Yoga for Anxiety and Panic Attacks

BY TIMOTHY MCCALL, M.D.  |  

Many of the principles discussed in my last column, Yoga for Stress and Burnout, are applicable to anxiety and panic attacks, as those are in many ways exaggerated forms of stress. Both conditions are marked by a rajasic (agitated) state of mind and by what is known in Ayurveda as vata derangement. And both respond to various yogic tools, including asana and Pranayama, as well as lifestyle adjustments and the cultivation of pratyahara, turning the senses inward.
Yogic Tools
One of the most useful yogic tools in these cases is a good asana practice, which burns off the nervous energy that can contribute to anxiety. And a number of breathing practices, including abdominal breathing and lengthening the exhalation relative to the inhalation, help reduce symptoms of anxiety. Scientific studies suggest that left-nostril breathing can effectively reduce symptoms of obsessive-compulsive disorder (and it’s probably also useful for less extreme forms of anxiety).
In addition, the regular practice of both asana and pranayama leads to greater internal sensitivity, which can allow students to detect the first glimmer of an anxiety or panic attack and respond with yogic tools that might head off the problem. The earlier in the process you can intervene, the greater the likely efficacy.
For students who are open to them, bhakti practices such as prayer, chanting, and devotional singing may be highly therapeutic for anxiety. In the longer term, meditation and self-study (svadhyaya) offer the hope of getting at the deeper causes of the problem. Through meditation perhaps more than any other yogic tool, you start to see how busy your mind is, and you gain insight into some of the tricks that it plays. Many people may not realize how repetitive thoughts, of which they are usually barely aware, may be fueling their worries. Getting your students to start to see this pattern clearly is often the first step to bringing it under greater control.
Yoga Philosophy
In fact, seeing clearly can be helpful for anxiety and panic attacks in a variety of ways. Over the years I’ve seen many patients, most of whom were otherwise vigorous and healthy, with incapacitating panic attacks. Their hearts were beating hard and fast, they were hyperventilating, and they felt as if they were having a heart attack and might suddenly die. But the reality is that a young and healthy person who is panicking is probably not going to have a heart attack no matter how fast and hard their hearts beat (when students are older or have risk factors for heart disease, such as high blood pressure or elevated cholesterol, you need to be more careful). It often helps them simply to understand that panic is at its core an emotional, not a physical, problem.
Seeing clearly is also useful in dealing with more run-of-the-mill anxiety. Most people who are anxious will admit, if they’re honest and paying attention, that much of what they worry about never happens. And even if it does, the consequences are often not as negative as they would have predicted. Sometimes, in retrospect, they realize that the thing they feared the most was precisely what needed to happen for them to grow or learn or get out of a bad situation—in other words, it was ultimately a good thing. One useful self-study exercise is to have students write down the 10 things they’re most worried about, then look back weeks or months later to see how many came true, and, if so, whether the consequences were as dire as they’d imagined.

Keep in mind that anxiety can be a useful symptom, and the ability to get anxious has survival value. Thinking about potential threats, and planning how you might lower the risk or respond appropriately, can be extremely useful, even lifesaving. Going over the same worry dozens or even hundreds of times, when the iterations bring no new insight, isn’t helpful and can make you miserable.
This is where yogic philosophy can be useful. It teaches that, ultimately, no one can control what’s going to happen. Despite your best efforts, some bad things undoubtedly will occur. All you can do is try to plan intelligently, give your best effort, let the universe take its course, and, when it does, respond as well as you can. When you realize that you ultimately don’t have control over the future, it can take the pressure off—and that alone may reduce anxiety.
Take care of the present, said the great 20th-century master Ramana Mararshi, and the future will take care of itself.
Dr. Timothy McCall is a board-certified internist, Yoga Journal‘s Medical Editor, and the author of the forthcoming book Yoga as Medicine: The Yogic Prescription for Health and Healing (Bantam Dell, summer 2007). He can be found on the Web at www.DrMcCall.com.
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