Using Stress Management Techniques for Medical Conditions

by Baxter and Nina

Dandelion by Melina Meza

If you're suffering from a stress-related disease, such as heart disease, hypertension, diabetes, obesity and digestive disorders, reducing chronic stress can be very beneficial. Stress management can also help with emotional disorders—including anxiety and depression—that are caused by or worsened by stress.

Because stress management helps reduce inflammation, reducing chronic stress can also help with inflammation-related problems, including most forms of arthritis, as well as certain gastrointestinal conditions, such as celiac disease and leaky gut syndrome. 

In general, yoga stress management techniques can be preventive medicine, as lowering overall stress levels may reduce your chances of even developing stress-related illnesses. They could also be curative because spending significant amounts of time in Rest and Digest keeps your immune system and repair systems functioning optimally. Finally, you can use stress management as a palliative technique to help you cope with the stress of living with a chronic illness, improving the quality of your life.

This provides some basic tips for practicing stress management when you have a medical condition. We'll address physical disorders first and then discuss emotional disorders. See The Relaxation Response and Yoga for general information about using stress management when you're healthy. 

Cautions: Generally stress management techniques are very safe. However, meditation is generally not recommended for depression or anxiety, because sitting alone with your thoughts can cause you to spiral downward. So avoid meditation unless you have a teacher experienced at working with your condition who can guide you. People who have uncontrolled high blood pressure should not practice full or partial inverted poses. 

For Physical Disorders

For digestive disorders, for periods without active symptoms, practice a well-rounded stress reducing sequence, combining active poses, both dynamic and static, and restorative poses, as well as meditation and breath work. For periods with active symptoms, stay with gentle poses, including easy dynamic poses and restorative poses, that do not create pressure on your abdomen (for example, no Cobra or Locust pose), and avoid twists. But you can practice any stress management techniques that work well for you, including focused relaxation, quieting breath practices, and meditation. For most digestive issues, you can include supported inversions. However, for hiatal hernias and gastro-esophageal reflux (GERD), symptoms will often worsen with inverted poses, so you should avoid them. 

For inflammation-related conditions, for the non-asana part of your practice, you can practice whatever stress management techniques work best for you. For arthritis of the lower back on down to the feet, supported inverted poses can be particularly helpful. 

For cardiovascular disorders, all of the stress management tools can be helpful, particularly meditation, calming breath practices, restorative poses, and focused relaxation. Just be aware that for certain conditions, such as congestive heart failure, lying flat in Savasana may bring on symptoms. In such cases, elevating your head and chest may relieve the symptoms. the head and chest may permit you to do Savasana safely. 

For cardiovascular diseases for which your doctor has warned you about situations that may increase your blood pressure, such as coronary artery disease and risk of stroke, practice supported inversion only if they do not cause an increase in your blood pressure. (Check your blood pressure with a home monitor immediately before trying a short hold of supported inversion and check again immediately afterwards to see if your numbers go high. Discuss with your doctor if you are uncertain how to proceed.)

One of the significant issues for people with just about any chronic is that the illness itself if a significant daily stressor. Examples are cardiovascular disease, diabetes and related conditions (metabolic syndrome), autoimmune diseases such as and rheumatoid arthritis, to name just a few. For all these conditions, you can use whichever stress management techniques make you feel better and do not aggravate your symptoms. Obviously, if you are seriously ill, practices that are physically undemanding, such as meditation, breath work, and focused relaxation (which you can do lying down as well as sitting) will be more accessible to you.

For Emotional Disorders

Because emotional disorders, including depression and anxiety, are either caused by or worsened by stress, practicing stress management for these medical conditions is extremely beneficial and may make you feel better, either immediately or with consistent practice over time. 

However, many stress management practices, such as restorative yoga, focused relaxation, and mediation are typically practiced with closed eyes. If this causes you to become more depressed or anxious, try practicing with your eyes open instead, keeping them softly focused. If trying to concentrate on your breath or physical sensations causes your symptoms to worsen, try using a mantra, a formal meditation practice, or a recorded relaxation practice that employs vivid imagery.

Anxiety. Because people with anxiety often have a hard time staying still, we recommend that you begin with a strong asana sequence to tire yourself out a bit before trying stress management techniques. Supported Inverted poses are particularly beneficial for anxiety, as the physical orientation of the poses triggers the Relaxation Response and concentration isn’t as essential. But if you find other techniques effective, use whichever ones you prefer. 

Lying on your back with your front body exposed can increase anxiety in some people, so for you prone restorative poses, such as Child’s pose, may be better than supine poses, such as Reclined Cobbler’s pose. If Savasana on your back creates anxiety, try lying on your belly or on your side instead, or skip the pose entirely and do Legs Up the Wall pose instead. 

Depression. For clinical depression, which has symptoms of lethargy and despair, if lying or sitting still causes symptoms to worsen, try a mindful asana practice with either short holds in static poses or slow dynamic poses. For restorative poses, choose backbend shapes, such as Reclined Cobbler’s pose, which can be uplifting, rather than forward bend shapes. In Savasana, try a supported version, with your torso lifted and your chest open, rather than lying flat.

For agitated depression, follow our suggestions for anxiety, adding in restorative backbends if those work for you.

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Reducing Cortisol Improves Anxiety

by Nina

New Leaves in the Desert by Melina Meza

Have you noticed that whenever we talk about the dangers of chronic stress (see About Stress: Acute vs. Chronic), we always mention anxiety? That’s because anxiety is basically on every doctor’s list as one of the potential problems that can result from ongoing stress. And my personal experience has been that anxiety is the first problem I start to suffer from when I go through a period of chronic stress. That is why I personally value yoga’s stress management tools so much; I’ve learned how much better my life is if I can nip those stress levels in the bud before my emotions get out of control. 

