Rooted in the Eastern traditions of yoga, Tai Chi, and Buddhism, breathwork developed in the West alongside the so-called “psychedelic movement” and overtook it as a more accessible means of harnessing non-ordinary states of consciousness when the “War On Drugs” entered full swing. Defined by deep, slow, or rapid breathing patterns repeated over the course of several hours, Holotropic Breathwork gained popularity as a therapeutic tool in clinical and non-clinical settings. Despite “Holotropic Breathwork” becoming something of a household name, the breathwork landscape is broad and broadening, with different techniques emerging for self-development and psychotherapeutic use.
Now that serious and evidence-based psychedelic therapy is reentering the spotlight, more people may be wondering what differentiates it from breathwork and breathing therapy, when one should be used over another, and what kind of research backs up their stated benefits. Here is what can be said already: While the actual research on Holotropic Breathwork in the Grof tradition is scarce, a much wider neurobiological and psychological body of knowledge on breathwork has grown over the past few decades. In a MIND Talk, Martha Havenith from the Ernst Strüngmann Institute for Neurosciences in Frankfurt has provided an overview on different aspects and traditions. In the following paragraphs we use the term “immersive breathwork” for the family of breathing techniques that are designed to evoke different altered states of consciousness. To “immersive” into something means to become absorbed into something.
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What Is Holotropic Breathwork?
Though it has branched out since first defining the scene in the 1970s, “Holotropic Breathwork”, the form of breathwork coined by Stan and Christina Grof, remains popular today. The term “holotropic” comes from the Greek trepein (orienting to) and holos (wholeness), meaning “moving toward wholeness.” As defined by the Grofs, Holotropic Breathwork involves a “transformation of consciousness associated with dramatic perceptual changes in all sensory areas, intense and often unusual emotions, and profound alterations in the thought processes” often accompanied by “a variety of psychosomatic manifestations and unconventional forms of behavior.” (1) In reality, the changes may be both subtle and “dramatic”.
As it often happens with pioneers, their theories about what they bring to life may be overreaching and have a tendency to become rigid in their followers. It’s also wise to look at the actual practice of breathwork and assume that there may be a difference to the theories about this practice.
The system of Holotropic Breathwork as defined in the early work of Stan Grof includes six elements: 1) a “birth map” covering so-called somatosensory, perinatal, biographical, and transpersonal matrices that are supposed to explain the processes that attendees report about; 2) enhanced breathing (that may include hyperventilation); 3) evocative music that is designed to drive the experiential process of the breather; 4) body work focusing on amplifying somatic processes until they resolve spontaneously (these are often considered “blocks”; 5) mandala drawing after the immersive experience; 6) and group sharing of experiences intended to go with little or without analysis or interpretation.
The breathing technique itself is defined by deep, often rapid breaths inward and outward, repeated over the course of two to three and sometimes up to six hours. The breathing pattern is important but nobody knows yet in which way — the claim that, an even balance of inhalation and exhalation needs to be established seems random when looking at the reality of the breathing sessions and observing breathing in action Breathwork usually happens in large groups but there are also one-on-one settings (3).
Other types of breathwork have similar effects but do not technically qualify as Holotropic Breathwork in the Grof tradition. For example, Rebirthing Breathwork (also known as “Conscious Energy Breathing”) uses “circular breathing” and deep relaxation techniques to help people “release energy blockages stored in the mind and body due to traumas surrounding one’s birth.” Clarity Breathwork, a branch of Rebirthing Breathwork, wants to “help people breathe fully, releasing emotional energy that may be stuck in one’s body, and involves a personal interview, somatic exploration, and in-depth intuitive counseling”. Biodynamic Breathwork claims to “restores balance to internal systems of the body through not only breath but movement, sound, touch, emotion, and meditation”. Other types of breathwork are branded as Integrative, Transformational, Zen Yoga, Vivation, and Shamanic breathwork. As one can tell from these words, some breathwork forms come with ideologic assumptions.
Holotropic Breathwork is distinguished from these by emphasizing group integration—typically through discussion and creative output (painting, mandala drawing, etc.)—evocative music, supine position, and guidance from a certified practitioner trained in the Grof “Transpersonal Training program”. There is limited scientific research on the benefits of Holotropic Breathwork (4), but so far studies point to enhanced self-awareness (5), greater personal meaning and significance (6), reduced anxiety and depression (7), resolution of trauma, increased self-esteem, better communication with others, and lower stress (8). Likewise, there is sparse research on the post-breathwork integration process. “It is assumed that a period of integration is needed after HB, but no record is available of what people do after HB sessions, nor is there a systematic integration process in place,” writes psychologist and breathwork scholar Felipe Landaeta. “Thus, HB lacks a comprehensive model, one based on the work itself, that shows the full effects of the experience.” (5)
That is where the psychedelic research renaissance comes in, helping to inform the HB model.
What Is Psychedelic-assisted Therapy?
