We all carry within us a voice that echoes with criticism, doubt, and negativity. This inner critic can often feel like a relentless adversary, undermining our self-esteem and hindering our progress. Yet, what if we were to tell you that this critical voice, though challenging, holds the potential to become one of your greatest sources of guidance and compassion? In the realm of psychotherapy, there are several profound perspectives that can help us navigate this intricate terrain. Let's embark on a journey to discover how we can transform our relationship with the inner critic into a compassionate and empowering alliance.

As we seek out long-term healing of our minds and bodies, it can be transformational in itself to understand that the healing comes not from quickly reaching our goals, but from going inward and transforming the relationship we have with ourselves. Coming to understand that patterns surrounding imbalances such as anxiety and depression, likely have come to take up residence within the mind and body for years, and may take time to slowly untangle these patterns with time, safety, and understanding.

The idea that our minds and bodies hold relationship to one another is not a new idea, though somehow still somewhat unaddressed within the mainstream, allopathic medical system as opposed to a homeopathic stance of addressing the whole human being. It is not surprising that when we live in a world where we seek to find rather instantaneous treatments to specific, localized issues, we might also seek this in our broader healing towards imbalances in our lives relating to such experiences of depression and anxiety; missing perhaps the interrelatedness of bodily manifestations of such conditions. For example, one may miss the subtleties as to how we carry our posture while experiencing prolonged notions of depression or anxiety and the quality of the breath. Or additionally, the extensive evidence relating to cardiovascular disease in clients experiencing anxiety and depression as cited by the National Institute of Health. Studies of patients with long-term depressive or anxiety disorders revealed elevated incidence of sub-clinical cardiovascular disease, as measured by a variety of parameters including plaque deposition and arterial stiffness, and blood pressure, glucose, body mass index (BMI), diet, and physical activity. There is so much interrelation as to how we engage within the world with our bodies based on where our mental state allows us, how much exercise we may be motivated to engage in, how much singing, how much joy; and this can directly impact how our minds and bodies come to change in time.

While medication and psychotherapy alone may be sought out to ease or “fix” the symptoms of anxiety and depression, yoga too, holds many beneficial components towards cultivating change in both the mind and body. Yoga’s physical poses (both active and restorative) help build new body experiences that differ from anxiety and depression. Yoga also influences postures: it can shift the very movement and alignment patterns that have led to a closed heart area, amped-up muscular tension, or sped us up to the point of agitation. For many people experiencing anxiety and/or depression, the body can become rather tense and/or rather under utilized. With this, muscle and ligament tension can occur, a lack of use in the body itself, disconnect from the breath (shallow breathing), and weight gain or loss can occur, to name a few effects.

Anxiety primarily revolves around thoughts of worry surrounding future events. The thoughts may race, the heart rate may elevate, physical movements may become more rapid as the anxiety continues to build. “Anxiety disorders are the most prevalent mental health conditions. Although they are less visible than schizophrenia, depression, and bipolar disorder, they can be just as disabling” (Bystritsky et al., 2013). With anxiety holding “up to 13.3% of individuals in the U.S. [as of 2013, with a likely continual rise annually] and constitut[ing] the most prevalent subgroup of mental disorders” (Bystritsky et al., 2013). It is no wonder that these racing thoughts of worry and fear may exist in a society that finds itself increasingly individualistic and isolated, as well as holding such strong praise upon productivity and financial success. “Your body helps wire anxiety, too. When you are feeling anxious, your movements can become more rapid, as though driven from within, and you may find it hard to slow down. You may struggle to be fully present in your body, which makes it difficult to realize how fast or erratically you’re moving” (Forbes, 2011). And so, with all of this in mind (and body), how can we begin to both personally embody and offer facilitated practices with a mindful slowing down and an intentionality both internally and externally to ourselves and our clients?

According to the work of Bo Forbes, founder of Integrative Yoga Therapeutics, a a clinical psychologist and yoga teacher with practical application towards physical and emotional issues, clients experiencing anxiety may hold one of two manifestations of anxiety within themselves. The first being “Anxious Body/Depressed Mind” and the second being “Anxious Body/Anxious Mind,” which we will explore more deeply here (Forbes, 2011). With an anxious body, it is important to offer forward bending poses which can offer restoration, “ground, calm” and soothing qualities for the body (Forbes, 2011). If and anxious mind is at play, clients can benefit from inhaling and doubling the length of their out breath, calming the nervous system, while clients with a depressed mind can benefit from keeping the same length of their inhale/outhale ratio to, keeping both the mind and body calm (Forbes, 2011). As we spoke of initially within this paper, clients should begin by checking in to notice their baseline both mentally and physically as a way to notice how changes occur as the practice continues. One might also invite clients to check in between each pose in this way as well. Poses that Bo Forbes particularly invites in a restorative practice to balance anxiety are working with a sequence of any number of poses such as child’s pose, reclining twist, inversion pose (savasana), side-lying pose, legs up the wall, and face down relaxing pose (Forbes, 2011). Within her instruction, she invites clients to stay within the poses for 5-30 minutes total or on each side, if the pose offers a twist or side facing position, with the addition of a bolster for child’s pose, reclining twist, and side lying pose, or a folded blanket to support the body in inversion pose, legs up the wall, and face down relaxing pose. Depending on the state of the client’s mind, either anxious or depressed quality, they may invite either the 1:2 ratio of breath for anxious mind, or 1:1 for depressed as they settle into their poses. In time they may decide to shift from 1:2 to 1:1 breathing if they notice the mind relaxing significantly from an anxious mind to more balance. In my own practice of these poses, I certainly noticed a great deal of comfort and relaxation arise as I settled into them and worked with the 1:2 breathing ratio and found that the anxiety shifted quite drastically which felt empowering to experience.