But even though I knew that chronic stress could cause anxiety, I didn’t really know exactly why. You know me—I always want to know why—when it’s possible to know why—so I was very interested to read this paper about anxiety and cortisol levels Elevated cortisol in older adults with Generalized Anxiety Disorder is reduced by treatment: a placebo-controlled evaluation of escitalopram. Even though this paper had nothing to do with yoga (the scientists were using a drug to reduce cortisol levels in older people with anxiety), I was interested to learn that older adults with Generalized Anxiety Disorder have higher levels of the stress hormone cortisol. The paper put it this way:

“Generalized Anxiety Disorder (GAD) is a common and impairing anxiety disorder in older adults, and it has been associated with elevated cortisol in this age group.”

And the paper also said that the experiment they did with reducing cortisol levels in this group helped improve the anxiety!

"Compared with placebo-treated subjects, SSRI-treated subjects had a significantly greater reduction in both peak and total cortisol. This reduction in cortisol was limited to subjects with elevated (above the median) baseline cortisol, in whom SSRI-treated subjects showed substantially greater reduction in cortisol than did placebo-treated subjects. Reductions in cortisol were associated with improvements in anxiety."

In the past, we’ve talked about cortisol in the past in terms of inflammation and celluar stress (Reducing Cellular Stress with Yoga and Cortisol, Stress and Yoga) as well as stress eating (see Yoga, Stress and Weight Management and Stress Eating and the Healthy Eating Meditation Practice), but we’ve never addressed its effects on our emotions. In my post Stress and Your Thought-Behavior Repertoire, I talked about how while you’re in stress mode, your thoughts are restricted to Fight or Flight options. Now it seems possible elevated cortisol levels might be to blame for this and/or for raising levels of anxiety or worry in general.

The paper also said that older adults in general have a harder time with elevated cortisol as, “aging increases vulnerability to adverse effects of elevated cortisol, because compensatory mechanisms preventing its deleterious effects are diminished.” It also mentioned that that chronic over-activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis causes wear and tear to the brain and body via toxic effects of elevated cortisol levels.

So, the bottom line is that elevated cortisol levels in older adults is particularly dangerous, potentially causing Generalized Anxiety Disorder as well as other diseases and physical problems. But although the researchers of this paper used medication to lower cortisol levels, this may not be the only way to do lower them. If you’re feeling well enough to forgo medication (and your doctor agrees with you about this) or if you just want to practice to prevent future problems with anxiety, you can use yoga to lower your cortisol levels. 

Reducing Anxiety with Yoga

I’ve done several posts in the past about how to use yoga to reduce anxiety (see 10 Ways to Soothe Anxiety with Yoga and Yoga Solutions for Anxiety). But it’s worth emphasizing here that some of the techniques we recommend for stress management in general, including meditation and restorative yoga, might not work well for anxiety. That’s because it’s very hard for many anxious people to lie or sit still, as they tend to become even more anxious if they are alone with their thoughts. See When Relaxing Isn't Relaxing.

On the other hand, while an active yoga practice can engage your mind and distract you from your worries (a welcome relief!) it is not necessarily going to lower your cortisol levels. An active practice is generally more stimulating than relaxing, although it is useful for tiring you out (plus, everyone needs exercise).

So, if you’re someone who has trouble lying still due to anxious thoughts, who feels generally hyper (I know that feeling!), or who has been sitting all day for work and needs to move, I recommend starting with an active practice, such as Featured Sequence: Lower Body Strength or Upper Body Strength. Then, after you’ve released some of your excess energy, try practicing one or more supported inverted poses. Because the Relaxation response is triggered by your physical position, supported inverted poses don’t require a mental focus (see Why You Should Love Your Baroreceptors). So you can keep your eyes open and even listen to music while you are practicing them and you’ll still quiet your nervous system. Of course, as with any pose, if you feel bad in an inverted pose, come out of the pose immediately. See All About Supported Inverted Poses to find a supported inverted pose that's right for you.

See When Relaxing Isn't Relaxing for more suggestions for what to do when anxiety means that relaxing isn’t relaxing. Of course, if you’re not experiencing anxiety and are comfortable with other forms of stress management, continue to practice the way you enjoy it the most (see The Relaxation Response and Yoga). Keeping cortisol levels low may very well help prevent problems such as anxiety from occurring or re-occurring in your future.

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Stress and Your Thought-Behavior Repertoire

by Nina

Last Thursday in my post Re-Patterning Your Nervous System, I described something intriguing that I’d learned from Dan Libby, who teaches yoga to veterans (see veteransyogaproject.org), which was that in stress mode our thoughts narrow and become limited to fight or flight strategies, while when we are calmer, our thoughts are more expansive, and therefore include a much wider range of possibilities. I quoted him saying:

"The basic gist is that regulating our autonomic nervous system, which really means activating the more newly evolved part of the parasympathetic nervous system via the vagus nerve, allows for an expansion of your thought-behavior repertoire. Instead of having a limited, narrow, tunnel-vision, like we do when our sympathetic nervous system is dominant, we have more cognitive and behavioral options available to navigate our world."

I also wistfully said that I wished I had copies of the figures he used in the presentation I had attended. After I wrote that, I thought to myself, duh, how about just asking him, Nina? And, guess what? He sent them along right away. So I today I’m pleased to say I can share them with you. And luckily I took some notes during his presentation so I can explain them a bit to you as they contain some rather technical terms.

First, Dan introduced the concept of “window of tolerance.” This is a level of arousal ("arousal" refers to the intensity of the Stress or Fight or Flight response) that is appropriate to the environment. While, for example, for a soldier, a very high level of arousal is appropriate in an actual battle, that same level is not appropriate while you’re stuck in a traffic jam or working at the office. This figure conveys the basic levels of arousal.

