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Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part I—Neurophysiologic Model
Abstract
Mind-body interventions are beneficial in stress-related mental and physical disorders. Current research is finding associations between emotional disorders and vagal tone as indicated by heart rate variability. A neurophysiologic model of yogic breathing proposes to integrate research on yoga with polyvagal theory, vagal stimulation, hyperventilation, and clinical observations. Yogic breathing is a unique method for balancing the autonomic nervous system and influencing psychologic and stress-related disorders. Many studies demonstrate effects of yogic breathing on brain function and physiologic parameters, but the mechanisms have not been clarified. Sudarshan Kriya yoga (SKY), a sequence of specific breathing techniques (ujjayi, bhastrika, and Sudarshan Kriya) can alleviate anxiety, depression, everyday stress, post-traumatic stress, and stress-related medical illnesses. Mechanisms contributing to a state of calm alertness include increased parasympathetic drive, calming of stress response systems, neuroendocrine release of hormones, and thalamic generators. This model has heuristic value, research implications, and clinical applications.
... Yoga has been shown to reduce stress levels [68] and oxidative stress markers, such as malondialdehyde, while simultaneously increasing the presence of antioxidant enzymes, such as superoxide dismutase [69]. Yoga has also demonstrated the ability to enhance insulin sensitivity and mitigate leptin resistance [70, [72,73], and normalize the circadian rhythm by decreasing the levels of cortisol and elevating the levels of melatonin [74,75]. All of the above aid in the reduction of BP and a consequent enhancement in the individual's cardiovascular well-being. ...
... All of the above aid in the reduction of BP and a consequent enhancement in the individual's cardiovascular well-being. There is ample evidence supporting how yoga alleviates symptoms of mental stress, anxiety, and depression by enhancing autonomic functions, activating neurohormonal processes, and suppressing sympathetic activity [73,76]. Incorporating yoga into one's lifestyle can even lead to improved dietary habits and a reduction in sodium intake [77,78], both of which have been associated with a decrease in BP. ...
Background:
Hypertension is a prevalent chronic condition that affects a substantial proportion of the world's population. Medications are commonly prescribed for hypertension management, but non-pharmacological interventions like yoga are gaining popularity.
Objective:
The purpose of this systematic review and meta-analysis is to assess the efficacy of Yoga Nidra (YN) for the management of hypertension.
Methods:
A systematic review and meta-analysis of clinical trials, i.e., non-randomized and randomized controlled trials (RCTs) was conducted to investigate the effects of YN on hypertension. PubMed, the Cochrane Library, SCOPUS, and EBSCO were searched for relevant studies published up to September 2022. The quality of the included studies was assessed using the Cochrane risk of bias tool. The primary outcome measure was the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after YN intervention, analyzed as weighted mean difference (WMD), in comparison to control groups. The random-effects model was used for the meta-analysis. Risk of bias was assessed for RCTs and non-RCTs using Cochrane's RoB-2 and ROBINS-I tools, respectively.
Results:
Five RCTs and three Non-RCTs involving a total of 482 participants (239 for YN vs 243 for controls) were included in this review. The meta-analysis indicated that YN significantly reduced SBP (WMD = 12.03 mm Hg, 95% CI [7.12, 16.93], Z = 4.80, p < 0.00001) and DBP (WMD = 6.32 mm Hg, 95% CI [3.53, 9.12], Z = 4.43, p < 0.00001) compared to control groups. The overall risk of bias for the three RCTs was high, whereas for the five non-RCTs, one had an overall moderate risk while the other four had an overall serious risk of bias.
Discussion:
This systematic review and meta-analysis provides evidence supporting the efficacy of YN as a complementary therapy for hypertension management. YN is a safe, cost-effective, and easily accessible intervention that primarily relies on interoception and induces a deep relaxation response in practitioners, aiding them in coping with various components of high blood pressure, such as stress, vascular inflammation, peripheral vascular resistance, etc. Our understanding of the mechanisms of YN is constantly evolving, and there is a need for further research to fully explore and appreciate the significance of this ancient science and its potential efficacy on BP. Considering the results and the multifactorial role of YN, it can act as a safe and reliable adjuvant therapy to complement the pharmacological treatment of hypertension. However, further studies with larger sample sizes, longer follow-up periods, and homogenous populations are warranted.
Conclusion:
This meta-analysis suggests that YN is effective in reducing SBP and DBP, particularly in individuals with hypertension. The results highlight the potential of YN as a complementary therapy for hypertension management. Healthcare providers may consider recommending YN to patients with hypertension as an adjuvant therapy to medication. Further studies are required to identify standardized optimal forms and durations of YN best suited for hypertension management.
