Yoga for Depression and Anxiety

The first point of entry for those who practice yoga is often the body. They desire to become more flexible and feel stronger. All these reasons are valid. Yet, as people begin their yoga journey, something else tends to take over. It’s how they feel in their minds. Often people will feel less stressed, refreshed and calmer. Yet, what happens to those who suffer from mental health issues. Can yoga help those with depression or anxiety?

In this article, I’m going to describe how depression and anxiety manifest themselves in the physical body. I’m also going to describe this in terms of our emotional anatomy, and how we should design a yoga practice that specifically addresses depression and anxiety.

How Yoga helps

The practise of yoga is often described in the context of ‘union’. There is a sense of ‘yoking within’, to realise the true nature of self. Yet, when focusing exclusively on mental health, it is the self itself that is fractured. There is often a complete disconnection or even disassociation and a sense of separation may arise. We note that the Greek words ‘schizo’ (means to ‘split’) and phrenia (means ‘mind’), implies that the mind itself may become split between different voices (ie ‘schizophrenia’).

Before some of the deeper inner yogic practices can occur, the self itself needs to be repaired and protected. When approaching yoga for mental health, we have to heal the body and mind, to support the body’s capacity to self-regulate and become more ‘whole’. The treatment plan needs to be one that is somatic and embodied allowing the student to connect with their sense of self-again. In addition, a safe environment (or ‘container’) needs to be established to allow the student to process their mental disturbances somatically.

Emotional Anatomy: Under-activated v Over-activated

‘Flight or Fight’

‘Somatic Collapse’

Images: Stanley Keleman (Emotional Anatomy)

Anxiety

Anxiety is a part of life and everyone experiences it from time to time. It can help us to avoid dangerous situations and motivate us to resolve everyday issues and problems. The more primitive part of our brains, known as the ‘limbic brain’ will sense a life threatening or dangerous situation. It governs basic biological functions such as heart rate, blood pressure, appetite, thirst and sex drive. When the body undergoes distress, the body’s biorhythms will be affected, often undergoing dramatic changes.

In such circumstances where there is a build of tension in the musculoskeletal body, symptoms such as an increase in heart rate, blood pressure and shallow breathing may occur.

Digestion may be effected and there is a retreat towards the centre or core of the body. The back of the body will become mobilised as the sympathetic nervous system becomes activated and the lumbar spine may tighten. The image below shows the organisation of the nervous system through the spine.

In the yoga of the subtle body involving the chakra system, strain and tension reside in the manipura chakra (which is located around the solar plexus). Given the plexus of nerves that surround the kidney and adrenals, any firing of the sympathetic nerves goes upwards and gets trapped in the upper chest, neck and skull. The result can be feelings of anxiety and panic.

The image below shows the web of nerves innervating from the adrenals, which fire in the case of sympathetic activation. Manipura is known as the ‘City of Jewels’ and we can see that the nerves themselves that comprise the sympathetic nervous system are like ‘crown jewels’.

As a result, a person may become restless and the connective tissue may become hyper-tonic. This is often described as the ‘flight or fight response’.

When it comes to anxiety disorders, anxiety symptoms that are more severe, long-lasting and interfere with a person’s work or relationships are a sign that help is required to help resolve the issue.

Yoga for Anxiety

When approaching a student or class focused on anxiety, a light vinyasa or somatic-based class is suggested to release the core without bringing a sympathetic excitement to the body. The aim is to stimulate the parasympathetic nervous system via a release of the sacrum/pelvis and cranium, as the sympathetic charge gets loaded into the back of the body. The aim is to release these areas around the core, including the groins, solar plexus, kidney/adrenal gland, the viscera of the abdomen, the respiratory diaphragm and the neck.

Interestingly enough, if we look at the anatomy of the respiratory system (below), the phrenic nerve has its origins in the C3 vertabrae and innervates the diaphragm, noting earlier than the word phrenic means ‘mind’.

In the context of the breath/mind connection, as the mind becomes anxious or under threat, the impulses from the central nervous system through the phrenic nerve to the respiratory diaphragm results in breathing becoming shorter and shallower.

The aim of any yoga practice is to bring about a deeper breath, involving abdominal breathing where there are more parasympathetic nerve receptors in the lower part of the lungs.

