BMC Complementary andAlternative Medicine

BioMed Central

Research article

Open AccessWellness through a comprehensive Yogic breathing program – A
controlled pilot trial
Anette Kjellgren*1, Sven Å Bood1, Kajsa Axelsson1, Torsten Norlander1 andFahri Saatcioglu*2
Address: 1Department of Psychology, Karlstad University, Karlstad, Sweden and 2Department of Molecular Biosciences, University of Oslo, Oslo,
NorwayEmail: Anette Kjellgren* - Anette.Kjellgren@kau.se; Sven Å Bood - sven.bood@kau.se; Kajsa Axelsson - kajsa.Axelsson@kau.se;
Torsten Norlander - at.norlander@mailbox.swipnet.se; Fahri Saatcioglu* - fahris@imbv.uio.no* Corresponding authors

Published: 19 December 2007
BMC Complementary and Alternative Medicine 2007, 7:43

doi:10.1186/1472-6882-7-43

Received: 26 January 2007
Accepted: 19 December 2007

This article is available from: http://www.biomedcentral.com/1472-6882/7/43© 2007 Kjellgren et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Background: Increasing rates of psychosocial disturbances give rise to increased risks and vulnerability
for a wide variety of stress-related chronic pain and other illnesses. Relaxation exercises aim at reducing
stress and thereby help prevent these unwanted outcomes. One of the widely used relaxation practices isyoga and yogic breathing exercises. One specific form of these exercises is Sudarshan Kriya and related
practices (SK&P) which are understood to have favourable effects on the mind-body system. The goal ofthis pilot study was to design a protocol that can investigate whether SK&P can lead to increased feelingof wellness in healthy volunteers.
Methods: Participants were recruited in a small university city in Sweden and were instructed in a 6-day
intensive program of SK&P which they practiced daily for six weeks. The control group was instructed torelax in an armchair each day during the same period. Subjects included a total of 103 adults, 55 in theintervention (SK&P) group and 48 in the control group. Various instruments were administered before
and after the intervention. Hospital Anxiety Depression Scale measured the degree of anxiety anddepression, Life Orientation Test measured dispositional optimism, Stress and Energy Test measured
individual's energy and stress experiences. Experienced Deviation from Normal State measured theexperience of altered state of consciousness.
Results: There were no safety issues. Compliance was high (only 1 dropout in the SK&P group, and 5 inthe control group). Outcome measures appeared to be appropriate for assessing the differences between
the groups. Subjective reports generally correlated with the findings from the instruments. The datasuggest that participants in the SK&P group, but not the control group, lowered their degree of anxiety,depression and stress, and also increased their degree of optimism (ANOVA; p < 0.001). The participantsin the yoga group experienced the practices as a positive event that induced beneficial effects.
Conclusion: These data indicate that the experimental protocol that is developed here is safe, compliancelevel is good, and a full scale trial is feasible. The data obtained suggest that adult participants may improvetheir wellness by learning and applying a program based on yoga and yogic breathing exercises; this can beconclusively assessed in a large-scale trial.
Trial Registration: Australian Clinical Trial Registry ACTRN012607000175471.

