Get a Grip on Panic Attacks
by Rolf Sovik
Jeff was sure he was having a heart attack. His heart was
pounding faster than it ever had before. His chest ached
and the pain radiated toward his left arm. He felt shaky.
As he tried to focus on what was happening to him, the
world grew distant and unreal. Anxiety welled up. Jeff
managed to call his physician, who arranged for quick
transport to the emergency room. There, however, a battery
of tests failed to reveal the cause of his symptoms.
A second attack occurred a few days later, and still
no physiological cause could be found. Before long,
panic attacks had become part of Jeff’s life.
Recognizing Panic Disorder
Everyone sometimes feels anxious for no identifiable
reason. At these times we think, “Something is happening—I
must stay alert.” Panic victims share these feelings,
but for them the stakes are higher. Their distress is
so overwhelming that the fearful possibilities take
on mammoth proportions. “I’m having a heart attack,”
they think, or “I’m losing my mind.” We all experience
periods of vague anxiety, which often pass without our
ever discovering or having to acknowledge the causes.
Panic anxiety, however, is the cue for a determined
(and often desperate) search for a source.
Panic attacks are characterized by rapidly escalating
and overwhelming anxiety. In the beginning, panickers
are rarely able to identify what has made them anxious,
describing the episodes as occurring “out of the blue.”
The attacks are triggered by frightening physical sensations
that occur suddenly, much like an unconscious reflex.
Among the most common are shortness of breath, a rapid
heart rate, heart palpitations, sweating, trembling,
a feeling of choking, chest pain, nausea, and dizziness.
Frightened sufferers develop painfully sharp sensitivity
to these sensations, often making several trips to the
emergency room before they finally realize that their
symptoms are panic-related.
Physical sensations alone are not the core of the illness.
Fearful thoughts, unpleasant emotions, avoidant behaviors,
disturbing sensations, and deteriorating relationships
all collude with one another to maintain panic. Thoughts
such as the fear of dying or of having a mental breakdown
are common. Even mild anxiety can trigger an attack,
and any disturbing emotion can be interpreted as a precursor
to full-fledged panic.
Gradually, the fear of having an attack in public leads
the panicker to avoid those places—a disorder known
as agoraphobia. Problems in relationships, which may
have been the original source of anxiety, become worse
as panic episodes develop. Difficulty with self-assertiveness
and with the resolution of conflicts increases. Friends
and partners are often frustrated because they cannot
understand what is happening.
The Road to Recovery
Fortunately, panic disorder can be treated successfully,
frequently with a combination of psychotherapy and medication.
Panic sufferers are now turning to yoga for help as
well, for yoga offers a wide range of stress-reducing
tools. An ancient model of recovery can be found in
the Yoga Sutra of Patanjali, one which is also embodied
in the Four Noble Truths of the Buddha. In its briefest
form, this model is an outline of the stages in the
healing process, presented here as four questions:
1. What is the nature of the pain that all humans experience?
2. What is the cause of that pain?
3. What will be experienced when the pain is removed?
4. How can the pain be removed?
Yoga tells us that before searching for a cure it is
important to look deeply into the nature and causes
of illness. It is also important to get an idea of how
things will be when symptoms have been removed, because
otherwise we may have illusions about what recovery
will be like. For example, eliminating anxiety is not
the outcome of treatment for panic—the outcome is the
ability to manage anxious feelings.
If we rewrite the four questions of the ancient model,
focusing on panic attacks, they might read:
1. What is panic disorder?
2. What causes it?
3. What will life be like for the person who has overcome
4. How is recovery accomplished?
Biologically oriented physicians have tended to attribute
panic symptoms to problems of the nervous system. Jacob
DaCosta, a Civil War physician, set the tone when he
wrote, “It seems to me most likely that the heart has
become irritable from its overreaction and frequent
excitement, and that disordered innervation keeps it
so.” This focus on biochemistry and physiology led to
the development of tranquilizers.
Not long afterwards, Freud identified a form of anxiety
that appeared in discrete, time-limited episodes. “An
anxiety attack of this sort,” he wrote, “may have linked
to it a disturbance of one or more of the bodily functions—such
as respiration, heart action, vasomotor innervation,
or glandular activity.” Nearly one hundred years later,
this focus on the emotional component of panic has resulted
in the psychiatric diagnosis called Panic Disorder.