It is also suggested that the iliopsoas complex can become ’emotional’ and hypertonic in the anxiety response. Given the anatomy of the iliopsoas muscles (which inserts at the 5th lumbar vertabrae (lower spine) and attaches to the lesser trochanter of the femur (thigh bone)), the presence of anxiety will inevitably involve some form of tightening of these muscles as the body retreats towards its core.

Gentle release of the iliopsoas muscles through movements that discharge any strain, guiding the student away from hyper vigilance and arousal is recommended.

Spinal Undulations

Overall, whilst restorative yoga may be deeply restful, where anxiety is present, students may be too restless to be still. Somatic practices that emphasise titration through the core to discharge any sympathetic pulse are helpful.

In a state of anxiety, as the action of the nervous system moves up through the body, encourage students to connect with their legs whilst at the same release through the lower back may also be effective. In particular, movements in the back of the body should have a widening effect to mitigate any somatic strain that has arisen through the sympathetic charge.

Forward bends are also a great way of releasing the back of the body and bringing quiet to the front of the body. As shown earlier, the nerves of the parasympathetic nervous system originate in the cranium and the sacrum. Forward bending stimulates these nerves by stretching the neck and low back. From an energetic perspective, there is a sense of withdrawing within, to our ‘safe container‘.

That said, if the student has tight hamstrings or iliopsoas muscles, then the process of flexing the spine may end up feel like ‘striving’, and the relaxation benefits are reduced. Sitting on a prop or softening the knees can help students who are tight or weak in these areas.

Paschimottoasana (photo: Cecilia Cristolovean)

Specific breathing techniques may also be helpful in helping to regulate the nervous system. As the breath and the mind are intermittently linked, practices that help to bring balance and harmony to both hemispheres of the brain and air deep into the abdomen are advised.

Encourage breathing to induce the relaxation response through the nose is the first step, which will help bring more nitric oxide into the body (which is a vasodilator) as well as driving air into the lower parts of the lungs through the action of the turbinates which are located along the nasal ridges.

By driving air into the lower parts of the lungs, there are greater parasympathetic receptors and a richer supply of blood vessels. This support the gaseous exchange of carbon dioxide and oxygen bringing about homeostasis in the body.

Anatomy of Breathing

Practices such Adham Pranayama (belly breathing) or Nadi Shodhana (alternative nostril breathing) are excellent techniques of bringing down the sympathetic charge and allowing the body to relax. In particular, Nadi Shodhana correlates to both the sympathetic and parasympathetic nervous systems helping to alleviate those in highly aroused states.

Nadi Shodhana (photo: Cecilia Cristolovean)

Depression

The word depression is often talked about in different ways. We can ‘feel’ depressed in reaction to a circumstance or event. This is an entirely normal human response and everyone feels like this from time to time. The ‘blues’ as they are often described may be associated with a short-term depressed mood, but the person is able to cope and recover without treatment. Often it is exercise, diet or simply the passing of time that allows things to ‘move on’ and the person can get back to their normal life.

According to MHFA England, depression though from a clinical sense is defined as one that lasts at least two weeks and affects the person’s behaviour as well as having physical, emotional and cognitive effects. It may also interfere with the ability to work and to have satisfying personal relationships.

The symptoms of depression are one that involves:

a usually sad mood that does not go away.
loss of enjoyment and interest in activities that used to be enjoyable.
lack of energy and tiredness.

They may also involve other symptoms such as:

loss of confidence in themselves or poor self-esteem
feeling guilty when they are not really at fault.
wishing they were dead or having suicidal thoughts.
difficulty in concentrating or making decisions.
bleak and pessimistic views of the future.
having difficulty sleeping or sleeping too much.
loss of interest in food, or eating too much, leading to either loss of weight or weight gain.

These symptoms may vary from person to person, depending on whether the depression is mild, moderate or severe.

From a somatic perspective, the experience of depression is one of loss of ‘core’. The essence of the self who is suffering from depression is summarised in this poignant quote:

“The no-core person, having no centerline around which to organise his perceptions and from which to orient towards the world, frequently has problems and difficulties with being present. Their manner and mode of occupying space are always somewhat uncanny and inappropriate. Their psychospatial orientation says, “I don’t know where here is.”

~ James Maitland, Spacious Body.

In these circumstances where the body-mind suffers collapsed, we lose the capacity to move forward in life. In this context, the focus of the practice is ‘build from the outside’. In yogic speak, this is known as ‘annamayakosha‘.