Now we have figures that illustrates the thought-behavior repertoire associated with an arousal level outside the window of tolerance and two within the window. When the arousal level is "optimum," your thoughts and behavior possibilities expand, until it is possible to consider altruistic possibilities and living in line with your basic values and goals. (I like how in that illustration, some of the thoughts are literally “out of the box.”)

Dan concluded his presentation by discussing how yoga can help people move into their optimal arousal zone, something I hope he’ll be writing about for us in the future (yeah, while I was at it, I asked him to write a post for us).

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Re-Patterning Your Nervous System: Practice for the Real World

by Nina  

Katja Huiras, Age 50

“I think Korb misses a key issue—asana practice induces a stress response in a controlled setting that we can use to retrain our brains. The real world is where we exercise our newly retrained brain, but it is very hard to actually do the retraining there. So for me the 'practice' aspect to yoga is very profound—I use yoga to practice how to respond to stress or unpleasant realities. Without the freedom to experiment and play with my capacity, it is not really possible to develop any degree of 'mastery' over my stress response. So for me, asana practice literally walks me through and teaches me how to cope with stress and unpleasant realities. Then I can use and build on those tools off the mat. I think Korb misses the need for practice and play.” — Comment left on our post Changing the Brain's Stressful Habits

Wow, I was so pleased and grateful when I read that comment back when I wrote my post Changing the Brain's Stressful Habits because our reader not only said added exactly what was missing from my post but they expressed themselves so clearly. And rereading the comment again, I was happy all over again because this is very topic I want to address in today’s post. That’s because while Baxter discussed how we can use yoga to change our habits in general his post Changing Your Habits with Yoga, I feel one of the most beneficial habits we change with yoga is the way we habitually react to stressors in our lives. 

This is because training ourselves not to react so strongly to stressors gives us the ability to choose a different way of reacting to them. Just recently I learned from Dan Libby, who teaches yoga to veterans (see veteransyogaproject.org), that in stress mode our thoughts narrow and become limited to fight or flight strategies, while when we are calmer, our thoughts are more expansive, and therefore include a much wider range of possibilities. (I wish I had the illustration he used in his talk at the SYTAR conference that showed the limited number of thoughts you might have in stress mode vs. the much larger number you might have in the same situation if you’re not reacting so violently to the stressor.) He says:

"The basic gist is that regulating our autonomic nervous system, which really means activating the more newly evolved part of the parasympathetic nervous system via the vagus nerve, allows for an expansion of your thought-behavior repertoire. Instead of having a limited, narrow, tunnel-vision, like we do when our sympathetic nervous system is dominant, we have more cognitive and behavioral options available to navigate our world."

In Dan's presentation, he was talking about veterans with PTSD, but even someone like me can relate because, for example, back in the day, I had a bad habit of overreacting to work deadlines my boss gave me by going into a full-fledged panic, something that was not particularly helpful as you might imagine. 

In Yoga: Changing the Brain’s Stressful Habits in Psychology Today, neurobiologist, Alex Korb wrote: 

“Your brain tends to react to discomfort and disorientation in an automatic way, by triggering the physiological stress response and activating anxious neural chatter between the prefrontal cortex and the more emotional limbic system. The stress response itself increases the likelihood of anxious thoughts, like "Oh god, I'm going to pull something," or "I can't hold this pushup any longer". And in fact, your anxious thoughts themselves further exacerbate the stress response.”  

“Discomfort and disorientation” is another way of describing a “stressor,” which is anything that has the potential to stress us out. And we do have habitual or “automatic” ways of reacting to our stressors. But in that same article, Korb discussed how by using our breath and mindfulness to stay relaxed as we encounter “stressful” yoga poses, we are unconsciously retraining our nervous systems to stop reacting in our habitual way to stress. And that this retraining can help us handle stress more effectively in our everyday lives.

 “Even actions as simple as changing your posture, relaxing the muscles on your face, or slowing your breathing rate, can affect the activity in your brain (beyond, of course, the required activity to make the action). These changes are often transient, but can be long-lasting, particularly if they entail changing a habit.” 

This is exactly what I mean by “re-patterning your nervous system.” According to Korb, this process is happening unconsciously when you take a yoga class and your teacher asks you to do a pose that scares you, that challenges you physically, or that makes you uncomfortable for some reason. So I guess we’re all doing a bit of this already (and maybe that’s one reason practicing yoga makes us feel better both in the classroom and in the “real world”). 

But if you have some habitual patterns of reacting to stressors that you’d like to change (we used to call them “buttons that get pushed” as I remember), you can work with this technique consciously in your home practice. Start by adding poses to your practice that tend stress you out in any way and find ways to approach them gradually and in a relaxed fashion. And after noticing your habitual thought patterns as you practice those poses, take a nice, deep breath as you face down “the enemy.” For example, in my early days of practicing, I worked toward kicking up into Handstand at the wall—which terrified me—by doing Handstand in a doorway to get me used to the feeling of being upside down on my hands. Eventually I gained the confidence to do the full pose without the negative, self defeating thoughts that were preventing me from getting up. I also worked on Urdva Dhanurasana, which was so unpleasant for me, both by doing more passive backbends and just plain old befriending the pose by doing it frequently. But those are just examples; each of us different and you’ll have to figure out the right poses or practices that will work for you. 

