Anxiety disorders as a group are the most common type of psychiatric diagnosis; over 8,000 adults (approximately 28% of people) report having experienced symptoms that met the older DSM-IV-TR criteria for diagnosis of an anxiety disorder (Kesller et al., 2005). This could largely be considered as a cultural evolution, that perhaps as we move further towards an increasingly wired and anxious culture, the pressures of modern life condition us to live in a hyper-sympathetic mode, being driven into perpetual sympathetic nervous readiness. When the sympathetic nervous system is triggered, the blood vessels in our gut squeeze shut, shunting the blood to our heart and large muscles to enable the infamous fight/flight response (Kaparo, 2012, p. 134). This response also channels the blood out of our neo-cortex (the seat of the conscious mind) and into the limbic or reptilian brain, for when our survival is at stake, we cannot afford to be slowed down by conscious thought… and since the subconscious part of the brain functions so many times faster, we rely solely upon our subconscious (Kaparo, 2012, p. 134). Through this chronic stress state, we fail to properly regenerate, repair, or digest via our parasympathetic response. Our primary stress comes from living in shame and fear, often resulting from misidentification with the image/objective world, and often with the past traumas and experiences where we were forced to react to ordinary situations in survival mode (Kaparo, 2012, p. 134).
Multiple brain structures are involved in the processing of somatosensory information and its translation into our experience of emotion, for as sensory information from the outside world is received; it travels first to the thalamus and then to the specific sensory association areas of the brain (Homann, 2010, p. 84). Kinesthetically this area is called the parietal lobe, or somatosensory cortex which receives neuronal input from each part of the body in proportion to the number of nerve endings in the body, making an internal body map in the brain (Homann, 2010, p. 84). This region works closely with the limbic system, including the hippocampus and the amygdala, to imbue the sensory perceptions with affective or emotional value, and finally the limbic system then interfaces with the cortical process areas and marks certain information as particularly relevant (Homann, 2010, p. 84). Therefore, emotional processing is first linked to the body’s response to the environment and then continues as a complex system, which influences cortical processing by imbuing experiences with meaning (Homann, 2010, p. 84). Thus, when trauma occurs say in infancy or childhood, there is often no way of remembering the occurrence without work based in body awareness first, for the body knows, remembers trauma often at a cellular level, but without a present and strong enough inner witness when the trauma is occurring, what the body knows therefore cannot be remembered (Tantia, 2012, p. 59). In fact, early childhood experiences are often the foundation in which anxiety disorders can grow over the course of time. Research has shown that if a mother’s capacity for self-regulation is compromised, she cannot soothe herself and therefore cannot adequately regulate her baby’s nervous system (Heller & LaPierre, 2012, p. 7). The stability of such early connections is particularly important in shaping an individual’s patterns of relationship to body, self, and others. A compromised capacity for self-regulation becomes an integral part of development and can impact a person for a lifetime (Heller & LaPierre, 2012, p. 7). More extensively investigated aspects of our psychoimmunological functioning are related to the phenomenon of connective tissue memories. Studies have shown that increased blood pressure occurs when emotionally charged material is suppressed or repressed from consciousness. It is well known, biologically, that the endocrine hormones are crucial to the mobilization of energy resources and the growth of new life throughout the entire body mind. In essence, what Barrat and many other somatic clinicians have found is that the complex modulated interaction between neural signals and human immune cells via the endocrine system accounts for much of the clinical phenomena that directly impact the body’s overall health (Barratt, 2013).
