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 Order Num ber 93S5165

The psychological and spiritual effects of Stanislav G rof’s

holotropic breathwork technique: An exploratory study

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Pressman, Todd Evan, Ph.D.
Saybrook Institute, 1993
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UMI
300 N. Zeeb Rd.
Ann Arbor, MI 48106

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 THE PSYCHOLOGICAL AND SPIRITUAL EFFECTS OF

STANISLAV GROF'S HOLOTROPIC BREATHWORK TECHNIQUE:

AN EXPLORATORY STUDY

by

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Todd Evan Pressman
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Submitted to the Graduate Faculty of the School

of Psychology in partial fulfillment of the

requirements for the degree of

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Doctor of Philosophy

Saybrook Institute

1993

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 CONTENTS

ABSTRACT.............................................. 4

CHAPTER I— INTRODUCTION............................... 6

Rationale and objective of the research............. 7

Definition of terms................................. 7

Statement of purpose........ 14

CHAPTER II— REVIEW OF THE LITERATURE................. 15

The effectiveness of psychotherapy................. 15

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The effects of breathing........................... 19

The work of Stanislav Grof......................... 29

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Critique of the field..................... 47

Preliminary work................................... 48
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Metatheoretical considerations..................... 51

Research question........ 56

CHAPTER 111 — METHODOLOGY............................. 57

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Participants................................ 57

Sample size...................................... 57

Selection and assignment of subjects.............58

Research design.................................... 60

Intervention ...................................... 61

Instrumentation.................................. 62

Profile of mood states......................... 62

Brief symptom inventory........................ 63

Spiritual orientation inventory................ 64

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 Interviews..................................... 65

Procedures....................................... 69

Justification for the treatment schedule.........73

CHAPTER IV— RESULTS.................................. 75

Treatment of the data.............................. 75

Demographic variables............................ 75

Underlying assumptions........................... 77

Dependent variables.............. ................. 80

Questionnaires................................... 81

Interviews....................................... 88

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CHAPTER V— DISCUSSION............................. ..113

Questionnaires.................................... 113

Interviews.......... ...........
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Integration of results............................ 122

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Limitations and delimitations..................... 123

Implications for future research............. ..128

APPENDICES...........................................131
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Appendix I— Informed consent form

(For those taking questionnaires)..... 131

Appendix II— Informed consent form

(For interview research)............... 137

Appendix III— Skewness and kurtosis values

for sample distributions............... 151

Appendix IV— Data analysis of

questionnaires........ 154

REFERENCES.......................................... 189

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 TABLES

Table 1— Demographic variables............. .76

Table 2— ANOVA results for Profile of Mood States....82

Table 3— ANOVA results for Brief Symptom

Inventory...................................... 83

Table 4— ANOVA results for Spiritual Orientation

Inventory...................................... 84

Table 5— T-test results for Profile of Mood States...85

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Table 6— T-test results for Brief Symptom

Inventory.................................. .86

Table 7— T-test results for Spiritual Orientation

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Inventory...................................... 87
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Table 8— Interview results........................... 89

Table 9— Tally of "Yes" versus "No" answers in

interview research........... Ill

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 ABSTRACT

The holotropic breathwork technique of Stanislav Grof has

been gaining increased attention in recent years and is being

practiced with increased frequency. To date, no scientific

research has been performed to substantiate or refute the claims

that this technique has psychological and spiritual effects, and

as a consequence the claims remain speculative.

The present research employed 40 volunteer subjects (25

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female, 15 male) and was conducted with a pretest-posttest

control group design. Subjects were randomly assigned to a

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treatment or a control condition. The treatment condition

consisted of six holotropic breathwork sessions, with subjects

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engaging in deep and rapid breathing to the accompaniment of

select music, bodywork and mandala drawing. The control

condition consisted of six sessions where subjects listened to

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the music of holotropic breathwork while lying down with closed

eyes. No specialized breathing, bodywork or mandala drawing was

involved.

