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An Argument for the use of Holotropic Breathwork as an Adjunct to Psychotherapy

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Abstract

The psychoanalytic viewpoint proposes that insight into one's unconscious thoughts, feelings, and motivations can be helpful in understanding and changing personal constructs (Goldenberg & Goldenberg, 2013). Conversely, anything that stands in the way of accessing that material may present a barrier to effective psychotherapy. Holotropic Breathwork, a process of rapid, deep breathing to evocative music, induces a non-ordinary state of consciousness (NOSC) (Taylor, 2007), which reportedly allows deeper access to the unconscious. Rhinewine and Williams (2007) offer a hypothetical, bio-psychological explanation of the disinhibiting mechanism of holotropic NOSC's, which reduce the self-protectiveness of the logical/thinking part of the brain, and potentially result in opening to new insights. Ryan and Deci's (2008) Self-determination Theory (SDT) model offers a current and accepted framework from which to explain the potential effectiveness of the therapeutic setting and practice of HB. SDT proposes that there are three universal psychological needs which are essential for the occurrence of growth toward psychological health and well-being: autonomy, competence, and relatedness. This paper describes how Holotropic Breathwork fulfills those three needs, potentially resulting in therapeutic benefit. An overview of research on the healing benefits of NOSC's, and in particular, on the use of HB as an adjunct to psychotherapy is included to support the argument that HB may be beneficial in this context.
An Argument for the use of Holotropic Breathwork as an Adjunct to Psychotherapy Laurel Watjen
© Journal of Transpersonal Research, 2014, Vol. 6 (1), 103-111
e-ISSN: 1989-6077 // p-ISSN: 2307-6607 JTR - 103
An Argument for the Use of Holotropic Breath-
work as an Adjunct to Psychotherapy
Consideraciones para el Uso de la Respiración Holotrópica
como Complemento de la Psicoterapia
Laurel Watjen*
Antioch University
Seattle, USA
Abstract
The psychoanalytic viewpoint proposes that insight into one’s unconscious thoughts, feelings, and motiva-
tions can be helpful in understanding and changing personal constructs (Goldenberg & Goldenberg, 2013). Converse-
ly, anything that stands in the way of accessing that material may present a barrier to effective psychotherapy. Holo-
tropic Breathwork, a process of rapid, deep breathing to evocative music, induces a non-ordinary state of conscious-
ness (NOSC) (Taylor, 2007), which reportedly allows deeper access to the unconscious. Rhinewine and Williams
(2007) offer a hypothetical, bio-psychological explanation of the disinhibiting mechanism of holotropic NOSC’s,
which reduce the self-protectiveness of the logical/thinking part of the brain, and potentially result in opening to new
insights. Ryan and Deci’s (2008) Self-determination Theory (SDT) model offers a current and accepted framework
from which to explain the potential effectiveness of the therapeutic setting and practice of HB. SDT proposes that
there are three universal psychological needs which are essential for the occurrence of growth toward psychological
health and well-being: autonomy, competence, and relatedness. This paper describes how Holotropic Breathwork ful-
fills those three needs, potentially resulting in therapeutic benefit. An overview of research on the healing benefits of
NOSC’s, and in particular, on the use of HB as an adjunct to psychotherapy is included to support the argument that
HB may be beneficial in this context.
Keywords: Holotropic Breathwork, non-ordinary state of consciousness, psychotherapy, self-determination theory,
unconscious
Resumen
El punto de vista psicoanalítico propone que comprender los propios pensamientos inconscientes, senti-
mientos y motivaciones puede ser útil en la comprensión y cambio de los constructos personales (Goldenberg y Gol-
denberg, 2013). Por el contrario, cualquier cosa que se interponga en el camino de acceso a ese material puede repre-
sentar un obstáculo para la psicoterapia efectiva. La Respiración Holotrópica (RH), un proceso de respiración rápida
y profunda acompañado de música evocadora, induce un estado no ordinario de conciencia (ENOC) (Taylor, 2007)
que, al parecer, permite un acceso más profundo al inconsciente. Rhinewine y Williams (2007) proponen una hipóte-
sis biopsicológica del mecanismo de desinhibición de los ENOC holotrópicos, el cual reduce la auto-protección de la
parte lógica/pensante del cerebro, y que potencialmente conduce a la apertura a nuevas comprensiones. La Teoría de
la Autodeterminación (TAD) de Ryan y Deci (2008) ofrece un marco actual y aceptado desde el que poder explicar la
potencial eficacia del entorno terapéutico y la práctica de la RH. La TAD propone que hay tres necesidades psicoló-
gicas universales que son esenciales para la aparición de crecimiento hacia la salud y el bienestar psicológico: auto-
nomía, competencia y capacidad de relación. Este artículo describe cómo la RH cubre esas tres necesidades, dando
potencialmente como resultado un beneficio terapéutico. Finalmente, se presenta una visión general de la investiga-
ción sobre los beneficios curativos de los ENOC y, en particular, en el uso de la RH como un complemento a la psi-
coterapia, para respaldar el argumento de que HB puede ser beneficioso en este contexto.