And although both Korb and our commenter both only addressed using the asana practice to re-pattern your nervous system, I’m sure you can use the meditation practice the same way. For although meditation will eventually trigger the relaxation response, sometimes sitting down to meditation can be initially stressful, especially if you’re new to it, if you know you’re going to be sitting with difficult thoughts and emotions, or if you will be sitting for a particularly long period of time. And perhaps for some of us practicing pranayama, which entails sitting or lying still for extended periods of time, or even practicing restorative yoga, which likewise means being still and quiet, could serve the same purpose. Once I did an hour-long Savasana with a teacher, and although I caught myself thinking, I’ll never be able to survive this (I tend to get hyper), I made it through with no problem!

How about you? Are any of you working on facing difficulty in your yoga practice?

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About Stress: Acute Versus Chronic

by Nina

We go on and on about stress management on this blog, don’t we? Well, that’s because the more we learn about the effects of chronic stress on the body, mind, and emotions, and the relationship between chronic stress and various diseases of aging, such as heart disease and hypertension, the more convinced we are that practicing yoga for stress management is one of the most important things you can do to promote healthy aging in the long term and enhance the quality of your life in the short term. 

But even though we think managing stress levels is so critical, it’s important to understand that stress in and of itself is not a bad thing. In fact, in certain situations, it’s actually a good thing. So today I’m going to do a little compare and contrast between acute and chronic stress and discuss how your nervous system responds to both. Yes, it’s another one of my little anatomy lessons but it is one that can have a profound effect on your physical, mental, and emotional health.

About Acute Stress

It was 5:04 on October 17, 1989 when the Loma Prieta earthquake hit. I was about to leave my Berkeley house to go grocery shopping with my five year old daughter at my side and my baby in his stroller when I felt such a violent shaking that I knew the quake was going to be a big one. I quickly looked around the house to find the safest place for us to be, and then grabbed my daughter and moved the three of us under a reinforced doorway. It turned out that our lives weren’t really in danger—though the framed artwork over the fireplace did come crashing down—but it was good to know that in an emergency, I could think and move with speed and clarity even while the floor underneath me was rolling and shaking. Although I didn’t realize it at the time—I was too busy reacting in the moment—my nervous system had switched into Stress mode (aka Fight or Flight mode, which is sometimes called Tend and Befriend for women). 

This is a dramatic example of a time in my life where I experienced acute stress. In my post Life-Changer: Understanding Your Autonomic Nervous System, I described how your nervous system responds to perceived danger or extreme physical activity. Preparing you to fight, run, or take evasive action, your autonomic nervous system releases hormones—adrenaline and noradrenaline—to increase your heart rate, blood pressure, blood flow to the muscles, and widens (dilates) your airways to make breathing easier. It also causes your body to release stored energy and increases muscle strength. And to increase your ability to assess your current situation and make important decisions, your nervous system causes your mind to race. So during that earthquake, my nervous system was doing just what it needed to do!

After the quaking stopped, we went outside onto the street to see what happened to the neighborhood. When we realized that everyone and their homes were all fine, we started to calm down. There was still some stress and worry while we waited to hear that my husband was safe and for him then to get home (which took several hours). My baby, of course, had no clue what was going on and I put him down at the usual time, but my daughter had to see her father before she could even think of going to sleep so I had her stay up with me (of course, even children feel stress).

By the next day, safe and reunited, we were feeling pretty normal as we dealt with the aftermath, like taking the brick chimney down (it had shaken dangerously loose). Of course, we were sad and horrified at the loss of life and property that occurred as a result of the quake, especially in nearby Oakland, where the double decker freeway collapsed. But our nervous systems recovered pretty quickly. 

After a bout of acute stress, you settle back down to normal. Your nervous system reduces the levels of stress hormones in your body, slowing your heart rate, decreasing blood pressure, reducing oxygen intake, and so on—your organs don’t need to work as hard now that the stressful situation has passed. And, now that you’re out of danger, your racing mind will also slow down. Your nervous system also stimulates your digestive tract to process food, eliminate waste, and use the energy from the processed food to restore and build tissues. After all, you need to build yourself back up after being depleted by a period of stress. 

Acute stress is a short-lived episode that is a natural, healthy response to danger, a perceived threat, or a physical challenge. And this is something we cannot and should not eliminate from our lives because even if we’re not living not in an earthquake zone, we all need to get out of danger sometimes, whether that means getting out of the way of an oncoming car or protecting a family member from a threat. But our stress response also prepares us for some really good things in life, including running a race, traveling to a foreign country, having a creative brainstorm, falling in love with someone, and even having an orgasm. 

About Chronic Stress

Back in the early nineties when my husband and I were raising our two children, I had a job as the documentation manager and lead technical writer at a software start-up company. As you might imagine, the pressure was intense as our small company struggled to meet our first deadline, the first test of the product by real customers (who needed my manuals to teach them how to use the product!) and balancing my work/home life was a definite challenge. As the deadline approached, I started working overtime. And I began having terrible insomnia—I could fall asleep but would be wide awake after just a couple of hours. I also started losing weight because the stress made me so feel nauseated that I lost my appetite.

Even though I wasn’t in the middle of an emergency, my nervous system was doing the same thing it had been doing during the earthquake, keeping my body and mind ready for fight or flight, but it was now a problem because the stress never let up and I had no chance to rest and recuperate. Eventually I was so anxious, exhausted and nauseated that even though I met my deadline (and the company went on to success), I couldn’t bounce back to normal health and my stress-related problems continued to plague me. It took a year and half of therapy, medication, and lifestyle changes to recover completely. (This was before I had the knowledge I do now both of the nervous system and how yoga can help.)