The research question asked: Does holotropic breathwork have

demonstrable psychological and/or spiritual effects? The

methodology included three questionnaires that yielded

quantitative data and interviews that recorded the subjects'

responses to five questions. The six sessions of both treatment

and control conditions were held once every two weeks, and the

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 questionnaires were adminstered before the first and after the

last of these sessions. The interviews were conducted after each

of the six sessions.

The data obtained from the questionnaires provided only

partial validation of the hypothesis, while the interview

responses provided strong evidence that holotropic breathwork has

beneficial psychological and spiritual effects. No deleterious

effects were found.

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 CHAPTER I

INTRODUCTION

In the early 1960s, Stanislav Grof initiated a program of

psychotherapy research employing the drug d-lysergic acid, or

"LSD," at the Maryland Psychiatric Research Institute. He

reported beneficial changes in the psychological and spiritual

status of participants, based on his clinical observations (Grof,

1980). These investigations, however, offered no formal

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scientific substantiation. No control groups were established,

nor follow-up studies reported. His clinical observations,

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similarly, were reported in an informal fashion (Grof, 1976) and

did not follow the standards of case study presentation which

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provide for scientific rigor (Fromm, 1981; Kazdin, 1981).

When the legal practice of LSD psychotherapy became

restricted, Grof continued his work with a technique he developed

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called holotropic breathwork. It employed deep and rapid

breathing, supported by specially selected music, focused

bodywork, and mandala drawing. It is Grof's belief (1983,

personal communication) that this technique is an effective

substitute for LSD psychotherapy. As with LSD psychotherapy, he

reported beneficial changes in the psychological and spiritual

status of participants undergoing this treatment (Grof, 1988).

Again, no formal scientific data were offered to validate these

claims, and his work has remained unsubstantiated.

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 Rationale and objective of the research

In recent years, the number of workshops being offered by

trained and untrained facilitators in holotropic breathwork has

dramatically increased. To date, the literature offers no report

of any formal research on the psychological and/or spiritual

effects said to be available through this technique.

Considering its gain in popularity and practice, as well as

the significance of its purported benefits, it is necessary at

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this time that empirical data be compiled to assess whether this

technique has demonstrable psychological and/or spiritual

effects.
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Without these data, practitioners run the risk of

misleading their audiences about the results available through

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holotropic breathwork. Not only is this unethical but it could

potentially lead to damaging psychological and/or spiritual

consequences. It was the objective of this study to initiate

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such research.

Definition of terms

There are two types of therapeutic experience which, for

functional purposes, I will label positive and negative. The

positive type is that which is hypothesized to have a beneficial

effect on one's psychological and/or spiritual state (to be

defined). The negative type is that which is hypothesized to

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 have no effect or a harmful effect on one's psychological and/or

spiritual state. That which distinguishes between the=e two

types is the way in which the therapeutic experience is

integrated with one's "ordinary psychological and/or spiritual

state" (as contrasted with the therapeutically changed

psychological and/or spiritual state) .

The description here used for the term "ordinary

psychological state" is borrowed from Natsoulas (1978) and is

given as "the particular set of mental episodes that provides the

raw material, as it were, for a person's subjective coherence and

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continuity over time" (p. 121). The term "ordinary spiritual

state" would be described in the same way, with the substitution

of Elkins, Hedstrom, Hughes, Leaf, and Saunders' (1988)

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definition of "spirituality" for Natsoulas' word "mental":
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Spirituality, which comes from the Latin, spiritus. meaning

"breath of life," is a way of being and experiencing that

comes about through awareness of a transcendent dimension

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and that is characterized by certain identifiable values in

regard to self, others, nature, life, and whatever one

considers to be the Ultimate. (p. 11)

Thus, one's "ordinary spiritual state" is the particular set of

spiritual (as defined) episodes that provides the raw material,

as it were, for a person's subjective coherence and continuity

over time. In my definition (to be provided) of "ordinary

psychological and/or spiritual state," a person's subjective

coherence and continuity over time includes both psychological

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 and spiritual episodes. For convenience, I will substitute the

term "ordinary subjective identity" for "ordinary psychological

and/or spiritual state."

