Breathing lessons

New Age flute music plays softly as people file into an apartment in West Los Angeles, remove their shoes and seat themselves quietly on Oriental carpets on the floor. A picture of a bearded guru in white robes sits at the front of the room with a tiny offering of fresh flowers. There are 14 students, and they have come here to learn to breathe.

Known as the Art of Living, this intensive breathing course will last six days. The class has drawn people ranging in age from their 20s to their 60s. There is a builder, a businessman, a masseuse, an acupuncturist and a Jacuzzi engineer. It includes some who are seeking relief from asthma, chronic pain and depression and others who have come because they heard about it from a friend. One man came after seeing a flier at a Whole Foods market.

Students of the Art of Living program say the breathing technique can bring greater awareness, a fuller and happier life, less stress, greater mental focus, and a bevy of other health benefits. But there is scant research so far to support those claims.

Now, a handful of doctors and psychiatrists in this country are touting the benefits of the special breathing technique taught in the Art of Living course to help relieve depression, post-traumatic stress disorder, insomnia and anxiety.

One of those is Dr. Richard Brown, an associate professor of clinical psychiatry at Columbia University’s College of Physicians and Surgeons. After Brown published a book in 1999 about holistic approaches to depression, people from the Art of Living contacted him and explained their program. Impressed with what he heard, Brown later began recommending the program to many of his patients.

“Many of them were transformed,” Brown says. “I didn’t expect that.”

Brown eventually took the Art of Living course, then started teaching the program to, among others, fellow mental health professionals in New York. He’s also become the main spokesman in the medical community for Art of Living.

The idea that breathing techniques can benefit one’s emotional health has become widely accepted, both in everyday life and the world of science. When we are upset, nervous, about to run a race or perform on stage, we urge each other, “Take a deep breath.” And many doctors now recommend breathing techniques, such as those used in meditation, as a therapy for relieving stress -- believed to aggravate a host of medical conditions including depression and hypertension.

Earlier this year, the national Centers for Disease Control and Prevention released a survey on Americans’ use of alternative and complementary medical therapies and found that 12% of adults reported that they had done some type of breathing exercises in the past year.

Studies of yoga, which places a lot of emphasis on breath, have demonstrated its effect on reducing blood pressure, relieving anxiety and boosting the immune system. Eastern exercises such as tai chi and qi gong also incorporate focused and deep abdominal breathing.

But it is difficult to design a research study that would weigh the health benefits of purposeful breathing techniques by themselves.

Dr. James Gordon, director of the Center for Mind-Body Medicine in Washington, D.C., says while there is considerable research on the health benefits of deep breathing, there has been very little research done on more active breathing techniques, such as those employed in the Art of Living’s program.

“I don’t know about using some of the more active techniques,” said Gordon, who has taught breathing techniques in global hotspots such as Kosovo and Israel. Such techniques, he says, can “bring up a lot of feelings. A lot of energy that is in the person -- feelings that you don’t normally admit to,” such as sadness and anger.

The Art of Living is a meditation and yoga practice started by Indian guru Sri Sri Ravi Shankar (he is no relation to Ravi Shankar, the Grammy Award-winning sitarist who rose to international fame when Beatles star George Harrison became his student). The 48-year-old Art of Living founder once studied with Maharishi Mahesh Yogi, the guru famous for teaching Transcendental Meditation. Art of Living’s Shankar says the centerpiece of his breathing program -- known as the Sudarshan Kriya -- came to him in 1982, during a 10-day period of solitary silence.

As Shankar tells it, during his time of solitude he perceived that the different rhythms of breath had a connection with different states of mind. He came to believe that this practice could help people with their suffering, and so began to teach the breathing technique to others.

Today, the Art of Living Foundation claims that its volunteers have taught 2 million to 3 million people in some 142 countries. The course includes 16 to 20 hours of instruction in a simple breathing technique that can be practiced daily at home. About 50,000 people have gone through the program in the United States, the foundation says.

“All of a sudden, it is everywhere,” said John Osborne, president of the Art of Living Foundation in the United States.

Osborne believes the course has grown in popularity because it fits the needs of the times. The breathing, he says, offers a powerful way to counter stress, and the course’s spiritual lessons appeal to people who may be feeling a sense of alienation and powerlessness.

The program received a publicity boost after 9/11, when the Art of Living ran a full-page ad in the New York Times a month after the terrorist attacks, offering the course free of charge to New Yorkers. Ten teachers were flown in from around the country, and during the next several months more than 1,000 people, including firefighters and police officers, took the course.