Palabras clave: Respiración Holotrópica, estados no-ordinarios de consciencia, psicoterapia, teoría de la auto-
determinación, inconsciente
Received: January 2, 2014
Accepted: October 8, 2014
An Argument for the use of Holotropic Breathwork as an Adjunct to Psychotherapy Laurel Watjen
© Journal of Transpersonal Research, 2014, Vol. 6 (1), 103-111
e-ISSN: 1989-6077 // p-ISSN: 2307-6607 JTR - 104
Introduction
As we work our way around the closing circle
at the end of the Holotropic Breathwork workshop, a
woman shares that today she found the courage to face
the memories of her childhood sexual abuse in a new
way. Years of talk therapy had helped her understand it
rationally, but she had never been able to go back to
those painful episodes of torment and allow the emo-
tions to emerge. It was as if her heart had been frozen
in terror since childhood, dulling her experience of life
and relationships. ―The emotions finally began to come
out today; it was painful, but my heart feels lighter,‖
she shared. The woman had spent the day at a Holo-
tropic Breathwork (HB) workshop at which I was one
of three facilitators. Over and over, I hear participants
sharing similar stories of emotions unblocked, traumas
healed, clarity found, insights gained, and connections
made. According to Grof and Grof (2010), HB is a
powerful and transformational approach to self-
exploration and healing that integrates insights from
modern consciousness research, anthropology, various
depth psychologies, transpersonal psychology, Eastern
spiritual practices, and other mystical traditions of the
world. HB was developed in the 1970’s by Stanislav
Grof, a pioneer in the fields of transpersonal psycholo-
gy and consciousness research, and his wife, Christina
Grof. A highly experiential method, HB combines
rapid, deep breathing, evocative music, focused body-
work, mandala drawing, and group sharing in a safe,
supportive environment (Taylor, 2007). Run by trained
facilitators, HB workshops typically span one to three
days. During the breathing sessions, half of the partici-
pants lay on mats with their partners or sitters‖ near-
by. For three hours, the ―breathers‖ breathe deeper and
faster, with rhythmic or, evocative music playing, and
they enter a non-ordinary state of conscious-
ness1(NOSC) where healing and growth reportedly can
happen. Grof and Grof (2010) found that people’s ex-
periences in holotropic NOSCs, while varying widely,
fall into one or more of the following four categories:
physical-sensory, biographical, perinatal2, and trans-
personal3. Later, breathers and sitters switch roles for a
second breathing session, followed by mandala work
and group sharing.
The HB process is said to allow deeper access
to the unconscious mind and activates what Grof
(2000) refers to as an ―inner radar,‖ known in HB cir-
cles as the ―Inner Healer,‖ which he explains ―automat-
ically brings into consciousness the contents from the
unconscious that have the strongest emotional charge,
are most psycho-dynamically relevant at the time, and
most readily available for conscious processing‖ (p.
28). Crowley (2005) compares the Inner Healer to
Jung’s concept of the Self, which regulates the psyche
by innately moving toward wholeness through the in-
tegration of unconscious material (Hart, 1997; Sharp,
1991). Participants come to HB workshops for self-
exploration, personal growth, and healing, and they
report a wide range of positive results, including heal-
ing from trauma, depression, phobias, anxiety, addic-
tions, and even psychosomatic or psychogenic condi-
tions including asthma, migraines, and Reynaud’s dis-
ease (Grof and Grof, 2010).
In a typical HB session, the breather engages
in voluntary hyperventilation in order to enter an
NOSC. The framework of the workshop provides both
a ―safe container‖ and an intentional setting for growth
and healing. Participants are encouraged to trust their
own Inner Healer to guide them and to allow the ex-
pression of whatever feels ready to emerge. Anything
goes, with the exception of externalized sexual energy
or violence directed toward oneself or others in the
workshop. At a recent workshop, I watched as a wom-
an pounded rhythmically on thick, floor pillows repeat-
edly shouting, ―No!‖; nearby, a man on his hands and
knees attempted to push through a pile of pillows with
his head, as if fighting his way out of the birth canal.
One woman lay still and silent for most of the session,
while the man to her left began to cry for the first time
in twenty years.