There are two possible ways in which the therapeutic

experience can be integrated with the ordinary subjective

identity, one for the positive and one for the negative type of

therapeutic experience. In the positive type, the new set of

psychological and/or spiritual episodes given by the therapeutic

experience is successfully integrated with the set given by the

ordinary state. That is, the raw material from the therapeutic

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experience, the new information it gives, is fitted into the

ordinary subjective identity in a coherent and continuous way.

With this, the ordinary state is changed to include the new

information.
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An example, from James (1902/1982), is of a man who was

given what we may call "therapeutic" advice. He was told to

"get rid of anger and worry." "But," said I, "is that

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possible?" "Yes," replied [the advisor]....[Then I had a]

revelation of a discovery, which framed itself into the

reasoning, "If it is possible to get rid of anger and worry,

why is it necessary to have them at all?" I felt the

strength of the argument, and at once accepted the

reasoning. The baby had discovered that it could walk. It

would scorn to creep any longer.

From the instant I realized that these cancer spots of

worry and anger were removable, they left me. With the

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 discovery of their weakness they were exorcised. From that

time life...had an entirely different aspect.

Although from that moment the possibility and

desirability of freedom from the depressing passions has

been a reality to me, it took me some months to feel

absolute security in my new position; but, as the usual

occasions for worry and anger have presented themselves over

and over again, and I have been unable to feel them in the

slightest degree, I no longer dread or guard against them,

and I am amazed at my increased energy and vigor of mind; at

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my strength to meet situations of all kinds, and at my

disposition to love and appreciate everything, (p. 181)

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This man's therapeutic experience was spurred with the

understanding that a previously "ordinary" fact about his

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subjective identity— that he was bound to worry and anger— was

not a fact. With this, he was able to integrate the information

over time and successfully apply it to relevant situations in his

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life, eventuating in what we must call a new "ordinary"

subjective identity, one which does not believe it is bound to

worry and anger. The therapeutic benefit of this experience is

clearly suggested by his "increased energy and vigor of mind; at

[his] strength to meet situations of all kinds, and at [his]

disposition to love and appreciate everything."

In the negative type of therapeutic experience, the new

information about one's subjective identity is not integrated

this way, but is repressed, denied, dissociated, or disallowed in

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 some other way, via Freud's (1933/1964) defense mechanisms.

Certainly, many therapeutic experiences cannot be successfully

integrated, and can lead one to chaotic dis-integration, or, at

least, confusion in relating the disparate bits of information of

the experience with one's ordinary subjective identity in a

coherent and continuous way. All too often, repressed memories

of childhood traumas, for example, brought out of repression in a

therapeutic episode, prove too painful for the experiencer to

integrate, causing aggravation of already existing difficulties

previously kept under control. Another kind of example, again

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from James (1902/1982), quotes one man's recounting of a

"therapeutic experience" that was not successfully integrated:

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I shall never forget that night of December...in which the

veil that concealed from me my own incredulity was

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torn....Anxiously I followed my thoughts, as from layer to

layer they descended towards the foundation of my

consciousness, and, scattering one by one all the illusions

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which until then had screened its windings from my view,

made them every moment more clearly visible....The

investigation went on more obstinate and more severe as it

drew near its term, and did not stop until the end was

reached. I knew then that in the depth of my mind nothing

was left that stood erect.

This moment was a frightful one; and when towards

morning I threw myself exhausted on my bed, I seemed to feel

my earlier life, so smiling and so full, go out like a fire,

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 and before me another life opened, sombre and unpeopled,

where in future I must live alone, alone with my fatal

thought which had exiled me thither, and which I was tempted

to curse. The days which followed this discovery were the

saddest of my life. (pp. 176-177)

In this example, the stimulus for the new psychological and

spiritual information is unexplained. However, the fact that the

experiencer gained new information about his psychological and

spiritual state is demonstrated by his phrase "scattering one by

one all the illusions which until then had screened its windings

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from my view." The evidence that this information was not

integrated with his ordinary or prior state is demonstrated by

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his phrase "I seemed to feel my earlier life, so smiling and so

full, go out like a fire." He was unable to link the information

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of the new experiences with his "earlier life" to situate them in

a larger context, understanding that both experiences represented

aspects of his subjective identity.

