Sudarshan Kriya

1. Introduction

Version followed: SKY Breath Meditation (Sudarshan Kriya Yoga) as the Art of Living Foundation currently offers it in courses led by its certified teachers, with the component description given by Brown and Gerbarg (2005) and the research course formats used in the Stanford and VA veterans trials. The core kriya is not published by the organisation and is not described procedurally here.

What it is. Sudarshan Kriya is a breathing practice introduced by Sri Sri Ravi Shankar, founder of the Art of Living Foundation. The organisation's own account is that he "emerged with the Sudarshan Kriya after a ten-day silence period" and it presents the practice as "ancient knowledge in contemporary application" [source: Art of Living Canada, Happiness Program page]. In the research literature, Sudarshan Kriya Yoga (SKY) is described as a sequence of three breathing techniques: ujjayi, bhastrika and Sudarshan Kriya itself [source: Brown & Gerbarg 2005, Part I abstract], using cyclical patterns "ranging from slow and calming to rapid and stimulating" [source: Zope & Zope 2013]. The public course combines Sudarshan Kriya with other breathing techniques, gentle yoga and meditation, taught interactively in a group, and participants are given a home practice [source: Art of Living Canada; Penn Almanac 2017].

How change is thought to happen. Two accounts sit side by side and should be kept apart:

The tradition's account (attributed, not fact): the organisation teaches that "the secret lies in our own breath", that negative emotions can be transformed through the breath, and that practice can "restore body, mind and spirit" and reconnect a person with an inner source of joy; its teacher training speaks of "becoming established in one's Self" [source: Art of Living Canada pages].
The researchers' hypothesis: Brown and Gerbarg proposed a neurophysiological model in which the varied breathing rhythms (including a hyperventilation-like rapid phase) shift autonomic balance towards parasympathetic activity, calm stress-response systems and produce a state they call "calm alertness". They present this as a model for research, not an established mechanism [source: Brown & Gerbarg 2005, Part I abstract].

Who may deliver it. Only teachers trained and selected by the Art of Living Foundation teach SKY [source: Art of Living Canada, Teacher Training page]. A psychotherapist who is not an Art of Living-certified teacher does not teach the kriya. This guide therefore covers the psychotherapist's role around SKY: deciding with the client whether it fits, screening and medical liaison, preparation and consent, monitoring, integration of what comes up, and handling adverse effects. For breathing methods a psychotherapist may teach directly (diaphragmatic, slow-paced and resonance breathing, cyclic sighing), see the other guides in this Breathwork family; for HRV biofeedback see the Domain IX biofeedback guides; for Holotropic Breathwork and similar intense connected-breathing work see the Domain VII Holotropic Breathwork guide; Wim Hof has its own guide (167) [synthesis].

Evidence status in brief (for informed consent, not as a claim of efficacy). Small randomised trials report benefit: a waitlist-controlled trial in 21 Iraq/Afghanistan veterans found reductions in PTSD and anxiety symptoms and respiration rate [source: Seppälä et al. 2014]; a VA non-inferiority trial (85 veterans) found SKY non-inferior to Cognitive Processing Therapy on PTSD symptoms at end of treatment, 1 month and 1 year, but inferior on depression and affect at 1 year [source: Bayley et al. 2022]; a pilot trial in 25 adults with major depression who had not responded to antidepressants found greater improvement with adjunctive SKY than waitlist, with no adverse events reported [source: Sharma et al., J Clin Psychiatry, Epub 2016]. A 2013 narrative review called SKY a possible "low-risk, low-cost adjunct" [source: Zope & Zope 2013]. A 2023 conference-abstract meta-analysis of RCTs found pooled effects near zero with very high heterogeneity for depression and anxiety [source: Population Medicine 2023 abstract]. Trial samples are small; SKY is not an established stand-alone treatment for any psychiatric or physical disease [synthesis]. Readers should check each trial's funding and affiliation declarations [synthesis].

Organisational context. The Art of Living Foundation is a large international organisation running many courses besides SKY (e.g. Sahaj Samadhi Meditation, youth programmes such as Yesplus and ART Excel) [source: Art of Living Canada pages]. In India, the National Green Tribunal held the organisation responsible for damage to the Yamuna floodplain linked to its 2016 World Culture Festival; it paid Rs 5 crore, which the Tribunal directed to floodplain restoration [source: The Wire, 7 Dec 2017]. Other reported figures and disputes about this case are [uncertain: not verified].