At the end of their sessions, these people
shared their stories and, when I saw them again several
months later, I heard how their sessions had impacted
their lives. The woman shouting, ―No!‖ believed she
had worked through some of the emotions around her
childhood sexual abuse and was feeling less anxious
and more open to the world. The man on his knees had
shared at the workshop the realization of feeling
trapped in his relationship and had since begun coun-
seling with his partner; he also brought her to the next
workshop. The woman who lay silent was feeling more
at peace with her breast cancer diagnosis, having expe-
rienced a deep sense of spiritual connection during her
session. And the wife of the man who cried was grate-
ful that her husband was finally allowing his emotions
to surface.
These stories are wide-ranging, and yet very
typical of the anecdotal reports HB facilitators regular-
ly hear. Often workshop participants will comment that
―one session of HB is worth ―x‖ sessions of talk thera-
py,‖ where x might be anywhere from ―10‖ to a ―year’s
worth.‖ Witnessing the transformative and lasting r e-
sults of this modality on a regular basis, both as a par-
ticipant and as a facilitator, has left me wondering how
it works and if it could be used as a beneficial adjunct
to psychotherapy. Rhinewine and Williams’ (2007)
bio-psychological explanation and the research de-
An Argument for the use of Holotropic Breathwork as an Adjunct to Psychotherapy Laurel Watjen
© Journal of Transpersonal Research, 2014, Vol. 6 (1), 103-111
e-ISSN: 1989-6077 // p-ISSN: 2307-6607 JTR - 105
scribed below explain part of the picture, but we be-
lieve there are other factors at work.
In this paper, an explanation of how and why
HB works is offered. The capacity of HB to open
people both to their emotions and to their unconscious
is proposed, arguing that, HB can also increase the
depth of psychotherapeutic work, resulting in both
healing and growth. A review of research in support of
these claims is also included.
Barriers to Effective Psychotherapy
Meta-analysis of various traditional psychothe-
rapy methods has shown that there is very little differ-
ence in the outcome rates of the different methods
(Wampold, Mondin, Moody, Stich, Benson and Ahn,
1997) and that the more critical issue is the skill of the
therapist. The common thread between the different
methods, which also takes into account the individual
therapist, is the ―therapeutic alliance‖ between therap-
ist and patient: the patient must feel emotionally safe
with the therapist in order for progress in psychothera-
py to occur (Blow, Sprenkle, and Davis, 2007). How-
ever, we propose that more is often needed to effect
permanent growth and change.
As Kelly (1963) pointed out in his personal
construct theory, we create our own constructs of how
the world is, and our unwillingness to change these can
keep us stuck in unhealthy ways of being. The goal of
therapy then, is to help patients construe reality in a
more permeable manner(Kelly, 1963). While some
action-oriented models of therapy may disagree, the
psychoanalytic viewpoint proposes that insight into
one’s unconscious thoughts, feelings, and motivations
can be helpful in understanding and changing personal
constructs (Goldenberg and Goldenberg, 2013), and
that anything that stands in the way of accessing that
material presents a barrier to effective therapy.
For example, changing maladaptive constructs
is more challenging if the patient is unwilling or unable
to access the associated emotions (Holland, 2003).
Emotions provide a rich source of information, giving
clues to the often unconscious roots of our thoughts
and behaviors, but when they are avoided or blocked,
access to that information is lost. Holland (2003) points
out that some patients develop self-protective means of
avoiding negative emotions and that this can cause
road blocks in the therapeutic process. Emotions give
information about the impact of situations and the envi-
ronment, and when combined with symbolic thought,
they give optimal adaptation (Holland, 2003). Ignoring
either the emotional or rational aspects of a situation
can result in a distorted assessment, and a person who
has difficulty accessing emotions may not sense when
they are in a harmful or unhealthy situation (Holland,
2003). Achieving insight into the internal conflicts
and unconscious issues may require stepping outside of
them to gain perspective. Different methods of therapy
aim to do this, generally through cognitive processes,
but as Einstein is often credited with saying4, ―We
cannot solve problems at the same level of conscious-
ness at which we created them.‖ We argue that holo-
tropic NOSCs, by their very definition, allow people to
view, and potentially solve, problems from a different
level of consciousness5.
How Holotropic Breathwork Works
When describing HB to people, facilitators of-
ten explain it as ―getting out of the logical/thinking
mind‖ and ―allowing the innate healing intelligence to
come forth‖ (G. Girlando, personal communication,
September 20, 2008). Entering into an NOSC is a
means of getting out of the day to day, rational mind
the part of the mind which holds on tightly to the con-
structs of how things are, however accurate or inaccu-
rate those constructs may be. It’s also the part of the
mind that shuts down emotions when they’re unplea-
sant or overwhelming. It follows that reducing the self-
protectiveness of the logical/thinking part of the brain
might open the mind to new possibilities of insight and
emotional experience.
