Sudarshan Kriya and Rhythmic Yogic Breathing Programs: Trials and Cautions

What it is

A review says "Sudarshan Kriya" is a Sanskrit term meaning "proper vision by purifying action" and describes SKY as rhythmic, cyclical breathing with slow, medium and fast cycles. [1] The same review says the Art of Living Foundation has taught it to more than 6 million people in 152 countries; at least one of its authors is affiliated with an Art of Living campus, and the paper declares no conflict of interest. [1] We did not read a source on how the program's founder drew on yoga texts, so we do not describe its lineage. Pranayama is a living tradition with its own texts; see pranayama and pranayama in the yoga tradition. SKY is an organized program taught by the Art of Living Foundation, and its proponents' mechanism claims (such as vagus nerve stimulation) are proposed mechanisms, not established. [1]

What trials found

1. PTSD in veterans, versus cognitive processing therapy (CPT)

   Unclear

   85 US veterans. SKY was not inferior to CPT on a PTSD checklist at 6 weeks, 1 month and 1 year, but was inferior on depression and mood scores at 1 year. Dropout was 27% for SKY and 34% for CPT [2]

   Promising but limited

2. Burnout in physicians, versus stress management education

   Unclear

   129 physicians, online, 2 months. Stress, depression and burnout scores improved more with SKY. Self-reported only [3]

   Promising but limited

3. Cardiometabolic risk (blood pressure, lipids)

   Unclear

   A systematic review of 21 studies, 14 of them weak quality; certainty was low for lipids and blood pressure and very low for glucose and body measures [4]

   Insufficient evidence

4. Veterans with PTSD, across complementary approaches

   Unclear

   A review judged SKY evidence moderate quality but "very limited" in amount [5]

   Promising but limited

Who ran the studies matters. In the veterans trial, SKY was delivered by the program's primary proponents, received 25 hours of contact versus 12 for CPT, and the authors say the extra time may have favored SKY. They declared no competing interests. [2] Power was limited by the moderate sample size. [2] In the physician trial, the control group did not have a home practice of equal length, there were no objective measures such as cortisol, and participants were mostly women who may have been self-selected and motivated. [3] The trials cannot be blinded, and a control of education or CPT is a different kind of comparison than a sham breathing practice.

Proper evidence not found for SKY compared head-to-head with plain slow breathing, or for long-term safety. We searched PubMed for SKY with safety, adverse events and harms. The veterans trial reported no adverse events in the SKY group, but it was small and short. [2]

Trauma and mental health

SKY is not a standard first-line treatment. In England, NICE recommends trauma-focused CBT and EMDR for PTSD. [6] See somatic breathwork and trauma claims. If you take psychiatric medicines, never stop or change them because of a breathing program. A review of SKY by program-linked authors says more study is needed in bipolar disorder, dissociative disorders and schizophrenia-spectrum illness. [1]

Training, cost and access

SKY is offered through organized courses; in the veterans trial it was taught by instructors from Project Welcome Home Troops, a non-profit outside the VA. [2] Regulation of SKY teachers is not described in the sources we read. Costs were not reported in the sources we read, so we state none. We list no teachers. Ask what health screening is done, whether fast breathing or holds are taught, how to stop at any time, and who to contact about problems. See choosing a qualified practitioner.