Why You Should Care About Your HPA Axis (and Find More Contentment)

by Ram

Taking Flight by Marie Lossky
(@Marie.Lossky on Instagram)

Recall the time when you were extremely irritable, anxious, moody, or facing some severe emotional upheaval. It was so severe that that all you wanted to do was drop everything and head to a quiet place that was far, far away from family, work, friends, etc. All you were looking for was some quietness and peace. Now if you wish to understand the cause or point fingers at something, you can blame it on your HPA axis. 

The HPA (hypothalamic–pituitary–adrenal) axis is a complex network of cellular interactions that trigger numerous biochemical responses and involves three main endocrine glands: the hypothalamus (aka the master gland), the pituitary gland (a pea-shaped structure located below the hypothalamus), and the adrenal glands (small organs on top of the kidneys). The physiological role of the HPA axis and the hormones associated with it are very fundamental, and similar systems exist in lower organisms as well. The hormones regulated by the HPA axis include: 

1. Vasopressin and Corticotropin Releasing Hormone (CRH). These are produced and secreted by the hypothalamus in response to either physical or psychological stress. While vasopressin controls water metabolism through its action on the kidneys, CRH regulates appetite, attention, and feelings of anxiety. Furthermore, it regulates the secretion of Adrenocorticotropic Hormone (ACTH).
2. Adrenocorticotropic Hormone (ACTH). This is released by the pituitary gland, and stimulates the adrenal glands to increase production of Glucocorticoids.
3. Glucocorticoid. These are a class of corticosteroids that regulate glucose metabolism and the immune system. Cortisol (or hydrocortisone) is the most important human glucocorticoid.
4. Cortisol. This is released in response to stress and low blood-glucose concentration, and regulates blood sugar, the immune system, and the metabolism of fat, protein, and carbohydrates. Cortisol also activates the body’s response to stress, injury, sleep deprivation, physical exhaustion, and anxiety. Low levels of the hormone has beneficial effects, such as protecting the body from stressful situations, providing more energy, increasing physical and mental performance, and memory recall. However, sustained high levels of cortisol can have deleterious effects. 

In short, the HPA axis coordinates effectively to modulate the stress response. Additionally, the HPA axis via all the above-mentioned hormones regulates other bodily processes, including digestion, mood, emotions, libido, metabolism, energy, and the immune system. So it appears that nearly all of the body’s physiological reactions and mental status are controlled by all of the above-mentioned hormones that are in turn regulated by the HPA axis. Each component of the HPA axis also has a negative feedback operation to keep the entire system in balance. Thus, any time there is an elevation/reduction in the levels of cortisol, this triggers the feedback loop to increase/reduce the output of CRH, which in turn raises/lowers the levels of ACTH and cortisol.

So when we define a person being a “yogi” or an individual existing in a state of equanimity (see 7 Ways to Cultivate Equanimity with Yoga), we are referring to those people whose HPA axis with its feedback loop works in a state of harmony. Any disturbance in this cycle or the feedback loop system and we are in an acute or chronic state of emotional turbulence. If the HPA axis is underactive, it results in a low production of the hormones, resulting in poor metabolism and brain function. Or, take the situation where an individual is facing a physical/emotional crisis, characterized by over production of cortisol. If the crisis is chronic, the sustained over-production of cortisol eventually desensitizes the HPA axis so it no longer responds to the feedback loop by “calming down.” In a chronically anxious or stressed state, we don’t give the HPA axis time to reset itself back to state of equilibrium, and as a result we get stuck in the sympathetic nervous system overdrive mode. A combination of the desensitized HPA axis and overdrive of the sympathetic nervous system triggers several diseases, including but not limited to abnormal moods, emotional upheaval, chronic fatigue, depression, OCD, multiple sclerosis, and thyroid abnormalities. 

Older individuals are more susceptible to a dysfunctional HPA axis and adverse effects of an elevated cortisol because of the poor functioning of the feedback system. Furthermore, a sustained over-activation of the HPA axis also causes destruction to the brain and body owing to elevated levels of cortisol. Hence, an elevated cortisol level in older adults is dangerous, as it can trigger mental or behavioral probles, as well as other physical problems (Reducing Cortisol Improves Anxiety). Thus, understanding the status of the HPA axis will help us to control our emotions and knee-jerk reactions, and bring ourselves back into a more relaxed state of mind and equanimity (see It's Complicated: Moving Toward Equanimity). 

There are several ways to reset the HPA axis and improve at all levels. Gentle physical exercises, being out in nature, proper sleep, and a nourishing diet are some of the practices that balance the body and mind thereby providing an overall sense of wellness. Additionally if you have a yoga and meditation practice, this helps as well in curbing the negative effects of the HPA axis (see Reducing Cellular Stress with Yoga). Yoga and mindfulness-meditation offer several benefits:

• Decreases in stress and anxiety
• Improvement in cognitive functioning and cardiovascular health
• Reduction in cortisol levels
• Reduction in pro-inflammatory molecules
• Decrease in systolic blood pressure

(See Mindfulness-Based Stress Reduction for Low-Income, Predominantly African American Women With PTSD and a History of Intimate Partner Violence.) Additionally, according to Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program, stressed individuals who practiced yoga and mindfulness reported better sleep, were more attentive and experienced reduced trauma. 

