Updated: Oct 14, 2018
Anxiety has been conceptualized as a significant physiological and behavioral response generated in order to avoid harm and elevate the chances of survival. It is defined as “a feeling of worry, nervousness, or unease, typically about an approaching event or something with an uncertain outcome” (Gelfuso 2014). Evolutionarily, anxiety was formulated as a response to a perceived or potential threat. It’s different than fear, as fear is experienced when there is imminent danger, whereas for some individuals, anxiety is an automatic and emotional baseline of their experiences, without any triggering stimulus. Anxiety disorders are among the most prevalent and disabling psychiatric disorders in the United States with approximately one in four adults suffering from an anxiety disorder at some point in their lives. (Kessler 2004)
Through this research, I am proposing that anxiety is a spiritual crisis that can be treated in the quest for deeper meaning as has been provided in the ancient texts of Yoga and Ayurveda.
Western/Allopathic Perspective of Condition:
Anxiety has been described by several authors since the late 18th century. According to the great first-century Roman philosopher, Seneca, fear of death is the main cognition preventing us from enjoying a carefree life (DTA, chapter 11.). This thought anticipates the future developments by Kierkegaard, Heidegger, and existentialist philosophers about the fundamental anxiety caused by man's realization that his existence is finite (Crocq, 2015).
In the article Current Diagnosis and Treatment of Anxiety Disorders, they have found that anxiety is triggered by an experience that brings up an unsafe memory. From a survival perspective, this makes sense; it would be helpful for us to remember that being chased by a bear did not result in a pleasant experience and should be avoided. The belief systems that were built around this memory flood in, and the person finds some way to cope with the present experience, either through avoidance, or through finding some way to feel safe. Their attempt to find 100% assurance of safety (or an environment that will not trigger them) is a failure, because this is impossible to provide, and so worry and anticipation of a future attack persists. “... because no absolute safety is to be found, these behaviors become more extensive and chronic in the attempt to alleviate anxiety” (Bystritsky, 2013). They have seen that it is a vicious cycle, that if uninterrupted, leads to depression and antisocial behavior in an attempt to avoid all triggers.
Western/Allopathic Treatment Protocol of Condition:
Neurotransmitters are the brain's communication system, making it possible for one nerve to communicate with another. It is believed that some symptoms of psychiatric disorders are created by imbalances, or improper amounts of these neurotransmitters. The neurotransmitter that is often associated with anxiety is serotonin, which is known for its effect on mood, appetite, and sleep. It has been shown that people who suffer from anxiety have decreased levels of serotonin, hence medications that are often prescribed for anxiety are Selective Serotonin Reuptake Inhibitors (SSRIs) which serve to increase the levels of available serotonin. (Bystritsky, 2013)
In addition to serotonin, GABA, or gamma-aminobutyric acid, has been linked to anxiety. GABA works to slow neural transmission down and "calm" the brain which in turn relaxes the body. People who experience chronic anxiety may have a GABA deficiency. It has been proposed that people with this deficiency might experience more anxiety because their body is already in a heightened state of arousal and vigilance, thus producing a biological vulnerability to increased levels of stress. A class of medication known as benzodiazepines, which are often prescribed for anxiety disorders, are thought to increase the release of GABA thus causing a relaxation effect. (Bystritsky, 2013)
Cognitive Behavioral Therapy (CBT) is another way that anxiety is treated in the west, serving as a springboard for patients to consider their erroneous beliefs and behaviors that cause them anxiety and fear. In this type of therapy, the therapist exposes the patient to potential triggers as they explore, and thus familiarize themselves with, the limiting beliefs and learned coping strategies that no longer serve. For example, when people repeatedly experience a lack of control over events in their lives, they may come to view the world as unpredictable and dangerous. This worldview may lead to feelings of helplessness and as a result, they develop a tendency to expect negative outcomes, no matter how they may try to prevent them. Through the practice of becoming aware of the unconscious belief systems and learning how to consciously respond, the patient learns ways to cope with potentially stressful situations in a more conscious way. This model helps them understand the dynamic and reciprocal relationship among feelings, thoughts, and behaviors.
Another way they deal with anxiety in the west is a system called exposure. They expose the patient to a trigger in very safe environments to help rewire the belief systems created around it. An example from the National Library of Medicine & National Institutes of Health is “a patient who is afraid of dogs might first be shown a picture of a dog, then stand across the street from a pet shop, and finally hold a dog in his or her arms. The patient would engage in each of these steps repeatedly and in a concentrated but not overwhelming way.
Ideally, the patient would experience a gradual lessening of anxiety at each step before moving on to the next. The patient would experience the alarm being reduced, and the exaggerated belief that all dogs are dangerous could be modified to a more accurate belief that most pet dogs are not threatening. The hoped-for outcome would be that the patient would no longer have a phobic avoidance of all dogs.” (Bystritsky, 2013).
