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Anxiety and Pilates

Courtney Morgan Sharp May-June 2019

Course location: TashB Pilates Ballito South Africa Course year: 2019

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Abstract Anxiety is relatively common, as many as 14% of individuals worldwide meet the criteria for the disorder at some point in their

lives. Anxiety is an extremely misunderstood disorder. Anxiety health disorders include generalized anxiety disorder,

posttraumatic stress disorder, phobias, social anxiety disorder, panic disorder and other related disorders. All the disorders in

the category are acute and are more specific to certain objects, situations or thoughts; whereas generalized anxiety disorder

involves worrying about everyday life situations, and are anxious more often than not (if not all the time). For this research paper

the focus will be on generalized anxiety disorder specifically and not the entire umbrella group of anxiety related disorders.

Modern trends have shown huge increases in persons making use of alternative and additional treatments within the traditional

medical sphere. Western medicine is now paired with better lifestyles, healthier diets, mindful exercise and the results people

are seeing is phenomenally positive. Modern healthcare practitioners and their associated networks now treat and focus on a

client as a whole (mind, body and emotion) and not only on their illness or disease. This approach has been immensely helpful

in the treatment of disorders such as anxiety, as it is a disorder that has negative implications on a person physically, mentally

and emotionally. Pilates is undoubtedly a holistic form of exercise that offers benefits to all the areas negatively affected by

anxiety, thus allowing those who practice it to enjoy not only physical rewards. It is due to this multifaceted nature of Pilates that

I chose to research its relationship with the equally all-encompassing disorder that is anxiety.

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Table of Contents Abstract Page 1

Introduction to Anxiety Page 3

Anxiety and Anatomy Page 3-4

Case Study Page 4

Conditioning Program Page 5-10

Conclusion Page 11

Bibliography Page 11

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Introduction to Anxiety At the root of anxiety is fear, and fear is a totally normal and natural emotion to experience. Fear can range from functional

(helpful and normal) to dysfunctional (unhelpful and abnormal). Functional fear is that which is in response to a realistic and

valid threatening situation, is of an appropriate severity given the posed threat, subsides when the threat is no longer imminent

and leads to adaptive behaviors to avoid or face the threat. However dysfunctional fear is in response to an unrealistic threat, is

excessive when compared to the threat, persists even after the threat has subsided and leads to negative or impaired behavior.

After understanding this we can understand that anxiety is not the ordinary experiencing of fear but rather dysfunctional fear(s).

Generalized anxiety disorder (GAD) includes worrying about minor issues or situations in one’s life and this worried/anxious

state is present for more days than not. Although many people understand the mentally draining mental implications of being

anxious, not many people understand the legitimacy of the physiological symptoms. Anxiety leaves one feeling restless, irritable

GAD sufferers experience excessive anxiety and worry about numerous activities or events; to such an extent that it causes

impairment in their occupational, social, home/family and other areas of functioning.

Anxiety and Anatomy As mentioned earlier anxiety is a disorder that affects the body in its entirety, its characteristics are somatic, emotional and

cognitive. This being said we are able to pin point the start of anxiety and that begins with the emotional component- the brain,

and then becomes physical. The mind/brain is extremely complex and professors of all schools of study are continuously

learning new information around how the brain, its chemistry and each of its’ systems operate.

The brain is divided into many divisions as seen above on the left, each division of the brain has its own role and function to play

individually and as a whole. The image on the right shows the Limbic System which is involved in emotions, memory and

arousal. Neuroimaging studies have found that people with GAD have a heightened reactivity to emotional stimuli in the

amygdala (which is involved in the processing of emotions). However it is hard to pinpoint exactly where a certain individual’s

anxiety would ‘start’ in the brain as people interpret stimuli differently, have different assumptions and have different emotions

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attached to specific situations or memories; which makes each person’s ‘process’ of anxiety unique. We cannot simply stop the

process of thought in an attempt to avoid anxiety.

Within the autonomic nervous system, we have the parasympathetic nervous system and the sympathetic nervous system.