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Background
Relaxation exercises offer a means to reduce the physiological and psychological reactions to stress [1,2]. Current
achievement-based, demanding and high-tempo society
has incurred increased risks and vulnerability for stressrelated chronic pain and other illnesses [3-5]. A multitudeof techniques for relaxation and stress-reduction are
described, e.g. flotation-REST [6], Tai Chi Chuan [2],meditation [7] and yoga [8,9].
The different relaxation techniques often lead to specificpsychological and physiological changes termed the'relaxation response' (RR) [10]. The RR is identified as thephysiological opposite of the stress or 'fight-or-flight
response' [11]. The RR is associated with instantly occurring physiological changes that include reduced sympathetic nervous system activity, reduced metabolism,
lowered heart rate, reduced blood pressure, and decreased
respiratory rate [12,1]. At the psychological level, individuals typically report that RR techniques result in genuine
rest, recovery from fatigue, better sleep quality, as well as
an increased sense of control and efficacy in stressful situations [13].
Yoga is one of the many different techniques for achieving
relaxation. Yoga has its origin in ancient India and in its
original form consisted of a system of spiritual, moral andphysical practices [9]. The most central and common
aspects of yoga practice today are different bodily postures(asanas) and breathing exercises (pranayamas) [14,9] that
aim to focus the mind, achieve relaxation and increase
wellness. Various health benefits of yoga have been
described in previous studies. A review of anti-depressive
effects of different forms of yoga [9] indicated potential
beneficial effects of yoga on depressive disorders. Other
studies reported beneficial effects of yoga on anxiety,stress reduction and general well-being [15-17]. However,
the results need to be interpreted carefully since many ofthe published studies about yoga are small and no systematic and comprehensive reviews of scientific research on
yoga have been published. It may also be difficult to compare studies done on different forms of yoga since benefitsof yoga practice might differ by the style of the practice[18].
Sudarshan Kriya and related Practices (SK&P) is a form of
yoga practice that emphasizes breathing exercises. In addition to asanas, three different forms of pranayamas arepracticed in succession [19]. Previous studies suggested
that SK&P may be useful for relieving depression, improving the antioxidant defenses of the body, giving rise tobeneficial EEG patterns, and possible improvements inblood chemistry [19-21]. For example, Janakiramaiah et
al. found that the degree of depression significantly
decreased (68–73 %) in subjects with clinical depression

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after they practised SK daily for three weeks and thisdecrease was as effective as conventional pharmacologicaltreatment [19]. Another study indicated concurrent highactivity of both alpha and beta waves in the EEG in SKpractitioners indicating focus and relaxation at the sametime, suggesting improved brain function [8]. A drop inblood lactate level, yet increase in the antioxidant
enzymes superoxide dismutase, catalase, and glutathione,
indicated favourable effects on antioxidant status [21].
The aim of the present study was to develop a protocolthat can investigate whether SK&P could be considered inconnection with increased wellness. Even though what
constitutes wellness can be debated, there are a number ofstudies demonstrating that the variables included in thisstudy are among the most relevant to feeling of wellness
by different approaches [22-24]. To that end, outcome
measures that were evaluated included depression, anxiety, mood, optimism, energy levels, and experience ofaltered states of consciousness.

Methods
ParticipantsThis study included 103 participants (109 subjects to startwith where 5 persons from the control and 1 person fromthe yoga group dropped out). The SK&P group was
recruited through advertisement in the local paper and fliers. The control group was yoga naive, but had an interest
in yoga and related practices, and were recruited in a similar way. The control group consisted of 55 participants(12 men, 43 females) and the yoga group of 48 participants (13 men, 35 females); mean age for the whole study
was 31.92 years (SD = 11.33) (for the control group M =31.90 years, SD = 10.84, and for experimental group M =31.95 years, SD = 11.85).

The yoga group participated in the beginner's course in
the SK&P program in November – December 2004 at the
Art of Living Yoga Center in Karlstad and Eskilstuna, Sweden. The participants of the control group were recruitedamong yoga-interested students at Karlstad University.
There were no significant differences between the groups(Mann-Whitney U test) regarding gender, occupation,
education, phase in the menstruation cycle and usage ofcontraceptives (ps > 0.42). Analysis with Independent
Samples T-test did not reveal any significant differences
between the groups at baseline regarding age, degree ofdepression, stress, energy, ongoing pain, affective personality (PANAS-test), number of sleeping hours, minutes
awake before falling asleep, experienced sleep quality,
consumption of nicotine (cigarettes/snuff) or alcohol (ps> 0.11).
Comparison of the two groups at pre-test, before the intervention, indicated that there was a significant difference