Researchers hypothesize that yoga and mindfulness stimulate the relaxation response and reset the HPA axis by altering cerebral blood flow and improving endothelial function that in turn lowers inflammation. The relaxation induced from yoga and mindfulness may also stimulate the production of endogenous opiates and cannabinoids that not only trigger the feel-good response but also stabilize the mood. In short, a daily practice of yoga and mindfulness will not only stabilize your HPA axis but also bring with it contentment, a sense of accomplishment, and improved health. Time to roll out your yoga mat!

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Stress Management for When You're Stressed!

by Nina

When you’re not feeling particularly stressed out, a well-rounded practice that includes active asanas and short-sessions of the stress management techniques of your choice will help keep your stress levels in check. And if you chose meditate every day, or do breath practices, restorative yoga or supported inversions on your rest days, all the better. 

But the nature of human existence is such that we all go through times when stress levels are high, whether that is due to family problems, illness, employment conflicts, uncertainty about the future, or even more serious problems. Today’s post provides recommendations for periods when you’re going through chronic stress. (For information about improving your sleep, see 5 Tips for Better Sleep. And for information about changing the way you react to stressors, see Re-Patterning Your Nervous System: Practice for the Real World.)

Confession: It was very easy for me to write this post because it was born out of my own experience. Practicing yoga on a regular basis to keep my stress levels in check in general and to give myself special attention when stress levels go up due to life circumstances has been a godsend to me. But I did have Baxter read through what I wrote and add a few recommendations of his own. So it’s all medical doctor approved!

How Often to Practice. Although we don’t recommend practicing a full-length active asana sequence seven days a week (your body needs time to rest and recover), if you are going through a stressful period, we do recommend practicing at least a short stress management session for about 20 minutes every day. What you practice for your short stress management sessions could be any of the relaxation practices you prefer or that work in your particular circumstances: seated or reclined meditation, calming breath practices, one or two restorative and/or supported inverted poses, or a guided relaxation program. And because exercise is important for reducing stress, you should aim for doing an active asana practice (or another type of exercise, such as walking) around three to four days a week.

How Long to Practice. For a balanced asana session, practice, such as one of our strength or flexibility sequences, we recommend practicing for 30-45 minutes. For a short stress management session, we recommend practicing 20 minutes per day. For both these sessions, you can actually divide them up, and practice part of your session in the morning and part later in the day. For example, you could practice active asanas in the morning and restorative poses at the end of the day, or you could meditate for 10 minutes in the morning and 10 minutes in the evening.

What to Practice. For days when you want to do a full-length active practice, practice any sequence that includes a combination of poses for cultivating the four essential skills (strength, flexibility, balance, and agility) or a sequence that focuses on one of the skills. Generally, it makes sense to include the active poses at the beginning of your sequence, although if you’re fatigued you can start with a resting pose and ease into the more active poses. But always quiet down after the active poses with a stress management practice. For days when you just need a short stress management session, choose any single or combination of stress management practices that work for you in your particular circumstances.

Static Poses. These poses are good for grounding you when you’re feeling anxious or flighty and for tiring yourself out a bit when you’re feeling hyper. Standing poses, such as Warrior 2 and Triangle pose, are particularly effect for this. But a balanced practice that includes poses from every category will engage your body and mind, and release physical tension from your body. Practice mindfully for best results (see Practicing Yoga Mindfully).

Dynamic Poses. These poses are good for releasing held tension in your body, engaging your body and mind, and mildly energizing yourself when stress makes you feel fatigued. Be careful, however, not to practice (or breathe) too quickly, as this can over-stimulate you. Practice mindfully for best results (see Practicing Yoga Mindfully).

Supported Inverted Poses. For many people, supported inverted poses are so effective for calming the nervous system and quieting the mind that even just one 15-minute session of Legs Up the Wall pose can turn the day around. And if these poses work well for you, during your active practice days, always include one or more near the end of your practice (before Savasana or meditation). Choose poses that you can hold for extended periods of time and use appropriate propping to ensure you’ll be comfortable. Warming up for these poses with active or reclining poses that stretch your legs and open your shoulders may help you be less fidgety. 

Restorative Poses. If stress is making you feel exhausted and depleted, you can put together an entire asana practice from restorative poses or even practice a single pose on its own. And if you are doing a more active practice and you enjoy restorative poses, include one or two at the end of your practice. Choose poses that you can hold for extended periods of time so you can relax, completely and use appropriate propping to ensure you’ll be entirely comfortable.

