Unfortunately, frontline treatments aren’t always effective in relieving panic attacks. Solutions such as benzodiazepines (known under brand names like Xanax and Valium) may relieve fear in the short term, but they have an extremely high potential for addiction, a notoriously difficult withdrawal and tend to treat the symptom but not the underlying cause.

Having panic attacks on a regular basis can have a severe impact on a person’s ability to enjoy life or even function normally, with some going on to develop co-morbidities such as agoraphobia (usually in an attempt to avoid anything that may trigger a panic attack or fear of not being close enough to “safe” people or areas) or substance misuse disorders.

What does a panic attack feel like?

Panic attacks are not dangerous (in the sense that they won’t cause bodily harm) and they are not the result of something “physically” wrong, but the symptoms can be so acute that people often assume they are having a heart attack, losing their mind, or even dying.

Common symptoms for panic attacks include:

• Shaking
• Sweating
• Intense chest or head pain
• A feeling of unreality
• A sense of impending doom
• Nausea and stomach cramping
• Feeling unable to breathe

It is important to understand that these symptoms aren’t imagined. What people experience in a panic attack is very real — it just isn’t going to cause them any physical harm. Activity in the brain and nervous system creates a physiological response that is indistinguishable from what a person would experience if they were in mortal danger, including a spike in blood pressure and a cascade of stress hormones.

What triggers panic attacks

Through observation and research, we now understand that panic attacks occur due to activity in three aspects of our being — our physical selves (a.k.a our physiology), our psychology and our respiratory system. We know that there is a physical cause as around 60% of panic attack sufferers respond to medication such as SSRI’s, and we can observe the panic response in their brain and nervous system.

The emotional aspect of panic attacks is more complex but no less powerful. Panic attacks can sometimes have emotional triggers, and our emotional response to feelings of panic can also serve to entrench patterns of worry and stress which make panic attacks more likely.

The third factor at the root of panic attacks is the way we breathe. The medical community is becoming more aware of the role our breath (and particularly, disturbed breathing patterns) have on our autonomic nervous system, and how conscious control of our breath may influence the way we feel for the better.

How yoga can help relieve panic attacks

There is a growing wealth of research to suggest that yoga can help people who experience panic attacks due to underlying mental health issues, particularly through the easing of symptoms associated with anxiety disorders and PTSD.  One notable example is a study published in the Frontiers of Psychology, which found “significant improvement in panic symptomatology following both the practice of yoga and the combination of yoga and psychotherapy.”

While there aren’t many studies that investigate panic attacks specifically, yoga therapy is increasingly viewed as a viable adjunct treatment for many of the conditions which include panic attacks in their symptoms. Unfortunately, around 40% of anxiety sufferers prove resistant to primary treatments for anxiety, creating a pressing need amongst health professionals and patients for other efficacious interventions.

The three aspects of yoga that support healing

Yoga therapy offers a sustainable treatment option that patients can continue long-term with their own private practice. Yoga addresses three parts of a person’s being (the breath, body and mind), which holistically supports healing across both the physical and psychological aspects of their illness, while also offering a spiritual framework for life should they wish to engage with it.

1. Breath

Breathing is often disordered in people with panic attacks, which can have a negative impact on their wider nervous system. They may “gulp” air, unconsciously hold their breath, over-breathe or breathe shallowly, and most especially when they begin to feel anxious.

Disordered breathing is something people develop unconsciously and it is often a reactive attempt to control their feelings. Unfortunately, however, it has the opposite effect, putting their nervous system into a state of high alert and culminating in periods of psychological crisis.

Pranayama (the yogic word for breathing exercises) is of increasing interest to anxiety researchers. The relationship between anxiety and our breathing is becoming ever more understood, and learning breath work with a yoga therapist can help people manage their anxiety in an effective and accessible way.