The parasympathetic nervous system is responsible for rest and digest, where the body conserves and restores by lowering the

heartrate, decreasing rate of respiration, increases digestion, removes waste

and stores energy. The sympathetic nervous system is responsible for the

response to situations of fear or action, also known as the ‘fight or flight’ mode

which is where the body will increase heartrate and the rate of respiration, and

decrease processes deemed unnecessary in the situation such as digestion,

energy is used up in this mode. People with anxiety too often in the ‘fight or

flight’ mode and their body’s do not enter the rest and digest mode often

enough.

It is through the brain that the sympathetic and parasympathetic nervous

systems are controlled. This shows how anxiety is often seen as a self-perpetuating cycle. After understanding from the basics

explained above we can see just how wide spread the effects of anxiety are to the brain, hormones and the internal organs

which then go on to negatively affect muscles and other physical areas and daily functioning.

Case Study I was born in July 1995, I was diagnosed with Generalized Anxiety Disorder (GAD) in 2010 and still currently take medication

(anti-anxiety and anti-depression prescription pills) daily to help manage my anxiety. I have General Anxiety Disorder and so my

anxieties and worries are not the same as the next person with the same disorder which makes it more difficult to treat and aid

my everyday challenges. Anxiety is not who I am but it most definitely is a part of me and affects me more often than people

think. I tend to stress, overthink and fixate on situations more than a ‘normal’ person would. I have the typical symptoms of GAD

and they all seem to have negative effects on each other. The only time my mind isn’t ticking is when I am sleeping, but even

then, I often wake up at early hours of the morning and struggle to fall asleep again because my brain is too active. I am also

often tired physically because my body is being drained of energy from being constantly alert and ready for action. Anxiety also

has a negative effect on my posture, I carry stress and tension in my neck and shoulders so they are often very stiff and painful.

My inconsistent sleeping patterns also has negative impacts on my body and mind. Having important work to concentrate on is

also a very difficult task as my mind is either on another topic, have already spent too much time and energy on mentally and

physically preparing for feared situations or avoiding them by procrastination or indecisiveness. I am new to Pilates equipment

and enjoy exercise that doesn’t require too much thinking or too little thinking that allows for anxious thoughts to surface.

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Conditioning Program

After briefly viewing the anatomical complexities of anxiety and remembering the symptoms of muscle tension, sleep

disturbance, irritability, restlessness, being easily fatigued and having difficulty concentrating; it is more and more clear that that

there is not one specific area of the body that needs special attention but rather that the entire body and mind is consciously

focused on.

Before even starting a program, I think remembering the 10 Basi Principles of awareness, balance, breath, center, concentration, control, efficiency, flow, precision and harmony are vitally important to adhere to as each of those can relate to anxiety and enable the anxious client to:

• Focus on their body, breathing and not have their mind racing elsewhere as it usually does.

• Calm their mind and heartrate.

• Execute the movements correctly and to the best of their ability.

• Teach balance through movement and the block system which can be practically applied to their lives.

• And promote healthy and positive thoughts and views. The lateral breathing used in Pilates should also be utilized as a tool when teaching the anxious client, generally their body is a buzz of thoughts accompanied by shortness of breath and accelerated heartbeat, by focusing on lateral breathing the client will reap the following benefits:

• Oxygenate the blood and nourish the body on a cellular level which allows oxygen rich blood to optimize the body’s performance.

• Improve circulation- which is vital as the anxious body would only be focused on processes and organs vital in surviving and enduring emergency situations.

• Calm the mind and body, this allows for mental clarity and internal serenity, which anxious people rarely feel but so desperately crave.

• Encourage concentration, when the body is getting the oxygen it needs and the mind is calmed it is so much easier for the anxious client to focus in on their body’s in the space and in the exercise at hand.

• Recruit the appropriate muscles for the movement which allows for successful and correct execution of the repertoire which creates a sense of success and accomplishment.

• Provides an “inner” rhythm for the movements and this allows the client to move at the pace and flow you set through the exercises chosen which differs from the chaotic and erratic rhythms that an anxious client is used to.

Another aspect of the Basi method that can be modified to an anxious client is the cues and verbal feedback used during a session. Using encouraging and positive words creates a willingness from the client to keep trying their best. Acknowledging and praising correct alignment and well executed moves instils a sense of success as well as a positive environment. Wording with negative connotations should be avoided as an anxious person can easily feel unmotivated if their efforts are not seen as good enough. Words carry more weight than we realize and so we should not give anyone a reason to overthink what has been said about them or their body. Using kind language creates the ideal environment in which to teach an anxious client.