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between the groups regarding degree of optimism andanxiety assessed by the Independent Samples T-test. The
control group had lower degree of anxiety (M = 4.63, SD= 2.59) than the yoga group (M = 7.58, SD = 3.58) (p <0.001, t (101) = 4.73). The control group also experienced
higher degree of optimism (M = 24.88, SD = 3.86) compared to the yoga group (M = 21.84, SD = 5.72) (p =0.002, t (101) = 3.11). The basis for these differences is notclear; however, the higher anxiety for the yoga group are
not indicative of clinical anxiety diagnosis, and the values
for optimism are in the normal range for both groups.
Please see Table 1 for a comparison of baseline characteristics.
Several criteria were used for subject inclusion and exclusion. Inclusion: having an interest in yoga and relaxation
exercises and that they would like to practice some kind ofrelaxation practise daily for 6 weeks. Exclusion: pregnancy, ongoing psychiatric disease, younger than 18
years, clinical depression or anxiety-problems.
The study was approved by the Ethical Committee at Karlstad University. All participants signed consent forms andthey were treated according to the ethical guidelines of
APA. Participants were informed that their data will be
kept anonymous, participated by their free will and were
free to leave the experiment whenever they wished without giving any reason for it.
Description of intervention
Sudarshan Kriya (SK) and related practices (SK&P) are
derived from the Yogic Science of Breath derived from
Vedic texts. SK&P includes gentle stretches (yoga postures), specific breathing exercises (the central technique
is SK; see below), and cognitive coping and stressor evaluTable 1: Baseline characteristics:

Age
Depression
StressEnergySleep Hours
Min AwakeSleep Quality
cig/monthsnuff/month
Alc ml/month
OptimismAnxiety

SK&P

Controls

31.95 (11.85)
4.07 (3.078)
2.68 (0.93)
2.99 (0.91)
7.46 (0.84)
20.12 (18.79)
64.82 (21.37)
12.47 (41.61)
1.40 (7,48)
184.915 (173.83)
21.84 (5.72)
7.58 (3.58)

31.90 (10.84)
3.25 (2.026)
2.61 (0.92)
2.97 (0.77)
7.68 (0.50)
17.71 (13.27)
70.28 (17.94)
15.00 (55.46)
0.13 (0.53)
156.73 (143.47)
24.88 (3.86)
4.63 (2.59)

The measures were as described in Methods. 'Sleep Hours' refers tonumber of daily sleep, 'Min Awake' the number of minutes before
falling asleep, 'Sleep Quality' refers to perceived quality of sleep, 'cig'
are number of cigarettes per month, 'Alc' is alcohol. The numbers inparentheses are standard deviation.

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ation strategies. SK&P is traditionally understood to dissolve emotional distress and create the subjective
experience of rest and well-being. The instructors in SK&P
were trained by the International Art of Living Foundationin two residential courses of two weeks each which
included approximately one year of practical field work in
between.
The breathing techniques that are part of SK&P are: (a)Three-Stage Pranayama with Ujjayi or "Victory Breath",(b) three sets of Bhastrika or "Bellow's Breath", and (c) SKor the "Healing Breath Technique" and they were practiced in that order. The breathing practices are done in asitting posture, either in a chair or on the floor. Eyes are
kept closed throughout the sessions.
Normal breathing is at the rate of 14 to 16 breaths per
minute. Ujjayi is a slow and deep breathing technique at
2 to 4 breaths per minute. Three-Stage Pranayama with
Ujjayi breath is an advanced form using a specific ratio of
inhalation and exhalation, and breath-holds. Participants
practice this component where specific arm positions areheld for approximately ten minutes in total.
The second breathing component of SK&P is Bhastrika.
Here the breathing is vigorous and faster, about twenty tothirty respiratory cycles per minute. Three approximately
one-minute rounds of Bhastrika are followed by a few
minutes of normal breathing. Arm movements are used toincrease the force and depth of inhalation and exhalation.
Practice of this component lasts for approximately fiveminutes.
The central component of SK&P is SK which is anadvanced cyclical breathing exercise of slow, medium,and fast rates in succession. Slow breaths are about 20 respiratory cycles per minute, medium breaths are about 40–
50 respiratory cycles per minute, and the fast breathing isabout 60–80 cycles per minute. The participant rotates
through these breathing patterns during SK. Daily home
practice of SK takes approximately 10 minutes. During the
instruction phase, several longer group sessions of SK,
lasting approximately thirty minutes, are practiced.
SK&P course was held in 6 consecutive days of approximately 3 hours each. Ujjayi breath and bhastrika wereintroduced on the first day, yoga on day 2, and SK on days
3 and 4. All techniques were performed everyday from day
3. Discussion of different cognitive coping and stressor
evaluation strategies took place at different time points
throughout the course.
The control intervention consisted of sitting in an armchair with the eyes closed and with gentle attention on thebreath, and lasted for at least 15 min. per session. If