2. Body

A key component of panic attacks and anxiety are the distressing physical symptoms that accompany feelings of fear. People living with acute anxiety often display high levels of physical tension and are extremely sensitive to physical stimuli. For example, a person who regularly has panic attacks may notice and fixate on a passing headache that another person barely registers, and feel increasingly anxious about the pain.

This creates a feedback loop where the pain is amplified by the body’s physical stress response, which goes on to heighten psychological anxiety. This leads to hyper-vigilance and for some can develop into a sense of alienation from their own body.

Yoga asanas offer a gentle method of exercise that helps people connect with their bodies and feel less uncomfortable within themselves. With the help of a yoga therapist, highly anxious people can increase their “window of tolerance” for physical discomfort, learn to breathe correctly under physical strain and increase their resilience to stress.

3. Mind

The psychological aspect of panic attacks is powerful and can impact people’s lives in a profoundly negative way. They may stop taking part in activities they once enjoyed, become convinced they will suffer a heart attack or stroke, avoid spaces that aren’t perceived as safe to them, or become depressed.

Mindfulness and meditation are key components of yoga and can help people to become calmer and more able to cope with negative thoughts and emotions. With regular practice, mindfulness increases people’s capacity to recognise their own stress triggers and gently guide themselves away from detrimental thought patterns and behaviours.

Summary

Experiencing panic attacks can be life-changing for the sufferer, estranging them from the person they thought they were and the life they thought they’d lead. Managing panic attacks and the mental health issues that cause them requires holistic support which sustains people through acutely vulnerable periods of their life. When used alongside talking therapies and medication, yoga therapy can provide another pillar of care on the road to recovery.

The post The beneficial impact of yoga on panic attacks appeared first on Complete Wellbeing.

What is Bipolar Disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders-5 [DSM], bipolar disorder is a serious mental health condition marked by radically opposite states of mood. These moods may occur in phases, also called episodes.

The manic episode is typically marked by feelings of grandiosity or heightened self-esteem. People experiencing this phase may seem to be in a “high”. They may be unusually energetic, have little need for sleep, may talk excitedly, get easily distracted, and often recklessly pursue pleasurable activities. In contrast, the depression episode is marked by intense sadness, dejection, lack of energy, apathy and lack of interest in pleasurable activities. Typically, between both episodes, there may not be any symptoms.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person and may be associated with good functioning and enhanced productivity. So even when family and friends learn to recognise the mood swings as a possible mental disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can convert to a manic episode or major depression.

Because bipolar disorder tends to run in families, researchers have been searching for specific genes that could be linked to the disorder. Recent research shows that the MLC1 gene could be associated with schizophrenia and bipolar disorder in southern India. [Verma, Mukerji et al, 2005]. External environmental triggers could also set off the disorder or worsen existing symptoms. Stressful life events, substance abuse, seasonal changes, sleep deprivation are all potential triggers for either mania or depression.

What does the treatment involve?

Bipolar Disorder is a bio-chemical condition, therefore psychotherapy is not the first line of treatment. The professional to visit immediately, if one suspects the illness, is a psychiatrist. The psychiatrist will assess the history, symptoms and overall functionality of the person and accordingly prescribe medication.

Mood stabilizers are medications that help control the highs and lows of bipolar disorder. They are the cornerstone of treatment, both for mania and depression. Lithium is the oldest and most well-known mood stabilizer [recommended by APA Practice Guidelines]. Psychiatrists may also prescribe benzodiazepines, anti-depressants or anti-psychotic medications based on the persons’ symptom presentation. Adhering to the medication guidelines prescribed by the doctor is crucial to recovery.

Deciding to seek psychotherapy for bipolar disorder

Although psychotherapy is not the first line of treatment for bipolar disorder, medication offers only partial relief for patients. Seeking a trained psychologist can make a marked difference towards treatment adherence, relapse prevention, symptom management and leading a better quality of life.

