In many or most cases Yoga breathing and meditation results in an alert and relaxed state. These breath techniques are described as gentle, safe and soothing;

  • “Ujjayi” (without breath-holds)
  • alternate nostril breathing (also ‘nadi shodadna’ or ‘anolum vilom’)

The following techniques are described as advanced pranayam breathwork also ‘High Frequency Yoga Breathing’ and fast/rapid/variable rate breathing in 8 published studies (2005 to 2018);

  • Kaphalbhati (breath of fire)
  • Bhastrika (bellows breath)
  • Sudarshan Kriya (trademarked) described as ‘modern form of Kapilibhati’ by Patanjali Yoga Foundation authors

Precautions and contraindications for advanced pranayam due to observed increased symptoms’;

  • anxiety
  • panic attacks
  • manic states
  • seizures
  • psychosis
  • flashbacks
  • dissociative episodes (as in PTSD, Dissosociative Identity Disorder, Schizophrenia and Schizoaffective disorders).

These were observed in over 200 people after South East tsunami 2004 and later clinical referrals. Dr Shirley Telles and Nikamal Singh of Patanjali Yoga Foundation additionally describe Kumbhak (period of breath holding), Kapilibhati and some forms of meditation as causing the above adverse mental health effects. They show a table of various techniques with detailed descriptions of health benefits and adverse effects. Describing Bhastrika and Sudarshan Kriya adverse effects;

in some (of these) cases, stabilization required psychiatric intervention, medication, or hospitalization.

(these advanced pranayam) practices may have an important place in treatment of PTSD and other anxiety conditions, when administered under supervision of an experienced yoga teacher in collaboration with a mental health professional”.

…”Clinically, it often requires several attempts to design an effective combination of treatments...Open dialogue between patient and physician helps prevent adverse outcomes….What is the physician’s… knowledge about the treatment and with whom should she/he consult?

Dr Patricia Gerbarg and Dr Richard Brown

They emphasise the importance of the ongoing relationship between a patient and their physician, sharing evidence-based research of Complementary and Alternative Medicine to together safely and effectively pursue a patient’s wellbeing.

The health benefits of advanced pranayam are theorized as reducing high Sympathetic Nervous System activity, and increasing low Parasympathetic Nervous System activity to normal levels. Additionally, ‘prosocial hormones’ oxytocin, vasopressin, and prolactin are theorized. These are associated with enhanced feelings of love, bonding, empathy, and meaning and are reported by yoga practitioners.

Breathwork Instructors : health screening

  • assess participant for history of significant and overwhelming ‘hyperarousal symptoms’, ‘autonomic instability or over-reactivity’.
    • individuals may need up to 3 months of gentle breathing (such as Ujayi, or Coherent breathing), and 20 minutes of alternate nostril breathing per day before undertaking the advanced breathing practices Kapilibhati, Bhastrika, Sudarshan Kriya.
  • assess participant for history of significant and overwhelming ‘hypoarousal symptoms’, particularly ‘capacity to maintain a sense of reality’. If dissociative episodes are prolonged as in ‘PTSD with significant dissociative symptoms’ or involve uncontrolled switching as in Dissociative Identity Disorder, then Kapilibhati, Bhastrika and Sudarshan Kriya are contraindicated.

Breathwork Instructors: Recommendations to reduce risk of adverse reactions

  • create a secure environment and ensure safety during and after sessions
  • minimize silent unguided meditation, (“can open the mind to intrusion of overwhelming trauma memories. Such practices would be contraindicated in group contexts where intensive support for handling such experiences is not available“).
  • train instructors and participants to recognize under what circumstances to discontinue the practice

Describing Complex PTSD, they say;

the stress-response system is altered, reactions to stimuli are different, and physical health may be compromised…individuals may function by suppression of feelings and memories,…at risk for adverse reactions to anything that lowers their defenses and exposes them to memory triggers…physical postures, their own thoughts and memories, or shifts in their state of consciousness”.

Parasympathetic Nervous System role…experiencing and regulating the internal state of the perception of feelings, (e.g., visceral sensations and pain), reflect the physiological state of the body … brain regions involved in mapping and regulation of internal states contribute to representational images of body states, a basis for awareness of feelings states”.

Additionally, people with a variety of anxiety conditions are known to have lower baseline PCO2*, vulnerability to and reactivity to changes in PC02 and chronically high arousal levels. (*PCO2 is Partial Pressure of Carbon Dioxide, reflects the the amount of carbon dioxide gas dissolved in the blood).

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