Effects of SKY Breathwork and Meditation Program on Emotional Well-being and Craving in Individuals Recovering From Substance Use Disorder

Emotional wellness can play a vital role in supporting recovery from substance use disorder. Developing skills to regulate emotions and manage stress during early stages of recovery can help manage triggers and prevent relapse. Controlled breathing (i.e., intentional manipulation of rate and/or depth of breathing over time - or "breathwork") can enhance emotional wellbeing (e.g., improve emotion regulation), but very little research has explored the impact of breathwork as a healthy coping mechanism for managing emotions and triggers in the context of recovery from substance use disorder.

The goal of this study is to obtain initial data on efficacy of a biopsychosocial intervention that involves breathwork as an adjunct to standard care in a residential treatment setting. Biopsychosocial interventions (e.g., "SKY Recovery") that focus on breathwork techniques, such as Sudarshan Kriya Yoga (SKY), reduce stress, anxiety and depressive symptoms in healthy individuals as well as those with depression, anxiety, and Post-traumatic Stress Disorder. They also reduce craving and withdrawal symptoms in people with Tobacco Use Disorder. Breathwork interventions improve quality of life, particularly in the psychological dimension, for people with opioid use disorder, reducing craving, depression, and increasing social and physical functioning. Craving and withdrawal symptoms promote the maintenance of addiction and predict return to substance misuse, and they are linked to the stress response in people who have substance use disorders. Results of prior studies thereby offer the promise of breathwork as adjunctive therapy for substance use disorder (SUD). Yet, breathwork has only minimally been examined in people with SUDs.

The aims of this pilot study are to evaluate the effectiveness of the SKY Recovery program in individuals with SUDs on emotional wellbeing and craving. Emotion regulation, impulsivity, and distress tolerance will be measured as indicators of emotional wellbeing using self-report questionnaires. 100 adult participants (aiming for 50 male and 50 female, ≥18 years old) who are scheduled to participate in the SKY Recovery program in a residential community treatment center will be enrolled. They will be randomized to two groups: SKY and Control ("delayed start"). Participants in the SKY group will receive the SKY Recovery Program (5 days, 3 h/day) followed by guided weekly in-person group practice sessions (1 h) for 3 weeks. SKY is typically taught in groups; thus, patients will be trained in cohorts of 4-10 people. The delayed-start Control group will receive the SKY Recovery program after all measurements have been obtained from the SKY group. Measurements will be taken before and after the intensive 5-day SKY training, one week after, and again 3 weeks after . Emotional wellbeing (e.g., emotion regulation) will be measured using standardized self-report questionnaires. Craving for their primary substance of choice will be measured using a brief self-report questionnaire. As sleep is related to emotional wellness and is often disrupted in individuals with SUDs, we will also obtain self-report ratings of sleep quality. We will address the following specific aims:

Aim 1. Evaluate the effects of SKY Recovery program on emotional wellbeing in patients receiving treatment for substance use disorder in a residential community setting. Hypothesis 1: Emotion regulation difficulties, impulsivity, and distress intolerance will be reduced and sleep quality will increase relative to baseline - more in the SKY group than in the Control group.

Aim 2. Evaluate the effects of SKY Recovery program on craving in patients receiving treatment for substance use disorder in a residential community setting. Hypothesis 2: Craving will be reduced relative to baseline - more in the SKY group than in the Control group.