Yoga's Role  in the Treatment of Extreme Anxiety ; Anixety Attacks ; Panic Disorders ; Phobias ; Anxiety disorder ;

“Automatic and involuntary circulation of psychic contents is at the root of all human misery. Automation gives us a sensation of imprisonment in our own mental cages. It robs us of the freedom to think, feel and choose. We feel that we are bound and driven to act.” Shivaram Karikal

Introduction
Our habitual responses to the world around us are often the source of our suffering; we go through the same reactions time and time again, apparently unable to change. For people who experience extreme anxiety states, such as phobic anxiety, life is indeed a cage; they are unable to act freely, hedged about by terrors which, while they appear to be externally caused, most often come from within the mind. These people often despair, avoiding the situations which trigger the anxiety, and even coming to rely on the anxiety to secure the support and energy of others.

According to western therapists, fear is 'a normal physical response to an external threat', an 'appropriate' response to a really imminent danger, while anxiety is a fear reaction without a clear or 'sensible' cause, an 'inappropriate' response. Anxiety can be 'free-floating' – chronic and not attached to any specific situation or object – or phobic – attached to a particular object or situation. Anxiety states are also related to so called 'neurotic' disorders, psychosis and schizophrenia, and to organic brain syndromes. They are closely related to depression, which is often the 'flip side' of anxiety, a result of the imbalance caused in the endocrine and autonomic nervous system by the overuse and exhaustion of the 'flight' responses.

It can also be argued that most of us live with a degree of anxiety or stress – understood as the overstimulation of the autonomic nervous system, which leads to exhaustion and disease. Sometimes the distinction between the 'real' external cause and the 'irrational' response is difficult to make – which fears are real and reasonable depends on the individual. In fact, a yogic approach would suggest that all fear, hatred, jealousy, anger, etc. are in a sense 'neurotic': our avoidance of or aversion for things or situations is a result of our phobic attitude, and based on the illusion of a separate, egoic 'self'. Anxiety states are, therefore, a matter of degree, ranging from 'normal' stress to abnormal 'neurosis' or 'psychosis' – the extremes of states of ignorance and despair.

Phobias – Abnormal anxiety
In our everyday experience, anxiety becomes 'abnormal', or phobic, when it prevents us from functioning fully in the world. A phobia can be defined as a persistent and irrational fear or dread, hatred or aversion for a specific object, activity or situation, resulting in a compelling desire to avoid the anxiety-inducing stimulus. The fear is recognized by the individual as excessive and unreasonable.

There are three broad groups of phobias: (i) simple phobias, in which a situation or object provokes anticipatory anxiety and avoidance, and panic attack if sudden exposure occurs; (ii) social phobias, which develop in adolescence and in which the person is concerned about shameful, stupid or inept acts, and (iii) agoraphobia, the fear of crowds in public places. Each of these phobias is incapacitating to the person, since it prevents them from engaging in ordinary activities, such as shopping, eating in public, etc. In contrast to free-floating or general anxiety, phobias are particularly characterized by a fear of fear: anticipation of the situation as bad as, or worse than, the event.

Symptoms and Causes Of Anxiety Attacks
Physical symptoms of phobic anxiety, which worsen during the acute stages of panic attack, include: chest pain, palpitations, drop beats, flushing, feeling faint, sighing, choking, yawning, dyspnoea, dry mouth, 'butterflies', nausea, abdominal pain, diarrhoea, frequency/hesitancy of urination, sexual dysfunction, tension headaches, blurred vision, sweating, ringing in the ears, shaking, dilated pupils, teeth clenching and chronic jerks. Psychological symptoms include: feelings of impending disaster, worry, inability to relax, not being able to cope, restlessness, sense of 'not being yourself', insomnia, nightmares, depression and panic attack. Some of these symptoms are also experienced in chronic ongoing anxiety or stress. The person often believes they have a physical condition such as heart disease, and this contributes to their anxiety.

In physiological terms, anxiety states are a result of overstimulation of the autonomic nervous system. The limbic and psychic centres in the brain are highly sensitive to emotional states such as fear. They in turn stimulate the hypothalamus which triggers the ANS and endocrine system to respond to the threat. The parasympathetic and sympathetic nervous systems which control the automatic processes of the body, such as digestion, respiration, blood pressure, etc. are thrown into an imbalanced state; the sympathetic nervous system is stimulated and hormones are secreted – thyroxin from the thyroid and adrenaline from the adrenals – resulting in the symptoms listed above. Long term imbalance in the autonomic nervous system and endocrine system caused by high levels of panic and anxiety also leads to exhaustion and depression and can result in lowered immunity as in conditions such as Chronic Fatigue Syndrome.

According to western therapists, certain types of people are more prone to experience phobias. Agoraphobics, for example, tend to be introverted, prone to depression, obssessive, full of self-defeating and self-punishing thoughts, and afraid of loss of control. They have difficulty expressing their feelings and communicating their needs and desires, especially anger and frustration. Agoraphobics, in particular, may tend to be female rather than male, a result, at least in part, of social conditioning which teaches women to be passive, introverted and fearful.

Causes of phobic anxiety are said to include: inherited disposition, childhood experiences and conditioning, and may be related to conditions where the functioning of the brain is in some way impaired. However, phobic anxiety is usually psychogenic; it originates in the mind. A psychoanalytic perspective suggests that the anxiety response in phobias is not
to the object or the event itself, but to the possibility that some unacceptable unconscious material is about to erupt into consciousness. Phobias are therefore understood as a result of repression: when the repressed event or content threatens to come to consciousness, the frontal passages of the brain are stimulated – the limbic and psychic centres – and a panic attack results. While the threat begins in the mind, the body responds as if it were real. Phobias thus illustrate the interdependence of the mind, body and the unconscious forces which shape our experience.

Conventional western therapies
Western therapeutic treatment of phobic anxiety comes into three broad categories: psychotherapy, behavioral therapy and medication. Briefly, psychotherapy involves what is known as the 'talking cure', the attempt to bring unconscious material into consciousness through association, and discussion in a supportive environment. Behavioral therapy is aimed not at uncovering the causes of the phobia, but at the person's patterns of thinking and behavior, working to retrain the body and mind. Techniques include: desensitization, where the person works through the fears from least to worst, confronting them in their imagination; flooding, where the worst fear is imaginatively confronted; and exposure, where the person actually enters into the situation or approaches the object so that they can experience the fear lessening and passing away. Relaxation techniques are also taught in this method. Medication involves the short or long term use of drugs, mainly tranquilizers.

Of these three methods, exposure has been found to be very effective. Facing, accepting and moving through the feared situation gives the person confidence and teaches them to live with the fear rather than avoiding it. The least effective of these therapies is medication, which is at best a short term solution, and does not allow the person to solve their own difficulties. Psychotherapy offers mixed results, since it is not always possible to access the repressed material, and it does not address the physical aspects of the phobic anxiety. Finally, another limitation of many western therapeutic approaches is their emphasis on developing a healthy ego, surely a contradictory approach if the ego is seen to contribute to a sense of separateness – the fear of those things 'out there' or 'in here' which are not conscious or amenable to our control.
 

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