Effects of Pranic Energisation Technique versus Mindful Stretching on Fear of Cancer Recurrence and Depression: A Pilot Study

INTRODUCTION

Cancer is a major global health challenge, contributing significantly to the rising burden of disease, premature mortality and escalating healthcare costs.^[1-4] Cancer incidence is rising, and by 2040, the number of new cancer cases per year globally is expected to grow to 27.5 million.^[5] Furthermore, cancer was responsible for nearly 10 million deaths, accounting for 17.7% of all deaths worldwide.^[6]

While advances in early diagnosis and treatment have improved survival rates, many continue to experience persistent psychological and emotional challenges long after treatment completion.^[7] Among these, fear of cancer recurrence (FCR) is one of the most common and distressing concerns, affecting up to 70% of survivors.^[8] FCR is defined as the worry that cancer may return or progress in the same or another part of the body.^[9] This fear can persist for years and significantly interfere with emotional well-being and daily life. A recent meta-analysis revealed that over 59% of cancer survivors report at least moderate levels of FCR, and approximately 19% experience high levels of it.^[8] Such findings highlight the urgent need for psychosocial interventions that specifically target FCR.

Several theoretical models have attempted to explain the mechanisms underlying FCR.^[10] For example, the self-regulation model posits that individuals’ inability to manage illness-related distress effectively leads to poor emotional outcomes.^[11] The uncertainty in illness theory suggests that anxiety arises from ambiguity about future health and disease trajectory.^[12] Terror management theory explores the existential fear of mortality triggered by a cancer diagnosis,^[13] while the social-cognitive processing theory highlights the role of ineffective cognitive and emotional processing in exacerbating psychological burden.^[14] Together, these frameworks illustrate how FCR can impair coping mechanisms, reduce quality of life and interfere with psychological adaptation. These findings underscore the importance of interventions that not only reduce psychological symptoms but also enhance patients’ perception, foster emotional regulation and support adaptive coping.

Although conventional psycho-oncology services,^[15] including psychological counselling, cognitive-behavioural therapy and pharmacological interventions, are available to manage FCR, they are often not accessible, affordable, or acceptable to all individuals.^[16] Moreover, such treatments may not fully address the interconnected physical, psychological and spiritual dimensions. This has led to a growing interest in integrative and complementary approaches, particularly yoga-based mind– body practices, which offer a holistic framework for enhancing resilience, mental well-being and quality of life in cancer care.^[5] Yoga is a multifaceted practice that combines physical postures (asanas), breathing techniques (pranayama) and meditation (dhyana) and has been shown to positively influence both physiological and psychological outcomes. One such practice is the pranic energisation technique (PET)—a specialised form of yogic meditation that integrates breath regulation, sound vibration (via specific chanting) and guided visualisation. Rooted in traditional yogic literature,^[17,18] PET is believed to activate and balance the flow of prana (vital energy) through the body, revitalising internal organs and supporting natural physiological function.^[19] Evidence from multiple randomised controlled trials and meta-analyses supports the use of yoga and mindfulness-based stress reduction as adjunct therapies in cancer care. These practices have been associated with improvements in emotional well-being, reduced stress and anxiety, enhanced body awareness and better quality of life.^[20-25] However, the specific effects of advanced meditative practices like PET, as compared to movement-based practices like Sukshma Vyayama, remain underexplored. Therefore, this pilot study was undertaken to compare the effects of PET and Sukshma Vyayama on FCR and depressive symptoms in individuals affected by cancer.

MATERIALS AND METHODS

This study used an active control design. Participants were assigned either to the yoga intervention arm or the control arm. Stratification was applied based on age and gender to ensure comparable groups and minimise potential baseline differences between them. The intervention was carried out for 4 weeks [Figure 1]. The study followed ethical guidelines and was approved by the Institutional Ethical Committee at SVYASA (RES/IEC-SVYASA/260/2022).

Close

Figure 1:

Trial profile.

Export to PPT

RESULTS

The results of the study indicated no significant difference between the intervention and control groups in demographic variables, with median age being 47 years (42–50) in the intervention group and 45 years (43–56) in the control group (P = 0.68) and the proportion of male participants being 29.41% and 70.58%, respectively (P = 1.00).

