Yoga Therapy Articles
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 to go outside. Surprisingly, I also found out that she had a boyfriend, who she saw regularly in her room, of course. Anne refused to go outside.
These are corona times, so I agreed to meet Anne on Zoom. I was expecting to see a girl with sleepy eyes, in her pyjamas, with possibly dirty hair and an attitude of defiance.
I couldn’t have been more wrong.
Anne was a vibrant, sweet girl with beautiful styled curly hair that she kept on re-arranging while we talked, a fresh face with just the perfect amount of make-up and wearing jeans and a white t-shirt.
When I asked her about the “why” she would need 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 been working with in the past few months. Girls as young as 10 years old and young women into their 30’s, all of them with one problem in common: they were all happy in the safety of their rooms.
Their parents, carers and partners were, however, very distressed about their voluntary imprisonment. Their concerned relatives emphasized the unhealthy aspects of their confinement, worried about their reclusion, with obvious and natural reaction about 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 short hours of 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 described. In fact they thought that they were absolutely fine, some of them with total convincement 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, uncontainable 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 carefree way that only teenagers know how to do naturally.
She struggled to walk 200 meters back to the house, making her outmost effort not to call her mum to come and pick her up, 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 again, and at this point Anne started to burst into tears uncontrollably 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 organized an appointment at a private psychology clinic where, after a short interview, 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 about this comment 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 two areas where I am well qualified with twenty years of experience: physical movement, breathing , relaxation, compassion and understanding from having worked with cases like this with wonderful results on their recovery.
Still, it is important to work in collaboration and in parallel with clinical professionals, so in all our appointments we made sure to find out the recommendations from her 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 it was all well and good.
The problem was that when Anne prepared herself 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 again.
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 healthy, well 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 so are millions of people suffering from traumatic disorders and depression. They feel paralized, unable to take the physical steps that would surely make them better. As they “fail” to materialize the recommendations of their psychotherapists, they have no other choice than to go down the road of medication, feeling useless and defeated.
Anne was lucky to have the support of a proactive family -who could afford the private psychologist and the Yoga Therapy sessions-, and so our Yoga Therapy program started straight away after our first meeting. We began every session with a little chat about how she felt on that day -checking-in time-, 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 and the idea of giving any“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” “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, and I have experienced excellent results when these strengthening practices were included in a yoga therapy program for people suffering from panic attacks.
A strong physical practice also 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 “start 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 for young people, who have a vivid imagination and spend much part 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 important, she has 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 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 that much different from everyone else after all.
But when the lights of the world turn on and the doors open in the Spring, I wonder how much scarier going outside might become, added to the pressure of having to start the so called “normal life” again.
From the perspective of those who have been feeling safe inside their gilded cage, going out into the busy world will feel overwhelming and right down frightening: over-crowded public transport, traffic jams, busy shopping malls, clubs, parties. The worst nightmare for those who, like Anne, preferred the secluded safety of their home, regardless of whether they might have been inadvertently prisoners of their own fears.
The line between government-imposed lockdown and self-imposed exile is rather blurry. Am I staying indoors because of social rules, or because I feel better this way? Do I really want to go out in the world as it was before?…
We think that for most people the end of the corona time will bring a return to sanity and a happy life. But It won’t be for everyone. We 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 socialize 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 in front of them.
By the time of writing this article, Anne has started to become stronger physically and mentally, manifested 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 often Anne falls asleep during relaxation!
Looking back, she could still be another number in a waiting list if it hadn’t been because her mum was not ready to wait for things to get worse.
We tend to misinterpret the easy concept that our future depends on today’s young generations. This idea puts a huge weight on young people’s shoulders, making it look really far away -and therefore not our responsibility-.
Today’s unresolved panic attacks create an unstable foundation for all members of our community, where not only mental health but also physical disability will be the consequence of our present lack of care.
Yoga Therapy is for everyone, and 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 what is our scope of practice, who can adapt to our client’s needs taking into account the possible serious contraindications, and who are trained to work in collaboration with medical professionals.
Together with them and other established complementary therapists, yoga therapists can work to relieve a tired, overloaded system that is barely managing on waiting lists for a future that is already here.