... Mind-body interventions, such as deep breathing exercises, can improve resilience, psychological well-being, physiological functions, autonomic imbalance, mood, cardiopulmonary output, and immune function [22][23][24][25]. Adaptive changes in the central nervous system, characterized as reduced sympathetic tone, have been described with these exercises [26][27][28]. ...
Background
Heart rate variability (HRV) biofeedback is often performed with structured education, laboratory-based assessments, and practice sessions. It has been shown to improve psychological and physiological function across populations. However, a means to remotely use and monitor this approach would allow for wider use of this technique. Advancements in wearable and digital technology present an opportunity for the widespread application of this approach.
Objective
The primary aim of the study was to determine the feasibility of fully remote, self-administered short sessions of HRV-directed biofeedback in a diverse population of health care workers (HCWs). The secondary aim was to determine whether a fully remote, HRV-directed biofeedback intervention significantly alters longitudinal HRV over the intervention period, as monitored by wearable devices. The tertiary aim was to estimate the impact of this intervention on metrics of psychological well-being.
Methods
To determine whether remotely implemented short sessions of HRV biofeedback can improve autonomic metrics and psychological well-being, we enrolled HCWs across 7 hospitals in New York City in the United States. They downloaded our study app, watched brief educational videos about HRV biofeedback, and used a well-studied HRV biofeedback program remotely through their smartphone. HRV biofeedback sessions were used for 5 minutes per day for 5 weeks. HCWs were then followed for 12 weeks after the intervention period. Psychological measures were obtained over the study period, and they wore an Apple Watch for at least 7 weeks to monitor the circadian features of HRV.
Results
In total, 127 HCWs were enrolled in the study. Overall, only 21 (16.5%) were at least 50% compliant with the HRV biofeedback intervention, representing a small portion of the total sample. This demonstrates that this study design does not feasibly result in adequate rates of compliance with the intervention. Numerical improvement in psychological metrics was observed over the 17-week study period, although it did not reach statistical significance (all P>.05). Using a mixed effect cosinor model, the mean midline-estimating statistic of rhythm (MESOR) of the circadian pattern of the SD of the interbeat interval of normal sinus beats (SDNN), an HRV metric, was observed to increase over the first 4 weeks of the biofeedback intervention in HCWs who were at least 50% compliant.
Conclusions
In conclusion, we found that using brief remote HRV biofeedback sessions and monitoring its physiological effect using wearable devices, in the manner that the study was conducted, was not feasible. This is considering the low compliance rates with the study intervention. We found that remote short sessions of HRV biofeedback demonstrate potential promise in improving autonomic nervous function and warrant further study. Wearable devices can monitor the physiological effects of psychological interventions.
... It can also help in reducing stress, anxiety, and depression in today's competitive society. [23,24] ...
Central serous chorioretinopathy (CSCR) is characterized by localized serous detachment of neurosensory retina secondary to leakage of fluid from choriocapillaris, accumulating under the macula, with or without pigmented epithelial detachment. A 30-year-old male presented with complaints of sudden painless diminished vision and floaters in the right eye for 5 days. The patient had no previous history of any ocular disease and no significant systemic illness. The visual acuity as per LogMAR was 0.5 in the right eye and 0 in the left eye. The fundus examination showed round elevated detachment around the macula, which was confirmed by optical coherence tomography, showing neurosensory detachment due to serous fluid accumulation under the macula along with small pigmentary epithelial detachment. Management was done on an outpatient basis over 2.5 months, which included both internal and topical interventions along with Yoga therapy. The disease was resolved in 2.5 months with complete resolution of serous fluid. The visual acuity was brought back to normal, that is, LogMAR 0. CSCR cases can be successfully treated with an Ayurvedic holistic approach, and they respond better when treated at an early stage. These practices can be considered as an alternative.
... Stress is an unavoidable aspect of life, but there are numerous strategies available to counter its impact. Many individuals advocate for various methods, such as adopting regular physical exercise, making lifestyle adjustments, and changing dietary habits, as effective ways to combat stress [17]. Additionally, yoga and pranayama (breathing exercises) are widely recognized as beneficial practices for stress management. ...