From a physiological perspective, when a person is in a state of somatic collapse, the tissues become hypotonic and lax and there is a lack of support in the joints. Because a person in such states will have trouble identifying with the ‘here and now’, new connections to the body have to be built. This includes the superficial fascia and outer musculature. Through rebuilding a person’s proprioceptive system, a person can start to feel sensations again and hence more alive.

The ‘hole’ in the core of the body can start to be filled in.

Yoga for Depression

In some respects, it is harder to work with a student who is depressed rather than anxious. When the body is collapsed, rather than hypertonic, the body has lost the ability to respond and there may be phobias or aversion to working with the body, especially where it feels numb. Therefore, the gentle titration of sensations is often the first step in helping the student recover. Any sense of vibration, visualisation and positive imagery or gentle pulsations may aid in the healing response.

Moreover, because of the inherent emptiness of those who are depressed, empowering the student, helping them to find some inner resource or symbol will help bring more agency and control. In Sutra 1.31, Patanjali recognised that pain and depression are ‘distractions’, and Sutra 1.32, dedication to practice are means of counteracting them. The importance of the teacher/student relationship cannot be emphasised enough here, providing the student with the motivation and consistency to practice.

Interestingly enough, Patanjali also suggests in Sutra 2.10 that in order to remove some of the afflictions in which people suffer from (including depression), then going back or ‘reversing out’ how these states of minds arose is the way to ‘remove’ these afflictions. This suggests returning to a state of balance of mind where there is sufficient support and guidance given by the teacher and the community or sangha generally.

In the New Testament, Matthew 11:28 also states:

Come to me, all you that are weary and are carrying heavy burdens, and I will give you rest.

This suggests that the practice of yoga can be a sanctuary where the past can be relieved and the person can come home to themselves and their subtle essences. In order to transcend and achieve self-realisation (through yoga or other mind-body arts), by acknowledging the heavy burdens and expectations that people carry upon themselves and providing a safe container for their release through mindful movement, the transformation through yoga can occur from a philosophical perspective.

From a yoga asana perspective, where there is neurological or sensory shutdown, encourage movements that hug muscle to bone to build self-support and possession is recommended. Over time, building support in the core tissues of the body, including the legs, arms and spine will encourage more mobility. For example, asking students to squeeze the block in between their inner thighs or the lifting of the inner ankles in standing postures will result in more core activation from the legs to the iliopsoas muscles as the energy begins to circulate upwards.

Whilst the ‘flight or fight’ response is all about the parasympathetic nervous system, the activation of the sympathetic nervous system is the focus. Given that the sympathetic nervous system resides around the spine, gentle activation of the lower spinal muscles will help achieve that. As the effect of the inhalation is stimulating, postures that create an extension in the lower spine may help to invoke a greater nervous system response. Poses such as bhujangasana (cobra), salabhasana (locust) or virasana (hero’s pose) may help.

Side Lying Virasana

It is suggested that supported backbends (through the use of a chair, bolsters or even physioballs) such as ustrasana (camel pose) or purvottanasana (upside down plank) can also be extremely effective. In more supine positions, poses such as supta baddha konasana (supine butterfly) can be extremely restorative, yet opening through the front part of the body.

These poses can help bring energy into the front of the body in a safe and supported manner without giving too much a shock to the body that has been previously deprived of life energy (prana).

Supine Butterly

The peripheral limbs may also be exhausted in the face of ongoing numbness and lethargy, so postures which activate the lower legs such as supta padagushtasana (reclined hands to foot pose) or supta dandasana (suppine staff pose) which may be useful. Supported standing poses on a chair such as virabhadrasana I (Warrior 1) may also encourage agency and stimulation through the back legs.

Twists can also be useful to stimulate movement through the visceral layer of the abdomen, encouraging ignition through the kidney/adrenal plexus.

Spinal Twists

Yoga for Depression & Anxiety

The practice of yoga as a therapy in its treatment for depression and anxiety requires a specific approach. First, it needs to recognise the unique emotional anatomy of students whose nervous system may be out of balance, either resulting in upward surges of energy through the core of the body (in the highly aroused state) or a lack of core (in the collapsed state).

Through establishing a safe place to practice, allowing the student to move through their experience – expanding and contracting, as well as careful and deliberate cues that allow titration and innervation through the central nervous system, yoga can be a useful complementary practice in the tool kit of a mental health practitioner, helping clients to recover and restore their mental wellbeing.