When anxiety manifests as pathology there are clear diagnostic criteria that a patient must meet for a diagnosis of either panic disorder (PD) or even generalized anxiety disorder (GAD). The symptoms of panic disorder include the prevalence of (greater than or equal to four) of the following symptoms: palpitations, sweating, trembling, shortness of breath, choking, chest pain, nausea, dizziness, chills, paresthesias, derealization, fear of insanity or death, a persistent concern or worry for greater than or equal to a period of one month, or maladaptive changes in behavior related to panic attacks (Nussbaum, 2013, p. 196). For a GAD diagnosis there must be three or more of the following symptoms for six or more months: restlessness, easy fatigability, difficulty concentrating, irritability, muscle tension, sleep disturbance, or avoidance of situations (Nussbaum, 2013, p. 196). When we examine the popular cultural phenomenology of sleep disorders, pervasive stress symptoms, and digestive instability one may preclude that there could be an anxiety pandemic, at least in the western world. When we examine the global epidemiology of anxiety disorders, we find that the age of onset may change according to the type of disorder, and it’s usually accepted that the age of onset of the anxiety disorders is during adolescence and young adulthood with panic disorder emerging between the ages of 12 to 17, and GAD in the middle of the lifespan. All the anxiety disorders are seen in higher rates in women than in men, and more likely in lower socioeconomic income levels, in the single, divorced, separated, widowed, and those with genetic histories of anxiety (Dogan, 2012, p. 158).
When looking at a study commissioned by the DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group, significant epidemiological variability was noted in comparative cultural populations (Lewis-Fernandez et al., 2009). Possible mismatches between DSM criteria for three anxiety disorders were found when compared to local phenomenology of the disorder in specific cultural contexts, and limited evidence was found throughout, particularly in terms of neurobiological markers, genetic risk factors, treatment response, and other DSM-5 validators that could help clarify the cross-cultural applicability of criteria (Lewis-Fernandez et al., 2009). The study’s authors noted that “worry is often a cultural phenomenon,” and the push for reliability, sometimes at the expense of validity has been a recognized limitation of multiple DSM editions. The study noted that the prioritization of psychological over somatic symptoms of anxiety might inadvertently exclude participants whose experience of pathological anxiety does not conform to these diagnostic assumptions (Lewis-Fernandez et al., 2009). Thus, it seems it is ever onerous upon effective clinicians to recognize the DSM 5’s limitations when it comes to both diagnosing and treating anxiety disorders across diverse cultures.
Central to the thesis that emotions are experienced and influenced through the complex interaction between body and mind, cognitive science posits that emotional knowledge can be represented by sensory-motor states that occur during emotional experiences (Cohen & ED.D. 2011, p. 398). Through the application of somatic psychology and the integration of sensory, affective, and cognitive elements, a multidisciplinary approach to treating anxiety disorders (and other psychopathology) has emerged with tremendous effectiveness. Last year, a study was published that attempted to establish the neurophysiological correlates, particularly brain activity measures demonstrated during high therapeutic alliances between client and therapist. The amygdale, situated again in the temporal lobes and the bed nucleus of the stria terminalis, were noted as the areas in the brain that appear to regulate the control of fear and anxiety (Stratford, Lal, & Meara, 2012). During high therapeutic alliance there seems to be less activity in the amygdale, and the reduced activity may be indicative of a client’s ability to re-experience fears and anxieties developed earlier in life in a corrective, interpersonal relationship (Stratford, Lal, & Meara, 2012). During another study published last year examining a two-year authentic movement treatment group, an increase in parasympathetic activity while maintaining high sympathetic activation during stages of conscious movement was noted where the mover often reported “being moved,” and an unusual increase in heart rate variability was also found both during movement and when speaking about the experience following movement (Tantia, 2012). This is because as most somatic therapists will purport, there is a dynamic relationship between the body and the mind that must cooperatively be engaged for optimal therapeutic outcomes. The study’s authors stated, “As the relationship between the mover and the outer witness develops, the relationship within the mover between her moving self and her inner witness develops… when the mover engages in spontaneous movement with the potential for re-connecting and healing parts of his or her unconscious while in the presence of a witness a shift happens.” This again is about the process of developing one’s own sense of self and internal witness that is described in developmental neuroscience that suggests that a caregiver’s Autonomic Nervous System (ANS) has the capacity to regulate an infant, and through somatic interventions like conscious movement therapies, a similar phenomenon happens between mover and witness when the mover engages in spontaneous movement with the potential for reconnection (Tantia, 2012). Even in group somatic therapy, therapists can provide group members with expanded access to their inner experiences, more secure attachment, increased empathy, and thus greater emotional regulation (Cohen & ED.D., 2011).
