathetic nervous system becomes engaged the adrenal glands increase
adrenaline and cortisone production. This is what causes the common symptoms
people often associate with anxiety. For instance, the heart rate begins to
soar and the breathing becomes shallow, the hands and feet become cold and
muscles tighten and contract.
Since the 1970’s researchers have
been testing how yoga and other stress-reduction and meditation techniques can reduce
the presence of anxiety. With research still on the rise today, yoga has been
greatly commended for its triumphs in “modulating stress response systems”
(Kirkwood, 890). The physiological symptoms associated with anxiety mentioned
previously have all been found to become significantly reduced in many cases of
research, including heart rate, blood pressure, and respiration.
A particular form of yoga, which
invites controlled breathing, was studied for its positive affects on
eliminating anxiety. The breath-work yoga technique is called Sudarshan Kriya
yoga (SKY). SKY “involves several types of cyclical breathing patterns, ranging
from slow and calming to rapid and stimulating” (Janakiramaiah,
258). In one study, participants conducted 30 minutes of SKY breathing six days
a week. This study compared the use of this breathing technique with bilateral
electroconvulsive therapy and the antidepressant, Imipramine in 45 people who
were hospitalized for anxiety/depression.
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The study showed that out of the
participants who used the SKY breathing technique, 67% achieved remission.
Although the participants who received electroconvulsive treatment (93%) and Imipramine
(73%) achieved a greater success rate then those who participated in SKY
breathing, the study reveals a notably positive improvement which is still
incredibly valuable. This technique offers a natural, healthy and safe
alternative to deal with this disorder.
There are four focal techniques used
in SKY breathing. The first is called Ujjayi
or “Victorious Breath,” it is also sometimes referred to as “Ocean Breath.” It
is called this “because the sound created by the gentle contraction of the
laryngeal muscles (respiratory and phonoatory) and partial closure of the
glottis (vocal cords) is reminiscent of the sound of the sea” (Brown, 711). The
effect that this technique has on the subject is that of mental calmness and
alertness. The next technique is called the Bhastrika
or “Bellows Breath.” During Bhastrika
“air is rapidly inhaled and forcefully exhaled at a rate of 30 breaths per
minute (Brown, 711). Bhastrika
breathing is said to create a sense of extreme excitement, quickly followed by
a deep feeling of calm. During very long bouts of exhalation the “Om” mantra is
also chanted three times. This helps center the body and bring focus and
awareness to the breath. Finally, Sudarshan
Kriya or “Proper Vision by Purifying Action” is an advanced form of
cyclical breathing that alternates between slow, medium and faster speeds.
PRANAYAMA AND ITS EFFECTS ON ANXIETY Manzella: 5
The SKY method has been shown to
reduce anxiety in medical students with examination anxiety, caregivers of
demented persons and patients with mild anxiety disorders. In stressful
situations the Ujjayi method can be
employed to help restore a sense of control in the person suffering. It is
urged however that patients who are about to begin treatment with SKY should be
slowly assimilated into the treatment for fear that the rapid breathing
techniques may mirror too closely the symptom of hyperventilation, that are all
too familiar to those who suffer from panic attacks. For this reason, it is
very important that the instructor remind the patient that at anytime they may
discontinue their rapid breath and return to a medium or slow cycle of
breathing that feels easeful and comfortable to them. The patient should also
be informed that just because of the rapidness of breath this does not mean
that they need to exhale forcefully. The over-exhalation of carbon dioxide can
induce tingling and cramping in the extremities that can prove to be
counterproductive in the alleviation of anxiety. Some symptoms that go hand in hand with
overuse of the SKY method are dizziness, lightheadedness, irritability,
euphoric states, and psychosis. So it is also very important that the student
make sure to follow the “prescribed” amount given to them by their instructor.
The SKY method is said to be most
effective when paired appropriately with pranayama, asanas, and meditation.
From documented evidence it can be concluded that Sudarshan Kriya Yoga is a
“potentially beneficial, low-risk adjunct for the treatment of stress, anxiety,
PTSD, depression, stress-related medical illnesses, substance abuse, and for
the rehabilitation of criminal offenders”(Brown, 715). On a simpler note, yoga
has much history and literature to back its remarkable outcomes. It has been
widely agreed upon amongst researchers, physicians and scientists that yoga is
a dependable practice to help stabilize mood, attention, mental focus and
improve overall well being in its followers. Yoga has also been praised for its
mass accessibility; the more habitual the practice becomes in one’s daily
routine the greater the results. It is also suggested that one make sure they
have a reliable yoga instructor that can provide important advice. It is also
recommended that it is most beneficial if he person can attend weekly sessions
in which members of the group can process and share their experiences amongst
themselves as well as support one another fully.
PRANAYAMA AND ITS EFFECTS ON ANXIETY Manzella: 6
The use of breath work, or pranayama,
is useful to those who suffer from anxiety particularly because breathing
exercises help combat the physiological symptoms such as, short, tight
upper-chest breathing. Relaxation is the key to the elimination of anxiety
because when one deepens the breath by lengthening the exhalation they are
reducing the short shallowness of breath that is associated with the
inhalation. It is maintained that this lengthening of the exhalation can help
the person achieve a healthy level of carbon dioxide in the bloodstream that
helps in the relaxation process.