However, just visiting a professional is not enough. Psychotherapy is hard work and is not just about “talking and listening”. The person needs to work within and between sessions to gain insight into their problems, change their activity level, daily schedule, mood, thinking and social relationships. The psychotherapist works with the person to change those negative thinking patterns that reduce their motivation to make these changes. It’s important to note that just meeting a counsellor will not be helpful, unless he or she is able to help you manage the illness effectively. You need to meet an accredited and trained psychotherapist, someone who will actively work to alleviate the symptoms.

How does psychotherapy help in bipolar disorder?

Psychotherapy teaches the benefit of adopting a rational stance when faced with difficult situations. The idea is that if one is upset by their problems, they now have two problems:

1. The problem
2. The upsetness.

In the initial phase of therapy, there will be an assessment. During this phase the therapist will take an extensive history, including timelines of the episodes. Some information that the therapist will seek:

• Age of onset of the illness
• Progression of symptoms over time
• Description of specific depressive symptoms
• Description of specific symptoms during elevated mood
• Description of sleep patterns and physical energy in each of the different mood phases
• Approximate duration for each of one’s mood phases
• Presence of suicidal thought and accompanying risk factors
• Impact of symptoms upon interpersonal relationships

Sometimes, along with bipolar disorder the person may also be diagnosed with another condition, eg: a personality disorder. Therefore, the therapist may conduct a psycho-diagnostic evaluation to rule out if there is any other mental illnesses. The therapist will also make a note of the medications the person is taking and monitor the psychiatric intervention, as also recommend any other medical interventions if needed.

The therapist will then provide “psycho-education”, which essentially means educating the client and the family about the illness. This will include explaining the symptom profile, the depression negative triad, brain physiology, the need for both medication and psychotherapy etc. Psychotherapy will also involve some family education, so that the family can learn to recognise symptoms, and how to adopt behavioural strategies to manage the mood episodes.

Psychotherapy will next involve the core phase, i.e. treatment of symptoms. This will include the following:

• Regulating daily schedule
• Keeping mood charts to note daily mood fluctuations
• Restructuring negative thinking
• Promoting adherence with medication regimens
• Reducing risk of suicide
• Identifying triggers that increase the risk for relapse
• Mediating any hospitalizations

Identifying the prodromal symptoms

The most important benefit of psychotherapy is helping the patient and the family detect “prodromes”.

The word prodrome comes from the phrase, “running before”, and refers to the period that precedes a mood episode. In bipolar disorder some environmental triggers may precede a mood episode. These triggers may include seasonal variation, certain stressors [such as disagreement with spouse], work overload etc. Although bipolar moods are not always “predictable”, identifying a certain set of triggers that typically precede a mood episode can prevent episodes from occurring and establish overall smoother management of the illness. The therapist can help the person analyse previous mood episodes, keep daily mood charts and use those logs to identify themes in triggers.

Support groups

Lastly, psychotherapists will guide their patients and families to seek out the help of support groups for bipolar disorder. Sharing within these groups, where other members report similar experiences, can not only reduce shame and guilt but also offer a different perspective on coping.

Bipolar disorder is a complex condition, with a long and often uncomfortable ride for both the patient and their loved ones. Seeking the right professional help can help the person not only manage their illness well, but also motivate them to seek their highest potential, and live their life with dignity and satisfaction.

The post Here’s why you should consider psychotherapy for bipolar disorder appeared first on Complete Wellbeing.

When I left India in 2001, with “just” an MBBS—unfortunately, being a general practitioner can be a challenge if you want to be able to earn enough for three meals a day—the government of India did not recognise an MD from the United States. So, pursuing a speciality in the US and coming back to India to practise was not an option. But since I was going to the US, I decided that I might as well pursue psychiatry, as it was something I had always wanted to do. I graduated from Duke University and I began practising in the US for a while before relocating to India. Thankfully, by the time I was back, the rules had changed and I was allowed to practice after registering with the appropriate authorities.