2. Framework

SKY is a course-based practice, not a phased psychotherapy. The structure below describes the course as published, then the psychotherapist's parallel phases [synthesis for the therapist phases].

Course formats as published (named, not prescribed):

Public course: SKY Breath Meditation (earlier called the Happiness Program in many countries), a group course with no prerequisites, led by certified teachers; the Canadian page describes it only as "a few hours" and does not state days, delivery mode or precautions [source: Art of Living Canada]. Local formats vary; confirm the actual schedule with the local centre [uncertain: format varies by country].
Research formats: a one-week group programme followed by daily home practice [source: Stanford CCARE 2014, on Seppälä et al.]; a group workshop of about 15 hours followed by twice-weekly one-hour group sessions for 5 weeks [source: Bayley et al. 2022]; group sessions plus home practice over 8 weeks as an add-on to antidepressants [source: Sharma et al.; Penn Almanac].
After the course: participants are expected to keep a daily home practice and may attend group follow-up sessions; long-term practitioners can go on to further courses and teacher training [source: Art of Living Canada pages; Stanford CCARE]. The content and length of the home practice are taught on the course and are not given here.

The psychotherapist's phases [synthesis]:

Exploration and suitability (1 session or part of ongoing therapy). Goal: decide whether SKY fits the client's goals, values and health. Move on when the client wants to proceed and there are no unresolved contraindications.
Screening and medical liaison (as needed). Goal: identify contraindications the organisation itself lists and obtain medical advice where required. Move on when the physician and client have decided, and the client has disclosed relevant conditions to the course teacher.
Preparation and consent (1 session). Goal: realistic expectations, a plan for strong emotion, and stop rules. Move on when the client can state what they will do if overwhelmed during or after the course.
During the course (usually brief contact or the scheduled session that week). Goal: monitor for mood elevation, sleep loss, dissociation or distress.
Integration (1-3 sessions, then folded into ongoing therapy). Goal: make sense of experiences, link them to treatment goals, review home practice without setting targets.
Review (around 1-3 months). Goal: re-measure symptoms, decide together whether SKY continues as an adjunct, and keep primary evidence-based treatment in place.

Criteria for moving between phases: client consent at each step; no emerging red flags (Section 5); medical advice obtained where a listed contraindication applies [synthesis].

3. Guiding principles

Respect teaching authority. Only Art of Living-certified teachers teach SKY [source: Teacher Training page]. Practical meaning: you refer, prepare and integrate; you do not coach the kriya or correct technique.
Do not proceduralise what the organisation keeps unpublished. Practical meaning: never give, ask the client to share, or reconstruct breathing rates, rounds, counts or timings in session.
Attribute spiritual claims. Joy, the Self and the transformative power of breath are the organisation's teachings [source: Art of Living Canada]. Practical meaning: say "the course teaches that…" rather than endorsing it.
Screen with the organisation's own contraindications. Art of Living Canada's physician letter lists seizure disorder, bipolar disorder, schizophrenia and schizoaffective disorders, major surgery within 8 weeks, and pregnancy as contraindications for learning SKY [source: Art of Living Canada medical information form]. Practical meaning: check each one before referral.
Add general breathwork cautions. Breathwork with rapid phases can cause hypocapnia (light-headedness, tingling, muscle spasm, panic-like sensations); cardiovascular disease, uncontrolled hypertension, glaucoma or retinal problems, severe asthma/COPD, severe PTSD with dissociation, panic disorder and current suicidality warrant medical and clinical review first [synthesis, from general breathwork safety guidance; not listed on the Art of Living form]. Practical meaning: ask about these too.
Never in water or while driving. Rapid or altered breathing can impair consciousness [synthesis]. Practical meaning: tell clients never to practise in a bath, pool or open water, or while driving or operating machinery.
Adjunct, not replacement. Trials used SKY as an add-on or compared it with a full evidence-based therapy [source: Sharma et al.; Bayley et al.]. Practical meaning: keep the client's psychotherapy and prescribed medication in place; never advise changing medicines.
Informed, balanced expectations. Evidence is promising but small and mixed [source: Section 1 sources]. Practical meaning: share both the trial results and their limits.
Client autonomy and values fit. The course is set in a spiritual organisation with its own teacher and community. Practical meaning: explore the client's beliefs and comfort; offer alternatives (including the organisation's Sahaj Samadhi Meditation, which its physician letter mentions some people choose instead [source: medical information form], or therapist-taught slow breathing).
Trauma-informed pacing. Veterans describe the practice as releasing trauma from body and mind [source: Stanford CCARE]. Practical meaning: plan in advance for strong emotion, memories and altered states, and make integration sessions available.
Consent and confidentiality in liaison. Practical meaning: contact the physician or course teacher only with the client's written consent, sharing the minimum needed [synthesis].
Measure, don't assume. Trials tracked symptoms with standard measures (e.g. PCL, HDRS, BDI, BAI) [source: Bayley et al.; Sharma et al.]. Practical meaning: use your usual measures before and after.
No touch. SKY as published involves no hands-on work by the therapist [synthesis]. Practical meaning: grounding is verbal; any touch would follow your professional code and explicit consent, and is never sexual.