Somatic interventions have also been introduced into perinatal counseling, a variety of interventions including imaging how the fetus is moving, encouraging the parents to move like the fetus, practicing mindful sensory awareness, keeping a journal on somatic sensations, practicing mindful breathing exercises, and offering massage to the mother (Lovkvist, 2012). These are perhaps the first steps towards prevention of anxiety disorders, by empowering mothers to recognize the somatic relationship driven by the prenatal-parental attachment. The scope of research conducted thus far in this domain appears to be a wide range of behavioral, psychological, medical, social, spiritual, cognitive, and emotional factors that impact the depth and quality of prenatal-parental attachment (Lovkvist, 2012).
Interestingly, most people with mental health disorders like anxiety engage in self-help treatments before seeking treatment from a medical or mental health professional (Forfylow, 2011). Many turn to complementary and alternative interventions such as yoga or meditation. Yoga is often used as a supplement to conventional treatments for clients with various mental health disorders (Forfylow, 2011). A randomized comparative trial comparing yoga to relaxation found that anxiety and quality of life scores were improved from yoga, and yoga was found to be as effective as relaxation in reducing stress, anxiety, and improving mood over seven measured domains: vitality, social function, mental health scores on SF-36, etc. (Smith, Hancock, Blake-Mortimer, & Eckert, 2007). While this is still a very emerging intervention (yoga as therapy), it does appear to have effective complimentary clinical applications for anxiety, though more rigorous research needs to be completed before using it as a true alternative versus a complimentary aspect of psychotherapy. We still aren’t entirely sure the dynamics or mechanics of yoga as an intervention.
Affective and physiological neuroscience seeks to explain how the physical body is linked to neurological processing, and conscious movement practitioners have known this implicitly for years, but we are just now gaining the language to describe and understand it (Homann, 2010). Conscious movement impacts psychological functioning because engaging the body engages the right brain and offers an in the moment experience which activates memory, emotion, and sensory processes simultaneously (Homann, 2010). Movement offers a multilevel opportunity to use the body alongside the mind as a resource for developing the capacity to regulate emotions internally and achieve improved emotional competency in relationship (Homann, 2010). Mirror neurons provide additional framework for how movement affects us and moving together thus creates a powerful relational experience and often stimulates a deep subjective feeling of connection, decreasing emotional isolation, and enriching relational interactions that help at reconnecting often-abandoned levels of neurological function.
This past summer, the first international conference on research in mindfulness was conducted in Rome, Italy. The conference presenters all noted that research on the psychological impact of a range of mediation and movement practices extends back for over fifty years including clinical effects and underlying neurobiological studies. Beginning in 2005, with the application of functional magnetic resonance imaging technologies (fMRI) to mindfulness research, noted increases in gray matter in the brain have been demonstrated to be associated with skill acquisition, motor skills, cognitive skills and performance abilities in mediation practitioners (Singh, Kristeller, Raffone, & Giommi, 2013). Coincidently, fMRI studies demonstrated that gray matter increases were also observed after participants completed the widely used Mindfulness-Based Stress Reduction (MBSR) program developed by Jon Kabat-Zinn (Singh, Kristeller, Raffone, & Giommi, 2013). The body of the literature presented this year is only at the precipice of giving us insight into the depths of the mind body connection. What we are seeing however is that there are in fact structural changes as the result of conscious movement and meditative exercise, most notably data presented by Tal Dotan, Ben Soussan, Filippo Carducci, Claudia Piervincenzi, Concetta Gardi, Emiliano Santarnecchi, and Enzo Egiziano showed that the posterior cingulate cortex and cerebellum show structural changes as the result of learning, memory process, emotional regulation, self-referential processing and perspective taking tasks involving empathy all from MBSR interventions (Singh, Kristeller, Raffone, & Giommi, 2013).