Rhinewine and Williams (2007), in their hypo-
thesis-posing synthesis paper on HB as an adjunct to
psychotherapy, suggested that the combination of the
hyperventilation-induced NOSC of HB and the thera-
peutic setting of HB can ―facilitate generalized extinc-
tion of covert avoidance behaviors, resulting in thera-
peutic progress‖ (p. 771). They noted that prolonged,
intentional hyperventilationthe method of NOSC
induction in HBproduces physical and cognitive
changes in the brain which correspond to those found
in other NOSCs, such as exercise ―highs,‖ meditation,
and some drug-induced states. These NOSC’s seem to
temporarily lower activity in the brain’s frontal lobes,
the area of the brain ―involved in control and selective
inhibition of cognition and behavior‖ (p. 774). Rhine-
wine and Williams (2007) reasoned that this creates a
state of psychological disinhibition, which allows sup-
pressed material to come forth, as well as a degree of
dissociation, which renders the brain less reactive emo-
tionally. The therapeutic environment of the HB format
allows the material to be experienced and processed as
it may not have been during the original event. Rhine-
wine and Williams’ hypothetical explanation of the
mechanism which makes HB effective describes bio-
psychologically how the logical/thinking part of the
An Argument for the use of Holotropic Breathwork as an Adjunct to Psychotherapy Laurel Watjen
© Journal of Transpersonal Research, 2014, Vol. 6 (1), 103-111
e-ISSN: 1989-6077 // p-ISSN: 2307-6607 JTR - 106
brain may lower its guard and open to new insights.
My personal experience as a breather and observations
as a facilitator also point in the same direction.
In his many years of observing NOSC ses-
sions, Grof (1994) foresaw Rhinewine and Williams’
conclusion, explaining that in a holotropic state:
The defense systems are considerably wea-
kened and psychological resistance decreases.
The emotional responses of the subject are
dramatically enhanced and one may observe
powerful abreaction6and catharsis7. Repressed
unconscious material, including early child-
hood memories, becomes easily available, and
this may result not only in enhanced recall but
in genuine age-regression and vivid, complex
reliving of emotionally relevant memories as
well. Unconscious material also frequently ap-
pears in the form of various symbolic pheno-
mena with a structure similar to dreams. The
emergence of the material and its integration
are associated with emotional and intellectual
insights into the psychodynamics of the pa-
tient’s symptoms and maladjustive interper-
sonal patterns. (p. 282).
SDT as an Explanation of the
Potential Effectiveness of HB
Ryan and Deci’s (2008) Self-determination
Theory (SDT) model offers a current and accepted
framework from which to explain the potential effec-
tiveness of the therapeutic setting and practice of HB.
SDT proposes that there are three universal psycholog-
ical needs, which are essential for the occurrence of
growth toward psychological health and well-being:
autonomy, competence, and relatedness. We propose
that Holotropic Breathwork fulfills those three needs in
the following ways:
Autonomy, or the need of people ―to organize
and self-regulate their actions‖ (Ryan and Deci, 2008,
p. 188), is important because change is more likely to
be lasting if it is client-driven (Ryan and Deci, 2008).
In HB, autonomy is supported by offering the structure
of the workshop, within which the participants are
encouraged to follow their own instincts. Trust in their
Inner Healer is encouraged, and with it, the belief that
whatever needs to emerge will do so in whatever way
the breather is ready to allow it to emerge. Grof and
Grof (2010) point out that in this kind of work, heal-
ing is not the result of brilliant insights and interpreta-
tions of the therapist; the therapeutic process is guided
from within by the Self‖ (p. 19). Grof (2000) considers
this approach to have a distinct advantage over many
traditional talk therapy methods because it eliminates
the personal and theoretical biases of the therapist in
directing the focus of the session, making it truly
client-driven.
Competence, or the sense that one is effective
in the world, is a result of this autonomy supportive
process. Ryan and Deci (2008) maintain that:
SDT is also reflective of a basic organismic as-
sumption that throughout development people
manifest active tendencies toward integration
(Ryan, 1995), synthesis (Freud, 1923/1962),
organization (Piaget, 1971), and self-
actualization (Patterson and Joseph, 2007).
From the SDT perspective, the promotion of
therapeutic change involves energizing and
supporting this inherent growth tendency as
patients take on the challenges confronting
them. (p. 188).