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thoughts were coming, participants were instructed to let
go of the thoughts and start counting their breathing from
1 to 10 (Benson-breathing) [10].
DesignThe current study used a two-way split plot design. Timewas relaxation (sitting in an armchair, or yoga) withassessments before and after the treatment period (6weeks) and it constituted the within-subject factor andwhere Treatment (control, yoga) constituted the betweensubject factor. The treatment for the yoga group was a sixday introduction course in SK&P and thereafter daily
home practice (approximately 1 hour) for the next 5
weeks. The control group participants had meetings withthe experimenter during the first six days for the sameamount of time as the SK&P group. They met in a silent
room and were instructed to relax in an armchair for 15
minutes; after that, they performed armchair relaxation
daily during the remaining 5 weeks.

The dependent variables measured were: depression, anxiety, dispositional optimism, stress, energy and degree ofaltered states of consciousness. Qualitative data (written
reports) about personal experiences were collected twice
during the treatment period.
ProcedureIn the very beginning, the participants were informed that
their participation is voluntary and that they can leave thestudy at anytime without the need for any explanation.
The participants then answered questionnaires for background data, as well as the tests HAD, LOT, SE, PANAS
and PAI (see instruments) in random order. The yogagroup then began their SK&P course of six days. The control group also met with a course leader for six consecutive
days in a dimly lighted room and relaxed in an armchairfor 15 min each session. At day 4, the EDN test (see Instruments) was given and in the end of day 6 verbal written
reports on experiences of the interventions were collected
as qualitative data.

A final assessment was done at the end of the treatment
period (6 weeks) with the test instruments HAD, LOT, andSE in randomized order. A second qualitative written
report was collected in response to the question "Havethese six weeks resulted in any changes in your life?" aswell as checking how many times per week they have performed the relaxation exercises. The extent of home practice during the treatment period was monitored by awritten self-report in response to the question 'How manydays of the week did you practice at home?' at the post-test
session. Only those who practiced at least 3 times a week
were included in the analysis.

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Instruments
Background data
Questions were included about participants' age, gender,
educational level, occupation, usage of contraceptive pills
and phase in menstruation cycle (for females), sleeping
habits and consumption of tobacco and alcohol.
HAD – Hospital Anxiety Depression Scale
The HAD is a rating scale concerning degree of anxiety anddepression. The HAD scale measures the degree of anxiety
and depression, wherein values under 6 are considered
normal, those between 6 and 9 are borderline and values
over 10 points are indicative of a probable depression oranxiety diagnosis. It was originally constructed by Zigmond and Snaith [25], for use with physically ill people.
It has since then been revised to be used as a rating scale
for anxiety and depression. The instrument consists offourteen statements with four response alternatives (i. e. 0to 3), ranging from positive to negative or vice versa andthere are seven statements regarding anxiety and seven
regarding depression. The validity and reliability of HAD
has been described (Hermann, 1997 #32).
LOT – Life Orientation Test
The LOT test [26] consists of eight items, plus four filler
items. The task of each subject is to take up a standpoint
to the extent of whether or not one is in agreement witheach of the items described, on a scale of 0 – 4, where 0
indicates "strongly disagree" and 4 indicates "strongly
agree". The test measures dispositional optimism, definedin terms of generalized outcome expectancies. Parallel
Test Reliability of LOT is reported as 0.76 and internalconsistency was 0.76 (Scheier, 1985 #23). LOT is also
regarded to have an adequate level of convergent and discriminate validity (Scheier, 1985 #23).
SE – Stress and Energy
The SE test is a self-estimation instrument concerning
individuals' energy and stress experiences [27]. It consistsof two subscales that elucidate the mood levels of the subjects on the dimensions: 'experienced stress' and 'experienced energy'. The response alternatives were arranged on
six-grade scales, extending from: 0 = not at all, to 5 = verymuch. The instrument has been validated by analyses
from studies focused on occupational burdens and pressures [28,29,27]. The SE-scale was constructed and basedon an early and much used checklist, the Mood Adjective
Check-List, constructed by Nowlis and Green [30] andmodified further and translated into Swedish by Kjellberg
and Bohlin [29]. Kjellberg and Iwanowski [27] reduced
the list to 12 adjectives on two dimensions. It is currently
the latest version of the SE-scale (with test-retest scores of
0.73 to 0.78) and was used in the present study. The test
did not have a time limit.