One technique that can be
particularly helpful for the eradication of anxiety in pranayama is called Bahmari, which in Sanskrit means “bee.” Appropriately
given because of the buzzing sound one makes when they are doing this
technique. To practice Brahmari
pranayama, find a place that is quiet and sit comfortably, with the spine
elongated, the shoulders relaxed and the shoulder blades rotated toward one
another. Start the exercise taking breaths as your body would naturally,
without effort. You may close your eyes, but it is also perfectly acceptable to
keep them slightly open if that feels more comfortable. Keep the lips slightly
sealed, but do not tighten them or clench the jaw, inhale deeply through the
nostrils, exhaling completely all of the air in you diaphragm, make the sound
of the letter “M.” Hold the sound for as long as possible before the
inclination to inhale once again arises. Repeat this for several minutes making
sure to bring awareness to your body’s limitations and sensations.
PRANAYAMA AND ITS EFFECTS ON ANXIETY Manzella: 7
The point is not to exhaust or push
yourself, you want the exercise to be stress relieving not stress inducing.
Finally when you feel satisfied with the practice sit there and take a few
breaths and inquire into how you are feeling in your body in that very moment. Do
you notice a change in your mood or breath or do you feel calmer? Even if the
exercise did not successfully alleviate your anxiety, it is important to tune into
that feeling and notice it, you will still be building a strong foundation for
future practice. Be mindful of this reality. The more effort you give to keeping
with practices like this one, the easier it becomes to master your anxiety.
Another study involving yoga and its
potential benefits to those who suffer from anxiety was taken at the All India Institute of Medical Science
in New Delhi. The overall aim of the study was to research the short-term
impact of a comprehensive but brief lifestyle intervention based on yoga and
anxiety levels in normal and diseased subjects. The sufferers that participated
in the study had a variety of illnesses including hypertension, coronary artery
disease, diabetes, obesity, gastrointestinal problems, thyroid disorders and
psychiatric concerns (which anxiety fell under). Although the study included
several different categories of intervention, the focus on pranayama is one that will be given particular attention. Anxiety
is treated as the largest major concern that contributes to unhealthy
lifestyles and eventually manifests itself as “pathogenesis of not only
psychiatric but also systemic disorders” (Grupta, 42). The article also insists
that the intervention of anxiety is absolutely necessary if the person with
disease wants to prevent and manage their disease on a long-term basis.
PRANAYAMA AND ITS EFFECTS ON ANXIETY Manzella: 8
The study was made up of 175
subjects in total who ranged from 19-76 years in age. The program that the subjects endured was an 8-day outpatient course that was comprised of 3-4 hours
of daily practice and lasted 10 days. As a part of a normal day the patients
would start by doing asanas (postures) followed by pranayama (breathing) for 1 hours
time. Along with the physical practice they also were counseled on how to make
proper nutritional choices and engage in other relaxation activities. The
ending of the day concluded with shavasana (relaxation technique) or
meditation. The pranayama techniques that were covered in the course were dog
breathing, tiger breathing, hands in and out breathing, interlocked hand
position breathing, chest holding breathing and stretch breathing.
During the activities the anxiety
levels of the participants were assessed using a questionnaire called the
‘State Trait Anxiety Inventory’ (STAI) (8). STAI is a self-report method of assessment
that is made up of two types of measurements. The first measurement is called
State anxiety (S-Anxiety). “S-Anxiety is defined as a transitory emotional
state characterized by consciously perceived feeling of tension and
apprehension. Trait anxiety (T-Anxiety) refers to relatively stable individual
differences in anxiety proneness” (Grupta, 44).
Along with the original assessment process, is the process of subscale
assessment in which the participants are asked to provide statements that they
would use to describe themselves. The qualities they evaluate are on the basis
of feelings of apprehension, tension, nervousness, and worry.
PRANAYAMA AND ITS EFFECTS ON ANXIETY Manzella: 9
The results of this study concluded
that at the end of the 10-day program both the State and Trait Anxiety scores
were “significantly lower than at the beginning in the intervention group”
(Grupta, 45). In the intervention group the mean scores for total anxiety were
24.4, the State Anxiety (12.4) and Trait Anxiety (12.0). By the end of the 10-day
period the total mean had dropped to 22.0, State Anxiety (11.0) and Trait Anxiety
(10.6). The study found that overall Yogic relaxation which includes pranayama,
amongst asana, relaxation techniques, and advice on how to conduct a healthier
lifestyle all reduced the physiological symptoms of anxiety such as racing
heart, palpitations, tremors, sweating, increased blood pressure, dry mouth,
avoidance behavior, signs of restlessness, and heightened responsiveness. In
essence the study proved that psychological stress has a clear correlation with
the risk of disease and proved the validity of pranayama and other yogic
stress- relieving techniques as valuable strategies to prevent anxiety.
Through the techniques of Sudarshan Kriya Yoga and other pranic
forms of breathing a sufferer of chronic anxiety has the opportunity to reduce
the presence of both their physiological symptoms and the psychological
problems beneath them. Pranayama and yogic breath work offers a safe, gentle
and very effective alternative to medical treatment and the use of prescription
drugs to help reduce anxiety. It seems that the commitment to a yogic lifestyle
is indicative to living a life in which the whole body's health is attended to.
One cannot employ just one strategy and continue on with all of their same
destructive habits. It is a commitment to the highest degree. It is important
that in conjunction with pranayama techniques one must also make an attempt to
radically improve their lifestyle. The practice of pranayama is only effective
if it is done consistently and with awareness. One must pay attention to what
is going on in their body and listen deeply to these inner cues; otherwise the
practice will bare little effectiveness for the afflicted person.
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(Feb. 2005): Vol. 11, No. 1, pp. 189– 201.
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Part II — Clinical Applications and Guidelines,"
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