In HB, the facilitators too must trust in each
participant’s Inner Healer. Facilitators do not direct the
breathers or their experience in any way, nor do they
interpret the breather’s experience. Even the bodywork
sometimes done at the end of breathers’ sessions to
resolve physical or energetic tensions is offered by
facilitators as resistance for the breather to push into,
rather than as something the facilitator is doing to the
breather. The structure of the workshop serves to em-
power the breather to do their own healing and growth,
rather than having it done to them or for them by an
external authority.
Relatedness is the sense of being cared for
and connected with the other‖, which is critical to
internalization and valuing of the therapeutic process
(Ryan and Deci, 2008, p. 189). Within the HB model,
this is addressed in multiple ways:
First, the facilitators strive to create a safe con-
tainer for the day through the workshop format. In
addition to making an intentional personal connection
with each participant, the facilitators open the work-
shop by encouraging each person to share something
personal with the group about what inspired them to
attend. At the end of the day, participants are offered
the chance to share the essence of their breathwork
session with the group. This may promote the devel-
opment of a sense of shared experience and connection
over the course of the day.
Second, participants work in pairs, alternating
between the roles of breather and sitter. While the
breather is actively engaged in doing the breathwork,
the sitter attends to the breather both physically and
emotionally. On a practical level, the sitter takes care
An Argument for the use of Holotropic Breathwork as an Adjunct to Psychotherapy Laurel Watjen
© Journal of Transpersonal Research, 2014, Vol. 6 (1), 103-111
e-ISSN: 1989-6077 // p-ISSN: 2307-6607 JTR - 107
of any physical needs: providing water or tissues when
requested, protecting the breather with pillows from
their own movements or those of other breathers, and
taking them to the restroom if needed. On an emotional
level, the sitter provides a sacred witness to the breath-
er’s process by being emotionally present and without
intervening in any way. This may sound inconsequen-
tial, yet anecdotal reports from breathers often indicate
a feeling of closeness to their sitter after having been
attended to with presence for three hours.
Third, and of tremendous significance, is that
one of the experiences that reportedly can arise for
breathers is a transpersonal awareness of their own
interconnectedness with other people, with nature, and
even with the cosmos. The Grofs (2010) explain:
People who gain an experiential access to the
transpersonal domain of their psyches typically
develop a new appreciation of existence and
reverence for all life. One of the most striking
consequences of various forms of transperson-
al experiences is the spontaneous emergence
and development of deep humanitarian tenden-
cies and a strong need to become involved in
service for some larger purpose. This is based
on a cellular awareness that all boundaries in
the universe are arbitrary and that on a deeper
level all of creation represents a unified cosmic
web (p. 133).
Research on Holotropic NOSCs
Research on holotropic NOSCs as an adjunct
to psychotherapy has a long history, beginning in the
1950s with NOSCs induced by psychoactive drugs
such as LSD, psilocybin, mescaline, and DMT. For
nearly two decades, Stanislav Grof and other scientists
researched promising methods for treating conditions
such as depression, anxiety, addiction, alcoholism, and
fear of death in terminally ill patients, using holotropic
NOSCs (Grof, 1994; Grinspoon and Doblin, 2001).
When psychedelics found their way out of the clinical
setting and into popular culture, the anti-drug senti-
ments of the late 1960s put an end to psychedelic re-
search. LSD was made illegal in 1966, and this chapter
in psychiatric history was nearly forgotten (Grinspoon
and Doblin 2001). Subsequently, the Grofs found that
the combination of deeper, faster breathing and music
brought people into states of consciousness which were
nearly identical to those induced by psychedelics.
Thus, HB was born in the 1970s as a legal way to con-
tinue working with the healing potential of NOSCs.
Particularly in the past decade, there has been
renewed research interest in the psychotherapeutic use
of NOSCs. Results have been promising in research on
the use of MDMA-assisted psychotherapy in alleviat-
ing PTSD in treatment-resistant veterans; the use of
psilocybin for treatment of fear of death in cancer pa-
tients, as well as anxiety, OCD, and pain; the use of
ketamine and psilocybin for treatment of addiction and
depression; the use of ibogaine for narcotic addiction;
and the use of LSD and psilocybin for treatment of
cluster headaches and anxiety (Sessa, 2012). Keeping
in mind Rhinewine and Williams’ (2007) assertion that
the temporary changes in the brain during HB are simi-
lar to those in NOSCs induced by psychoactive drugs,
both the historical and current research with psychedel-
icsand its promising resultsadd credibility to the
proposal that HB can be used beneficially in the psy-
chological realm.
