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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.
... Considering the multi-modal effects of yoga-based interventions (32), this study was planned as a stepping stone toward addressing the hot topic of burnout among Indian HCPs. Accounting for the feasibility and ease of access provided by mHealth, it was decided to deliver the intervention online. ...
... This is supported by the findings of other yoga-based intervention studies (38,39,(41)(42)(43)(44). This decrease in EE can be attributed to the increase in parasympathetic drive due to regular practice of yoga, which helps calming down the stress response systems (32). ...
... Yoga breathing modulates the hypothalamic-pituitary axis via hypothalamic and anterior pituitary vagal afferents (45,46). Yoga practice brings about a state of calm alertness (32). Yoga also helps increase the production of well-being hormones like prolactin, oxytocin, and vasopressin (45,46). ...
Introduction: Burnout is "Chronic workplace stress that has not been successfully managed". Professional quality of life (PQL) includes work related experiences of compassion satisfaction and compassion fatigue. Healthcare providers (HCPs) are highly susceptible to burnout and compassion fatigue due to their demanding work, which lowers PQL. Burnout leads to poor care, medical errors, and patient safety across healthcare disciplines. Yoga has been shown to improve resilience, reduce stress, and increase self-compassion and psycho-physiological coherence. This study compared HCPs in a mHealth-aided 12-week yoga-based meditation and breath intervention to waitlist controls for HCP burnout and PQL at a north Indian tertiary care hospital.
Methods: This was randomized waitlist-controlled trial. Total 98 HCPs (62 males and 36 females) with an average age of 28.26±3.547 years were enrolled consecutively from March 2021 to November 2022. Randomization was done with opaque sealed envelopes numbered in a computer-generated sequence. The experimental group (n=49) received 12 online weekly yoga sessions and performed daily home practice (6 days a week). The waitlisted control group (n=49) continued their daily routine. Maslach’s burnout inventory (MBI), professional quality of life (PQL) and anthropometric measurements were assessed at baseline and after 12 weeks.
Results: After 12 weeks, the MBI outcomes of emotional exhaustion, depersonalization, and personal accomplishment showed a highly significant difference between the two groups (p<0.001). PQL outcomes of compassion satisfaction, burnout, and secondary trauma also differed significantly (p<0.001). Within group analysis showed that MBI and PQL outcomes improved significantly (p<0.001) for the experimental group after 12 weeks.
Conclusion: The current study contributes to the existing evidence on the effectiveness of Yoga in managing stress and developing resilience among doctors, nurses, and other medical professionals. Integrating yoga into healthcare settings is crucial for addressing the detrimental impact of burnout on decision-making and promoting positive patient outcomes. mHealth technologies have the potential to enhance the user-friendliness of yoga-based interventions by personalizing the practice space and time. Yoga-based interventions and mHealth technologies can effectively address physician burnout, in a simple and implementable manner.
Keywords: Mental Health, mind body medicine, Occupational Health, physician health, Pranayama, resilience, stress, tele-medicine
... The study results are so far not sufficient in quantity and quality to determine whether studies with a focus on the asanas are more effective as compared to studies with meditation-focused or pranayama-focused styles. There has been an attempt to explore mechanisms of action and to understand the complete picture of the effects of yoga on depression looking at electrophysiological markers of attention, and neurotransmitters which were found to change with yoga [7]. Fatigue: Fatigue is a lack of energy and motivation, a feeling of not caring about what happens can be symptoms that go along with fatigue. ...
This paper studies the current research on the impact of yoga applications on various components of different mental and physical health aspects, by focusing on the findings presented in review articles. Inclusively, these articles suggest a variety of areas where yoga may be helpful, but some more research is required for all of them to identify the benefits of yoga on mental and physical health. The variability of the treatments and conditions examined has hampered the usage of meta-analysis as an appropriate tool for summing up existing literature. However, some meta-analyses indicate the beneficial effects of yoga treatments, and there are several high-quality randomized controlled trials (RCTs) that suggest favourable effects of yoga on pain-associated injury and mental health. Yoga may be successful in reducing some medical problems as a supporting supplement, yet not an established stand-alone, curative therapy. Larger-scale and more comprehensive work with higher methodological quality and appropriate control applications are strongly recommended as yoga can have the ability to be applied as a fairly cost-effective supportive/adjunct therapy, may be used at least in part as a self-care treatment procedure, delivers lifelong skills, increases self-efficacy and promotes self-confidence with positive side effects. In the last years, a new view called positive psychology has been formed on mental healthcare. In this new research, mental health is not composed of reducing negative symptoms but also generating positive experiences as well. In this research, the effect of yoga on mental health but little has the focus physical condition Yoga's incorporation of meditation and breathing can help improve a person's mental well-being. "Regular yoga practice creates mental clarity and calmness; increases body awareness; relieves chronic stress patterns; relaxes the mind; centres attention; and sharpens concentration," says Dr Nevins.
... Such practices may provide benefits by teaching practitioners to slow their breathing patterns and self-soothe during stressful situations; or by building CO 2 tolerance, which is inversely related to symptoms of stress and anxiety [110]. They may, alternatively, train the autonomic nervous system to engage the parasympathetic branch more readily following high sympathetic activation [111]. Yet another interpretation resides in the connection between breathing patterns and the brain's neural circuitry, whereby shifting breathing patterns may correspondingly shift neural circuit dynamics and thus mood and mental state [26]. ...