Focused Relaxation. Guided relaxation, meditation, calming breath practices, and Savasana with a mental focus are practices that you can do on their own or include in an active practice. Although these are good practices to end your practice with, you can also use them to start a practice as a way to center yourself. Choose the techniques that work best for you and your particular circumstances (maybe you’re on an airplane, for example). And make sure to use seated or reclined positions that you can hold for extended periods of time so you can relax completely, and use appropriate propping to ensure you’ll be entirely comfortable.

If you've tried any of these techniques when you're feeling stressed out, please let us know which are your favorites!

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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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Four Ways to Survive the Holidays (Rerun)

by Nina

Hegel's Holiday by Rene Magritte*

We’re quickly moving into the full-blown, end of the year holiday season that is Christmas/Hanukkah/Kwanzaa topped off by New Year’s Eve. For many of us, this time of year is very challenging. We have too much to do. We’re traveling through snow and rain to get some place and then a few days after that slogging home again. And when we’re together for days at a time with family members, old behavior patterns and conflicts can raise their ugly heads. Or maybe we can’t be with family—or don’t have one—so the whole season looks nothing like at all like a Hollywood movie. And yet there are always those expectations for having a “wonderful” time. So it’s no wonder this time of year many of us experience disappointment and sadness, not to mention stress and anxiety.

But this year we have our whole yoga toolbox at our fingertips, so I’m sure we can all do a better job of surviving these challenges with a measure of equanimity and grace.

After some thought, I’ve decided to suggest a two-part strategy. The first is to use the wisdom of yoga to change your attitude toward the holidays. It seems that in great part it is our plans going awry or hopes being crushed that cause so much emotional difficulty during this time. By changing your attitude, you can do your best not to get stressed out in the first place. Then because, well, some amount of stress is inevitable—even when we trying our best not to let things get to us, we tend to crack once in a while—you can use your favorite yoga stress reduction techniques to calm yourself  down and quiet your mind.

YOGA TIPS FOR SURVIVING THE HOLIDAYS

 1. Consider your attachment to your plans and hopes for the holidays.

The Yoga Sutras tells us in sutra 3.3 that attachment to pleasure and aversion to pain are two of the “afflictions” that cause human suffering.

And it seems to me that one of the pleasures we become attached to is our fantasies about how our lives will turn out (see Attachment (Raga) to Our Ideas About Ourselves). So start by recognizing your attachment to your plans and hopes for the holiday season. And admit to yourself that your attachment to those plans IS an affliction. (As I wrote in Attachment (Raga) to Our Ideas About Ourselves, I sometimes think we cling to our attachments in a form of magical thinking, because we feel as if holding on to our plans and hopes will make some kind of magic that will allow us to obtain what we desire.) Then see if you can work your way to letting go of some of those attachments. 

And maybe the discomfort we feel while traveling and while witnessing—or even participating in—family conflicts is pain to which we feel aversion. Can you try to shift your thinking a bit about whether the suffering these situations causes you is inevitable? 

As the Bhagavad Gita says, “When a man has mastered himself, he is perfectly at ease in cold, in heat, in pleasure or pain, in honor or disgrace.” And speaking of family members, the Gita says this, too:

He looks impartially on all:
those who love him or hate him,
his kinsmen, his enemies, his friends

the good, and also the wicked.

2. Go ahead with your plans, but do your work with “detachment” or “skill in actions,” as the Gita recommends. 

The wise man lets go of all

results, whether good or bad,

and is focused on the action alone.

Yoga is skill in actions.

So take your trip, help with all that cooking, give your gifts, spend time with your family members, and open your home to others, all without worrying about success or failure. This is the combination of active engagement and acceptance that we’ve been writing about since the early days of the blog (see What We Need to Practice and Acceptance, Active Engagement, and the Bhagavad Gita), which is the way to achieve equanimity in your everyday life. And equanimity is definitely something we can all use a bit more during the holidays.

3. Practice yoga for stress management to quiet your nervous system and your mind.

Reducing your stress levels will support your ability to put the wisdom of yoga in to practice. After all, yoga’s relaxing practices, including meditation and pranayama, were developed specifically to help quiet the mind so a yogic approach toward life would be possible. See The Relaxation Response and Yoga. For those who are pressed for time, here are a few suggestions: 

• Mini Restorative Practice (see Featured Sequence: Mini Restorative Practice)
• One or more Supported Inverted Poses (see All About Supported Inverted Poses)
• Meditation session (see Starting a Meditation Practice)
• Body Scan or Yoga Nidra (see Audio Tracks for guided versions by Baxter)
• Breath Practices that calm you (see Friday Q&A: Breath Practices for Anxiety)

4. Let contentment lead to joy.  

Both Ram and I have written about cultivating santosha as an important part of yoga practice (see Santosha: Happiness and Longevity and Yoga and the Pursuit of Happiness). Santosha means "contentment" and TKV Desikachar defines contentment as "the ability to be comfortable with what we have and what we do not have."

To help you cultivate contentment, the Yoga Sutras recommends meditation, pranayama (breath practices) and detachment. And then there’s this:

1.33 Through cultivation of friendliness, compassion, joy, and indifference to pleasure and pain, virtue and vice respectively, the consciousness becomes favorably disposed, serene and benevolent.