4. Intervention inventory

Two parts follow. Part A describes, descriptively and only as sources publish it, what the client meets on the course, so you can prepare and debrief them. Part B lists the psychotherapist's own interventions. Example language is illustrative throughout.

Part A. What the course contains (descriptive only; taught by certified teachers)

A1. Ujjayi

Purpose: the first of the three named SKY components [source: Brown & Gerbarg 2005, Part I abstract]; in the SKY literature it belongs to the slow, calming end of the range [source: Zope & Zope 2013].
Steps: taught by the course teacher; no procedure is given here.
Example language (illustrative): "On the course you'll learn some slower breathing first. Notice what it's like for you, and tell me afterwards."
Watch for: whether slow, deliberate breath attention itself raises anxiety (common in people with panic or interoceptive fear) [synthesis].

A2. Bhastrika

Purpose: the second named component [source: Brown & Gerbarg 2005]; it sits at the more stimulating end of the range [source: Zope & Zope 2013].
Steps: taught by the course teacher; no rate, round or count is given here.
Example language (illustrative): "Some of the breathing is faster and more energising. You're allowed to slow down or stop and just breathe normally at any point."
Watch for: light-headedness, tingling in hands or lips, muscle cramp, chest discomfort or panic, which suggest over-breathing; the client should stop and breathe normally and tell the teacher [synthesis].

A3. Sudarshan Kriya (the core kriya)

Purpose: the central rhythmic, cyclical breathing practice that gives the course its name [source: Art of Living Canada; Brown & Gerbarg 2005]. In the researchers' model, its rapid phases involve hyperventilation-like effects and are hypothesised to contribute to the shift into "calm alertness" [source: Brown & Gerbarg 2005]. The organisation's physician letter notes transient hypocapnia during the first sessions and its theoretical effect on seizure threshold [source: Art of Living Canada medical information form].
Steps: not published by the organisation; taught only by certified teachers. Do not ask the client to describe or demonstrate it for you to coach.
Example language (illustrative): "The main practice is taught only by their teachers, so I won't be teaching it. What I can do is help you get ready and make sense of whatever comes up."
Watch for: intense emotion, crying, laughter, memories surfacing, feeling detached or unreal, euphoria, or exhaustion afterwards. Veterans in the Stanford study described the practice as releasing trauma and entering meditative states [source: Stanford CCARE 2014]. Ask about each in integration (B7).

A4. Supporting elements: yoga, meditation, knowledge talks, group follow-ups

Purpose: the course adds "low-impact yoga", meditation and interactive teaching about stress and emotions, and the organisation offers follow-up group practice [source: Art of Living Canada; Bayley et al. 2022 for twice-weekly follow-ups in the trial format].
Steps: as taught. Any meditation or chanting element beyond those named here is [uncertain: not verified].
Example language (illustrative): "There'll be some gentle movement and talks about the organisation's view of stress and happiness. You can take what helps and leave the rest."
Watch for: physical strain in the yoga element if the client has injuries; group pressure to adopt beliefs or sign up for further courses (see Section 5).