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The definition of psychological and/or spiritual state and

the criteria for assessing its improvement, derive from the

above. One's psychological and/or spiritual state is defined

here as the relative comparison of integrated versus non­

integrated information about one's ordinary subjective identity.

In a therapeutic experience one has, by our definition, access to

more information about one's subjective identity. With

successful integration of this information, one can access new

resources, and develop new strategies, for dealing with

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 psychological and spiritual material which previously seemed

unmanageable and was therefore not integrated; the information

was repressed or denied. This defines the criterion for

assessing improvements in one's psychological and/or spiritual

state: when information previously repressed or denied is

integrated with one's ordinary subjective identity, we may say

there has been an improvement in psychological and/or spiritual

state or well-being. Grof (1988) concurs when he says:

In the case of major traumas...it is very likely that

...the original traumatic event was not really fully

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experienced at the time when it was happening....As

a result of it, the event cannot be psychologically

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"digested” or integrated, and remains in the psyche

as a dissociated foreign element. When it then

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emerges from the unconscious during...[a therapeutic

experience] it is not as much reliving of what happened as

it is the first full experiencing of this event which makes

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it possible to complete it and integrate it. (p. 225).

In sum, this definition of one's psychological and/or

spiritual state and the criteria for assessing its improvement

depends on the degree of integrated information that exists about

a particular psychological and/or spiritual issue. With the lack

of such integration comes a deficit in psychological and/or

spiritual well-being; with an increase of such integration comes

an enrichment of psychological and/or spiritual well-being.

It must be stressed that the therapeutic experience is not,

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 itself, a state which improves (or harms) psychological and/or

spiritual well-being. It merely holds the potential for

improvement by virtue of the new information it affords.

Improvements in psychological and/or spiritual state can only be

attained with the successful integration of this information.

Thus, Grof (1980) has said,

In discussing the therapeutic results achieved with the use

of LSD [as a tool for inducing therapeutic experience] it is

essential to realize that all the drug can do is to bring

previously unconscious material into consciousness; the

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outcome of this process depends critically on the way this

material is dealt with and integrated. There is nothing

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inherently beneficial or detrimental about the effect of the

drug per se. (p. 234)

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It is essential to note, however, that our current level of

understanding of what can and can not be integrated, of what does

and does not constitute an experience with positive therapeutic

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potential, must not be imposed upon the present research, for our

current level of understanding has not widely explored the edges

of what can be integrated. Grof's work reports to have begun to

do so and suggests that what would previously be regarded as

negative therapeutic episodes of psychotic proportions can lead

to profound increases in psychological and/or spiritual well­

being, beyond what conventionalists would have conceived

possible.

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 Statement of purpose

With these definitions of the relevant terms, the purpose of

this research was to provide the first scientifically rigorous

data to help validate or invalidate the claim that holotropic

breathwork gives therapeutic experience which improves

psychological and/or spiritual well-being.

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 CHAPTER II

REVIEW OF THE LITERATURE

This review of the literature covers three relevant areas:

research assessing the effectiveness of psychotherapy in general,

the psychological and spiritual effects of alterations in

breathing, and Grof's work with LSD psychotherapy and holotropic

breathwork.

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The effectiveness of psychotherapy

The literature evaluating therapeutic effectiveness was

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hallmarked with the publication of Eysenck's (1952) famous

article entitled "The Effects of Psychotherapy: An Evaluation."

It was from this meta-analysis, a statistical review of the data

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of several psychotherapeutic outcome studies, that the

controversy over whether psychotherapy offers any benefit began.