The researchers who wrote Current Diagnosis and Treatment of Anxiety Disorders (3) also speak about breathing and relaxation techniques as techniques for mental hygiene, assisting clients in creating space between a trigger and their response. Mindfulness is an emerging area in the field of Cognitive Behavioral Therapy that focuses on bringing the mind to a present state with total acceptance.
Ayurveda Perspectives of Condition:
Similar to Seneca’s hypothesis, from the Ayurvedic perspective, the word for anxiety is autsukya, defined as fear of death (AH 1.32). Anxiety is considered one of the subtle manifestations of jvara, a pathology that comes at the beginning and end of all diseases. Yoga guides us towards the realization of our True Nature, while Ayurveda gives us the tools to navigate the world from that deeper place. When the elements begin to mingle, creating dosha, the ability to connect to our true essence gets clouded. The moment we begin to identify with matter (thus forgetting who we really are), raga and dvesha (attachment and aversion) are born within the heart. We want things that are moving away from us, or we don’t want things that are coming towards us, seeking lasting happiness in a world that can only promise temporary fulfillment, as the nature of matter is that it’s in a constant state of flux. This raga and dvesha, attachment and aversion, is said to be the root cause of all fear, anxiety, and disease (AH Su. 1.1).
Ayurveda goes farther to explain that deviation from the principles of Dharma is the cause of anxiety, illusion, restlessness, and every other disease. In AH Su. 2.20 it is stated sukham ca na vina dharmat tasmad dharmo-paro bhavet, which means that without dharma there can be no happiness in life. So anytime there is an experience of autsukya, Ayurveda suggests asking yourself “which principle of dharma did I break in order to cause this suffering upon myself?”.
Anxiety falls under the general heading of Unmada ("Insanity") in Ayurvedic medicine. Sushruta describes Unmada as "a derangement of bodily Doshas affecting the upcoursing nerves and thereby producing a distracted state of Manas (mind)” (Bhishagratna). Due to aggravation of Vata dosha in the nervous system and the mind, one may become anxious. Specifically, anxiety affects prana vayu, which governs our mental faculties as well as the nourishment that we receive through the air, food and water that we consume. Prana is responsible for the movement of the mind, thoughts, feelings, emotions, sensations, and perceptions. When prana vayu is affected, it sends nervous energies throughout the entire body, resulting in an imbalanced individual whose mind, body, senses and memory are working ineffectively (Lad, 32, 166).
Ayurveda also recognizes prajnaparadha (literally, ‘crimes against knowledge’) as a main cause of acute anxiety. Charaka describes prajnaparadha as an “unritious act done by one who is ignorant and of impaired memory” (Charaka Samhita Vimana 3:4–16). At its most basic level, prajnaparadha is doing something that you know you shouldn’t be doing because you want to. For example, eating something that I know makes me sick just because it tastes good, or watching a scary movie even though I know I’ll have nightmares. Acting from ignorance, I ignore my own wisdom, trying to satisfy particular needs, though in a temporary and unsatisfactory way.
Prajnaparadha occurs when an individual is living life from a self-centered and self-satisfying way, without the acknowledgment of how we are affected by external factors, and how our actions affect others as well. In every circumstance there is right action. Not right as opposed to wrong, but “right” in the sense of what actually serves. Because of raga and dvesha, attachment and aversion, we become clouded and unable to make this distinction. This inability to control our sense desires, or replace lower sense desires with ones that actually serve, is a main reason that our mental faculties move into an imbalanced state.
Ayurveda Treatment Protocol of Condition:
The Ashtanga Hridayam opens with the Mangalacharanam, which honors God as the greatest Vaidya (doctor) and the only one who can remove raga and dvesha (attachment and aversion) within the heart, as well as their various transformations, which are the root cause of all fear, anxiety, and disease (AH Su. 1.1). The symptoms born of raga and dvesha are preference for specific outcomes and the dualities of like and dislike, happiness and distress, and so on. If one is to go beyond all anxiety, one must learn to tolerate all dualities in this material world, understanding them as temporary. It is said that this position can be achieved when one surrenders their individual preference or will to the will of the Supreme, trusting that whatever situation we are in is perfect for the evolution of our Spirit (Prabhupada, 2.45, 12.5).
If anxiety is born out of a disconnection from our true self and deepest purpose, in order to combat anxiety we must strive to understand our dharma. Understanding our dharma essentially means understanding the real essence of our existence. We strive to find that essence, and then live with every thought, word and action in accordance with it. Literally, dharma translates into “not deviating from a position of stability.” Everything is most stable in its natural state. Dharma is the natural state of everything and every person (Pishoradi, 299).
Dharma is defined as the inherent characteristic of something that can never be separated from it. For example, the dharma of fire is to be hot; of water is to be wet. You can not separate heat from fire or wetness from water. In the same way, as humans our dharma is to serve. Whether we are serving our minds, our bellies, our children, or our boss, we cannot separate ourselves from that position. Thus a healthy service attitude, devoid of selfish intentions, is the foundation of a healthy and happy life, free from anxiety (Prabhupada, Introduction p.17).