The review encompasses the therapeutic effects of Pranayama practices on diverse health parameters. This review explores the Therapeutic Impact of Pranayama Practices on Physical and Mental Health. The authors conducted a comprehensive review of the Scopus, Research Gate, web of science, pub med and google scholar databases, looking for relevant studies focused largely on the Pranayama Practices on Physical and Mental Health. It underscores the importance of incorporating pranayama into fitness routines for a well-rounded and balanced approach to health Significant improvements in cardiovascular variables, including blood pressure, heart rate variability, and exercise tolerance. Respiratory indices, such as vital capacity and respiratory rate, displayed positive outcomes. Cognitive functions in conditions like type 2 diabetes were positively influenced by Pranayama. Mental health parameters, including stress, saw remarkable improvements. Physical fitness components, such as strength, endurance, flexibility, and body composition, demonstrated significant enhancements with the incorporation of Pranayama protocols. The review highlights the preventive and therapeutic applications of Pranayama in disorders ranging from psychosomatic conditions to chronic obstructive pulmonary disease (COPD). The evidence supports the integration of Pranayama practices into daily life for holistic health benefits. Further research is urged to unravel specific mechanisms underlying these therapeutic effects and establish optimal guidelines for incorporating Pranayama into contemporary health and wellness strategies. This review contributes to the growing body of literature on the intersection of traditional yogic practices and modern healthcare.
... On all 3 days, participants were engaged for 3 h in the morning and 3 h in the afternoon. The participants practiced yoga asanas, ujjayi pranayama, SKY breathwork, and guided meditation every day (see Table 2, Brown and Gerbarg, 2005;Sloan and Kanchibhotla, 2023 for details). The intervention also included a discussion component. ...
Background
Human capital plays a crucial role in the success of an organization and further contributes to the broader goals of growth and development of society. In this regard, it is essential to ensure the well-being of employees at the workplace. Given the positive impact of yoga on psycho-physiological aspects of health, this study aims to examine the impact of a breath-based yogic intervention, Sudarshan Kriya Yoga (SKY), on stress, anxiety, thriving, general health, emotional well-being, social well-being, and psychological well-being among employees of a leading manufacturing firm in India.
Methods
Undertaking a randomized-control experiment design (n = 64), we examined the impact of SKY on stress, anxiety, thriving, general health, and emotional, social, and psychological well-being. Two certified instructors conducted the SKY intervention in a retreat format over 3 days.
Results
The analysis demonstrated positive outcomes across various aspects of participants’ well-being, i.e., it significantly reduced their stress and anxiety and increased the levels of thriving, general health, and emotional, social, and psychological well-being. These findings are valuable for understanding the potential benefits of the SKY intervention.
Discussion
The findings provide support for considering SKY as a potential well-being intervention for employers at the workplace and society at large. Further exploration, implementation, and research in diverse contexts will be crucial to fully understand the long-term impact and scalability of the SKY intervention in promoting holistic well-being.
... Yoga promotes both physical and mental relaxation, which lowers anxiety and stress. [4] It includes the practice of meditation, precise postures (asana), and controlled breathing exercises (Pranayama). The purpose of meditation-based practice is to consciously calm the mind by separating thoughts from each other and/or focusing on one's breathing. ...
Stress is an enormous concern in our culture because it is the root cause of many health issues. Yoga asanas and mindfulness-based practices are becoming increasingly popular for stress management; nevertheless, the biological effect of these practices on stress reactivity is still a research domain. The purpose of this review is to emphasize various biosignals that reflect stress reduction through various yoga-based practices. A comprehensive synthesis of numerous prior investigations in the existing literature was conducted. These investigations undertook a thorough examination of numerous biosignals. Various features are extracted from these signals, which are further explored to reflect the effectiveness of yoga practice in stress reduction. The multifaceted character of stress and the extensive research undertaken in this field indicate that the proposed approach would rely on multiple modalities. The notable growth of the body of literature pertaining to prospective yoga processes is deserving of attention; nonetheless, there exists a scarcity of research undertaken on these mechanisms. Hence, it is recommended that future studies adopt more stringent yoga methods and ensure the incorporation of suitable participant cohorts.
Importance
The increasing attention to the management of perimenopausal and postmenopausal women parallels the growth of the aging population. Although hormone therapy is commonly used to alleviate menopausal symptoms, it carries a potential risk of cancer. Recently, mind-body exercises have emerged as innovative approaches for improving menopausal symptoms and bone health. However, research findings have needed to be more consistent, highlighting the significance of this study's systematic review of mind-body exercise effects on perimenopausal and postmenopausal women.
Objective
This study aims to evaluate the impact of mind-body exercises, including tai chi, yoga, Pilates, qigong, baduanjin, and mindfulness-based stress reduction, on bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.
Evidence Review
Four electronic databases—PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science—were systematically searched from inception until July 2023. The search focused exclusively on randomized controlled trials to examine the impact of mind-body exercise interventions on perimenopausal and postmenopausal women. The methodological quality of the included studies was evaluated using the Cochrane Bias Risk Assessment tool.
