Mental Health Awareness Week 2023
Anxiety
The UK Mental Health Foundation explained the choice of “anxiety” for Mental Health Awareness Week 15-21 May 2023 was to “kickstart a nationwide conversation, encouraging people to share their own experiences and any helpful ideas on how they manage anxiety”, Alexa Knight, Director of England at the Mental Health Foundation.
An anxiety response can be triggered by external or internal events and tends to manifest in feelings of dread, fear and uneasiness and physiological symptoms including rapid heartbeat, sweating and digestive issues.
State anxiety is in response to a particular perceived event (exams!) and trait anxiety is associated with an anxious personality. Extreme anxiety which becomes excessive, uncontrollable, more maladaptive, manifests with a wide range of symptoms affecting behaviour and cognition and happens often over time may be a sign of a pathologic anxiety disorder.
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) lists anxiety spectrum disorders as; - general anxiety disorder (GAD), separation anxiety, social phobia, selective mutism, agoraphobia, panic disorder, specific phobia and they share several symptoms including poor sleep, concentration and reduced occupational and social functioning.
Whether a diagnosed anxiety disorder or an anxious reaction to a set of events, anxiety can affect us all from time to time.
Navigating a global health pandemic, increased social isolation, political uncertainty, rising costs of living and worries about climate change are all potential factors in current increasing levels of anxiety amongst adolescents and adults. Although I remain uncertain about labelling a particular week as “mental health awareness week” I applaud the campaign’s intentions and efforts to highlight the need for more mental health awareness. The statistics are concerning.
The latest mental health statistics show that:
1. Every week in England, 6 in 100 people will be diagnosed with generalised anxiety disorder (Mind)
2. In the UK, over 8 million people are experiencing an anxiety disorder at any one time (Mental Health UK)
3. Less than 50% of people with generalised anxiety disorder access treatment (Mental Health Foundation)
How can Yoga Therapy help?
In a previous blog I have talked about the Koshas as a therapeutic lens through which to view the whole person and through which yoga therapists may introduce techniques to alleviate the physical, physiological, and emotional symptoms of anxiety.
Yoga practices including movement and breathwork provide ideal opportunities to build emotional regulation, release excess energy and activate the calming parasympathetic nervous system. Mindfulness provides the chance to downgrade an overactive amygdala (our brains alarm bell), an opportunity to support present moment attention and step away from constant and fearful rumination about the future.
A number of studies have found yoga (Hoffman et al 2016) (Hardoerfur et al 2018) and mindfulness to be effective techniques in the treatment of anxiety (Rodrigues et al 2017) although the research tends to find positive results on the benefits of yoga for alleviating general anxiety rather than specific anxiety disorders and this may be because an initial downgrading of the acute physiological response being experienced is required in addition to an individualized approach in the practices offered.
When working with individuals with anxiety starting points for yoga therapists are likely to be ensuring safety such as a quiet, private, and appropriately heated and lit space to practice in and avoiding uncertainty by explaining what the practices involve. For some experiencing anxiety long holds and stillness could be unbearable and allow for rumination and overthinking so perhaps initial movement is preferable but for others an increase in heart rate from movement may make them feel anxious. Thus, highlighting the importance of an individualized approach.
What can you do if feeling anxious?
1. Breath
Controlling our breath is an incredible free tool which we already have at our disposal which can downgrade the sympathetic nervous system, activate the calming para sympathetic nervous system, and help improve emotional regulation. In addition to specific practices such as Ujjayi breath or Brahmari breath which help lengthen the exhalation my favoured techniques are slowing the breath down and drawing awareness to diaphragmatic breathing by focusing on the movement in the abdomen (rising on the inhalation and falling on the exhalation), and grounding breath ( inhaling from the ground up the body to the lungs and exhaling from the lungs down the body to the ground).
2. Mindfulness practise
The 5,4,3,2,1 technique- acknowledge five things you see around you, acknowledge four things you can touch around you, acknowledge three things that you can hear, acknowledge two things that you can smell, acknowledge one thing that you can taste.
A practise which can help to ground us in the present when our thoughts are running away with us.
3. Movement and stretches – a great way to provide relief from hyperarousal, to capture attention and focus the mind and to release calming serotonin is to move (whether cat/cow or a sun salutation). Stretches provide the opportunity for para sympathetic system arousal and that “ahhh” sensation as the body experiences the stretch response and relaxes into the long hold stretch. Consider alternating movement with relaxation (cat/cow followed by childs pose) which lifts and lowers the Autonomic Nervous System and builds ANS regulation.
4. Other practices – some of my personal favourites including.
. Walking meditation – combines the benefits of movement with mindfulness and is often more accessible if seated meditations are challenging. It can be a wonderfully grounding practice and even better when practised outside with the sounds, smells, and sights of nature.
. Chanting – a great way to lengthen the exhalation and focus the mind and cut through ruminating thoughts.
. Lions Breath – add this to Cat/Cow and it’s not only a useful practice to release tension in the face but its fun and worth a giggle or two.
. Journaling – not for everyone but it may well be a practice that helps you to examine and shift thoughts from anxious and ruminating to ones that are empowered and reduce fear of the unknown.
Dancing, tensing and releasing muscles, singing and laughing are just a few other ways to release anxiety. Finding what works for you is key and remember that anxiety is a physiological response and this can be empowering because that knowledge alone gives you options to address and possibly alleviate it.