There are numerous articles on the internet recommending certain yoga poses for those who have anxiety as a means to manage anxiety and prevent anxiety. The yoga poses are level one to level two poses that are meant for students who have practiced yoga. I would like to offer a different viewpoint on this matter and different recommendations.

After receiving my yoga teacher certification, my first yoga job in 2005 was working with physicians and physician assistants in the treatment of patients at a medical clinic in Centennial, Colorado. I was a Clinical Yoga Therapist. It was a revolutionary practice. At the time, there was hardly a western medicine clinic that offered not just yoga classes, but private one-on-one yoga therapy to patients in conjunction with medical treatment. Doctors would refer patients to me and in the electronic medical record system, they would input the patient’s diagnosis, any imaging scans and a note in the referral such as: “Develop a program and teach the patient yoga therapy tools to manage anxiety.” So it was my job to come up with a yoga therapy program individualized to each patient’s needs. I saw patients who had anxiety, depression, panic disorder, chronic fatigue disorder, chronic low back pain, knee pain, hypertension, cervicalgia, etc. I learned a lot about how yoga, yogic breathing techniques and meditation could support the patient in their treatment.

One of the most common issues patients came to me with was anxiety. And one of the top side effects I noticed with my patients was the effect anxiety had on their muscular system.

There is a field in psychology and in medicine called psychoneuroimmunology. And psychoneuroimmunology is a sub-field of health psychology. Psychoneuroimmunology is exploring the connection between psychology and the body’s nervous and immune systems. Basically they affect each other. Anxiety affects the nervous system as well as the immune system and vice versa. Health psychology explores the connection between psychology and chronic illnesses and diseases in our biological and physical systems. These are the medical terms and fields to explore the mind-body connection. The mind and our emotions are affected by illnesses affecting the body. And in reverse, the issues in the body can also affect our psychology. There is no separation.

People who have chronic anxiety and chronic stress have common issues present in their physical body. Chronic anxiety and stress contributes to severely tight and stiff muscles, stiff joints, decreased mobility, poor circulation, chronic muscular pain, chronic pain (such as migraines and headaches), and poor balance. Due to the issues in the body, I never gave patients yoga poses right away. In medicine, there is a mantra, “Do no harm.” It basically means, it is your responsibility to protect and support each patient and literally do no harm to them. So I knew that if I had given these patients with chronic anxiety yoga poses, I would be injuring them. Their bodies were not ready to learn yoga right away. I needed to stretch their bodies and muscles before going into yoga. Going into yoga with chronically stiff muscles and joints can be harmful and counterproductive. There is a step by step process and the first step is not practicing yoga poses. The first step is practicing yogic breathing.

I’m sure you’re thinking, “Wait, what?! Yogic breathing?” Yes. Let me explain.

Remember psychoneuroimmunology? Anxiety and stress activates the sympathetic phase of our nervous system which is our fight or flight response. Muscles tighten, blood and oxygen rush to our muscles, our breath quickens and is shallow (breathing from the chest and not the diaphragm), and systems that are not needed such as the reproductive system, and the digestive system shut down and are put on pause. Chronic anxiety and stress can lead our bodies to remain in the fight or flight phase. So breathing shallow and quickly, and having tight muscles, and joints become the norm. And our systems are constantly on pause (which is why stress can contribute to poor digestion, GI issues and infertility issues). The good news is that we can affect the nervous system in a positive way by changing how we breathe. Abdominal or diaphragmatic breath stimulates the parasympathetic phase of our nervous system which is the relaxation phase. In the relaxation phase, our muscles are relaxed, breathing is slow and deep in our lungs and diaphragm, joints are lubricated, and systems in the body are being repaired as we relax and sleep. So with anxiety issues, we began with breath. And more specifically with the yogic breathing technique called Ujjayi breath.

After practicing the breath, we then stretch the body from head to toe. The tension and stiffness in the muscles and joints need to be released first before going into actual yogic poses. Stretches for the neck, shoulders, arms, chest, abdomen, upper/mid/low backs, hips, gluts, hamstrings, quadriceps, calves, shin, ankles and feet, are learned and practiced. So first is learning and practicing the Ujjayi breath, then deep muscle and joint stretches, and then we go into yoga poses.

Learning and practicing the breath and stretches took anywhere from 2-3 months for most of my patients. Our bodies take time to stretch out, especially if the stiffness and tension is severe. One of my patients took almost a year of yoga therapy before yoga poses could be practiced.

It is important to respect the body with where it’s at. If it’s not ready to practice full yoga poses, then we take a step back and start with where the body is able to start at, which is breath and stretching. So when it comes to yoga for anxiety, it depends greatly on the severity of the anxiety and the effects it has on the body (more specifically the muscles, joints, and the nervous system). Individuals with mild anxiety and intermittent stress can most likely go straight into learning and practicing yoga. But chronic anxiety and chronic stress is a different issue. Just to be safe, always start with Ujjayi breath and stretches. Once the body feels loose and flexible and the breath is slow and deep, then go into the yoga poses or asanas for anxiety.

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