Much of the evidence for the effectiveness of
HB is anecdotal; however, there are some studies offer-
ing empirical evidence in varying areas. Eyerman’s
(2013) ―A Clinical Report of Holotropic Breathwork in
11,000 Psychiatric Inpatients in a Community Hospital
Setting‖ described weekly, group HB sessions offered
over a 12-year period to a spiritually and HB naïve
population. In 11,000 patients from ―specialty units
including sexual trauma, dual diagnosis, chemical de-
pendency, anxiety, depression, adolescents, and acute
intensive care for psychoses‖ (Eyerman, 2013, p. 25),
there were no adverse reactions reported, either by
patients or staff, over the entire 12 year period. Eyer-
man (2013) reports that HB was considered by many
departing patients to have been their best therapy while
at the hospital.
While individual patient diagnoses and out-
comes were not tracked, personal reports were record-
ed from 482 participants. Their experiences fell into
combinations of the four categories described by the
Grofs: physical-sensory, biographical, perinatal, and
transpersonal, with 82% having a transpersonal expe-
rience in at least one session. Eyerman (2013) con-
cluded that ―Holotropic Breathwork could be consi-
dered a low-risk therapy to assist patients with an ex-
tremely broad range of psychological problems and
existential life issues‖ (p. 26).
Binarová (2003) considered the effect of HB
on personality by studying three groups: ―Non-
breathers,‖ who did not participate in HB, ―First-
breathers,‖ who experienced HB for the first time, and
―Breathers‖ who had done HB at least four times. Us-
ing Crumbaugh and Maholick's Purpose in Life
(PIL) test, Harman, Fadiman, and Mogar’s test of atti-
tudes and values (Value-Belief Q-Sort), and Sho-
strom’s Personal Orientation Dimensions (POD),
Binarová (2003) compared First-breathers before and
after their first session, and then compared Breathers
with Non-breathers.
An Argument for the use of Holotropic Breathwork as an Adjunct to Psychotherapy Laurel Watjen
© Journal of Transpersonal Research, 2014, Vol. 6 (1), 103-111
e-ISSN: 1989-6077 // p-ISSN: 2307-6607 JTR - 108
First-breathers developed a statistically sig-
nificant reduction in rigidity and dogmatic thinking.
Breathers had decreases in rigidity, dogmatism, and
conventional approach to values. They had increases in
flexibility toward values, sensitivity toward their own
needs and emotions, spontaneity, self-esteem, capacity
for connecting with others, ability to enjoy the present
moment, and overall appropriate approach toward real-
ity. There was evidence to suggest that many of the
―Breathers had some of these qualities beforehand,
but the increase in these areas may demonstrate that
HB can assist in the continued development of these
areas (Binarová, 2003). Both the First-breathers and
the Breathers reported better communication with
others, a deeper understanding of the world around
them, and an increase in their openness to previously
rejected ideas as a result of the HB. All of these results
can be considered signs of mental health that would
contribute to the psychotherapeutic process.
Brewerton, Eyerman, Cappetta, and Mithoefer
(2012) researched the use of HB as an adjunctive
treatment for substance abuse, with positive results in
both cessation and continued abstinence from alcohol
and/or drugs ranging from 2-19 years. Their article also
included summaries of several other studies (Jefferys,
as cited in Brewerton et al., 2012; Metcalf, as cited in
Brewerton et al., 2012; Taylor, as cited in Brewerton et
al., 2012) with similar results. The Grofs (Grof and
Grof, 1990) attribute these positive results to the trans-
personal experiences available in holotropic NOSCs:
In many cases the intense and sometimes over-
powering craving for drugs, alcohol, food, sex
or other objects of addiction is really a mis-
placed yearning for wholeness, a larger sense
of self, or Godone that cannot be satisfied in
the external world. When the true object of this
craving, an experience of the Higher Power,
becomes available and even partially fulfills
this consuming desire, the desire diminishes.
(p. 106).
Holmes, Morris, Clance, and Putney (1996) of-
fered one of the few empirical studies on the effective-
ness of HB as an adjunct to verbal therapy. Their study
compared two groups: one using verbal therapy only
and the second using HB in conjunction with verbal
therapy. Participants self-reported on the following
scales: death anxiety (measured with Templer’s Death
Anxiety Scale), self-esteem (measured with the Ab-
asement subscale of the Personality Research Form-E),
and sense of connection with others (measured with the
Affiliation subscale of the PRF-E). A positive correla-
tion between both a statistically significant decrease in
death anxiety and a statistically significant increase in
self-esteem was found in the participants who received
the combined protocol of HB and verbal therapy, when
compared to those who only received verbal therapy.
Holmes et al. (1996) selected their measure-
ment criteria for the study based on S. Grof’s statement
that ―Holotropic Breathwork experiences often lead to
a marked reduction in death anxiety, increases in self-
esteem, and increases in one’s sense of connection with
others‖ (S. Grof, as cited in Holmes et al., 1996, p.