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PANAS – Positive affect and Negative Affect Scales
The PANAS-instrument [31-34] assesses the degree ofaffect, both negative (NA) and positive (PA). The instrument consists of 10 adjectives for the NA-dimension and
10 adjectives for the PA-dimension. In the test manual[34], it is postulated that the adjectives describe feelings
and mood. The participants were asked to estimate how
they had been feeling during the last week. Response alternatives are presented on 5-degree scales ranging from 0 ="not at all" to 5 = "very much". The PANAS-scale has beenvalidated through studies focused upon several different
routinely used scales within psychopathology [35].
PAI – Pain Area Inventory
The test, developed by Human Performance Laboratory,
Karlstad University, for use in research studies on pain[36] and consists of two anatomical images of a humanbeing, one frontal and one dorsal. The task of the participants is to indicate with a colour pen their areas of pain
and colour them in. A transparent, plastic film is thenplaced over the colored areas on both figures and thenumbers of colored areas are counted.
EDN – Experienced deviation from normal state
An instrument modified for use with floatation-REST[37,6] utilizing the internationally-applied psychometric
instruments APZ-questionnaire and OAVAV [38] for
obtaining judgments of altered states of consciousness
and the relaxation response. Several studies indicate
strong connections between altered states of consciousness and different RR techniques such as Qigong [39], Tai
Chi [40] and muscle relaxation training [41]. In total, theEDN consists of 29 questions whereby each is responded
to on a visual analogy scale (0–100). A complete "index ofexperience" was constructed from the points obtained
from all 29 questions and were averaged to provide a"sum of experience." These values reflect the total experience of deviation from normal states. Cronbach's alphafor EDN was 0.973 in the present study. Typical EDN-values after an individual's experience of flotation-REST isaround 30 EDN-points for the first experience of flotation-REST and 40 EDN-points for further occasions [42].
This should be compared to the experience of resting on a
bed in a dark quiet room (15 points) [43].
Data analysis
All statistical analysis was done using SPSS v13.1. The
qualitative part was analysed by thematic analysis [44].
Statistical analysis were carried out using two-way split
plot ANOVA with Time (before, after) as the within subject factor and Group (control, yoga) as between subject
factor, and with depression, anxiety, optimism, stress andenergy as the dependent variables.

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Results
Personality variables
Depression
The analysis yielded a significant difference for Time [F2(1,91) = 13.47, p < 0.001, Eta = 0.13, power = 0.95] where
the degree of depression diminished from 3.67 (SD =2.56) to 2.97 (SD = 2.02) during the treatment period.
There was a significant interaction between Time andGroup [F (1,91) = 11.24, p = 0.001, Eta2 = 0.11, power = 0.91]
where the yoga group significantly lowered the degree ofdepression from 4.11 (SD = 2.99) at pretreatment to 2,73
(SD = 2.19) at posttreatment, while control group had ascore of 3.25 (SD = 2.03) at pre-treatment and had no significant alteration at posttreatment (M = 3.19, SD = 1.84).
Anxiety
The analysis yielded a significant difference for Time[F(1,91) = 30.21, p < 0.001, Eta2 = 0.25, power = 1.00] where
the degree of anxiety diminished from 6.06 (SD = 3.50) at
pretreatment to 5.19 (SD = 3.01) at posttreatment. Furthermore, there was a significant interaction between
Time and Group [F(1,91) = 26.15, p < 0.001, Eta2 = 0.22,
power = 1.00] where the degree of anxiety in the yogagroup significantly decreased, from 7.60 (SD = 3.71) at
pretreatment to 5.87 (SD = 3.18) at posttreatment, while
the control group did not show any significant alterations(from 4.63, SD = 2.59 to 4.56, SD = 2.72).
Optimism
The analysis yielded a significant difference for Time[F(1,91) = 4.55, p = 0.036, Eta2 = 0.05, power = 0.56] where
optimism increased from 23.14 (SD = 4.91) at pretreatment to 23.65 (SD = 4.62) at posttreatment. Furthermore,
there was a significant interaction between Time andGroup [F(1,91) = 9.86, p = 0.002, Eta2 = 0.10, power = 0.87]
where the degree of optimism was significantly increasedin the yoga group from 21,29 (SD = 5.27) at pretest to
22.60 (SD = 5.16) at posttest, while the control group
started at 24.88 (SD = 3.86) and had no significant alteration upon intervention (M = 24.63, SD = 3.84).
Stress
The analysis yielded a significant difference for Time[F(1,89) = 8.25, p = 0.005, eta2 = 0.09, power = 0.81] wheredegree of stress diminished from 2.64 (SD = 0.92) to 2.41
(SD = 0.89) during the treatment period. There was also asignificant interaction between Time and Group [F(1,89) =9.06, p = 0.003, Eta2 = 0.09, power = 0.85] where a significant decrease in stress for the yoga group was found wherestress at pretest was 2.70 (SD = 0.92) and at posttest was
2.22 (SD = 0.85). For the control group there were no significant alterations during the treatment period (from2.59, SD = 0.92 to 2.61, SD = 0.89).