Well, that certainly seems like a good approach for the holiday season. So I wish you joy—no matter what your plans are this year.

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A Balm for the Soul: Practicing Simple Breath Awareness

by Nina

The Boundary is Fuzzy by Marie Lossky

Well, well, well, we’ve been blogging here for over four years and now I’ve find that while we have often referred to simple breath awareness as a way to trigger the Relaxation Response (see The Relaxation Response and Yoga) and to practice meditation (see Yoga Meditation Techniques), we’ve never actually described how to practice it. So I thought today I would remedy that rather serious omission. After all, this is the practice that helps me get back to sleep when I’m awake in the middle of the night and makes my Savasana and Legs Up the Wall poses profound relaxation practices.

I’ll start by comparing simple breath awareness to pranayama (breath control). Simple breath awareness is a practice of observing your breath without changing it. With pranayama, you intentionally change your breathing patterns, by making your inhalations and/or exhalations longer, holding your breath, or by breathing in a special fashion (such as humming, alternating nostrils, and so on), which has a potentially stronger affect on your nervous system (see Pranayama: A Powerful Key to Your Nervous System). With simple breath awareness, you just watch your natural breathing patterns, which is both very effective and completely safe. 

Breath awareness can be used in two different ways. The first is as a stress management technique. Ten to 20 minutes of simple breath awareness will trigger the Relaxation Response, quieting both your nervous system and your mind. And even a few minutes of practice can help center you or head off a spike in your stress levels. The second is as a meditation technique.

Whether you are practicing for stress management or as a form of meditation, the way you practice will depend on your location and position. If you’re going to practice as meditation, see Yoga Meditation Techniques for options for location, position, and timings. See the end of this post for information on choosing a focus, as this applies to both forms. This post provides information about location and positions for stress management. At the end of the post, I’ll provide information on choosing a focus for both forms of practicing.

Choosing Your Location

You don’t need a special location to practice breath awareness. As long as there is a quiet spot for you to sit—whether on the floor, out in nature, or on a chair—you can practice. You can also practice breath awareness while you are doing your favorite restorative pose or even while you are in bed as a way to soothe yourself to sleep (or back to sleep if you are awake in the middle of the night).

And when you’re traveling or are stuck somewhere busy and noisy, such at your office or on a train or airplane (yes, I’ve done that), you can practice there, too. It’s more challenging to practice when there are distractions or you are in a public place, but it is still an effective way to calm yourself in the middle of a hectic day.

Choosing Your Position

The position you choose will depend on your location. You have the most options in a house, where you can practice in a yoga sitting pose, sitting on a chair, in a restorative pose, or lying in or on your bed. Obviously, if you are at work or some other public place, you may have to limit yourself to sitting on a chair.

Sitting. Our recommended positions for seated breath awareness are Seated Crossed Legs and Hero pose (although a few people are comfortable enough in Half Lotus or even Full Lotus to practice breath awareness in those poses). 

In his post Learning to Sit on the Floor, Baxter described how you can use props to get comfortable in these poses. 

For people who can’t get comfortable on the floor or if the current setting doesn’t allow it, sitting on a chair is always an option. But rather than leaning against the back of the chair and slumping, sit on the front edge of the chair with your feet flat on the floor (if you are short, you might need to put a prop under them or if your legs are long you might need to put some padding on the chair seat) and your spine in its natural curves and your head in line with your spine. Obviously someone with physical disabilities who is in a wheelchair can practice breath awareness in whatever position they are able to take, in whatever chair they happen to be.

Restorative yoga poses. You can practice breath awareness in any restorative yoga pose that you find comfortable, as well as in gentle supported inverted poses (see All About Supported Inversions), such as Legs Up the Wall pose. We especially recommend Reclined Cobbler’s pose and Supported Savasana, if those poses are comfortable for you. I, myself, have found the combination of Legs Up the Wall with breath awareness to be extremely powerful.

If you’re someone who tends to be anxious and lying on your back makes you feel vulnerable or if you can't lie on your back for any reason, Supported Child’s pose or a Side-Lying Savasana are good alternatives. Both will allow you to bring awareness to your breath in your back body, which can be more relaxing for anxious people. 

In bed. You can practice breath awareness under the covers in your bed, in your customary sleeping position. This is a good way to improve your sleep because you will fall asleep in more relaxed state or to get back to sleep if you wake in the middle of the night (see Yoga You Can Do In Bed). Depending on what’s most comfortable for you, practice either on your back with your head supported by a pillow or lying on your side, with a pillow between your legs.

Standing. If you just want to center yourself—or help head off a spike in stress—you can practice breath awareness any time and any where in Mountain pose (Tadasana). This position is best for a short session of breath awareness, as standing still for 10 to 20 minutes is very challenging. But it’s excellent for a quick fix!