116). While S. Grof’s decades of research on holotrop-
ic NOSCs suggest that this is frequently the case, the
criteria measured were not necessarily personally rele-
vant to the study subjects. For instance, had the sub-
jects been of advanced age or patients with a terminal
medical diagnosis, we suspect the decrease in the death
anxiety scale rating would have been even more pro-
nounced. Grof’s (1994) early research using psychedel-
ic therapy with terminal cancer patients demonstrated
―dramatic improvements‖ in 30% of the subjects, and
moderate improvements in another 40% (p. 261). De-
spite the very general measurement criteria, the study
by Holmes et al. still offers empirical evidence that HB
can be useful as an adjunct to psychotherapy.
Contraindications
One of the potential limitations of using HB as
an adjunct to psychotherapy is that it is not an appro-
priate intervention for everyone. Clients must be
screened for physical and emotional contraindications.
Serious cardiovascular disorders, pregnancy, convul-
sive disorders (e.g. epilepsy), glaucoma, or retinal de-
tachment may contraindicate HB as an inappropriate
therapy for some clients because of physiological
changes in the body which may occur during the ses-
sion (e.g. intense physical tensions and pressures, ute-
rine contractions, change in brainwaves) (Grof and
Grof, 2010).
Additionally, clients with a history of serious
emotional issues, especially those who have required
hospitalization, may not be appropriate candidates for
HB in shorter (one to three day) workshop settings. S.
Grof and Grof (2010) point out that for those individu-
als, HB has the potential to bring more material from
the unconscious to light than the client may be able to
resolve within the context of a shorter workshop set-
ting. This effect may be similar to that experienced in
other holotropic states, such as spontaneous spiritual
emergency8or those triggered by experiential therapies,
intense meditation or spiritual practice, psychedelics,
or near death experiences (Grof and Grof, 2010).
Therefore, a critical component of this intervention is
careful screening and follow-up with clients. Tradi-
tional psychiatry might consider the presence of unre-
An Argument for the use of Holotropic Breathwork as an Adjunct to Psychotherapy Laurel Watjen
© Journal of Transpersonal Research, 2014, Vol. 6 (1), 103-111
e-ISSN: 1989-6077 // p-ISSN: 2307-6607 JTR - 109
solved unconscious material a ―psychotic break,‖ but
the Grofs (Grof and Grof, 2010) believe that:
Within the philosophical framework of holo-
tropic therapy, it constitutes a major therapeu-
tic opportunity. It means that very important
traumatic material from the deep unconscious
has become available for conscious processing.
With the right understanding, guidance, and
management, this could be extremely benefi-
cial and result in radical healing and positive
personality transformation. (p. 59).
The Grofs (Grof and Grof, 2010) explain that
proper management of such client processes requires
both a recognition of their potential therapeutic and
transformative nature, and an appropriate setting in
which clients can come to a natural resolution of their
process. Depending on the amount of time required,
this could mean a residential facility with staff trained
in working with holotropic states. Unfortunately few, if
any, of these exist today, and most residential psychia-
tric facilities are far more likely to pharmaceutically
reduce any expressed symptoms than to allow them to
reach a natural resolution (Grof and Grof, 2010).
Conclusion
Evident in the emotional contraindications are
both the challenges and the potential healing benefits
of using HB as an adjunct to psychotherapy. Anecdotal
and research-based evidence indicate a strong potential
for bringing unconscious material into consciousness
and a movement toward mental health (Binarova,
2003; Brewerton et al., 2012; Grof andGrof, 2010;
Holmes et al, 1996). Eyerman’s (2013) report on the
long term use of HB in an inpatient psychiatric hospital
with no adverse effects is some of the strongest, re-
search-based evidence available on the safety of HB in
populations which would normally be screened out of a
brief workshop setting. It also demonstrates the need
for a paradigm shift in the treatment of mental illness.
Until such a shift occurs, we believe HB can be a very
effective adjunct to psychotherapy for appropriately
screened clients, or when an appropriate set and setting
can be provided for clients with more serious emotion-
al issues.
As an intervention, HB can be offered only by
facilitators who’ve undergone a lengthy training and
certification process. Currently, there are 1,150 certi-
fied facilitators world-wide (C. Sparks, personal com-
munication, October 6, 2014), which limits availability
to clients in proximity to facilitators offering work-
shops or with the means to travel. It is hoped that with
additional research, the knowledge, acceptance, and
availability of HB as a safe and effective adjunct to
psychotherapy will become widespread.