More recently, clinicians have been exploring the role
of disturbed breathing in panic attacks. As early as
1950, the physician R. L. Rice maintained that anxiety
attacks were often the result, not the cause, of disturbed
breathing; now psychotherapies for panic that include
breath training are state-of-the-art. (Even so, very
little training in this area is available to clinicians.)
Those who are familiar with yoga will recognize the
classic body-breath-mind triad in these three points
of view. But if a single cause for panic disorder exists,
it has yet to be discovered. Instead, these three areas
seem to interact with one another, forming feedback
loops that grow larger if not addressed in some way.
For example, if someone is afraid of going to public
places, then self-esteem plummets, fears increase, opportunities
for relationships are limited, and panic-prone factors
such as the fear of being labeled “incompetent” grow.
Conversely, if the fear has been overcome, then self-esteem
improves, fearful thinking is reduced, opportunities
for relationships expand, and panic-prone factors are
The First Steps to Recovery
We have already seen what panic disorder is and we have
a general idea of what causes it. Our next step is to
discover how yoga, coupled with clinical experience,
can help panickers take the steps necessary to recover.
The first priority is to manage the frightening physical
sensations accompanying panic attacks, because they
will make any other work impossible. Panickers walk
on pins and needles attempting to avoid the sudden,
uncontrollable symptoms of their disorder, and because
these involve rapid arousal of the nervous system, it
is imperative to find ways to strengthen the nerves
and calm anxiety.
Arousal is subtle and is triggered in a number of ways,
but the key to calming it is to learn how to “talk”
to the nerves, how to communicate across the great divide
between voluntary and involuntary functioning. Once
the panicker has learned to manage involuntary reactions,
the sense of being out of control is enormously reduced.
Yoga training can be particularly useful here, for yoga
teaches us how to interact with the nervous system.
If we want to soothe and strengthen it, we need to learn
deep, relaxed yogic breathing. Regardless of the pathways
of arousal, breathing is the language of nervous system
balance and control.
To illustrate this relationship, imagine how you would
react if you were walking along a dark street, and a
pointed object were thrust suddenly into your back.
You might gasp, then tense your whole body. Gasping
is the natural reaction to sudden fear. If you discovered
that the attacker was only a friend playing a joke,
you might sigh with relief. Then your breath might become
agitated as your fear turned to irritation. The way
you breathe reflects how you feel.
This relationship between breath and nerves is a two-way
street. Just as emotions create changes in breathing,
so changing our style of breathing can alter the way
we feel. Breathing is the only involuntary function
that can be easily and voluntarily controlled. During
times of panic, relaxed, controlled breathing will give
us immediate access to the nervous system. This means
that by changing our breathing, we can change the condition
of our nerves when tension disturbs and frightens us.
Then, when breathing is relaxed and the panic response
has been calmed, the underlying anxiety can be gradually
brought to conscious awareness for processing.
Learning Relaxed Breathing
Practicing yoga is a good way to learn breathing skills,
for it is a gradual process, often needing considerable
support over a period of time. Yoga teachers quickly
recognize when a student is having trouble (as is often
the case with panickers), and they know a wide variety
of alternate practices that will help the student master
The ultimate goal of breath training is to make smooth,
diaphragmatic breathing a twenty-four hour habit. The
corpse pose (lying on the back) and the crocodile pose
(lying on the stomach with arms folded under the forehead)
are both helpful training postures. Breathing with a
ten-pound sandbag on the upper abdomen while lying in
the corpse pose will help to strengthen the diaphragm
and serve as a reminder to focus on the abdomen as well.
In addition, it is helpful if the panicker learns to
pay attention to breathing as often as possible during
the day. Notice when the breath stops, notice when it
jerks, for once an irregularity is obvious, it can be
corrected. This practice not only fosters awareness,
it makes the relationship between stress and breathing
Panickers will find that diaphragmatic breathing not
only calms the effect of arousal at the time of panic,
it also provides an alternative focus for attention,
allowing them to focus on their breathing instead of
on the panic symptoms. As diaphragmatic breathing becomes
a habit, the nervous system is less susceptible to panic
in the first place. It usually takes about two weeks
to become accustomed to the feeling of diaphragmatic
breathing, and about six months of regular practice
to make it a habit.