In the mood of service, we move from a more self-centered state (which is where all anxiety arises) to a more selfless one. We are less consumed with our own attachments and aversions, and more concerned with the happiness of others. This naturally brings us more happiness, situates us within our dharma, and thus relieves us of the symptoms of raga and dvesha, which is where anxiety is born.
To treat acute anxiety, Ayurveda would treat vata dosha. Too much laghu (lightness), sita (coolness), ruksa (dryness) and cala (mobility) in diet or lifestyle will create an increase in anxiety, insecurity, and fear, so with the principle that like increases like and opposites balance, these treatments will be grounding, lubricating and nourishing, and will include oiliation and heat, both internally and externally.
Our physiology and mental health is supported by regularity. Routine has a very grounding and stabilizing effect on the system, affirming to the deep tissues of the body that all is well, that we can be at ease. When the body becomes accustomed to a daily routine that includes things like adequate rest, nourishing and timely meals, and self massage, the mind and the nervous system naturally begin to relax (Welch, 45). This alone is one of the most beneficial ways to calm vata in the mind.
The skin is said to be the gateway to the nervous system. To apply oil to the skin is not only extremely calming and balancing to the body, but even more so to the mind. A person experiencing or prone to anxiety should receive massage daily for fifteen minutes to an hour, either administered by themselves or a massage therapist. Sesame oil is warming, subtle and penetrating, and thus moves into the deeper tissues of the body and helps to relieve the nervous system of stuck or stored emotions. In addition, the oil itself forms a protective sheath around the body that can help to buffer the nervous system and the mind against undue stress or anxiety.
For internal oleation, ghee or sesame oil is best for Vata dosha, in prescribed dosages for four to seven days. Taking oil internally pacifies vata and stimulates the liquefaction of toxins that can then drain out of the system. This should be followed by a gentle purgative such as castor oil or triphala (Lad, 130, 223). After internal and external oleation, Ayurveda recommends applying heat, whether through a wet or dry sauna or even a hot shower. This opens the pores to allow the oils to penetrate deeper, and also liquifies the internal toxins even more so that they can be flushed out.
Finally, Ayurveda recommends a steady practice of mantra meditation and pranayama to reduce anxiety. The practice of specific pranayamas can be quite a powerful means of calming an anxious mind. In general, pranayama helps to restore fluidity and vitality to the subtle energy channels of the body, releases accumulated tension, and offers deep support to the mind and the nervous system. Because a mind and nervous system with symptoms of anxiety may be hard to calm, rather than silent or formless meditation, the easiest and fastest way to settle the mind and awaken to one’s true nature is through the chanting of the maha mantra, giving the mind and senses a clear focus point. When a mirror is covered with dust, we look into it and try to see ourselves, yet all we see is the dust. In the same way, there are layers and layers of raga and dvesha, attachments and aversions, desires, and past conditions that cover our true nature. Rather than identifying with our true selves, we identify with these coverings. The maha mantra is a powerful sound vibration that cleanses the mirror of the mind and the heart, and connects us to Sanatana Dharma, the eternal position of the soul. (Praphupada, 6.12).
Seneca's recommendation to combine together past, present and future in only one time (present moment awareness) is the foundation of the deeper practices of yoga and meditation. Mindfulness is an emerging area in the field of Cognitive Behavioral Therapy that focuses on bringing the mind to a present state with total acceptance.The researchers who wrote Current Diagnosis and Treatment of Anxiety Disorders (3) speak about breathing and relaxation techniques as techniques for mental hygiene, assisting clients in creating space between a trigger and their response. These practices that deal directly with the mind and its conditioned responses were discovered thousands of years ago by the great rishis of Yoga and Ayurveda. They were taught as ways to rid the mind of anxiety, which was perceived as the symptom of raga and dvesha (attachment and aversion). Ayurveda goes even farther; not just treating the symptom, but dissolves the root cause of anxiety and fear, acknowledging that raga and dvesha (as the cause of anxiety) are born of material identification. As soon as the pure soul (jivatman) identifies with matter (the 5 elements), raga and dvesha are born within the heart. So the cure for anxiety is in the remembrance of our true nature, and the ability to navigate the material world from that deepest, spiritual place.
Bibliography / References:
Gelfuso EA, Rosa DS, Fachin AL, Anxiety: a Systematic review of Neurobiology, Traditional Pharmaceuticals and Novel Alternatives from Medicinal Plants. Drug Targets 2014; 13 150-165.
Senaca, Of Peace of Mind (De tranquillitate animi [DTA] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610616/
Alexander Bystritsky, MD, PhD, Sahib S. Khalsa, MD, PhD, Michael E. Cameron, PhD, and Jason Schiffman, MD, MA, MBA, Current Diagnosis and Treatment of Anxiety Disorders. 2013 Jan https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628173/