DISCUSSION

The present pilot study evaluated and compared the effects of an advanced meditation practice, PET and psychological outcomes among individuals affected by cancer, compared to Sukshma Vyayama. The findings indicate that a 4-week PET intervention significantly reduced FCR and depressive symptoms compared to the active control group, supporting the growing evidence that yoga-based mind–body interventions can be effective in cancer care.

Importantly, this intervention aligns with the principles of patient-centred oncology care,^[31] which emphasises not only disease management but also psychosocial well-being, functional recovery and quality of life. Many cancer patients experience anxiety, emotional instability, sleep disturbances and fear of recurrence even after treatment completion— concerns that are often insufficiently addressed by conventional medical approaches.^[32] PET offers a non-pharmacological and holistic approach that addresses emotional, mental and spiritual dimensions of cancer recovery.

The significant reduction in FCR aligns with earlier findings indicating the efficacy of mind–body practices in mitigating cancer-specific anxiety.^[33,34] Similarly, the observed decrease in depressive symptoms mirrors results from other yoga-based trials that report improvements in mood and reduction in psychological distress.^[35] These outcomes suggest that PET may exert its effects by inducing deep relaxation, enhancing interoceptive awareness and supporting cognitive reframing. For instance, Step I (Prayer) and Step VI (Silence) in PET result in deep relaxation and a sense of surrender by engaging the parasympathetic nervous system, reducing physiological arousal and fostering internalised awareness conducive to emotional regulation and healing. Steps II (Breath Awareness) and III (Recognition of Vyana) deepen interoceptive awareness by tuning attention to breath flow, nerve impulses and pranic resonance. Meanwhile, Step VII (Resolve) encourages cognitive reframing through the repetition of positive affirmations (Sankalpa), helping participants cultivate hope, resilience and a sense of inner control amidst uncertainty and existential fears. This aligns with existing neuropsychological models, which propose that mindfulness and meditative practices modulate brain regions involved in fear processing, emotional regulation and self-referential thinking, such as the amygdala, prefrontal cortex and default mode network.^[36]

In addition, PET may enhance psychological flexibility, the capacity to remain open to distressing thoughts while maintaining purposeful engagement in life.^[37] Mindfulness and breath-focused techniques promote non-reactivity, allowing patients to observe fear and uncertainty without becoming overwhelmed.^[36] Such mechanisms foster emotional resilience, reduce avoidance behaviours and support adaptive functioning. On a physiological level, yoga has been shown to influence the hypothalamic–pituitary–adrenal axis, reduce cortisol levels and improve autonomic balance—all of which contribute to emotional stabilisation and psychological recovery.^[38]

This study contributes to the growing evidence base supporting individualised, structured yoga modules for cancer care, where previous trials have shown that yoga can reduce fatigue, enhance sleep quality and improve emotional functioning in cancer patients and survivors.^[39,40] Building on these physical and psychological benefits, the present study adds yoga’s potential role in alleviating anticipatory anxiety—a specific and often under-recognised concern related to FCR.^[41] The limited psychological changes observed in the control group suggest that while mindful stretching may support mild relaxation and body awareness, it may lack the introspective and energetic depth necessary to influence complex constructs like FCR.

The use of an active control group (Sukshma Vyayama) enhanced the rigour of this trial by minimising expectancy and placebo effects. Stratified allocation by age and gender further reduced baseline bias. The employment of validated psychological scales (FCRI-SF and PHQ-9) enhanced the reliability of outcome assessments. However, this study has several limitations. First, the small sample size restricts generalisability and limits the ability to detect smaller effect sizes. Second, the short intervention duration may not capture sustained psychological change. Third, reliance on self-reported measures introduces the potential for social desirability or recall bias. Finally, the absence of objective physiological or neurobiological markers limits understanding of the underlying mechanisms.

Future studies should be conducted with larger, more diverse samples, extended follow-up periods and multi-modal assessment tools, including biological stress markers (e.g. cortisol, heart rate variability), to better understand the pathways through which PET affects psychological health. In addition, comparisons with other established practices, such as mindfulness-based stress reduction or Yoga Nidra, would help distinguish the unique contributions of energy-based meditative techniques.

CONCLUSION

This pilot study provides preliminary evidence that PET, an advanced yogic meditation, is effective in reducing FCR and depressive symptoms in cancer-affected individuals. Compared to mindful stretching, PET offers deeper psychological benefits and holds promise as a complementary approach in integrative oncology. Larger randomised trials with long-term follow-up and biological markers are needed to confirm and expand on these findings.