Tomorrow starts now: A Yoga Therapy perspective of Panic Disorder in the young population

Yolanda was a desperate mum who contacted me regarding her 19-year-old daughter: “She doesn’t leave her room, she only comes out to eat and not much else”, she said. Her daughter, Anne, spent all day on her laptop and her mobile until 4 am in the morning, only to wake up at 2 in the afternoon for breakfast.

Anne spoke to her friends online, but she had lost all interest in going outside. Surprisingly, I also found out that she had a boyfriend, whom she saw regularly in her room. Anne refused to go outside!

Due to the restrictions imposed for Covid-19, I agreed to meet Anne on Zoom. I was expecting to see a girl in her pajamas, with sleepy eyes, messy hair and an attitude of defiance.

I couldn’t have been more wrong.

Anne was a vibrant, sweet girl with beautifully styled, curly hair that she kept on re-arranging while we talked, a fresh face with the perfect amount of make-up and wearing jeans and a white t-shirt.

When I asked her “why” she needed my help, Anne was very clear and eloquent: “Because I have panic attacks, a lot of them”.

This was not the first such case I had worked with in the past few months. Girls as young as 10 years old and young women in their 30’s, all of them with one common problem: they were all ‘happiest’ in the safety of their rooms.

Their parents, carers and partners were, however, very distressed about their voluntary imprisonment. Their concerned relatives emphasised the unhealthy aspects of their confinement, worried about their reclusion and the implications for their physical and mental health: lack of fresh air, no direct social contact, absence of exercise, insomnia (which in most cases was not a case of too little sleep, but an extremely disrupted circadian rhythm), and so on.

Surprisingly, when I spoke to these young women, they didn’t seem to be suffering in the way that they were being described. In fact, they thought that they were absolutely fine, some of them convinced that what they were doing was perfectly normal.

Anne, however, was one step ahead of them. She had already tried to go out to the supermarket – encouraged by her mother- but she found herself at the cheese counter showing clear symptoms of distress: profuse sweating, fast breathing, pressure in the head, nausea and a powerful, uncontrollable desire to run away.  

In the past, Anne would roam around that same supermarket with her friends, picking up chips, beer and sweets in the natural, carefree way that only teenagers know how to do.

She struggled to walk the 200 meters back home, requiring all her strength not to call her mum to pick her up and afraid that she would faint at any moment.

“It felt like I was going to die” she said, “but then I got back home and I was fine. I slept for hours after that”.

This episode repeated itself and at this point Anne started to burst into uncontrollable tears at home, for no apparent reason. Her family was so concerned that they contacted Anne’s family doctor. Without seeing Anne in person, her doctor put her on a waiting list to receive psychological support.

She was not a priority as she didn’t have clear self-harm or suicidal tendencies.

After several weeks without any news, Anne’s mum organised an appointment at a private psychology clinic where, after a short interview, she was diagnosed with PTSD from the effects of the lockdown.

Anne had been a really sporty girl in the past, so when she asked the psychologist who interviewed her if exercise would help, the psychologist dismissed her and told her that all those stories about how exercise and breathing can help with the recovery from panic disorder were simply not true and “silly things” in the news.

Anne was surprised but luckily this “senior” psychologist referred her to a younger, more open minded therapist who encouraged her to move.

As a Yoga Therapist without a psychology or psychotherapy degree, PTSD is outside my scope of practice, however  there are a few areas in which I am well qualified with my twenty years of experience: physical movement, breathing, relaxation, compassion and understanding from having worked with cases like these and seen the wonderful results.

However, it is still important to work in collaboration with clinical professionals. We made sure to find out what the recommendations were from Anne’s psychologist, who seemed to be on the right track. She told Anne that she needed to go outside in nature and Anne agreed to do what she was told. So far, so good.

The problem was that when Anne prepared to leave her front door to go to the park, her legs wouldn’t move! She started to sweat, shake uncontrollably and she would burst into tears.

Going out in nature, as great as it might be for her, was simply physically impossible.

A client of mine, diagnosed with depression (a man in his early 40’s who had been planning suicide) told me: “ The problem is, my psychotherapist tells me to go out in nature, exercise and eat healthily. I know that! If I could do those things, I wouldn’t be here, right? I just can’t do it!!

Anne was the same, as are millions of people suffering from traumatic disorders and depression. They feel paralysed and unable to take the physical steps that would make them better. As they “fail” to act on the recommendations of their psychotherapists, they are then faced with the choice of taking medication, feeling useless and defeated.

