Everyone sometimes feels anxious for no identifiable reason. At these times we think, 'Something is happening-I must stay alert.' Panic victims share these feelings, but for them the stakes are higher. Their distress is so overwhelming that the fearful possibilities take on mammoth proportions. 'I'm having a heart attack,' they think, or 'I'm losing my mind.' We all experience periods of vague anxiety, which often pass without our ever discovering or having to acknowledge the causes. Panic anxiety, however, is the cue for a determined (and often desperate) search for a source.
Panic attacks are characterized by rapidly escalating and overwhelming anxiety. In the beginning, panickers are rarely able to identify what has made them anxious, describing the episodes as occurring 'out of the blue.' The attacks are triggered by frightening physical sensations that occur suddenly, much like an unconscious reflex. Among the most common are shortness of breath, a rapid heart rate, heart palpitations, sweating, trembling, a feeling of choking, chest pain, nausea, and dizziness. Frightened sufferers develop painfully sharp sensitivity to these sensations, often making several trips to the emergency room before they finally realize that their symptoms are panic-related.
Physical sensations alone are not the core of the illness. Fearful thoughts, unpleasant emotions, avoidant behaviors, disturbing sensations, and deteriorating relationships all collude with one another to maintain panic. Thoughts such as the fear of dying or of having a mental breakdown are common. Even mild anxiety can trigger an attack, and any disturbing emotion can be interpreted as a precursor to full-fledged panic.
Gradually, the fear of having an attack in public leads the panicker to avoid those places-a disorder known as agoraphobia. Problems in relationships, which may have been the original source of anxiety, become worse as panic episodes develop. Difficulty with self-assertiveness and with the resolution of conflicts increases. Friends and partners are often frustrated because they cannot understand what is happening.
The Road to Recovery
Fortunately, panic disorder can be treated successfully, frequently with a combination of psychotherapy and medication. Panic sufferers are now turning to yoga for help as well, for yoga offers a wide range of stress-reducing tools. An ancient model of recovery can be found in the Yoga Sutra of Patanjali, one which is also embodied in the Four Noble Truths of the Buddha. In its briefest form, this model is an outline of the stages in the healing process, presented here as four questions:
1. What is the nature of the pain that all humans experience?
2. What is the cause of that pain?
3. What will be experienced when the pain is removed?
4. How can the pain be removed?
Yoga tells us that before searching for a cure it is important to look deeply into the nature and causes of illness. It is also important to get an idea of how things will be when symptoms have been removed, because otherwise we may have illusions about what recovery will be like. For example, eliminating anxiety is not the outcome of treatment for panic-the outcome is the ability to manage anxious feelings.
If we rewrite the four questions of the ancient model, focusing on panic attacks, they might read:
1. What is panic disorder?
2. What causes it?
3. What will life be like for the person who has overcome panic attacks?
4. How is recovery accomplished?
Looking for a Cause
Biologically oriented physicians have tended to attribute panic symptoms to problems of the nervous system. Jacob DaCosta, a Civil War physician, set the tone when he wrote, 'It seems to me most likely that the heart has become irritable from its overreaction and frequent excitement, and that disordered innervation keeps it so.' This focus on biochemistry and physiology led to the development of tranquilizers.
Not long afterwards, Freud identified a form of anxiety that appeared in discrete, time-limited episodes. 'An anxiety attack of this sort,' he wrote, 'may have linked to it a disturbance of one or more of the bodily functions-such as respiration, heart action, vasomotor innervation, or glandular activity.' Nearly one hundred years later, this focus on the emotional component of panic has resulted in the psychiatric diagnosis called Panic Disorder.
More recently, clinicians have been exploring the role of disturbed breathing in panic attacks. As early as 1950, the physician R. L. Rice maintained that anxiety attacks were often the result, not the cause, of disturbed breathing; now psychotherapies for panic that include breath training are state-of-the-art. (Even so, very little training in this area is available to clinicians.)
Those who are familiar with yoga will recognize the classic body-breath-mind triad in these three points of view. But if a single cause for panic disorder exists, it has yet to be discovered. Instead, these three areas seem to interact with one another, forming feedback loops that grow larger if not addressed in some way.
For example, if someone is afraid of going to public places, then self-esteem plummets, fears increase, opportunities for relationships are limited, and panic-prone factors such as the fear of being labeled 'incompetent' grow. Conversely, if the fear has been overcome, then self-esteem improves, fearful thinking is reduced, opportunities for relationships expand, and panic-prone factors are undermined.
The First Steps to Recovery
We have already seen what panic disorder is and we have a general idea of what causes it. Our next step is to discover how yoga, coupled with clinical experience, can help panickers take the steps necessary to recover. The first priority is to manage the frightening physical sensations accompanying panic attacks, because they will make any other work impossible. Panickers walk on pins and needles attempting to avoid the sudden, uncontrollable symptoms of their disorder, and because these involve rapid arousal of the nervous system, it is imperative to find ways to strengthen the nerves and calm anxiety.
Arousal is subtle and is triggered in a number of ways, but the key to calming it is to learn how to 'talk' to the nerves, how to communicate across the great divide between voluntary and involuntary functioning. Once the panicker has learned to manage involuntary reactions, the sense of being out of control is enormously reduced.
Yoga training can be particularly useful here, for yoga teaches us how to interact with the nervous system. If we want to soothe and strengthen it, we need to learn deep, relaxed yogic breathing. Regardless of the pathways of arousal, breathing is the language of nervous system balance and control.
To illustrate this relationship, imagine how you would react if you were walking along a dark street, and a pointed object were thrust suddenly into your back. You might gasp, then tense your whole body. Gasping is the natural reaction to sudden fear. If you discovered that the attacker was only a friend playing a joke, you might sigh with relief. Then your breath might become agitated as your fear turned to irritation. The way you breathe reflects how you feel.
This relationship between breath and nerves is a two-way street. Just as emotions create changes in breathing, so changing our style of breathing can alter the way we feel. Breathing is the only involuntary function that can be easily and voluntarily controlled. During times of panic, relaxed, controlled breathing will give us immediate access to the nervous system. This means that by changing our breathing, we can change the condition of our nerves when tension disturbs and frightens us. Then, when breathing is relaxed and the panic response has been calmed, the underlying anxiety can be gradually brought to conscious awareness for processing.