In for a surprise

I assumed that armed with a degree from a reputed university and four years of psychiatric practice under my belt, I could swoosh in like Zorro and get a job anywhere I wanted. In my practice, I had seen a lot of cases of Post Traumatic Stress Disorder [PTSD], so the altruist in me offered to volunteer with the military services. Unfortunately, the armed forces were not keen on hiring me. So I began thinking about joining a private hospital and contacted a number of them, but without success.

So there I was—a qualified and experienced psychiatrist, in a country with more than a billion people, where 20 – 30 per cent of them suffer from anxiety or depression and yet I could not find a job. My faith in Zorro began to wane. Was I wrong to move back? Should I have stayed in the US? Was I going to stay unemployed for the rest of my life in India? My fears were exhausting. Eventually, I did join a private hospital [where I currently practice], but not before working for three years at The National Institute for Mental Health and Neuro Sciences [NIMHANS]. During my tenure there, I learnt fascinating things about the Indian mindset, aspects that were very different from my experience in the US. I went through a whole new learning process.

There I was—a qualified and experienced psychiatrist, in a country with more than a billion people and yet I could not find a job

Indians don’t like seeing a shrink

I learned what it means to have neither the money nor the access to mental healthcare. I learnt that in India, people with psychiatric issues go through immense and prolonged suffering before they seek help. And once they came to you, they want to be fixed quickly [even though their problem might have started a decade ago]. I learned that even though many people are depressed and even more have all kinds of anxiety disorders, most are not aware of their problem. Others don’t know about treatment options. A significant section of the population cannot afford even basic mental healthcare. The most heartbreaking thing I learned was the stigma associated with mental health due to which most prefer to suffer in silence. I found that literacy does not make it any better. Even educated people hesitate to seek out mental healthcare. People would rather see the heart specialist or the neurologist than a shrink!

It isn’t that people in the US always seek help on time. There are issues even in the developed world but they talk about mental illness a lot more than we do and are generally more accepting of it.

On the brighter side, what uplifted my spirits during my camps was that some of the patients [in spite of not being literate and having very little support] would follow the advise of my team and would see a tangible improvement. The gratitude these people expressed on getting better was overwhelming and motivating—I found myself getting back into the groove, thanks to these patients.

What my patients taught me

I know that I have learnt more from my patients than I could ever learn in my residency or in books and I should acknowledge them. We often get cases that are straight out of a textbook, but no matter what kind of a patient, every “case” is a person who has unique problems and is suffering.

In the US, I met patients who saw me every week for therapy. I call it therapy and so would the patients but a part of me wonders if they came so that we could just talk. I loved hearing about the lives they lead, the houses they live in, their relationships and their heartaches. I heard as they spoke about their holidays and the trips they made with their family. For the one hour I spent with each of my patients, I found myself absorbed into a life that was painful even though it was not mine. Many of them suffered from serious mental illnesses and were disabled as a result. Some of them were old, well into their 60s. A few even told me how they missed being manic, energetic and ecstatic.

The most heartbreaking thing I learned was the stigma associated with mental health due to which most prefer to suffer in silence

But when I started working in India, these stories only got more challenging. The women I met in my rural clinic seemed to have a common theme of an alcoholic husband, 2 – 3 kids, no support and domestic violence. Many of these women worked just to put food on the table and did not rest from the moment they woke up to the time they went to bed. Their resilience astonished me.

A case of attempted suicide

I remember how a mother and a father brought their 20-year-old married daughter who had attempted to kill herself the day before. The whole family was in tears and they talked about how unsupportive the girl’s husband was. He was in another relationship and he provided neither financial nor emotional support to his wife and two children. On finding out about the affair, the young woman attempted to hang herself and was stopped just in time by her mother who happened to walk into the room.

I sat in a crowded noisy OPD [300 patients on any camp day] wondering how I could help this family, especially the young woman even as I struggled to keep myself from breaking down. I counselled her and her parents on that hot sweaty afternoon, over the noise, the din and the curious onlookers. I told her things I would tell a friend who came to me for advice. I counselled her about the power of the soul, the self and reminded her of her love for her children. I hope it helped.