Anne was lucky to have the support of a proactive family – who could afford a private psychologist and the Yoga Therapy sessions and so our Yoga Therapy programme began straight away, after our first meeting. We began every session with a little chat about how she felt on that day and we adapted the class to her physical and mental levels of energy.

I say “we” because, in Yoga Therapy, the therapist works together with the client in a Trauma-Sensitive manner, avoiding any power structures or the giving of “instructions”.

As Anne was quite a fit young woman, I discovered that we had endless possibilities. We focused on standing, empowering practices and sequences with a strong cardiovascular component, building up strength, especially in the legs.

The large muscles of the legs (quadriceps and hamstrings) are one of the main areas of the body where we store glucose, in the form of glycogen, an important energy reserve ready to be used when we need it.

I have found that many people who suffer from panic disorder, lack substantial leg muscle tone and many refer to physical reactions described as “the legs couldn’t hold me”, “I couldn’t move” or “my legs were shaking”.

Building up the muscle tone and power of the legs literally offers the individual the chance to stand up and move through life. I have experienced excellent results when these strengthening practices were included in a Yoga Therapy programme for people suffering from panic attacks.

A strong physical practice has to be balanced with the right dose of calming breathing techniques and relaxation tools. Anna loves water and swimming, so she enjoys it when she finally lies down on the floor at the end of the session in a “star fish” pose with all four limbs stretched out and breathing in the belly. The cues are related to a feeling of freedom: “Feel free like a starfish on the ocean floor” and “Breathe like a starfish”.

Metaphors and visual images work really well with young people who have a vivid imagination and spend much of their time day-dreaming!

After just five sessions, Anne was able to go out to the park with her boyfriend, which was a huge step for someone who hadn’t been out of the house for months. She seemed happier and more involved with her family and most importantly, she had started to say that she was looking forward to going out in the future. She had started to see beyond the four walls around her and could contemplate the possibility of change.

There is, however, still a lot of work to be done. The toughest job will be when lockdown is over. At the moment everyone is staying indoors, the weather is cold and dark, so staying at home doesn’t seem like a bad idea. Anne doesn’t see herself as very different from everyone else at the moment.

But when the lights of the world turn on and the doors open in Spring, I wonder how much scarier going outside might become, added to the pressure of having to start a so called “normal life” again.

From the perspective of those who have been feeling safe inside their gilded cages, going out into the busy world will feel overwhelming and even frightening: over-crowded public transport, traffic jams, busy shopping malls, clubs and parties. The worst nightmare for those who, like Anne, preferred the secluded safety of their homes, regardless of whether they might have inadvertently been prisoners of their own fears.

The line between a government-imposed lockdown and self-imposed exile is rather blurry. Am I staying indoors because of social distancing rules or because I feel better this way? Do I really want to go out into the world as it was before?

We think that, for most people, the end of Covid-19 will bring a return to sanity and a happy life. But it won’t be the case for everyone. We will need to continue working with young people like Anne, who will be expected to go out and enjoy their freedom, under pressure to catch up with their studies, find a job and socialise again.

Yoga Therapy in combination with psychological treatments and counselling can offer the kind of tools that young people will need to face the world ahead of them.

At the time of writing this article, Anne had started to become stronger, physically and mentally. This was reflected in small steps, such as spending some time outdoors every day and even going out in the snow, which she really enjoyed. We move, breathe and laugh a lot in our sessions and Anne often falls asleep during relaxation!

Looking back, she could still have been a number on a waiting list, if it hadn’t been that her mother was not prepared to wait for things to get worse.

We tend to minimise the effect that our expectations can sometimes have on the younger generation, that they will secure our futures. This idea puts a huge weight on young people’s shoulders and relieves us of the responsibility to secure our own futures.

Today’s unresolved panic attacks create an unstable foundation for all members of our community. The consequences of our present lack of care, will result in mental health issues as well as physical disabilities in the future.

Yoga Therapy is for everyone. It will soon become an accessible tool for the physical and mental well-being of our society, hence the need for internationally certified Yoga Therapists who understand our scope of practice, who can adapt to our clients needs, take into account the possible serious contraindications and who are trained to work in collaboration with medical professionals.

Together with other established complementary therapists, Yoga Therapists can work to relieve a tired, overloaded medical system that is barely managing the growing waiting lists.