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EnergyThe analysis yielded no significant differences or interactions regarding energy for either group (ps > 0.96).
Experience of altered states of consciousness – EDN scale
A one-way ANOVA was used to compare the means of
EDN measurements. The analysis showed a significant
difference between the control and yoga groups regarding
EDN [F(1,97) = 177.14, p < 0.001, Eta2 = 0.65, power =1.00]. For the yoga group the EDN score of 42.50 (SD =19.40) was significantly higher than that found for thecontrol group of 3.19 (SD = 2.89).

Discussion
The aim of this pilot study was to develop a protocol that
can investigate whether SK&P can be of interest in connection with increased wellness in adult participants. As variables for wellness, a number of parameters were tested,such as degree of depression, anxiety, optimism, stressand energy.
The results suggested that the current protocol can be
adopted for a full-scale trial and that the aspects of wellness measured in our study increased in the yoga group.
The participants in the SK&P program had decreased levelof depression and anxiety as well as increased degree ofexperienced optimism. There was also a decrease of stressexperience in the SK&P group compared with the control
group. Furthermore, SK&P induced an altered state of consciousness (ASC) during the practice of the program, but
not in the control group.
The yoga group which practiced SK&P for 6 weeks
decreased their degree of depression by 33% (according to
the HAD scale) whereas the control group did not haveany significant change during the treatment period. Earlier
studies have shown that those with clinical depression canbenefit from SK&P [19]. The current study, where only
apparently healthy people without clinical depression
were included, suggests that SK&P does not only have utility as a possible therapeutic strategy for patients, but also
may be a method for healthy people who would like toincrease their wellness.
The strong decrease in the experienced anxiety that the
SK&P practitioners exhibited is interesting. There was noclinical anxiety diagnosis in the participants, but the yogagroup had higher degree of anxiety before treatment (inthe borderline zone between normal and anxiety diagnosis according to the HAD scale) compared with the control
group. The SK&P group decreased the anxiety scores down
to normal values after 6 weeks of practice.
Heightened optimism is another important aspect of thewellness experience. There was an increase in the degree of