Choosing Your Focus

So what does it mean to bring your awareness to your breath? There are actually many options as you explore either the quality of your breath or the way your breath moves in your body. Try out the various techniques listed below to find one that engages your attention and also that doesn’t make you feel anxious about your breathing. As you observe your breath, consciously refrain from changing it. You may notice, however, as time goes on, that your breathing patterns may change on their own because you are relaxing more and more.

Feeling your body respond to your breath. For beginners, probably the easiest way to observe the breath is to watch the dramatic way your body moves as your lungs expand and shrink. As you inhale and exhale, you can watch your belly rise and fall, your chest expand and shrink back, or your ribs move out to the sides and back again. In positions where you are lying on your side or are prone (like Child’s pose), an interesting option is to feel your back expand and fall back with your breath, and this may be more soothing for those who tend to be anxious.

Sound. If it is quiet enough, you can focus on listening to the internal sounds you hear as you breath in and out. 

Feeling your breath. The best way to “feel” your actual breath is to bring awareness to the nostrils, sensing the air flowing in and out of them. You can also notice the quality of the breath moving in and out of your lungs. Is it smooth or rough? Relaxed or forced? Is your exhalation or inhalation longer? Or are they the same? 

As you watch your breath, be sure to maintain a non-judgmental attitude about your ability to concentrate. If you want to trigger the Relaxation Response, continue practicing for 10 to 20 minutes. If you just want to center yourself, a shorter period of time will be effective, even for just one minute. If you practicing as a form of meditation, see Yoga Meditation Techniques.

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Keeping Your Cool: Stress Management and Equanimity

by Nina

Karen Knight, Age 54

I learned about dangers of chronic stress the hard way. Back in the early nineties, I had a job as the documentation manager and lead technical writer at a software start-up company, while at the same time I was raising two children. 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!). As the deadline approached and I started working overtime, I began having difficulty sleeping. I also started losing weight because the stress made me so feel nauseated that I lost my appetite. 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. What began as simple, chronic stress had ultimately turned into something more serious: agitated depression. It took a year and half of therapy, medication, and lifestyle changes for me to recover completely.

So, yes, chronic stress is not only dangerous for your physical health, but it can have a strong impact on your mental health, affecting the way you feel, the way you think, and the way you sleep. 

Moods and Emotional Disorders 

To start with, chronic stress has a negative effect on your moods. When your sympathetic nervous system is over-stimulated, you may experience any of the following negative feelings: anxiety, restlessness, lack of motivation or focus, irritability or anger, sadness or depression. Obviously those moods are not only unpleasant but they can interfere with your ability to conduct yourself in a way that is in line with your values and goals. For example, if you’re restless and irritated, it’s hard to be patient with and loving to family members and friends. 

Then, for people who are susceptible, full-blow anxiety or depression may develop. There are several different theories about the mechanisms that cause depression and anxiety. Chronic stress leads to elevated hormones such as the “stress” hormone cortisol and reduced serotonin and other neurotransmitters in the brain , including dopamine, all of which are associated with depression. And, lately, there is a new theory that depression may be caused by inflammation, which itself can be triggered chronic stress (see Depression May Be Caused by Inflammation). High levels of cortisol can also be responsible for causing Generalized Anxiety Disorder, a common anxiety disorder in older adults (see Reducing Cortisol Improves Anxiety).

Even though research about the exact mechanisms is ongoing, the bottom line is that there is agreement that chronic stress can cause a whole range of emotional problems, including both depression and anxiety.

Stress and Your Thoughts

In my post Stress and Your Thought-Behavior Repertoire, I described how when you’re in stress mode, your thoughts narrow and become limited to fight or flight strategies, while when you are calmer, your thoughts are more expansive, and therefore include a much wider range of possibilities. Practicing stress management on a regular basis allows you to keep your level of arousal (the intensity of the Stress or Fight or Flight response) appropriate to your current environment. For example, for a soldier, a very high level of arousal is appropriate in an actual battle, but that same level is not appropriate if he or she is stuck in a traffic jam or working at the office. On the other hand, when your arousal level is "optimum" for your situation, your thoughts and behavior possibilities expand, until it is possible to consider altruistic possibilities and living in line with your basic values and goals. Here’s how psychologist Dan Libby puts it:

"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."

Obviously being able to live in line with your basic values and goals is going to contribute to your equanimity. You’ll be able to interact with people and solve problems in a more peaceful and productive way. And reducing chronic stress will help you keep your thought-behavior repertoire appropriate to your circumstances.

Stress, Your Sleep, and Your Emotions and Thoughts

One of the common effects of an overactive sympathetic nervous system is insomnia, something I know about all too well. Your nervous system keeps you on the alert—and awake—so you’re prepared to face imminent danger, except in the middle of the night when your worries are about everyday life, that’s rather counterproductive. And, according to Ram, our brain health expert, lack of sleep or sleep deprivation triggers accelerated mental decline. Sleep appears necessary for our nervous systems to work properly. Too little sleep leaves us drowsy and unable to concentrate, and leads to impaired memory and physical performance. If sleep deprivation continues, hallucinations and mood swings may develop.