Special Problems in Breath Training
There are a few potential problems that panickers may
experience during breath training, and it is well for
both student and teacher to understand them at the outset.
The most common is that panickers have often developed
a highly self-vigilant style that can lead to performance
anxiety. (“Is it supposed to feel this way?”) Micro-managing
has become a way of life to panickers. The teacher needs
to be warm—reassuring but firm, letting the practice
do the teaching, without becoming over-analytical. Breathing
does not need to be perfect to be good enough.
Sometimes panickers carry a great deal of physical tension
in their bodies, and in these cases the natural unblocking
effect of yoga stretches and postures can be helpful.
Releasing abdominal tension while resting between postures
promotes deep breathing. Covering the body with a blanket
during relaxation and breath training can ease the feeling
of being exposed or vulnerable.
A knot may sometimes form in the abdomen during panic
attacks, making breathing difficult. As the attack continues
hunger for air increases, but despite the need for air
the panicker may feel that holding the breath is the
way to “catch” it. Relaxed, continuous breathing, on
the other hand, releases the unconscious tension created
by holding the breath, and with practice it is possible
to actually breathe through the knot that forms in the
stomach during periods of anxiety. As increased awareness
makes it possible to recognize tension early, it becomes
easier to remain relaxed. To establish a smooth, unbroken
flow of breath, the teacher might say, “When you come
to the end of the inhalation and your abdomen has fully
expanded, simply relax and let the exhalation begin.
When you come to the end of the exhalation and your
abdomen has contracted, simply relax and let the inhalation
begin. Let each breath flow into the next breath by
Many therapists have begun to use breath training in
their work with clients, but few have been trained to
teach more than the basics of diaphragmatic breathing.
Yoga, on the other hand, offers many additional breathing
and relaxation skills that can help recovering panickers.
Perhaps the most effective of these is nadi shodhanam
(channel purification). As its name suggests, nadi shodhanam
works to unblock tensions and resistance in the energy-conveying
channels of the physical and subtle bodies, thus calming
and strengthening sensitive nerves.
Normal breathing carries away wastes and brings in fresh
energy with each breath. As energy is brought in, it
must be assimilated and distributed efficiently in order
to fulfill the purpose of breathing. That’s where nadi
shodhanam comes in. The process of channel purification
slows breathing down and focuses our attention on its
flow. At the same time, according to yoga masters, this
practice cleanses the subtle vessels through which physical
and mental energy is passing. As these vessels become
cleaner, energy moves with less effort, and its distribution
and assimilation within the mind and body are improved.
The result is reduced tension in the nervous system
as well as a calmer mind.
Nadi shodhanam is not the only yoga tool for deepening
relaxation. Techniques combining postures, breathing,
and systematic relaxation kindle a sense of confidence
in us no matter how much daily life seems to bend us
out of shape. Exercises that relax both muscles and
joints, as well as the 61-points relaxation exercise,
lead further toward relaxed self-awareness. These techniques
can be taught once students are familiar with the beginning
practices. (For a detailed description of nadi shodhanam,
see the Yoga International reprint “Balancing Active
and Receptive Energies: The Practice of Nadi Shodhanam.”
Expanding the Recovery Process
Along with breath training, panickers need to begin
the process of resolving their fears. Sometimes they
do this work on their own or with the help of friends
and family members. Often, however, a period of psychotherapy
is needed because the worries and stresses that initially
contributed to the onset of panic require objective
attention. Before treatment these factors are outside
of the panicker’s awareness for some reason. As recovery
continues, however, they become the proverbial elephant
in the living room—there is no way to avoid noticing
and dealing with them.
Often the stresses that are most difficult to recognize
have to do with significant relationships. A question
that can elicit awareness is, “Am I avoiding conflicts
within myself?” As one panicker continued in recovery,
for example, he was able to explain that his younger
brother, who was in line to become a co-partner in the
family business, was performing very poorly. Despite
many signs to the contrary, the younger brother continued
to imagine that he was doing well at his work. Addressing
this problem raised many fears, for it would affect
a complex web of family relationships. As a result,
the older brother resisted speaking up and began having
panic attacks instead.