Unlike acute stress, which is short-lived and in response to a single event, chronic stress is ongoing stress that never lets up. Many different life circumstances can cause chronic stress, from job pressures, marriage or family problems, and financial or health problems to living in a stressful environment, such as a dangerous neighborhood or war zone. But regardless of the reasons, when your nervous system is continuously on the alert, and your body and mind never have a chance to recover and recuperate, your body and mind become overtaxed. And some of the serious health problems that can be caused by chronic stress include:

• heart disease 
• hypertension (high blood pressure) 
• insomnia and/or fatigue 
• digestive disorders 
• headaches 
• chronic anxiety or depression 
• weakened immune system 

But helping you manage chronic stress is where yoga really shines. Sometimes you can change your circumstances and your yoga practice can help support you through those changes, but other times circumstances are out of your control. Either way, yogic stress management practices (see The Relaxation Response and Yoga) and yoga philosophy (see Why You Should Study Yoga Philosophy) can help you face difficult challenges while at the same dialing down your stress levels. Maybe you will even be able to move toward equanimity. After all, the Bhagavad Gita defines a yogi as: 

“Who unperturbed by changing conditions sits apart and watches and says “the powers of nature go round”, and remains firm and shakes not. —trans. by Juan Mascaro

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2 Steps to Take Charge of Your Stress or Anxiety

by Nina

Enclosed Field with Rising Sun by van Gogh

Lately I’ve been trying to help several people who are suffering from stress and/or anxiety. Although these people are all quite different from each other—they range from a young woman with a new baby to man with newly diagnosed heart disease to an older man with chronic insomnia—I found myself saying the exact same things to each one of them. And since my advice was, in a way, very basic, I thought I’d write it up for the blog.

One of the things that motivated me to share this advice was that I was struck by something my friend said when talking over her daughter’s problems with her. “Well, I guess, anxiety just comes and goes.” My friend seemed to feel that her daughter was at the mercy of some emotion that took her over periodically and that there was nothing she could do to change that. But I feel that through a combination of educating yourself and making some lifestyle changes, you can empower yourself to deal more effectively with stressful situations and hopefully also reduce the levels of stress and/or anxiety that you are suffering from. 

And the advice I’ve been giving boils down to two simple steps.

1. Learn About Your Nervous System.

The first thing I always tell people I’m teaching to manage stress and anxiety is to read The Relaxation Response by Herbert Benson so they can learn about how their nervous system—specifically the autonomic nervous system—works. I recommend this book because although we have some information on the blog about the nervous system (see Chronic Stress: An Introduction and Stress, Your Health and Yoga), we don’t yet have a comprehensive overview of the nervous system. (I am going to write one tomorrow, though, because I’ve realized how important it is!) 

I feel strongly that educating yourself about your nervous system will help eliminate some of the mystery of what’s happening to you and empower you to make some important decisions. Knowing the symptoms of chronic stress, such as insomnia, digestive problems, headaches, high blood pressure and so on, will help you choose the right solutions (see below) for you and to take action before things get out of hand. And I also believe that knowing about how your nervous system works and understanding the difference between sleep and conscious relaxation (see Conscious Relaxation vs. Sleep) will motivate you to start practicing stress management. Otherwise, you might think—as one friend did—that exercise and sleep are all that is needed.

For example, I can always tell when I’m getting stressed out because I start sleeping poorly, lose my appetite (sometimes even feeling nauseated), and, because my mind is racing, I talk more than usual! If things get really bad, I start to feel a burning sensation in my chest. So rather than just waiting until things get even worse (I have been there—“going over the edge” I call it), I double down and focus my yoga practice on stress management (see Friday Q&A: Practicing to Manage Stress). I believe this has helped keep me emotionally healthy for almost 20 years now.

2. Find Ways to Manage Your Stress and Reduce Anxiety, and Practice Them.

Once you’ve learned about your nervous system and how important conscious relaxation is for your emotional as well as physical health, you should take the time to explore the possibilities yoga offers for helping you manage your stress and reduce your anxiety. We’ve been writing about the different ways that yoga can help you manage stress since the very earliest days of the blog. And throughout the years, we’ve continued to write about this. That’s because we feel that yoga includes such a wide range of possibilities that you’re sure to find something that works for you. Interestingly, the paper I wrote about in Self-Regulation, Psychological Health, and Yoga confirmed this very opinion!

But everyone needs to experiment to find what suits them best. For example, even though breath practices (see Friday Q&A: Breath Practices for Anxiety) are traditionally thought to be helpful for stress and anxiety, one person I’m working with found that breath practices I recommended tend to agitate him. Happily, however, I introduced him to supported forward bends, which he immediately found soothing. Another man I’ve been counseling does find breath work helpful, and he has used to it to relax while getting medical procedures that make him tense. He also really enjoys the guided relaxation tracks we have available on our site (see Audio Tracks). 

I myself love the breath practices and supported inversions (see All About Supported Inversions). But I never enjoy restorative yoga, unless I’m super exhausted, and I don’t like listening to an audio recording of any kind while I practice, which are two of Baxter’s favorite things. Hey, we’re all different, not only in our tastes but in the ways we get stressed out. See The Relaxation Response and Yoga for an overview of the different practices.

Finally, once you’ve identified the practices that work for you, you need to practice them regularly. This is crucial! Although some of the practices can provide quick, temporary relief, none are going to instantly re-balance your nervous system. After all, it probably took a while for your nervous system to become over-stressed, so it will take some time to return it to normal. But making the commitment to actively take care of yourself by practicing regularly is empowering—you are no longer at the complete mercy of outside forces—and that in itself is a huge step to take.

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Yoga for Emotional Wellbeing: An Epiphany

by Nina

Sand Dollar by Melina Meza

I don’t have a particularly exciting story about why I started practicing yoga. (It’s kind of humorous actually. When I was in my late twenties, I was working at a small software company and we wanted to start an on-site exercise class. One of our co-workers said that his wife could come and teach us, so we decided to give it a go. We had no idea she was a yoga teacher! So there we were, for our first class, and she asked us to stand in “Mountain pose,” with our big toes together and our heels slightly apart, which was the opposite of the foot position I was used to doing in ballet and modern dance, my previous forms of preferred exercise. And just standing that way felt so wonderful for my body, I thought, whatever this is, this is for me!). However, I do have a more dramatic story about why I decided to become a yoga teacher.