This controversy, however, is largely attributable to a mis­

reading of a particular passage in the article:

In general, certain conclusions are possible from these data

[drawn from 19 studies involving over 7,000 cases used to

assess therapeutic outcomes]. They fail to prove that

psychotherapy facilitates the recovery of neurotic patients.

They show that roughly two-thirds of a group of neurotic

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 patients will recover or improve to a marked extent within

about two years of the onset of their illness, whether they

are treated by means of psychotherapy or not. (p. 322)

This does not say that psychotherapy has no effect. Rather, as

Luborsky and Spence (1971) point out, Eysenck simply made a claim

that there is "no good evidence" that psychotherapy has had a

discernible effect. Further research, perhaps targeting the

specific effects of psychotherapy, could show a different result.

Bergin (1971) critiques Eysenck's study, thus suggesting

that even the "no good evidence" finding is questionable. His

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reasons for this are listed in the following quote:

(a) Lack of precisely comparable cases across studies,

(b) lack of equivalent criteria outcome,

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(c) large variations in the amount of therapy received and
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in the quality thereof,

(d) differences in duration and thoroughness of follow-up,

(e) variation in the nature of onset and in duration of

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disturbance, and

(f) (where comparable cases and outcome estimates appear to

be used) impreciseness of definitions of disorder and

criteria for improvement, to the extent of rendering their

reliability questionable. Perhaps most troublesome of all

is the fact that these early studies were not objective.

There are no assessments of outcome made independently of

the therapist's evaluations, and there are no checks on the

reliability of the author's methods of tabulating the raw

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 data. (p. 218)

Bergin's attempt to correct for these problems in Eysenck's

approach led him to claim, in one re-interpretation of the data,

a 91% improvement rate, compared to Eysenck's 67% (Ibid.).

Frank (1961) takes Bergin's argument another step,

describing the lack of suitable criteria for successful

measurement of therapeutic outcome. He further emphasizes that

the inability to prove that a phenomenon exists is quite

different from proving that it does not exist. The

difficulty in demonstrating by statistical or experimental

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methods that therapy works or that one form is superior to

another may lie in our inability to define adequately any of

the variables involved.

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We cannot yet describe patients,

therapies, or improvement in terms that permit valid

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comparison of the effects of different therapies on the same

class of patient.

In the present state of ignorance, the most reasonable

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assumption is that all forms of psychotherapy that persist

must do some good, otherwise they would disappear. (pp. 15-

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He also proposes that the similar success rates of different

forms of psychotherapy is attributable to the features they have

in common, and it is these that should be sought in the question

of the effectiveness of psychotherapy.

Another important meta-analysis, reviewing the data of close

to 400 controlled studies involving approximately 25,000 control

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 and experimental subjects each, was performed by Smith and Glass

(1977). It measured not only whether psychotherapy had an effect

or not, but the "effect size," specifically how much of an effect

it had in the positive cases. Their findings showed 75%

effectiveness for therapy in general, interpreted as "on the

average, the typical therapy client is better off than 75% of

untreated individuals" (p. 752). In this meta-analysis, the

researchers chose studies which involved one or more

psychotherapy treatment groups being compared to untreated groups

or groups that received a different kind of psychotherapy. All

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particular outcome measures, e.g., anxiety level and self-esteem,

were lumped together to give a result intended to indicate

overall effectiveness of therapy on "well-being."

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Brown (1987) performed a review of 6 major meta-analyses on
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psychotherapy outcome research. His findings in this "meta-meta-

analysis" were consistent with the above, generally showing a

favorable result for psychotherapy: "Of the reviewed meta­

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analyses, most reported little or no differences between the

various schools of psychotherapy while also reporting at least a

slight efficacy for psychotherapy in general" (p. 19). Brown

drew two conclusions from the evidence that the different forms

of psychotherapy were equally efficacious: "Either one might

choose to specialize in a form of psychotherapy, or,

alternatively, one might develop proficiency in a number of types

of psychotherapy, utilizing that which would seem most

appropriate for each client" (p. 20). But, he cautioned, the

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