Notes
1. S. Grof and Grof (2010) use the term ―non-ordinary
states of consciousness (NOSCs)‖ to refer to what
is often called an altered state of consciousness, or
one which is other than our ―normal‖ state of con-
sensus-based reality. StanislavGrof coined the term
―holotropic‖ meaning ―moving toward wholeness‖
from the Greek words holos = whole and trepein =
moving toward to describe the particular variety of
NOSC that activate our innate healing mechanisms.
2. Perinatal refers to memories or experiences related
to the period of time from conception through
shortly after birth (Grof, 1985; Grof and Grof,
2010).
3. Transpersonal refers to experiences beyond our
sense of our physical self, such as experiences of
connection with a higher power, being an animal or
another person, past lives, ―Oneness,‖ archetypal or
mythological visions, and so on (Grof, 1985; Grof
and Grof, 2010).
4. Einstein’s original (and often paraphrased) quote
was, A new type of thinking is essential if man-
kind is to survive and move toward higher levels.‖
Atomic education urged by Einstein. (1946, May
25). New York Times. Retrieved from
http://www.turnthetide.info/id54.htm
5. The definition of ―non ordinary state of conscious-
ness‖ implies a different level or type of conscious-
ness from which people can view problems. We
propose the inverse of the quote: that we can poten-
tially solve problems, or ―internal conflicts and un-
conscious issues‖, at a different level of conscious-
ness than that at which we created them.
6. Freud originally believed that all psychoneuroses
were caused by early, unresolved traumas which,
because of their nature, had not allowed the victim
to fully experience and release the associated emo-
tional and physical energies. These trapped energies
created what Freud called ―jammed affect‖ in the
unconscious mind. In their early work together,
Freud and Breuer developed the method of abreac-
tion as a means of resolving these unconscious con-
flicts. They put patients into a holotropic NOSC us-
ing hypnotic or auto-hypnotic trance, which al-
lowed the patients to age-regress back to the origi-
nal problematic event. By experiencing the event
An Argument for the use of Holotropic Breathwork as an Adjunct to Psychotherapy Laurel Watjen
© Journal of Transpersonal Research, 2014, Vol. 6 (1), 103-111
e-ISSN: 1989-6077 // p-ISSN: 2307-6607 JTR - 110
and associated emotions fully, from the simultane-
ous positions of age-regression and objective adult,
patients could release the blocked emotional ener-
gies, integrate the event, and move toward healing.
(Freud, as cited in Grof and Grof, 2010).
7. Similar to abreaction, catharsis is the release of
non-specific, blocked emotional energies (Grof and
Grof, 2010).
8. Grof and Grof (1990) coined the term spiritual
emergency to describe the:
critical and experientially difficult stages
of a profound psychological transforma-
tion that involves one’s entire being. They
take the form of non-ordinary states of
consciousness and involve intense emo-
tions, visions and other sensory changes,
and unusual thoughts, as well as various
physical manifestations. (p. 31).
Acknowledgements
I’d like to thank Hidy Basta, Ph.D. for her en-
couragement and for sharing her passion for the
process of conceptualizing and writing academic pa-
pers. I’d also like to thank my fellow HB facilitator,
Glenn Girlando, M.A., for his support, feedback, and
willingness to listen as I worked through the concepts
for this paper.
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*Laurel Watjen is currently a Masters candidate spe-
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och University, Seattle, WA. She has been practicing
Holotropic Breathwork since 2008 and is certified as a
Holotropic Breathwork facilitator. In 2011, she co-
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Email: laurelwatjen@gmail.com
... Finally, after the breathing session, artwork (i.e. drawing of mandalas), and group sharing are typically used to help integrate the experience (Grof & Grof, 2010;Watjen, 2014). ...
... These frameworks include the Self Determination Theory (SDT) by (Deci & Ryan, 2008), pivotal mental states (PIMS) (Brouwer & Carhart-Harris, 2020), and finally the process of hormesis (Mattson, 2008b;Pruimboom & Muskiet, 2018). Regarding the former, it may be that HBW may have fulfilled the three psychological needs, namely autonomy, competence, and relatedness as outlined in the SDT which ultimately may have driven improvements in mental health related variables (Watjen, 2014). For example, participant autonomy may have been supported by the facilitator encouraging the participants to follow their own instincts and bodily sensations during the session. ...
... Competence may have followed from the HBW session through the participant being empowered to care for their own well-being and growth through participating in the HBW session. Relatedness defined as 'the sense of being cared for' or 'connected with the other' may have been achieved by the facilitators' aim to 'hold a safe space' for the participants and while being in connection to the other participants (Watjen, 2014). The second framework, namely PiMS, has been defined as "transient, intense hyper-plastic states of mind and brain that have the potential to mediate rapid, major and potentially enduring psychological change" (Brouwer & Carhart-Harris, 2020). ...
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