During the period when I was studying yoga with Rodney Yee and writing our first book together, Yoga: The Poetry of the Body, Rod helped me understand how my yoga practice was benefiting me in emotional and spiritual ways, as well as physical ones. It turned out that by practicing regularly at home—something I had taken up intuitively rather than with any specific goals in mind—I had been learning to manage my stress, balance my emotions and cultivate equanimity without even realizing it. (If you read the dialogues in the book Yoga: The Poetry of the Body, you can witness Rod helping me toward that realization.) And as someone who had suffered in the past from chronic stress (working full time at a software start-up while raising two children!), which had led to a bout of agitated depression, I began to see the tremendous power yoga had for helping people with emotional difficulties of all kinds, including stress, depression, anxiety, anger, and general dissatisfaction or unhappiness.

Then, one morning when I was practicing yoga with Rod and his best friend, Ian, Ian began talking about how he had just learned that a colleague of his had committed suicide.  (Yes, sorry to disillusion you, those guys chatted constantly while they were practicing.) And while I was in Shoulderstand, I kept thinking about about Ian’s story, and filled with compassion for his friend—for the suffering he must have experienced to lead him to take his life—I began to cry. I realized then that while I could not help Ian’s friend, I did have quite a lot of knowledge that I could use to help other people who were suffering. And while I had no particular ambition to become a yoga teacher per se, I understood at that moment that I really should look into finding a way to share what I knew. Yes, it was one of those actual epiphanies (and I had it while I was doing a yoga pose).

After that, I started doing two things. First, I began taking as many workshops as I could from teachers like Patricia Walden, who teaches workshops on Yoga for Depression (I took that more than once!) and Yoga for Emotional Healing, and Roger Cole, who teaches about the physiology of inversions. Then, I enrolled in a three-year teacher training program at The Yoga Room, in Berkeley. Clearly I believe in being thoroughly prepared! Finally, when I felt ready (and when I got the go-ahead from Patricia, who was informally mentoring me) I did begin teaching workshops on Yoga for Emotional Wellbeing, Yoga for Stress and Yoga for Better Sleep. Those were rewarding—there is nothing like having even just one person tell you that you made a difference in their lives by teaching them a simple practice, like breath awareness—and I still teach them occasionally. But I eventually realized that writing is still my forte and that I could reach a larger audience through my writing than by teaching local workshops.

When Baxter and I came up with the idea of starting a blog, I realized that a blog could be the perfect venue for me; having our own blog would allow me to give myself the power to write about what I wanted to write about, the way I wanted to write about it (frankly, the way some publications edit/rewrite you can be positively painful). And because the blog was free and accessible world wide, I could reach people who would never be able to study with me in person.

Because I not only write for the YFHA blog but I’m also the Editor in Chief, I work on the blog at least five days a week (and sometimes behind the scenes on the weekends). And that takes a lot of dedication. But that original epiphany I had in Shoulderstand and my ongoing passion for sharing what I know about the emotional and spiritual benefits of yoga—as well as the physical ones—are a wellspring that never runs dry.

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Changing the Brain's Stressful Habits

by Nina

Peeling Paint by Melina Meza

Yesterday I read this article Yoga: Changing the Brain’s Stressful Habits in Psychology Today by a neurobiologist, Alex Korb, who took his first yoga class (which, surprise, surprise, turned out to be much more difficult than he was expecting!) and had a little epiphany:

“I came to realize that yoga works not because the poses are relaxing, but because they are stressful. It is your attempts to remain calm during this stress that create yoga's greatest neurobiological benefit.”

Ignoring for the moment that fact that this dude obviously knows very little about yoga (duh, some yoga poses ARE relaxing) and has only experienced an active asana class—from a single teacher yet—I hope he does his scientific research a little more thoroughly—I found what he wrote rather intriguing.

“Your brain tends to react to discomfort and disorientation in an automatic way, by triggering the physiological stress response and activating anxious neural chatter between the prefrontal cortex and the more emotional limbic system. The stress response itself increases the likelihood of anxious thoughts, like "Oh god, I'm going to pull something," or "I can't hold this pushup any longer". And in fact, your anxious thoughts themselves further exacerbate the stress response.”

In the past, we’ve written extensively about how to use yoga to trigger the relaxation response (see The Relaxation Response and Yoga) to help you manage your stress. In this case, we’re not talking about “stressful” practices but rather relaxing ones, whether that means restorative or supported inverted poses, meditation, breath practices, Savasana with a mental focus, or yoga nidra. But most of us also know from experience that an active asana class that includes some very challenging poses can relieve stress. We’ve mentioned that in that past, explaining that an active yoga practice is a form of exercise so it releases endorphins, the allover stretching you experience releases held stress from your body, and the mindfulness you bring to your practice gives you respite from your everyday concerns—and we’re not taking that back. However, this idea Dr. Korb expresses that by doing challenging yoga poses mindfully, with attention to breath and physical sensations, you’re teaching your nervous system to react more calmly to stressful situations is an interesting one:

“Even actions as simple as changing your posture, relaxing the muscles on your face, or slowing your breathing rate, can affect the activity in your brain (beyond, of course, the required activity to make the action).  These changes are often transient, but can be long-lasting, particularly if they entail changing a habit.”