Part B. The psychotherapist's interventions

B1. Exploring fit and goals

Purpose: decide whether SKY serves a clear therapeutic goal (e.g. stress, residual depressive or PTSD symptoms alongside treatment) and fits the client's values. Use when a client raises SKY or when you are considering a breathing-based adjunct [synthesis].
Steps: (1) Ask what the client knows and hopes for. (2) Link the hope to a treatment goal. (3) Explain that SKY is taught in a group course by the organisation's teachers, with spiritual framing and a daily home practice. (4) Explore religious, cultural and personal comfort with that setting. (5) Name alternatives: therapist-taught slow breathing, the organisation's non-breathing meditation (Sahaj Samadhi), or no adjunct. (6) Agree a decision or a period to think.
Example language (illustrative): "What draws you to this course? … It's run by a spiritual organisation, and its teachers lead the breathing. How does that sit with your own beliefs?"
Watch for: hope that SKY will replace therapy or medication; pressure from family or partner; a history of high-control groups. Working: the client can say what they want from it and how they'll judge it.

B2. Contraindication and safety screening

Purpose: identify conditions the organisation lists and general breathwork risks before referral.
Steps: (1) Ask about each condition on the Art of Living physician letter: seizure disorder, bipolar disorder, schizophrenia or schizoaffective disorder, major surgery in the past 8 weeks, pregnancy [source: Art of Living Canada medical information form]. (2) Ask about general breathwork risks: heart disease, uncontrolled blood pressure, stroke history, glaucoma or retinal problems, asthma or COPD, recent injury, panic disorder, severe dissociation, current suicidality, active substance use [synthesis]. (3) Ask about medication and adherence, especially mood stabilisers. (4) Screen for over-breathing tendencies if relevant: some clinicians use the Nijmegen Questionnaire as a screen for breathing-pattern problems [synthesis; instrument not reproduced]. (5) Record findings and the plan.
Example language (illustrative): "Before you sign up, I'd like to check a few health conditions that the organisation itself asks doctors to consider. None of these is about judging you; it's about safety."
Watch for: undiagnosed hypomanic episodes (ask about periods of reduced need for sleep and racing thoughts), unreported seizures, early pregnancy. Working: a clear yes, no or 'medical review first'.

B3. Medical liaison

Purpose: get medical advice where a contraindication or general risk applies. The organisation's own letter asks physicians to review the risks before advising a patient [source: Art of Living Canada medical information form].
Steps: (1) Obtain written consent. (2) Suggest the client take the organisation's medical information form (where their centre uses one) to their physician or psychiatrist. (3) Share relevant clinical information with consent. (4) Respect the physician's advice; if they advise against, help the client consider alternatives.
Example language (illustrative): "Because of your bipolar diagnosis, the organisation itself treats this as a reason not to learn the practice. Let's talk to Dr X together before you decide."
Watch for: a client planning to skip the medical step, or to stop medication to 'do it naturally'. The organisation's letter itself raises a theoretical concern that euphoric effects might lead some people to stop medication [source: medical information form].

B4. Psychoeducation and informed consent

Purpose: balanced, honest expectations.
Steps: (1) Describe the course descriptively (Part A). (2) Summarise evidence: promising small trials in PTSD and depression, mixed pooled results (Section 1). (3) Name possible effects: strong emotion, memories, tingling or dizziness during faster breathing, tiredness, temporary sleep change, euphoria. (4) Clarify that the organisation teaches spiritual ideas that the client is free to accept or not. (5) Confirm SKY is an adjunct. (6) Record consent.
Example language (illustrative): "Some studies found people's PTSD or depression symptoms eased; others found little difference. It's an add-on to what we're doing, not a replacement."
Watch for: over-idealised expectations; anxiety about 'losing control'. Working: the client can describe both potential benefits and risks.

B5. Preparation plan and stop rules

Purpose: give the client a plan for strong reactions during and after the course.
Steps: (1) Agree stop rules: stop and breathe normally at dizziness, chest pain, numbness, cramping, panic, a flashback, or feeling unreal, and tell the teacher. (2) Agree to disclose relevant conditions to the course teacher. (3) Practise a brief non-breathing grounding skill in session (e.g. naming things in the room, feeling feet on the floor) [synthesis]. (4) Plan support after sessions and a check-in with you. (5) Never practise in or near water, in the bath, while driving or operating machinery [synthesis]. (6) Agree what would make you both pause the course.
Example language (illustrative): "If at any point it's too much, you can just stop and breathe normally. You don't need anyone's permission. Then tell the teacher and let me know."
Watch for: clients who feel they must 'push through'; trauma survivors who freeze rather than speak up. Working: the client can rehearse the stop plan aloud.