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optimism in the SK&P group during the treatment period,
whereas there were no changes in the control group. There
was a difference in optimism before the treatment where
SK&P group was less optimistic than the control group;
the basis of this is currently unclear.
A reduction in stress was observed in the yoga group compared with no change in the control group. The value of asimple, functional method for stress reduction may be ofsignificance. To have access to an effective method forstress reduction (i.e. SK&P) can lead to better health and amore effective daily life [7,10].
The increased experience of altered states of consciousness(ASC) during SK&P is also very interesting. Experience ofASC has been associated with deep relaxation and stressrelease [37,6]. That an ASC-state is achieved during SK&P
can be interpreted as an indication of deep rest and relaxation. During an ASC-state many different psychologicalchanges occur compared with normal waking state, forexample, very deep relaxation, the feeling that the border
between body and surroundings is eliminated, and thischanges the sensation of time or mindset where new andcreative thoughts are generated. A mild ASC-state is often
described as having the character of daydreaming. This
aspect of relaxation has previously been documented byour earlier work in connection with relaxation training inflotation-tank [6,42]. This technique is a method for deep
relaxation where the subjects lie down on their back floating in a dark, isolated specially constructed tank filledwith salty water at body temperature. The research on
floatation tank therapy showed that the ASC-aspect ofrelaxation is an important aspect for inducing deep relaxation and other positive effects on quality of life [6,42].
Since SK&P was comparable to flotation rest in inducing
ASC, it indicates that a very deep relaxation was experienced as a result of SK&P which could be the basis for theeffects that are observed on wellness parameters.
The verbal descriptions from the subjects complement thequantitative data, for example in regards to reduced stressand a more optimistic outlook on life (data not shown).
Here comes even other aspects of increased wellness as
feeling of peace and balance, calming down, living in thepresent moment, and experience of a new outlook on life.
The subjects who practiced SK&P felt that they havegained a tool that can be used in stressful situations thatwould make it easier to relax and better handle them. Furthermore, they experienced that yoga program decreased
tensions, unpleasant sensations, blocks and locked-up
feelings, as well as the experience of better control overtheir feelings. SK&P group expressed that it is easier to feel
joy after they have learned this program. In addition,
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practice of this program. Despite their written statementson their experience of having more energy, this was notdetected by statistical analysis based on the SE instrument.
One possible reason for this could be that the increased
energy that they have experienced was used to assimilate
all the new impressions that they have received. These
new impressions consisted, among others, increased
thought activity about how they live their lives, how they
think, and how they feel. Furthermore, it could be that theenergy was used to handle the feelings and emotions thatthey previously suppressed. Additional work that utilizes
multiple instruments is needed to assess these possibilities.
The shortcomings of this pilot study are that, first, this was
not a randomised controlled trial. It is therefore possiblethat there has been a selection bias in the formation of thetwo groups. This could be alleviated with proper randomization in a full-scale trial. Second, checking for longer
term effects of the interventions are desirable. Are they
only effective for 6 weeks, or are they durable, as long as
the techniques are practiced on a regular basis? This isimportant to determine for the possible long term utilityof SK&P. Third, even though the two groups were treatedas equally as possible, significantly more interaction
occurred with the SK&P group and the instructor than thatwith the control group and its instructor which may have
had some effects. Therefore, in a full trial, comparable
interaction of the subjects with the instructor is desirable.
Fourth, sampling was not preceded by a power estimation; instead participants that were available were
included. Fifth, blinding was not possible. Sixth, co-intervention effects cannot be ruled out. Therefore, larger andlonger term full-scale trials with a randomised protocol
are required for the future.
As SK&P appears to have the potential to generate positiveeffects on wellness, it would be interesting to conduct
studies that also focus on physiological parameters, suchas biochemical markers, as this can give indications as tothe mechanism that underlie the effect of these practices,
as well as providing a means to objectively test the efficacyof this program. It would also be interesting to conduct
additional qualitative studies that specifically focus on
psychological experiences during SK&P as this appears to
be a method with the potential of generating insight into
the psyche.
The need for well-documented methods for increasing
wellness is large. There exist a number of techniques,
which could increase quality of life and health for many
people but they may have shortcomings by different criteria. Data presented here suggest that SK&P may be an efficient and practical method to increase wellness and thus
further evaluations are warranted.

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Conclusion
The current findings suggest that adult participants of normal health can improve their wellness by learning andapplying a program based on yoga and yogic breathing
exercises. This pilot study, with its limitations discussed
above, has allowed a number of recommendations to bemade to facilitate the design of a large-scale trial. Theseeasily learned and applied cost-effective yogic practices
can thus be offered as an intervention to the adult population at large to relieve psychosocial stress and its associated disorders; this in turn may result in the prevention ofa score of mental and physical disorders. Full-scale trials
are required to conclusively assess the validity of thishypothesis.

Competing interests
The author(s) declare that they have no competing interests.

Authors' contributions
AK carried out the design of the study, supervision of datacollection, and in data analysis, as well as drafting andfinalizing of the manuscript. SB assisted with data collection and analysis. KA helped design the study, was the
major person in data collection, and drafted the manuscript. TN was the main person in analysing the data andperformed the statistical analysis. FS participated in thedesign and coordination of the study as well as in draftingand finalizing of the manuscript. All authors read andapproved the final manuscript.

Acknowledgements
KA, SB, and TN were supported by the University of Karlstad, and FS by
University of Oslo. We would like to thank Art of Living Foundation – Karlstad with help in implementing the SK&P intervention, and Ronnie Newman
for suggestions to the text.

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