These data combined with the existing physiological understanding of the manifestations of anxiety in human physiology leads us to further quest for more research on the use of yoga as a powerful psychotherapeutic intervention for anxiety disorders and other psychopathologies. Somatic therapies such as yoga combine the effect of mindfulness while engaging the multisensory aspects of conscious movement. This powerful combination has solicited repeated reactions in my own clients often bringing them back into seemingly infantile states of consciousness, or completely invigorating their nervous systems resulting in a myriad of parasympathetic responses from pseudo-seizures to deep sleep. While the more Dharmic practitioners of yoga may attribute these phenomena to the raising of their mythological Kundalini energy, or the power of the Ma Shakti that is the pervasive symbolism of creation force, I am confident that with further inquiry and study we will begin to unravel the mysteries of yoga into greater understanding and healing application for the great western anxiety pandemic. While not on a quest to prove yoga; we must however introduce yoga into the greater continuum of care along with the myriad of other somatic interventions that have demonstrated repeatedly through research the application of these interventions. Somatic intelligence is self-sensing, self-organizing, and self-renewing. It is born via the cycles of learning, and through our ability to notice changes in our bodies, we become able to transform our relationship to gravity and aging, and to live more gracefully with far more proprioceptive illumination. This light can be shined within any of our clients, and certainly ourselves to cast away the shadow of fear and worry and therefore, invite greater autopoiesis as we strive for greater wholeness in our form.
Works Cited
Barratt, B. (2013). The Advances of Neuroscience. In The Emergence of Somatic Psychology and Bodymind Therapy (2 ed., pp. 118-126). New York, NY: Palgrave Macmillan.
Cohen, E. D., Suzanne L. (2011). Coming to Our Senses: The Application of Somatic Psychology to Group Psychotherapy. International Journal of Group Psychotherapy, 61(3), 397-413.
Dogan, O. (2012). The epidemiology of anxiety disorders. Anatolian Journal of Psychiatry, 13(2), 158-164.
Forfylow, A. L. (2011). Integrating Yoga with Psychotherapy: A Complimentary Treatment for Anxiety and Depression. Canadian Journal of Counseling and Psychotherapy, 45(2), 132-150.
Heller, L., & LaPierre, A. (2012). Healing Developmental Trauma (1 ed.). Berkeley, CA: Atlantic Books.
Homann, K. B. (2010). Embodied Concepts of Neurobiology in Dance/Movement Therapy Practice. American Journal of Dance Therapy, 32(1), 80-99.
Kaparo, R. F. (2012). Awakening Somatic Intelligence (1 ed.). New York, NY: North Atlantic Books.
Kesller, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age of onset distributions of DSM IV disorders in National Comorbidity Survey Replication. Archives of General Psychiatry, 62(7), 593-602.
Lewis-Fernandez, R., Hinton, D., Laria, A., Patterson, E. H., Hofmann, S. G., Craske, M. G., Liao, B. L. (2009). Culture and The Anxiety Disorders: Recommendations for DSM-5. Depression and Anxiety, 0, 1-18.
Lovkvist, M. (2012). Somatically Informed Parent-Prenate Psychotherapy. Journal of Prenatal & Perinatal Psychology & Health, 27(1), 56-65.
Moss, A. S., Wintering, N., Roggenkamp, H., Khalsa, D. S., Waldman, M. R., Monti, D., & Newberg, A. B. (2012). Effects of an 8-Week Meditation Program on Mood and Anxiety In Patients with Memory Loss. Journal of Alternative and Complimentary Medicine, 18(1), 48-53.
Nussbaum, A. M. (2013). The Pocket Guide To The DSM-5 Diagnostic Exam (1 ed.). Arlington, VA: American Psychiatric Association .
Singh, A. N., Kristeller, Jean L., Raffone, A., & Giommi, F. (2013). Advances in mindfulness research. Neuropsychiatry, 3(5), 467-470.
Smith, C., Hancock, H., Blake-Mortimer, J., & Eckert, K. (2007). A Randomized comparative trial of yoga and relaxation to reduce stress and anxiety. Complimentary Therapies in Medicine, 15(2), 77-83.
Stratford, T., Lal, S., & Meara, A. (2012). Neuroanalysis of Therapeutic Alliance in the Symptomatically Anxious: The Physiological Connection Revealed between Therapist and Client. American Journal of Psychotherapy, 66(1), 1-21.
Tantia, J. F. (2012). Authentic Movement and the Autonomic Nervous System: A Preliminary Investigation. American Journal of Dance Therapy, 34(1), 53-73.