This reminded me of what I have already written about samskaras (the ingrained habits of the mind) in my posts Meditation and Brain Strength and A Pathway in the Mind. In case you haven't read those posts, here is Stephen Cope’s definition of a samskara:

“Yogis discovered that consciousness is dominated by highly conditioned patterns of reactivity—patterns that are deeply grooved, and very difficult to change once established. 



“Every action based on craving or aversion leaves a subliminal impression on the mind. These impressions are called samskaras, or literally, “subliminal activators.” Yogis sometimes think of these subliminal activators as being pressed into the “hot wax of the mind.”



“Samskaras are like little tracks, little vectors, little ruts in the muddy road. The next time the car travels that road, these muddy ruts will have hardened into permanent fixtures, and the car wheels will want to slide into them. Indeed it’s easier to steer right into them than to try to avoid them.”

It seems to me that what Korb is saying here is that by using our breath and mindfulness to stay relaxed as we encounter “stressful” yoga poses, we are unconsciously retraining our nervous systems to stop reacting in our habitual way to stress. And that this retraining can help us handle stress more effectively in our everyday lives.

“Some people might think that the stress response is an innate reflex and thus can't be changed.  To clarify, the response is partly innate and partly learned in early childhood.  Yes, the stress response comes already downloaded and installed on your early operating system.  However, this tendency is enhanced, by years of reinforcement.  In particular, you absorb how those around you, particularly your parents, react to stressful situations.  Their reactions get wired into your nervous system. However, just because a habit is innate, and then reinforced, does not mean it is immune to change. Almost any habit can be changed, or at least improved, through repeated action of a new habit.”

This seems like a worthwhile way to approach the practice of active asana, especially if you’re someone who habitually “stresses out” when encountering difficulty. I’ve worked this way myself in my own yoga practice, as I’ve faced down my fears of doing poses that scared me, such as Headstand in the middle of the room, and poses that were difficult and stressful for me, such as Upward Bow pose (Urdva Dhanurasana). So I’ve long been an advocate of incorporating challenging poses—and those vary from person to person—into your practice for this very reason. So if you’re not already doing this, as you notice a stress reaction to a new pose, to a pose you already hate (yeah, that happens to the best of us) or to holding a pose for a longer time than usual, focus on slowing your breath, especially your exhalations. It’s nice to know that this will not only make your experience of the dreaded pose more pleasant, but that you’ll also be retraining your nervous system to handle stress with more equanimity.

Okay, now that I’ve said some nice things about Korb’s epiphany about how “yoga” works, it’s time to return to some snark. Because now that he’s figured it all out, Korb concludes by saying:

“The good news is that you don't actually have to go to a class to practice yoga. The poses most people associate with yoga are just a particular way of practicing yoga called the asana practice ("asana" translates to "pose"). The asana practice challenges you in a specific way, but life itself offers plenty of challenges on its own".

Well, thank you very much Dr. I haven’t even finished my post-doc yet! I’m so glad you learned everything you needed to know about yoga in just a few classes with one teacher. I, on the other hand, have been taking yoga classes for decades, and continue to read and study on my own as well. And while I agree that you can use your breath and mindfulness to retrain your nervous system while facing life’s challenges, essentially practicing a form of “yoga” outside the yoga room, I’m pretty sure there is more to yoga than just that. I asked Dr. Ram Rao—a scientist who not only has finished his post doc, but who has also trained to become a yoga teacher—what he thought of this article, and here’s what he said:

People practice yoga not for the challenge per se, but for its overall profound effects, which they do not get from other life's situations.

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Of Mice and Men: Yoga as a Refuge

by Nina

Two Mice by Hokusai

Recently a friend sent me a link to this video on stress by Dr. Kelly McGonigal because she thought I might find it interesting. Well, I started to watch it thinking I might share it on Facebook, but I was so troubled by what Dr. McGonigal said during the first minute that I switched it off. What Dr. McGonigal said—and perhaps she was just being dramatic—was that she had entirely changed her mind about how stress affects our health because of a study she read that showed that people only got sick from stress when they believed that stress was bad for them.

I just found that hard to believe! Now I know Kelly’s a Stanford psychologist and all, but I’ve been married to a scientist for a very long time so I tend to be very skeptical about some of these types of studies. So I decided to do a reality check with said scientist (for our newer readers, that would be Brad Gibson, a medical researcher at the Buck Institute for Research on Aging). I told him about what she claimed, and asked if that was possible.

“It’s BS,” he said firmly. “After all, most of the studies on the effects of stress have been done on mice.”

I understood his point: they didn’t exactly divide the mice into two groups, one who they told that stress was bad for mice and the other who they just stressed out without telling them that stress was bad.

And just as I was starting to wonder how you stress out a mouse, he said, “For example, in some studies they make it impossible for a mouse to create its little nest.”

I thought that was fascinating—a mouse needs to go off by itself for periods of time into its cozy little place in order to stay sane.

Brad went on, “If they disrupt a mouse’s ability to nest, it becomes very stressed out and there are obvious chemical changes they can measure. If they continue the disruption for only a short period of time, the mouse’s chemical balance will return to normal. However, if this goes on for a very long period of time, the imbalance can become permanent.”

Well, we’ve been talking on this blog about the negative effects of chronic stress since the early days (see Chronic Stress: An Introduction and Stress, Your Health and Yoga). But what this particular story about the experiments on mice made me think of was my own yoga practice. Yes, my regular home practice is my refuge, not unlike the little nest a mouse makes for itself to retreat to. Spending that quiet time alone, feeling my body and my breath, almost never fails to make me feel better than before I practice. And when I am experiencing stressful events—that is unavoidable of course, and maybe the point Kelly McGonigal was trying to get to—I tailor my practice to calm and comfort myself. And this yoga as a "refuge" concept is one of the main reasons I’m on a mission to encourage people to start practicing yoga at home, even just for short sessions.