Just as sleep gives the body time to heal itself, sleep allows neurons to lower down their neurochemical activity and repair themselves. Without sleep, neurons become “fatigued” and begin to malfunction. Sleep helps to clear out toxins from the brain as well as from the body (see Sleep, Alzheimer's Disease, and Yoga). Finally, the brain gets exposed to thousands of stimuli through the five senses, and sleep helps to reduce chaos and bring order to the information flow, helping to put an order to these information inputs and archive them as memories. 

Whew! Do I even have to explain chronic insomnia is going to interfere with your ability to face life’s difficulties with equanimity? So, if sleep is problem for you, it’s a really good idea to consciously manage your daytime stress levels so you don’t go to bed with an over-active nervous system—that’s going to improve your nights as well as your days. 

How to Practice Stress Management for Equanimity

Practicing stress management in general is good preventative medicine for fostering good emotional and mental health, just as it helps foster physical healthy. And when you are trying to deal with existing mood and/or emotional problems as part of a self-care program, you should definitely include stress management techniques in your yoga practice. All the stress management techniques we describe in The Relaxation Response and Yoga will help you reduce chronic stress levels, with the only exception that for people with depression, meditation is not recommended (it can cause a downward spiral). Re-patterning your nervous system as described in Re-Patterning Your Nervous System will train you so you don’t react as intensely to stressors in the first place. And learning to self-regulate as described at Self-Regulation and Yoga: Managing Your Internal States will allow monitor and manage your internal states, so you can take appropriate actions to calm yourself, comfort yourself, uplift yourself, or energize yourself, and bring yourself to a more balanced state. For extra information about improving your sleep, see 5 Tips for Better Sleep.

Although I'm sold on the effectiveness of yoga for keeping us as physically healthy as possible, I actually became a yoga teacher specifically because I realized that my yoga  practice was helping to keep me emotionally healthy and that was something I wanted to share with others. So if you're someone who wants to cultivate emotional stability, I hope this post will inspire your practice!

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Self Regulation and Yoga: Managing Your Internal States

by Nina

You Are Conscious Matter by Marie Lossky

About a year ago, I wrote a post about self regulation (see Self-Regulation, Psychological Health, and Yoga) because I was excited to learn about a study Potential self-regulatory mechanisms of yoga for psychological health by Gard, et al in the journal Frontiers in Human Neuroscience that provided a model for understanding how yoga can achieve the benefits of improved psychological health. I also said that the real takeaway for me from this article was that these scientists included all eight branches of yoga (see Ashtanga Yoga: Following the Eight-Fold Path) in their model as the tools that yoga provides to facilitate self regulation. 

But lately as I’ve been noticed that “self regulation” was becoming quite the trendy concept, I’ve been wondering, what exactly IS self regulation? I mean, I had a working definition when I wrote that post but because I hadn’t researched the subject that thoroughly, I wondered how accurate my understanding was. I soon discovered that some other people had the same question. Haha, unlike me who just typed the term into my handy search engine, those people—three York University researchers—actually conducted a study! They, too, observed that there was a lot of confusion around the term, and they were looking for clarity. (Weird, I know, but it turns out people conduct studies to determine what a term means.) Without going into how they came up with this conclusion (see for yourself at Researchers map 'self-regulation' to develop comprehensive definition), I must say I quite liked their “comprehensive” definition. 

Learning 'self-regulation' involves learning how to monitor and manage your internal states, understanding what it feels like to be calm and alert, and so also learning to recognize when certain activities help you to return yourself to those states most easily, as well as what pulls you out of them.

The term “self regulation” is often used regarding children (I think you can imagine what a child who is not able to self regulate at all might be like) but of course it can apply to all of us, because who among us is not sometimes swamped with emotions that cause us to do things we might later regret

And now that I have a better understanding of what the term means, I thought I’d look at bit more closely which yoga techniques can help improve self regulation. (I read or hear so often that “yoga” can help with this or that problem, but yoga is such a large collection of techniques and practices that I feel that it is important to be more specific than just saying "yoga.") So I’ve broken down the definition the following five different phases:

1. Monitoring Your Internal States. Whether you are meditating or practicing asana mindfully, using your witness mind as I described in The Power of Svadhyaya (Self Study), Part 1 allows you to observe your emotional responses and thought patterns, helping you uncover habitual responses to stressors. This is the first step toward improving self regulation.

2. Understanding What It Feels Like to Be Calm and Alert. Yoga practices that trigger the Relaxation Response, including meditation, breath awareness, and restorative yoga, allow you to experience conscious relaxation in the safety of the yoga room (see The Relaxation Response and Yoga). In this state, your mind opens to a wider range of possible reactions to stressors (see Stress and Your Thought-Behavior Repertoire). Having this experience in the yoga room teaches you that you can learn to respond to stressors in the real world in a similar way. 

3. Recognizing When Certain Activities Help you Return to Those States Most Easily. Experimenting with a wide range of yoga practices, including different yoga poses, different meditation techniques, different breath techniques, and even studying yoga philosophy helps you recognize which yoga “activities” work best to help you return to a more balanced state. (I know, for example, that Baxter loves a yoga nidra practice, while I myself prefer Legs Up the Wall pose and revisiting some of my favorite passages from the yoga scriptures.)