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Week One, Two and Three – Two 1hour sessions a week Reason

Warm Up Mat • Basic Warm Up Sets a strong foundation for the rest of the session, try set a goal for the session. Take this slow-allow mind & body connection. Establish calmness.

Foot Work Reformer • Footwork Series Mental activation as equipment is used & needs to be respected Eliminate prehensile Eyes can be closed to focus on movement

Abdominal Work Reformer • Hundreds Prep

• Co-ordination

Pick up session tempo & allows for core activation Encourage a movement rhythm to focus solely on the movements required.

Hip Work Reformer • Hip work series #1 (frog, circles & openings)

Lying supine on reformer allows for optimal concentration and support of body.

Spinal Articulation Reformer • Bottom lift

• Bottom lift with extension

Builds on the basics of the pelvic curl so the movement is familiar. Extension creates progressive nature.

Stretches Pole • Pole series (sitting on reformer bed/ carriage)

Make use of mirrors & encourages client to be accountability in the movements. Take time, rather ensure slow quality movements than faster incorrect ones.

Full Body Integration

Reformer • Stomach massage series

Aid digestion & strengthen spine by maintaining a C curve & flat back respectively, promoting strong postures.

Arm Work Magic Circle • Arm series Visual feedback from the magic circle. Add holding each exercise for 10 seconds.

Leg Work Magic Circle • Sitting series Visual feedback. Opportunity to sit up straight and proud Add holding each exercise for 10 seconds.

Lateral Flexion/Rotation

Mat • Side lifts

• Side kicks

Balance is tested and awareness is totally on the body and movement with the lack of equipment.

Back Extension Mat • Basic Back

• Swan Prep

• Rest Position

Client leaves feeling taller & better equipped to face whatever the day may hold.

Mat • Roll down x3 Acknowledge changes in body & allow for quiet, calm moments before finishing. Think back on the goal/intention set at the start of the session.

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Week Four, Five and Six – Two 1hour sessions a week Reason

Warm Up Mat • Basic Warm Up Familiar and comfortable with this routine, however optimal posture and muscle recruitment should now be focused on to keep the body challenged.

Foot Work Reformer • Footwork Series Add prehensile Familiar equipment and series.

Abdominal Work Reformer • Hundreds Prep x4

• Hundreds

Allows for progression of the already familiar work, by now breathe is used correctly so the hundreds can be executed correctly.

Hip Work Reformer • Hip work series #2 (circles, extended frog, ext frog reverse)

Circles are familiar & the introduction of the extended frog & extended frog reverse add new challenges, keep the mind active on the movements.

Spinal Articulation Reformer • Short Spine

• Long Spine

Short spine offers a hamstring stretch & long spine creates use of a co-contraction between the abdominals & hamstrings. New movements with new objectives & challenges

Stretches Step Barrel • Shoulder stretch lying side

New equipment introduced, relaxed cyclic exercise. Allow for stretch in shoulders & thorax.

Full Body Integration

Cadillac • Sitting forward

• Side Reach

New equipment introduced, seated exercise after side lying stretches.

Arm Work Cadillac • Arms standing series

Leaning slightly forward for all exercises in series=trust balance and stability in one’s body. More complex than magic circle arms.

Leg Work Wunda Chair • Leg press standing

• Hamstring curl

• Hip opener

New equipment, use of different leg muscles & different leg placements. More mentally challenging than squeezing the magic circle.

Lateral Flexion/Rotation

Wunda Chair • Side stretch Stretching of the lateral flexor, posture and shoulder awareness. Exploring different positions with the Wunda chair.

Back Extension Wunda Chair • Swan basic

• Back extension single arm

• Rest Position

Progression from mat back extensions, simple to flow from swan basic to back extension with single arm so no confusing repositioning for client.

Mat • Roll down x3 Acknowledge changes in body & allow for quiet, calm moments before finishing. Celebrate new equipment & exercises the body is working with.

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Week Seven, Eight and Nine – Two 1hour sessions a week Reason

Warm Up Mat • Intermediate Warm Up

To avoid boredom & to keep the mind present in the session the intermediate warm up will be introduced.

Foot Work Reformer • Footwork Series Add prehensile Routine series.