Somatically and cognitively speaking, the mind/body experience of depression may begin as a feeling or experience of rejection and/or disappointment. We can filter these experiences as a form of taking this personally, that it may have something to do with ourselves at a core level or something we have done. The thoughts may move in a slow fashion, ruminating and even in a pattern of self blame. Ultimately we may become blind to the positive experiences occurring around us. “While depressed, the body feels lethargic and tired. Depression can imprint not only on the movement patterns, but on the posture as well. “Closed Heart Syndrome,” a postural pattern that illustrates the helplessness, hopelessness, and self-protective withdrawal of depression. The chest sinks, and the heart sinks, causing the breath to become shallow and slow” (Forbes, 2011). An effect of this may transform into challenges with intimacy as well. From a more behavioral perspective of depression, “Lewinsohn emphasized environmental events that produce losses of major sources of response-contingent positive reinforcement (RCPR), such as a divorce or the loss of a job, and social skills deficits that limit an individual's ability to reobtain RCPR once it has been lost” (Kanter et al., 2008). Once can see that regarding clients experiencing depression, recurring experiences that may reduce their confidence and relation to self as a capable being, as well as feelings of interpersonal disconnect and hurt may be occurring simultaneously, withdrawing them potentially from the world outside them. Finding solutions to understand and reintegrate a new or refound relationship to self and interpersonal relationships feels key.

As we look towards lifting depression and energizing the mind and body through yogic and breathing practice, we will discuss a few postures and breathwork offerings here. These offerings will “typically feature back-bending restorative poses to open, energize and uplift the body” (Forbes, 2011). As previously stated when discussing the practices for an anxious body, if the mind is slow or grounded, clients can stay with a 1:1 breathwork pattern. However, if clients are experiencing an anxious mind, then a 2:1 breath ratio is preferred. Again, clients can come to check in and take a baseline of themselves as they begin their practice as well as noticing their experience as they move through different poses to notice any changes or emotions that arise. The poses that Bo Forbes recommends for clients experiencing depression are relaxation pose, gentle backbend pose, inversion pose, butterfly pose, and legs up the wall. Clients again may stay in poses anywhere from 5-30 minutes depending on the poses and may make use of a bolster, blanket, eye pillow, or blocks. “As a common complementary therapy in the United States, yoga may be particularly helpful for depression because it can be adapted to daily mood through integrating practices to enhance physical, emotional, and spiritual health; it is easily available; and can be self-administered. The slow rhythmic breathing practices and meditative/ relaxation practices of yoga are designed to induce a sense of calm, well-being, stress tolerance, and mental focus, all of which may minimize depression, anxiety, stress, and rumination” (Kinser et al., 2012). Ultimately, providing clients experiencing depressive states alternatives to medicated treatment, and/or talk therapy seems key in working towards a provision of multifaceted care aimed to address a multifaceted issue.

To touch into the importance of the practices we have discussed here, it feels key to highlight the notice that with meditative practice, the aim is not simply to erase the experiences but to illuminate them (Forbes, 2011). As we have touched within this paper on the notion that meditative, long-term change is not a quick fix, but rather a practice of meeting and experiencing the Self, again and again and again. At the start, a great deal of determination may be asked for by clients and students as they begin their relationship to their practice. It likely may not be easy, for the new pattern is “weaker” than the old ones, and will take tending to grow strong and firm. As the practices continue though, clients and students will deepen in their capacities around the practice as well as their awareness of self and may notice, from time to time, subtle shifts that occur with themselves regarding their experiences of anxiety, depression and may even become aware of other challenging experiences here. Of course, this, too, is okay, and they can receive guidance to hold their realizations with lightness, with freedom to always continue adjusting, little by little, to meet the needs that arise, and stay true to themselves and that which arises as information to them (Forbes, 2011). Additionally, it is not uncommon that clients’ meditative practices may wax and wane, and so to offer encouragement in times of waning regarding the key of consistency rather than length of practice feels important to state (Scott, 2021). Ultimately, each client’s practice will look different and it is important to allow these differences as we allow the differences to exist amongst all people in existence, and to help each client cultivate what works for them in their own specific needs and Selves.