Findings
A total of 11 randomized controlled trials, comprising 1,005 participants, were included in the analysis. Traditional meta-analysis indicated that mind-body exercise significantly enhanced bone mineral density in perimenopausal and postmenopausal women compared with control groups, with a standardized mean difference (SMD) of 0.41 (95% CI, 0.17 to 0.66; P = 0.001, I ² = 7%). In addition, significant improvements were observed in sleep quality (SMD, −0.48; 95% CI, −0.78 to −0.17; P = 0.002, I ² = 76%), anxiety reduction (SMD, −0.80; 95% CI, −1.23 to −0.38; P = 0.0002, I ² = 84%), depressive mood (SMD, −0.80; 95% CI, −1.17 to −0.44; P < 0.0001, I ² = 79%), and fatigue (SMD, −0.67; 95% CI, −0.97 to −0.37; P < 0.0001, I ² = 0%).
Conclusions and Relevance
The findings of this meta-analysis demonstrate that mind-body exercise positively influences bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.
The limitations of current methods of treatment for dysthymic disorder justify experimentation with new alternatives. Techniques of yoga hold promise. A brief package; Sudarshan Kriya exerts demonstrable effects on brain functioning and may have effects akin to ECT in depression. Sudarshan Kriya Yoga (SKY) was used to treat 46 hospital out-patients (22 males) of dysthymic disorder. Over 3 months, they had to practice it everyday for half-an hour and avoid any medication. They were assessed initially, at one and 3 months on interviews video-rated and self-report scales. In a subsample of mates (n=12), plasma prolactin and cortisol levels were obtained before and after the first full SKY session. 37 patients completed the treatment through three months and 25 (68%) of them remitted. A higher proportion of those practising SKY regularly remitted. Significant elevation of plasma prolactin, but not cortisol occurred after the first SKY session. SKY has demonstrable biological effects and is therapeutic in dysthymic disorder.
We explored relationships between anxiety and antisocial behavior and autonomic heart rate regulation in a homogenous sample (N= 175 (of 15-year-ofd males. Measures for anxiety and antisocial behavior were obtained at yearly intervals over a period of 4–6 years. Components of heart rate variability associated with postural (sympathetic) and respiratory (vagal) change and transfer of respiratory to heart rate variability were estimated an age 15 using Spectral analytic techniques. Anxiety and antisocial behavior were predictably related to enhanced and diminished levels of mean heart rate, respectively. Anxiety was also predictably related to enhanced sympathetic mediation of phasic postural effects on heart rate. Antisocial behavior was unexpectedly related to disruption of vagally mediated, phasic respiratory effects on heart rate. Anxiety and antisocial behavior showed distinct relationships to heart rate, and to the autonomically mediated component, of heart rate variability from postural and respiration sources. Spectral analytic techniques helped elucidate these unique regulator; patterns, suggesting utility for future research in this area.
Left vagus nerve stimulation (VNS) is a promising new treatment for epilepsy. In 1997, VNS was approved in the United States as an adjunctive treatment for medically refractory partial-onset seizures in adults and adolescents. For some patients with partial-onset seizures, the adverse effects of antiepileptic drugs (AEDs) are intolerable; for others, no single AED or combination of anticonvulsant agents is effective. Cerebral resective surgery is an option to pharmacotherapy in some cases, but many patients with partial-onset seizures are not optimal candidates for intracranial surgery. VNS entails implantation of a programmable signal generator—the Neurocybernetic Prosthesis (NCP)—in the chest cavity. The stimulating electrodes of the NCP carry electrical signals from the generator to the left vagus nerve. Although the mechanism of action of VNS is not known, controlled studies have shown that it is safe and well-tolerated by patients with long-standing partial-onset epilepsy. Side effects, which are generally of mild to moderate severity, almost always disappear after the stimulation settings are adjusted. Encouraging results have also been reported in pediatric patients.
The purpose of this study was to examine the effects of paced respiration on autonomic and self-report indices of affect within a clinical population. Thirty-six alcohol-dependent inpatients scoring high in trait anxiety were randomly assigned to either a pacing or attention control group. The paced subjects received 10 minutes of slow-breathing training during the first experimental session, while control subjects simply counted the pacing tones. In a second session, paced subjects were asked to breathe at the same lowered rate (10 cycles per minute) on their own, while the remaining subjects were instructed to relax. Prior to and following each session, self-ratings of tension level and state anxiety were collected. As expected, paced subjects evidenced greater reductions in self-rated tension, state anxiety, and skin conductance levels compared to the control subjects. It was concluded that respiratory pacing is an easily learned self-control strategy and potentially may be a useful therapeutic tool.