Abdominal Work Reformer • Hundreds Prep x4

• Hundreds

Allows for progression of the already familiar work, by now breathe is used correctly so the hundreds can be executed correctly.

Hip Work Reformer • Hip work series #2 (circles, extended frog, ext frog reverse)

Circles are familiar & the introduction of the extended frog & extended frog reverse add new challenges, keep the mind active on the movements.

Spinal Articulation Reformer • Short Spine

• Long Spine

Short spine offers a hamstring stretch & long spine creates use of a co-contraction between the abdominals & hamstrings. New movements with new objectives & challenges

Stretches Ladder Barrel • Shoulder stretch

• Shoulder stretch 2

New equipment introduced, simple yet deep stretch. Allowing stretching of tight and stressed shoulders and upper back. Loosen shoulders before arm work.

Full Body Integration

Cadillac • Kneeling cat stretch

New exercise to challenge the body and mind in its entirety. Nice flow movement.

Arm Work Cadillac • Arms standing series

Same as last program as to not create stiff & tense arms, shoulders & traps that are often drawn up from stress.

Leg Work Wunda Chair • Forward lunge

• Backward step down

Same equipment as the previous weeks program but exploring new exercises in new positions.

Lateral Flexion/Rotation

Wunda Chair • Side kneeling stretch

Abdominal oblique stretch, more complex as scapular stabilization is required as well as keeping the pelvis square & straight.

Back Extension Wunda Chair • Swan basic

• Back extension single arm

• Rest Position

Simple to flow from swan basic to back extension with single arm so no confusing repositioning for client. Add more repetitions & correct client’s alignment & muscle activation to desired goal.

Mat • Roll down x3 Celebrate journey and progression made. Allow body to re-center and realign before leaving the Pilates space

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Week Ten, Eleven and Twelve – Two 1hour sessions a week Reason

Warm Up Mat • Intermediate Warm Up This warm up has been practiced now and can be made more challenging with variations of more repetitions if need me.

Foot Work Cadillac • Parallel heels & toes

• V position toes

• Open V heels & toes

• Calf raises

• Prances

The sequence is familiar from the reformer however now we move onto the Cadillac to add a change to the usual footwork that was being done on the reformer from week one.

Abdominal Work Cadillac • Roll up bottom loaded

• Teaser 1

Staying true to the idea of remaining on one piece of equipment for multiple blocks we now do ab work on the Cadillac for the first time.

Hip Work Cadillac • Single leg supine series

The sequence of frog and circles is familiar from the reformer & we continue on with the series with hip extension & bicycle.

Spinal Articulation Cadillac • Monkey original

• Tower prep

Learning new exercises on new equipment is now a process the client trusts & hopefully enjoys.

Stretches Ladder Barrel • Gluteals

• Hamstrings

• Adductors

• Hip flexors

The ladder barrel is no longer new equipment. This stretch combination is great for the client to lengthen out in their limbs & stretch out muscles.

Full Body Integration

Reformer • Up stretch 1

• Elephant

Similar set up which does not interrupt flow of being on a different piece of equipment.

Arm Work Reformer • Arms supine series Arms have previously never been worked on the reformer, displays functionality & speaks to the endless possibilities going forward.

Leg Work Reformer • Side split Exploring new positions on the very familiar reformer is an exciting process. Balance is tested & hip adductor is strengthened & stretched.

Lateral Flexion/Rotation

Reformer • Mermaid Multiple muscle focus which requires mental aspect as well as correct muscle recruitment.

Back Extension Reformer • Long Box Series This allows for the introduction of not only the long box but using it in conjunction with the straps.

Mat • Roll down x3 Ask client to take a moment to remember the anxious person who walked into the Pilates studio for the first session of week one & smile at the person they are now, & acknowledge & trust the process for what it has done & will continue to do.