4. Recognizing What Pulls You Out of Those States. Working with your witness mind in the yoga room trains you to start observing yourself in more volatile situations in your everyday life. You can learn which external or internal events set you off or make you more likely to be off balance. Some of these may be things you can change, for example, by eating more regularly, finding a less stressful way to get to work, or getting more sleep. For those stressors that you cannot avoid, you can learn to respond differently to them (see Re-Patterning Your Nervous System: Practice for the Real World).

5. Managing Your Internal States. Besides relaxation practices, you can use yoga asanas and breath practices to energize yourself when you are feeling fatigued and to uplift yourself when you’re feeling depressed. Using yoga to manage your internal states allows to make yourself feel better through your own efforts rather than relying on outside events or other people to calm you down or cheer you up, and gives you feeling of control over your emotional life.

Although “self regulation” is new concept to me, because I’ve been practicing yoga for over 20 years and using it to reduce my stress levels, to restore myself when I’m depleted, to energize myself when I’m fatigued, and to uplift myself when I’m feeling a bit depressed, it turns out I’ve been self regulating all this time without even knowing it. And that’s one of the main reasons yoga is so important to me. How about you?

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Proof of the Effectiveness of Reducing Chronic Stress!

by Nina

Joy Sassoon, Age 60, by Tanja Constantine

“the data suggests that mind body interventions should perhaps be instituted as a form of preventative care similar to vaccinations or driver education. Such interventions are likely to be useful in population management and supported self-care, have negligible risk and cost and may help reduce the demand curve in healthcare.” —James E. Stahl, et al

According to a new study “Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization” by James E. Stahl, et al, published in the journal PLOS one, practicing Relaxation Response techniques, such as meditation and yoga, could reduce the need for health care services by 43 per cent. To me, this was really exciting news (and not just because I’m not very fond of going to the doctor or the emergency room). I feel it’s solid scientific proof that using yoga’s stress management techniques will be very likely to improve your health. The authors of this study decided to do a thorough study of the effects of mind-body interventions on health care services because stress-related illnesses are “drivers” of healthcare use. Here is how they put it:

“In primary care, stress-related illnesses are known drivers of healthcare resource utilization in the US. Health care expenditures attributable to stress-related disorders, such as, depression and anxiety, were over 80 billion dollars/year in 2012. These have been the third highest cause of healthcare expenditures after heart disease and cancer in the US; each of which carries their own substantial stress burden. Over 90% of people suffering from stress or stress-related problems seek help through primary care and tend to be frequent healthcare utilizers. These visits can comprise as much as 70 percent of physicians' case- loads. In addition, more than 80% of patients presenting to general practice evidence lack of resiliency and psychological stress. Common physical manifestations of stress, e.g., headaches, back pain, insomnia, gastroesophageal reflux disease, irritable bowel, chest discomfort, are among the most frequent reasons people seek care.”

To conduct this study, the researchers tracked all 4452 patients who received training at the Relaxation Response Resiliency Program at the MGH Benson-Henry Institute from 1/12/ 2006 to 7/1/2014 for a median of 4.2 years. They then compared the usage of health care resources by this group against that of the control group of 13149. Total utilization of health care resources for patients with Relaxation Response training decreased by 43% compared with the control group. Here’s the breakdown:

• Clinical encounters decreased by 41.9%
• Imaging by 50.3% 
• Lab encounters by 43.5%
• Procedures by 21.4%

In addition, the intervention group’s Emergency Department visits decreased from 3.6 to 1.7 per year (although Hospital and Urgent care visits converged with the controls).

Pretty impressive, isn’t it? Using mind-body techniques to manage chronic stress keeps you healthier in a whole range of ways. And the training that these people received at the MGH Benson-Henry Institute was in using meditation and similar techniques to trigger the Relaxation Response, all of which are similar to, if not exactly the same as, the techniques that yoga provides. (See The Relaxation Response and Yoga for information about the Relaxation Response and how to trigger it with yoga.) 

So my ongoing campaign for reducing or stress levels using yoga (see 6 Ways to Bust Stress with Yoga) is supported by this very thorough study. In fact, the researchers were so encouraged by the study results they proposed that mind-body interventions should be instituted across the board as a “form of preventative care, similar to vaccinations or driver education.” With that, all I can say, is that if you’re practicing yoga solely as “exercise” and not exploring the stress management tools because “relaxing” feels like wasting time, you’re missing out on some valuable health promotion activities (not to mention that peace of mind stuff).