Restorative yoga in particular, with all the blankets and pillows and comfy bolsters, is a little bit like nesting, isn’t it? If you’re not familiar with restorative yoga, read Restorative Yoga: An Introduction and see Mini Restorative Practice for a mini restorative practice that is suitable for most everyone. Even just a brief session of Supported Child’s pose can be extremely calming and comforting.

P.S. I suppose that some of you will or have already watched the entire video, and may want to straighten me out about what Dr. McGonigal's real message was. Feel free! But this post isn’t really a response her video so much as a little tale of mice and men.

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The Nature of Being

by Nina

New Bay Bridge by Melina Meza

As you can probably tell from my post yesterday on non-holding, I'm in a philosophical mood. To be honest, as much as I value the physical benefits I get from my asana practice, I think I value even more the benefits I've gained from studying yoga philosophy. This is why when Baxter and I describe what I might call the pillars of yoga for healthy aging, we always include "cultivating equanimity" along with strength, flexibility, balance, agility, and stress management. And as I was looking for something to write about this morning, I found a quote from B.K.S. Iyengar that perfectly summed up my reason for holding yoga philosophy in such high esteem:

Yoga recognizes that the way our bodies and minds work has changed very little over the millennia. The way we function inside our skin is not susceptible to differ either in time or from place to place. In the functioning of our minds, in our way of relating to each other, there are inherent stresses, like geological fault lines that, left unaddressed, will always cause things to go wrong, whether individually or collectively. The whole thrust of the yogic philosophical and scientific inquiry has therefore been to examine the nature of being, with a view to learning to respond to the stresses of life without so many tremors and troubles. —B.K.S. Iyengar, from Light on Life

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Cortisol and Good Health

by Baxter

Fallen Tree by Brad Gibson

We have mentioned one of the body’s important hormones, cortisol, on these pages a few times in the recent past, but always with the slant of it somehow being a problem child, a bad actor, a rotten apple, as it were. But cortisol, when it is working in harmony with a well-balanced body and mind, is part of a elegant system that tries to help us respond in the best way possible to short term stressful situations that are bound to arise in our daily lives. So on a daily basis, during the early morning hours - around 4-5 am, the body releases a bit of cortisol to get your inner furnace ready for the first foot hitting the floor in the morning. It releases a bit of sugar into the blood stream, sends a bit more blood to the brain and heart, and really gets us ready for action, however mellow or intense our morning will be. Then, if the day is relatively uneventful, the level of cortisol gradually diminishes to its lowest levels around 10pm.

When released in response to unexpected stressful events, it has many more helpful roles to play. It has a strong anti-inflammatory effect, which is helpful with acute injury, so it can act like a fire truck when the body’s immune response to infection is too strong by decreasing the life span and production of one of our white blood cells known as lymphocytes. Basically, it tries to keep a balanced approach to infections.

Cortisol has an effect on the cardio-vascular (CV) system by controlling the smooth muscles in the walls of our arteries. In normal circumstances, this allows cortisol to help boost our blood pressure in the short run when we need extra work from the CV system. It has effects on the central nervous system (CNS), too, influencing behavior, mood, excitability, and the electrical activity of neurons. When we put all that together, cortisol is designed to respond to stress by providing fuel in the form of glucose, mobilizing fat and proteins for back-up fuel supply, modifying the immune response, heartbeat, blood pressure, brain alertness and the response of the nervous system to get us through the rough spots.

The cool thing about cortisol is that is has evolved to enhance the body’s response to stress while also protecting from excessive response to stress. The key thing about the place that produces cortisol, the adrenal glands, is that they need time to recover after stressful events have passed. And herein lies the rub!  If we give the body some time to recover between stressful events, the adrenal glands can do their job well, cortisol levels are adequate to the demands of the body, and you stay healthy and ready for the next stressful event.

But if you are either under constant stress, or your mind is prone to brooding about the past or anxious musings about the future or even negative assessments about the present moment, your adrenals interpret this as an actual stressful event occurring right now, and cortisol gets released into your system. So cortisol levels remain high in the blood stream for greater periods of time, which can result in swelling of the gland itself, and an increased chance of the following negative effects: loss of immunity secondary to shrinkage of lymph glands, increased risk of stomach ulcers, increased risk of hypertension, heart disease and other vascular disorders, excess sugar in the blood stream and more chance of developing diabetes. Not a good outlook! 

And as I mentioned last week, chronic stress depletes your supply of cortisol and can steal the building blocks of your sex hormones (see Yoga and Male Menopause), thus negatively impacting your sexual function and your reproductive capacity. What’s a yogi to do? 

Supta Baddha Konasana (Reclined Cobbler's Pose)

The good news is that your regular yoga practice, if it includes those much needed restorative poses (see Restorative Yoga), yoga nidra (see Yoga Nidra and Deep Relaxation), long guided meditations and generous Savasana (see Savasana Variations), should be the perfect balancing act for keeping the adrenals healthy and the cortisol cycle in synch with your changing needs. One fact that might influence your asana and even your exercise regimen is that aerobic or effort-full exercise (and some forms of yoga definitely fit the bill) can cause a release of cortisol to deal with the short term “stress” of the increased physical effort. If you work out or do asana in the morning, when there is still a bit of cortisol around from the 4 am release, the effects of the brief elevation are minimal. However, a late day work out could be theoretically more problematic, with a negative effect on sleep patterns as one possible side effect. So I would recommend active workouts and asana for the morning, and restorative practices in the evening if you want or need to do something later in the day.

So remember, cortisol is a good guy just trying to do its job. It’s the stress and our reactions to it that are really the culprits. Fortunately, we have the technology to neutralize this threat to our healthy aging! 

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