The nonprofit Art of Living Foundation has built four ashrams around the world, and sponsors numerous service projects and schools in underdeveloped countries. Volunteers have taught the course in war-torn regions of Kosovo, in prisons in South Africa, and to gang members in Los Angeles. The parish of St. Monica Church in Santa Monica has made the Art of Living one of its official ministries. Before beginning the class in West L.A, all students pay $250, commit to completing the course and sign a non-disclosure statement, promising not to reveal the contents of the course.

The technique “is simple,” Osborne says. He adds somewhat cryptically: “But if done wrong, people might try it at home and they might hurt themselves.”

The teachers, Josette Wermuth, an instructor at Los Angeles High School, and Phylis LeBourgeouis, a lab technician at UCLA, tell the class to avoid alcohol for the duration of the course, and to stick to a vegetarian diet.

There is a strong touchy-feely aspect to the course. The teachers seem to glow with happiness, and they never stop smiling. We begin by walking around the room, looking into one another’s eyes and saying, “I belong to you.” Over the next six days we sit in small groups and talk about expectations, responsibility, happiness. The intimate philosophical discussions initially made some students uncomfortable.

On the first two days we learn the pranayams -- three positions of sectional breathing. All three positions -- hands on hips; thumbs in the armpits, elbows folded out; arms folded above our heads -- involve inhaling, holding, and slowly releasing the breath. Then we do a fourth breath work, called bellows breath, in which we shoot our arms overhead to move energy through the body. The deep breathing of the pranayams, as well as the bellows breath, is based on ancient yogic techniques.

It is not until the four-hour weekend sessions that we learn the Sudarshan Kriya, the active breathing technique that is the heart of the course and is, according to the Art of Living Foundation, unique.

Before we begin, our teachers tell us our hands may grow numb, our body temperatures may drop. It is the middle of a stifling heat wave, sticky by 10 a.m. Someone opens the windows. Shankar, we are told, has decreed that the Kriya must always be done with fresh air.

With that, Wermuth slips in a cassette tape of the guru. From far away, Shankar begins to guide us through the breathing in his melodic voice. We breathe in cycles, slow, faster, fast, until it feels like controlled hyperventilation. “The rhythm of the breath is linked to emotions,” Wermuth tells us. “There is a specific rhythm for every shade of emotion.”

At the end we lie on our backs.

The second day we do the Kriya, the effect is more dramatic. A few people cry. One man says his hand became immobile; another says he felt temporarily paralyzed from the waist down. Our teachers don’t explain much about why this may be happening. But clearly, something seems to be going on.

Medical professionals who recommend the Art of Living program in the United States say they would like to see more clinical studies of the technique, while noting the difficulty of obtaining financial support for research on breathing.

There are, however, some studies on the health benefits of the Art of Living’s breathing techniques done in other countries.

In a 2000 study, doctors at the National Institute of Mental Health and Neuro Sciences in India found that daily practice of the Sudarshan Kriya was as effective as a standard antidepressant in treating patients hospitalized with severe depression, and nearly as effective as electroconvulsive shock therapy, with far fewer side effects. Two earlier studies done the same year by the same institute found levels of cortisol, a hormone released under stress, and depression both decreased over a three-month period during which patients practiced the Sudarshan Kriya.

For now, U.S. doctors cite their own experiences -- most anecdotal -- as evidence of its benefit.

“Having done this course helped me to help my patients,” says Brown, the Columbia psychiatrist. “Breathing not only calms down the stress response system, which is what antidepressants do, but it activates the recharging, healing part of the nervous system.”

Dr. Sharon Sageman, director of a women’s clinic that treats post-traumatic stress disorder at St. Luke’s-Roosevelt Hospital in New York City, has referred about 50 patients to the program. She believes the Art of Living program provides a form of exposure therapy, with the Kriya technique allowing the brain to retrieve memories and thoughts we cannot normally access.

“My trauma patients will say the rapid breathing can make them think of a traumatic event, so they re-experience it,” she says. “But this time they are in a relaxed state, in a supportive setting.”

Shankar recommends students carry on the breathing practice for at least six months. The daily regimen takes about 30 minutes.

By the end of the six-day course in West Los Angeles, some students were already reporting changes.

Rasik Raniga, a hotel manager at the Travelodge in Culver City who took the course hoping for relief from asthma, claimed he was already able to cut down on the use of his inhaler. Michael Miller, a home builder who said he had been feeling depressed, found himself feeling better after three days. Analilia Silva, a businesswoman who came to the course at the suggestion of a friend, described the change as subtle: “It’s like when you start exercising,” she said. “And you suddenly feel better but you don’t know why.”