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Our Hyper-Competitive, Stressful World

by Ram

Las Vegas Sign by Melina Meza

We are living in a hyper-competitive and stressful world thanks to global urbanization, competition, and the spread of technology. Stress comes from a multitude of reasons, including but not limited to financial problems, work place tensions and a difficult boss, unsatisfying jobs, relationship problems, domestic issues, and stress in school, among others. If one were to compare the statistics of stress and its effects world wide, it is interesting to note that that numbers are nearly similar throughout the world. Within the USA, nearly 33% of Americans are living with extreme stress. While acute short stress is good and has a positive impact, chronic and high stress levels that many Americans report have severe impacts on relationships and work productivity. Money and work are the two leading causes of stress. Forty eight percent of Americans believe that their stress has increased over the past five years. Seventy two percent of adults report that money is their single cause of stress. Fifty percent of Americans report that stress has a negative impact on both their personal and professional lives. Stress causes more than 50% of Americans to fight with people close to them, with 41% of adults reporting that they have yelled at their partners owing to stress. And 42% of adults report that they are not doing enough to manage their stress (see Stress a Major Health Problem in The U.S., Warns APA).

Chronic stress affects every aspect of people's lives, from work to personal relationships to sleep patterns and eating habits (see Acute Stress Impairs Self-Control in Goal-Directed Choice by Altering Multiple Functional Connections within the Brain's Decision Circuits). This takes a toll on people’s health, contributing to numerous physical, mental, and behavioral problems. Psychological symptoms of stress include: experiencing irritability or anger, constant fear, worry, anxiety, and nervousness and mental fatigue (see Stress A Major Health Problem in the U.S., Warns APA).

The adverse effects of stress at the physical and mental level include:

• effects on lung capacity and function as it quickens breathing and episodes of hyperventilation leading to asthma and panic attacks
• hypertension and a rise in bad cholesterol, 
• underactivity of liver’s metabolic and detoxification functions leading to metabolic disorders like Type-2 diabetes and obesity
• irregular menstrual cycles and decreased libido
• improper digestion and absorption of nutrients leading to malabsorption and other inflammatory conditions in the gut
• insomnia and/or fatigue 
• chronic anxiety or depression 
• weakened immune system
• effects on muscle function (under stress, muscles tense up and this can lead to systemic pain especially in those already compromised areas like shoulder, back, neck or joints)

For more details on how stress affect at the physical and mental level see How Does Stress Affect You.

Stress management techniques vary among the general public. For those who manage their stress poorly, health status is affected. It is common to see stressed individuals overindulging in unhealthy foods, resorting to poor eating habits, smoking, or seeking out sedentary activities including TV, video games or internet ,which affects the body and mind further, putting these people in an endless cycle of stress and stressful behavior (see Stress a Major Health Problem in The U.S., Warns APA).

The American Heart Association lists several tips for dealing with stress, including maintaining a positive life-style and positive communication, involving in those activities or simple things that provide pleasure, and daily relaxation (see Four Ways to Deal with Stress). The Mayo Clinic, too, has detailed information on how to identify and deal with stressful situations (see Stress Relief). 

Interestingly, all of the literature searches on stress unanimously describes the positive impact of yoga, meditation, and guided relaxation in alleviating stress, even though the Yoga Sutras do not allude to their role in relieving stress. These techniques were actually developed to strengthen the body and mind to delve deeper into meditation, pranayama, and other spiritual practices as a means to achieve enlightenment. However, the positive effects of the asanas, breath techniques, and meditation were so astounding that over the years these practices were adopted as part of stress management techniques (see About Stress: Acute vs. Chronic). Interestingly, for each of the physical and mental effects described earlier, there is a suitable yoga regimen for managing the stress. Just type the ailment + stress using our blog search function and you will find the recommended techniques. 

Anyone can resort to short sessions of yoga and relaxation as a quick practice, especially to deal with stress. There are several articles on our blog that have advocated the need to incorporate short sessions of yoga, meditation, and breath practices to deal with acute and/or chronic stress at home or office (see Stress, Your Health and Yoga and Featured Sequence: Mini Office Practice). One may question the benefits, if any, from a short session of yoga. However, scientific studies have shown the numerous benefits including the rejuvenation of the body and mind, from even a short session of yoga and relaxation. Participants not only showed improvement in their physical parameters but short sessions added a cognitive boost as well. The reasoning is simple: stress triggers all the physical and mental changes, while yoga practices can reduce stress, so use yoga to reverse the physical and mental effects. At the cellular level, yoga, meditation, and relaxation techniques de-stress the mind and body through numerous mechanisms including:

• releasing brain chemicals that contribute to a feel-good response and ward off anxiety and mental stress
• normalizing blood pressure and stabilizing the heart beats 
• reducing anxiety and depression
• improving the ability to sleep by de-activating the hypothalamic-pituitary-adrenal stimulus (HPA) and lowering the hyperarousal phenomenon (see Proof that Meditation Helps Improve Sleep)

Thus, yogic stress management practices not only help to deal with stresses of all kinds, but they also enable you to move toward equanimity (see 7 Ways to Cultivate Equamity). Making the commitment to take care of yourself through regular asana, meditation, and relaxation practices may seem to be a huge undertaking, but, remember, not only does these practices empower you—they keeps you free from the mercy of stressful forces.

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