There are many possible causes of panic attacks—stressful
relationships, past traumas, fear of separation from
loved ones are among the most common. One panicker’s
attacks began when her husband’s promotion resulted
in his being away from her and their infant twins at
night. Pleased about the promotion, the husband had
not been willing to see the effect it was having on
his family, and the wife had not been able to express
her fears directly. In the course of psychotherapy,
this woman learned that finding practical ways to expand
the scope of awareness and implement stress-reducing
changes (ask for them, create them, or compromise for
them in some way), although difficult, was the most
satisfying process in the entire recovery.
There will inevitably be leaps forward as well as setbacks
while recovery continues. This is natural, for the recovering
panicker is learning to work with him- or herself in
an entirely new way. Whether or not the panicker is
undergoing psychotherapy, the psychological insights
acquired through yoga can make a profound contribution
to this process. A young student once remarked, “Yoga
stands for You Oughta Get Aware,” because it provides
such a wide range of tools to help everyone, including
recovering panickers, do just that.
The Role of Meditation
In addition to the body and breath, yoga works with
emotions, mental images, thoughts, and relationships,
seeing them all as part of an integrated whole. During
meditation, for example, a normally disturbing image
arising in the mind is greeted by a very different reaction
than might otherwise be the case. Now the body remains
rested and still; the breath sends messages of steadiness
and balance to the emotions and nervous system. Though
the image might seem upsetting at another time, now
the meditator can witness it with equanimity. This neutral
reaction allows time and space for the image either
to be processed or to pass through the mind without
What is more, meditation seems to pace itself; it allows
the mind to gradually gather strength before bringing
up the images that might prove most frightening or challenging.
Trivia can be dismissed, but the thoughts and images
that persist are the ones that have important consequences
to us. For instance, suppose I begin to recognize a
deep-seated unhappiness with my work, but at the same
time I see no other way to support my family. This conflict
haunts me, affecting my work and frustrating my family
relationships. Panickers may force themselves to push
such conflicts out of awareness because they cause a
discord that seems unresolvable. Meditation will allow
them to recognize it with less fear so that they can
see their way through the problem.
Yoga psychology also suggests many techniques for resolving
conflicts, including acknowledging and accepting the
conflict in all its depth; recognizing the need for
some kind of change; resisting the inclination to act
out feelings or to do nothing; exploring alternatives;
communicating with others without blaming them; accepting
feedback from others; using discrimination in accepting
or rejecting alternatives; surrendering to necessary
losses; acting with determination; accepting outcomes
with equanimity; working calmly on a problem even if
a negative outcome, or no outcome, seems inevitable;
and letting intuition suggest new possibilities. These
strategies are derived from what in yoga are called
the yamas and niyamas—the attitudes toward life that
are the basis of all yoga practices.
Finding Refuge in Our True Nature
Ultimately, yoga provides a philosophy that places the
relationships between body, mind, and spirit in a new
perspective. The Bhagavad Gita, a classic yoga text,
tells us that “No one has the power to bring to destruction
this unalterable entity [our true inner self]. . . .
The body-bearer in everyone’s body is eternally undestroyable.”
Anxiety arises from attachment to passing and impermanent
things, but the more we are aware of our own true nature,
the less anxious we become.
Yoga gives us a practical tool for working at this level
of awareness—the mantra. This is a word or phrase that
can guide and protect us. It serves as a focus of attention
in times of panic, and it is a resting place for awareness
leading to our true nature. Through its connection to
the deep spiritual resources that lie within us, the
mantra pacifies fear and encourages us to persist in
the face of disturbing thoughts and upsetting emotions.
We cannot prevent life from changing. Life is inherently
unstable. But during periods of change we can have the
courage to identify and express our needs. We can look
for ways to surrender gracefully to the inevitable.
We can trust, through our experience of yoga, that the
essential Self within us will guide us through the emotions
of change successfully.
Dr. Rolf Sovik is a licensed clinical psychologist
in private practice in Buffalo, NewYork. He has been
practicing and teaching yoga for more than twenty years.
article was provided by the Yoga International
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