B6. Monitoring during the course

Purpose: catch early adverse effects.
Steps: (1) Offer a brief check-in during the course week. (2) Ask about sleep, mood, energy, intrusions, dissociation, suicidal thoughts. (3) In bipolar spectrum or psychosis-risk clients who have proceeded on medical advice, watch especially for reduced sleep, pressured speech, unusual beliefs. (4) Act on red flags (Section 5).
Example language (illustrative): "How have you been sleeping since the course started? Any times you felt unusually high, unreal or overwhelmed?"
Watch for: the organisation's letter names mania or hypomania triggered by rapid cyclic breathing and dissociative or psychotic episodes as theoretical risks [source: medical information form]. Working: stable sleep and mood, manageable emotion.

B7. Integration sessions

Purpose: help the client make sense of experiences and connect them to therapy goals.
Steps: (1) Invite an open account of the course. (2) Ask about body sensations, emotions, memories, images. (3) Validate without interpreting surfaced memories as literal truth; note that vivid material in altered states is not a reliable record [synthesis]. (4) Link insights to the treatment plan (e.g. bring trauma material into your evidence-based trauma work). (5) Distinguish the client's own meanings from the organisation's spiritual framing.
Example language (illustrative): "You said a memory came up during the main breathing practice. Let's look at it gently and decide together whether and how to work with it here."
Watch for: new or unexpected 'memories', shame about crying, or a sense that therapy is no longer needed. Working: the client can describe experiences calmly and connect them to goals.

B8. Supporting home practice without prescribing it

Purpose: the course teaches a daily home practice [source: Stanford CCARE; Penn Almanac]. Your role is to support consistency, not set its content.
Steps: (1) Ask what the client was taught to do at home and how it's going, without asking for counts or timings. (2) Problem-solve barriers (time, privacy, motivation). (3) Refer technique questions back to the teacher or follow-up group. (4) Reaffirm: never in water or while driving.
Example language (illustrative): "How is the home practice fitting into your day? If you're unsure how to do any part of it, the teacher or the follow-up group is the place to check."
Watch for: guilt about missing practice (note that in the Stanford study, improvements were reported even in veterans who did not keep up home practice [source: Stanford CCARE]); practising more intensively than taught. Working: practice fits the client's life without strain.

B9. Measurement-based review

Purpose: judge whether SKY adds value.
Steps: (1) Measure symptoms before the course with your usual instruments (e.g. PCL for PTSD, BDI or HDRS for depression, BAI for anxiety, as the trials used) [source: Bayley et al.; Sharma et al.]. (2) Re-measure after the course and around 1-3 months [synthesis]. (3) Review with the client and decide whether to continue.
Example language (illustrative): "Let's look at your scores from before the course and now, and see what's changed."
Watch for: improvement attributed solely to SKY when other changes occurred; deterioration on any scale. Working: stable or improved scores and client-reported benefit.

B10. Coordinating with evidence-based treatment

Purpose: keep primary treatment in place. In veterans, SKY was compared head-to-head with CPT and was non-inferior on PTSD symptoms but inferior on depression at 1 year [source: Bayley et al. 2022].
Steps: (1) Continue the primary evidence-based therapy and medication. (2) Decide sequencing: in high-arousal clients, some clinicians may use SKY to reduce arousal before trauma-focused work [synthesis]. (3) Avoid scheduling an intense course and a demanding trauma-processing phase in the same week [synthesis].
Example language (illustrative): "The breathing course can sit alongside our trauma work. Let's plan it so you're not doing the hardest parts of both in the same week."
Watch for: avoidance of trauma-focused work by switching to breathing alone. Working: engagement in both.

B11. Addressing spiritual and organisational questions

Purpose: keep the client's autonomy and values central.
Steps: (1) Ask how the client relates to the spiritual teachings. (2) Explore any pressure to take further courses, donate or volunteer. (3) Name that further courses and teacher training exist, with prerequisites such as a year of daily Sudarshan Kriya and Sahaj Samadhi practice and a two-week training from which "selected graduates" become teachers [source: Teacher Training page], so the client can make informed choices. (4) Neither endorse nor disparage the organisation.
Example language (illustrative): "Some people love the community and teachings; others just want the breathing. What feels right for you?"
Watch for: rapid shifts in identity, withdrawal from previous relationships, financial strain. Working: choices are freely made and consistent with the client's values.