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Week 1-3 Week one, two and three will consist of two sessions a week meaning the client will complete the program above six times in total. The program has been designed to move from one piece of equipment, stay on it for multiple blocks and then move onto another piece of equipment, the reasoning behind this is that Pilates equipment is very dangerous and extremely overwhelming to clients. By following the program, a client is able to familiarize themselves and moving their body on each piece of equipment used, this aids in keeping a flow to the session and eliminates the disjointed feeling of equipment hopping. Mat exercises are used to keep the session simple so the client isn’t overwhelmed with the movements and expectations. The mat also creates good foundational connection within the client’s mind and body so they may focus on breathing and improving their body awareness before advancing forward. All of the Pilates repertoire can be reduced into a final form or a starting/preparation exercise and all of that fundamental repertoire is mat work. The exercises have been chosen to keep the session challenging but not to raise the heartrate too much as to create a habit of relaxing the mind when Pilates is being done. As the client progresses from week one through to three more repetitions may be added accordingly so that the client is still adequately challenged and does not become bored of any of the exercises. Week 4-6 Week four, five and six start with the same basic warm up as the previous weeks program, this is to keep the new changes for later in the session as the client becomes more settled in their body by doing what is familiar. Trust needs to be built with the client and changing the program drastically each time will result in too much uncertainty for a client with anxiety. The equipment remains the same not to frighten or overload the anxious client with new information. Prehensile is added to the footwork to show a progression and growth in the client’s capability as they frequent Pilates more and more. Hundreds prep now progresses into the hundreds as core activation, stability and breathing is understood on a better level. New repertoire is added to the hip work and spinal articulation as the client is comfortable on the reformer and trusts the equipment more. The introduction of the step barrel, Cadillac and Wunda Chair allow the client have a sense of motivation and success as their body is now being expected to move in new and different ways, the progression also allows for a better understanding of Pilates and creates a momentum for the upcoming program of week seven, eight, nine and ten. By becoming more familiar with the work and equipment this allows the anxious client to now consider the Pilates studio a familiar and unthreatening environment that may have previously caused some anxiety around being at Pilates. It is important that praise is given for consistent work and commitment to sessions as it is very easy for anxious people to quit or pull out of arrangements as their lives become more anxious. Week 7-9 By keeping some of the exercises the same as previous programs, we allow the anxious client to feel a sense of confidence but the introduction of the ladder barrel to the stretches and new exercises in the Cadillac and Wunda chair will create the necessary challenge for the client to remain engaged mentally and not retreat into their usual anxious state of mind. It is important to remind the client that when a new exercise is introduced they may not execute it perfectly on the first attempt, this is where mindful cuing and encouragement play a huge role as we do not want the client to feel they cannot do a certain exercise. Make use of moments to mention how far the client has progressed and how beneficial the two hours of every week are. It is important to ensure muscle objectives are being met so that each exercise is beneficial to the client’s body, just because a certain movement may be familiar- it does not mean that it cannot be corrected further, as one’s range and awareness increase. Week10-12 The client now has a much greater body awareness and is able to move on the equipment on a better level, different blocks on different equipment is now explored and because of the client’s confidence in Pilates, the space and the instructor they are now able to adapt to changes and progressions. It is important that they do not lose the integrity and correct execution of the fundamental exercises, so I would even tell the client that they should consider a semiprivate session or even try a mat class as they are now more than capable and feel safe in the space. Joining a bigger session or a class will help the anxious client’s social life and allow them to maintain their now amazing posture and more adaptive thinking.

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Outcomes The possible outcomes for a client with anxiety to do Pilates are endless. But I think beginning it should be that the client leaves feeling calmer, that their body feels lighter and that they are moving their body in a harmonious environment and as a whole. Once the client understands that it isn’t helpful to address the body in segments they may start to address their mind and body as one too, this will improve their daily functionality. The benefits will not be confined to the walls of the studio as the deep lateral breathing, the increased body awareness, the positive thinking and healthy exercise will directly impact the cycle of anxiety and stop the downward spiral that so many anxious people become stuck in. We want Pilates to be a pleasurable experience that the brain stores as a positive reward process, so that the mind chooses to repeat the techniques and thoughts learnt and experienced at Pilates.

Conclusion It is without a doubt that the holistic approach to The BASI Pilates method is an extremely powerful tool that can be used in helping people living with anxiety disorders. Living with anxiety is not always about overcoming fears and stressors but rather learning how to work and manage your anxiety, and again this ties in so well with Pilates and it’s never ending modifications, variations and progressions- because just as life is forever moving and changing so Pilates will teach functional exercise that can be molded to what you need in that particular space based on whatever is happening in your life. By attending Pilates and simply just calming the body and mind through breathing we are already able to rewire the body from a state of stress / fight or flight into the parasympathetic nervous system.

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