Psychedelic-assisted therapy relies on a mind-altering substance to achieve non-ordinary states of consciousness. In the classic clinical setting, it typically involves lying down with eyeshades and music while a psychedelic drug is administered with a facilitator present. The administration procedure and the duration of the session differ depending on the psychedelic substance. In a typical MDMA-assisted therapy session, for instance, a capsule is administered orally, and a session might last up to eight hours. In a ketamine-assisted therapy session, the drug is administered intravenously, and the session lasts around thirty to sixty minutes. In most cases, the substance session itself is preceded by a series of preparatory sessions and accompanied by several post-substance integration sessions with a therapist.
Psychedelic-assisted therapy quickly began to evolve after its first appearance in the 1950s, when LSD was used to treat alcoholism. It was soon divided into two techniques: psycholytic therapy (lower doses, focus on continued psychoanalysis) and psychedelic treatment (higher doses, focus on one peak experience). Today this distinction has become rare since there are many types of variations from the low to high dose, the number of sessions, and the therapeutic models behind them. The type of therapy used in integration sessions today is typically a combination of in-depth psychology and third wave behavioral techniques, from Cognitive Behavioral Therapy to Acceptance and Commitment Therapy to transpersonal to somatic. The setup of the psychedelic session itself—eyeshades, music, facilitator—has not changed significantly since the 1950s despite little research comparing it to other methods. However, psychedelic studies with groups and couple constellations are recently gaining ground.
There is no consensus among the scientific community on how psychedelics elicit therapeutic effects, but leading theories revolve around changes within the Salience Network and Default Mode Networks of the brain, increased connectivity between brain regions, and enhanced bodily and emotional awareness (9). The “therapeutic window” during which the brain remains in a malleable state primed for healing is now believed by Johns Hopkins Researchers to be not just weeks but months after a session—which means the potential for treatment lies not only in the intensity of an experience but also the efforts made at integrating that experience afterwards (10). Dozens of research centers both academic and private around the world are now devoted to studying how psychedelic treatment works, and how it can provide the greatest benefits to patients.
On our website, you can read more about the current state of psychedelic therapy.
Psychedelics and Breathwork
Psychedelic-assisted therapy overlaps with Holotropic Breathwork in several ways: typical effects include bringing elements of the unconscious into conscious awareness, releasing emotional and somatic “blockages,” greater mental awareness of self and other, trauma exposition and reconciliation, and relief from stress and other ailments.
Studies comparing the effects of Holotropic Breathwork and psychedelic therapy are limited, but what research does exist emphasizes the so-called transpersonal elements of healing: one study, led by psychologist Iker Puente at the University of Barcelona, found that “the proportion of volunteers who met the criteria for having had a ‘complete’ mystical type experience during the breathwork sessions (14.7%) and the ayahuasca ceremonies (12.6%) was similar.”(5) The transpersonal orientation in the psychedelic field emphasizes states of self-transcendence and the similarity of such states with some spiritual traditions.
Similar guidance is given in terms of navigating challenging experiences in both cases: “The primary injunction in HB is not to ‘go into the trauma’ but ‘do the breathing until you are surprised by what emerges.’” (11) The same piece of advice might be given in preparation for a psychedelic session.
And just as psychedelic-type drugs such as MDMA are being used to treat PTSD, immersive breathwork methods are now being considered by research institutes like Johns Hopkins as a candidate for treatment. “Given encouraging results being found in FDA studies of psychedelic therapy for treating PTSD and the relationship of the Grof’s style of breathwork to psychedelic experience, it is compelling to test the safety and effectiveness of breathwork as a stand-alone treatment,” writes the research team, which is currently partnering with the Psykia Institute, Flow Genome Project, and Veterans for Natural Rights to fund a study on breathwork and veteran PTSD (12). The MIND Foundation’s own “Translational Breathwork Study Group” has recently partnered with Imperial College to combine their breathwork studies, too. MIND is the research and training partner of the OVID Clinics.
One major difference between the two is the one-on-one setting versus group setting. At a clinic, psychedelic-assisted therapy typically happens in a one-on-one setting with a participant and one or two facilitators. Holotropic Breathwork sessions, as stated before, frequently happen in a group setting where participants not only trade off on experiencing altered states of consciousness and facilitating this experience for others, but also get to process with the entire group during the session and afterward—or at least, if not with the group, in the presence of the group, which can be just as inspiring, encouraging and healing. Research on psychedelic therapy in group settings is becoming more common (13), but so far these are usually experiences being studied outside a clinical context. In this sense, Holotropic Breathwork may currently have a leg up on psychedelic-assisted therapy in terms of relational healing potential.
Another difference is the bodily side of things: in settings involving psychedelic drugs, there is usually no focus on the breath and very little focus on bodywork. While a psychedelic session may very well have a major impact on the body, it is not typical for the facilitator to direct a patient’s focus to their body, and not especially common for the integration sessions that follow to involve bodywork or a discussion of the physiological impact of the trip. Breathwork sessions, by contrast, are by themselves highly somatic and much of the focus of processing the experience centers around the body, even though the term “states of consciousness” assumes a focus on the mind.
Psychedelic-assisted therapy and immersive breathwork techniques may have their obvious differences, but there is clearly enough similarity between the two methods to justify further research comparing their effects. We will likely begin to see immersive breathwork used as both a substitute for and a complement to psychedelic-assisted therapy. Including it in more studies will lead us toward a greater understanding not only of altered states of consciousness but also the understated role of the body in such transformations.