This study examined the psychophysiological effects of slow-paced breathing while subjects breathed through external respiratory resistive loads. Twenty-four normal volunteers completed four 5-min trials of paced breathing (.125 Hz) through an inspiratory resistive wire mesh screen (0 to 25 cm H2O/L/s). Each trial was followed by a 5-min rest trial. There was evidence for hyperventilation and/or fatigue during paced breathing. Also, respiratory sinus arrhythmia (RSA) was elevated in the first minute of paced breathing, and then declined toward baseline. Heart period decreased during paced breathing trials, and fell significantly below baseline during rest periods. These data suggest decreased vagus nerve activity and/or sympathetic activation, following an initial increase in parasympathetic activity during paced breathing. They are not consistent with the use of .125-Hz paced breathing as a relaxation technique, particularly during respiratory resistive stress. Finally, although RSA and average heart period changed synchronouslywithin paced breathing and rest conditions, they diverged incomparisons between pacing and rest. This dissociation suggests that different mechanisms mediate these two cardiac parameters. These data are consistent with Porges' theory that vagal influences on tonic heart rate are mediated by the combined effect of vagal projections from both the nucleus ambiguus and the dorsal motor nucleus, while RSA is mediated only through the nucleus ambiguus alone.
Recent neurophysiological findings in relation to thalamocortical mechanisms for sensory processing, together with established anatomical and expanding functional evidence, have provided a rational theoretical framework for the interpretation of normal and abnormal EEG rhythmic activities. This perspective is integrated here with earlier animal studies which were the foundation for many current applications of EEG self-regulation as a clinical tool. Basic evidence concerning the origins, frequency modulation, and functional significance of normal EEG rhythmic activities is reviewed here in an effort to provide guiding principles for the interpretation of clinical abnormalities and their remediation with EEG feedback training.
The nonapeptide oxytocin is released into systemic circulation in situations of psychosocial interaction, and has been shown
to be involved in mechanisms of social bonding and social recognition in laboratory studies. In view of disturbances in psychosocial
relationships being a triggering factor for depression and anxiety, it is interesting to note that experimental studies have
shown oxytocin to possess antidepressant- and anxiolytic-like actions. Thus, in the present study we examined effects of the
SSRI citalopram (20 mg/kg IP) on plasma oxytocin, acutely and upon repeated administration, in adult male Sprague-Dawley rats.
Plasma oxytocin, and some functionally related peptides (CCK, gastrin, somatostatin and insulin), were measured by standard
radioimmunoassay techniques. Acute citalopram administration produced a statistically significant increase in plasma oxytocin
and CCK levels. Administration of citalopram for 14 days did not attenuate the oxytocin-releasing effect to a challenge dose
of the SSRI zimeldine (20 mg/kg SC), whereas CCK levels were not increased after the subchronic citalopram treatment. Thus,
the SSRI citalopram produces increased plasma oxytocin levels acutely, and there appears to be no or little tolerance to this
effect upon repeated administration. There were no, or variable, effects on plasma levels of gastrin, somatostatin or insulin.
It is suggested that oxytocin release is an important aspect of the pharmacological actions of SSRIs, and this could be an
important contributory factor for the clinical profile of this group of antidepressants with particular efficacy in disorders
of psychosocial origin.
The effects on the EEG rhythms recorded from the sensorimotor cortex (post-sigmoid gyrus) of anaesthetized cats were studied under 4 conditions of artificial mechanical hyperventilation (HV) before and after cervical bilateral vagotomy. In animals with intact vagus nerves, using visual examination, EEG changes were only observed within the 2nd min during HV produced by increased stroke volume (delta V) with associated hypocapnia. Quantitative EEG (qEEG) showed that, for the same increase in minute ventilation and the same degree of hypocapnia, delta V induced a greater and earlier relative decrease (2nd min) in the power density of delta, theta and alpha bands, than increased pump frequency (delta F). The delta F tests produced a fall only in the theta band and within the 3rd min. With constant paCO2, transient modifications occurred only with delta V and were limited to the first 30 sec. In bivagotomized cats, moderate EEG responses to delta V plus associated hypocapnia persisted partly in the alpha band. Finally, no changes appeared with delta V or delta F when the vagus nerves were cut and paCO2 was maintained constant. The present data suggest strongly that, in anaesthetized cats, peripheral vagal afferents from the respiratory system play a major role in the EEG changes caused by artificial hyperventilation.