Being a psychiatrist in India is not easy. I see people every day that look like me, dress like me and speak my language, in my accent and have problems that are just like everyone I know in my own life. It is really hard not to get angry at the couple that won’t stop fighting and start loving, it’s even harder not to cry when a son comes into my clinic with his mother and says to me that his mother sees no reason to live anymore because her 22-year-old daughter just died in a road accident because a lorry would not slow down while she crossed the road.

Fixing life is difficult

There are illnesses and then there is life. Mostly what I see in my practice is people whose lives are not what they want it to be. Occasionally, I see an illness too. It’s easy to “fix” the illness but fixing lives—that’s a whole different ballgame.

As I conclude, I am reminded of one professor at Duke University who underscored the power of kindness in transforming lives. In my experience I have found that therapy is about working with gratitude, acceptance and kindness and teaching the same to my patients.

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Practising Yoga in your career

Would it be appropriate for a Yoga practitioner to be a hired overseas enforcer for an international corporation, a factory farmer, a casino manager or a lobbyist for a cut-throat pharmaceutical company? We think not. All these jobs involve unsavoury practices or goals that definitely compromise a Yoga practitioner’s moral integrity. We actually had a student who, attracted by a handsome salary, took on a job at a casino. Before very long, he found that the atmosphere in the casino was so disagreeable that at the end of the day he felt filthy and didn’t even want to continue with his practice of Yoga. In the end, he resigned and has never regretted his decision.

It is important for a Yoga practitioner to pursue a proper livelihood. That means earning one’s living in a decent and respectable way that does not violate any of Yoga’s many moral virtues

Your beliefs are not part-time

We cannot practise integrity part-time, or in one aspect of our life and not others. Integrity cannot be compartmentalised; it is an all-or-nothing matter. We regard integrity as an aspect of truthfulness, which is considered a major virtue in Patanjali’s Yoga and, of course, in other branches of Yoga as well. He tells us that when a practitioner is firmly established in truthfulness, whatever he or she affirms comes true. We personally would limit this ability to spiritual matters, because in worldly affairs a master often relies, like everyone else, primarily on information that may or may not be entirely correct. As a rule, however, a master does not indulge in chitchat or unconsidered opinions.

The splintering of Yoga

Regretfully, the contemporary Yoga movement in the West lacks integrity in several respects. The first is that many Yoga teachers give the wrong impression that Yoga is no more than a postural practice. This is unfair to traditional Yoga, which is obviously much more. It is also unfair to newcomers to Yoga, who don’t know any better, but should be given an opportunity to explore the spirituality of Yoga and the full range of its practices.

Most deplorable is the absence of traditional Yoga’s moral disciplines from many of the teachings offered at modern centres.

This is like offering a person a chair with only three legs to sit on, which is an accident in the making. What good, one may ask, will it do for a student to know the headstand if, when he or she has a car accident, they do not know how to manage life afterward? Or, of what advantage is mastering the Warrior III pose when the mind is worrying about death?

It is irresponsible for a Yoga teacher to tell his or her students that the moral disciplines are unimportant

Not only is modern Yoga by and large not grounded in the moral precepts, it is also shot through with the moral apathy and shallowness that characterises our mainstream culture.

Yoga is a way of life

It is irresponsible for a Yoga teacher to tell his or her students [as we have heard] that the moral disciplines are unimportant. In fact, without them there can be no attainment of mental health, never mind inner freedom. And it is negligent for a Yoga teacher to publicly dismiss the spiritual orientation of Yoga, because this is precisely what is missing from our troubled culture. Integrity, among other things, means to present and practise Yoga as the spiritual tradition that it is. Anything less is dishonest.

Excerpted from Yoga: A Beginner’s Guide by Georg and Brenda Feuerstein.
Published by Jaico. Used with permission.

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