B12. Responding to adverse effects and passing them on

Purpose: act early and inform those who need to know.
Steps: (1) Assess safety (suicidality, mania, psychosis, dissociation). (2) Advise pausing practice. (3) Liaise with the prescriber or GP and, with consent, the course teacher. (4) Document. (5) Use your service's adverse-event procedures [synthesis].
Example language (illustrative): "I'd like you to pause the breathing practice for now while we look at what's happening, and I'd like to speak with your doctor today."
Watch for: see red flags in Section 5. Working: symptoms settle after pausing and medical review.

5. Handling problems

Most guidance below is [synthesis] from general psychotherapy and breathwork safety practice; points drawn from sources are tagged.

Over-breathing symptoms during or after practice (dizziness, tingling, cramping of hands, chest tightness, panic). Response: stop, breathe normally and slowly through the nose, sit or lie down, tell the teacher; seek medical help for chest pain, fainting or symptoms that do not settle. In therapy, normalise the sensations and review whether to continue. The organisation's letter links rapid breathing to transient hypocapnia [source: medical information form]. [synthesis for response]
Emerging hypomania or mania (reduced need for sleep, racing thoughts, grandiosity, spending). Response: pause practice, same-day contact with the prescriber, check medication adherence, safety planning. The organisation names this as a significant theoretical risk in bipolar disorder [source: medical information form]. [synthesis for response]
Psychotic or dissociative symptoms (unusual beliefs, hearing voices, prolonged unreality). Response: pause practice, urgent psychiatric assessment, do not interpret content spiritually. [source for risk: medical information form; synthesis for response]
Seizure or near-seizure. Response: emergency care; no further practice without neurological advice. [source for risk: medical information form; synthesis]
Overwhelm, flashbacks or abreaction in trauma survivors. Response: use the agreed grounding plan; slow the pace of trauma work; consider pausing the course or choosing a non-breathing alternative; review in integration. [synthesis]
Suicidal thoughts appear or increase. Response: standard risk assessment and safety planning; pause practice; involve the care team. [synthesis]
'Memories' of new events surface. Response: explore with curiosity, avoid confirming them as historical fact, avoid suggestive questioning, and work with present meaning and distress. [synthesis]
Stuck: no benefit after the course. Response: review measures; note pooled trial evidence is mixed [source: Population Medicine 2023 abstract]; return focus to the primary evidence-based therapy without blaming the client. [synthesis]
Non-adherence to home practice. Response: explore barriers non-judgementally; offer follow-up group support via the organisation; reassure that benefits in one trial were reported even among those who did not keep practising [source: Stanford CCARE]; never set practice targets yourself. [synthesis]
Over-adherence or intensification (practising beyond what was taught, combining with other intense breathwork or breath-holding, practising in water). Response: advise returning to what the teacher taught; repeat water and driving cautions; cross-refer to the Wim Hof (167) and Holotropic (Domain VII) guides for risks of other intense methods. [synthesis]
Stopping medication or therapy because 'the breathing fixed it'. Response: explore without confrontation; involve the prescriber; reiterate that trials tested SKY as an adjunct or alongside comparison therapies [source: Sharma et al.; Bayley et al.]; never advise on changing medicines. The organisation itself flags this concern [source: medical information form].
Rupture: client feels judged for their spiritual interest, or feels the therapist is promoting the organisation. Response: name the rupture, apologise for any misattunement, restate neutrality and the client's freedom to choose. [synthesis]
Group or organisational pressure (to recruit, take costly courses, volunteer heavily, cut contacts). Response: explore values and boundaries; support informed choices; if coercion appears, address it as you would any high-control group dynamic. Whether such pressure occurs within Art of Living is [uncertain: not verified]; treat each client's account on its merits. [synthesis]
Client asks you to teach or check their kriya technique. Response: decline kindly; explain teaching authority rests with certified teachers; refer back to the follow-up group. [source: Teacher Training page; synthesis]
Physical complaints from the yoga element (back or joint pain). Response: advise modifying or skipping postures and informing the teacher; refer to a physician or physiotherapist as needed. [synthesis]
Pregnancy discovered after the course. Response: advise stopping and consulting the obstetric clinician; the organisation states there is no data indicating that SKY is safe or unsafe in pregnancy [source: medical information form].
Sharing with the course teacher. Response: with consent, share only what supports safety (e.g. 'avoid strenuous parts'); avoid sharing diagnoses or trauma details unnecessarily. [synthesis]

Sources

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