Anxiety and stress plague populations worldwide. Voluntary regulated breathing practices offer a tool to address this epidemic. We examined peer-reviewed published literature to understand effective approaches to and implementation of these practices. PubMed and ScienceDirect were searched to identify clinical trials evaluating isolated breathing-based interventions with psychometric stress/anxiety outcomes. Two independent reviewers conducted all screening and data extraction. Of 2904 unique articles, 731 abstracts, and 181 full texts screened, 58 met the inclusion criteria. Fifty-four of the studies’ 72 interventions were effective. Components of effective and ineffective interventions were evaluated to develop a conceptual framework of factors associated with stress/anxiety reduction effectiveness. Effective breath practices avoided fast-only breath paces and sessions <5 min, while including human-guided training, multiple sessions, and long-term practice. Population, other breath paces, session duration ≥5 min, and group versus individual or at-home practices were not associated with effectiveness. Analysis of interventions that did not fit this framework revealed that extensive standing, interruptions, involuntary diaphragmatic obstruction, and inadequate training for highly technical practices may render otherwise promising interventions ineffective. Following this evidence-based framework can help maximize the stress/anxiety reduction benefits of breathing practices. Future research is warranted to further refine this easily accessible intervention for stress/anxiety relief.
... Thus, psychophysiological data have been used as secondary or primary outcomes in treatment development research. [16][17][18][19] The physiology undergirding mind-body well-being may be more adequately explained by conceptualizing a spiritual-mind-body (SMB) connection, as spiritual individuals are more likely to engage with IM than nonspiritual individuals. 20,21 A recent systematic review of experimental studies shows that spiritual practices such as prayer promote healthy neurocognitive and physiological functioning. ...
... Controlling the breathing process maintains a healthy balance of oxygen, carbon dioxide, and other chemical components which in terms improves the endurance of respiratory muscles. The slow breathing cycles stimulate the vagus nerve (Brown and Gerbarg, 2005b) and the fast breathing cycles provide mild sympathetic stimulation (Brown and Gerbarg, 2005c). The combination of slow and fast breathing cycles may aid in emotional processing by reducing excitation with slow breathing and emotional calming (Zope and Zope, 2013). ...
... Slow breathing, particularly at a pace around 10 seconds per breath, elicits high-amplitude oscillations in heart rate (Lehrer et al., 2003). Slow breathing also stimulates the vagus nerve (Brown & Gerbarg, 2005), which sends projections to the LC by way of the nucleus tractus solitarii (NTS; Badran et al., 2018;Fornai et al., 2011). Performing HRV biofeedback over a period of weeks has been shown to reduce levels of stress and anxiety (Goessl et al., 2017) in younger as well as older adults (Jester et al., 2019), but it is unknown whether HRV-biofeedback affects the LC's structure and function. ...
As an arousal hub region in the brain, the locus coeruleus (LC) has bidirectional connections with the autonomic nervous system. Magnetic resonance imaging (MRI)-based measures of LC structural integrity have been linked to cognition and arousal, but less is known about factors that influence LC structure and function across time. Here, we tested the effects of heart rate variability (HRV) biofeedback, an intervention targeting the autonomic nervous system, on LC MRI contrast and sympathetic activity. Younger and older participants completed daily HRV biofeedback training for five weeks. Those assigned to an experimental condition performed biofeedback involving slow, paced breathing designed to increase heart rate oscillations, whereas those assigned to a control condition performed biofeedback to decrease heart rate oscillations. At the pre- and post-training timepoints, LC contrast was assessed using turbo spin echo MRI scans, and RNA sequencing was used to assess cAMP-responsive element binding protein (CREB)-regulated gene expression in circulating blood cells, an index of sympathetic nervous system signaling. We found that left LC contrast decreased in younger participants in the experimental group, and across younger participants, decreases in left LC contrast were related to the extent to which participants increased their heart rate oscillations during training. Furthermore, decreases in left LC contrast were associated with decreased expression of CREB-associated gene transcripts. On the contrary, there were no effects of biofeedback on LC contrast among older participants in the experimental group. These findings provide novel evidence that in younger adults, HRV biofeedback involving slow, paced breathing can decrease both LC contrast and sympathetic nervous system signaling.
Every job or organization may have specific job demands and resources leading to (dis)engagement depending on the specific job characteristics that prevail in that job. Drawing from JD-R theory, we attempt to study the specific demands and resources pertaining to volunteering in humanitarian and spiritual non-government organizations (NGOs) in India. Thematic analysis of nineteen semi-structured interviews with full-time volunteers serving in such NGOs revealed unique job demands and resources. While three job demands included challenge of adaption, challenge of persuasion, and challenge of social derision, four job resources included opportunity to serve, opportunity to meditate, opportunity to travel, and community connect. Findings suggest that volunteers find job resources to be more in number and with stronger impact that helps them buffer the negative effects of job demands on engagement and facilitate them in achieving their work goals while enhancing their self-worth and overall development.
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.