Examining the Effectiveness of Breathwork to Improve Resilience and Psychological Wellbeing While Reducing Anxiety, Depression, Stress, and Insomnia in Paramedicine Students: A Single-Blind Randomised Controlled Trial.
Little A, Stainer M, et al. • Stress and health : journal of the International Society for the Investigation of Stress • 2026
The A52 Breath Method significantly reduced reported symptoms of psychological distress and enhanced resilience in student paramedics, even during exam stress, with medium to large effect sizes.
Key Findings
Results
Breathwork intervention significantly reduced stress, anxiety, and depression scores compared to controls at post-intervention.
All comparisons reached statistical significance at p < 0.05
Effect sizes were described as medium to large
Outcomes were measured using the DASS-21 (Depression Anxiety Stress Scales)
The study was a 12-week single-blind parallel-group RCT with 98 student paramedics from two Australian universities
Results were interpreted in light of differential attrition between groups
Results
Breathwork intervention significantly improved resilience scores compared to controls at post-intervention.
Resilience was measured using the RS-14 (Resilience Scale-14)
The improvement reached statistical significance (p < 0.05) with medium to large effect size
Improvements were observed even during the period of exam stress
Analyses included 2 × 2 mixed factorial ANOVA and ANCOVA for baseline differences
Results
Insomnia and psychological wellbeing outcomes showed non-significant changes between the breathwork and control groups.
Insomnia was measured using the ISI (Insomnia Severity Index)
Psychological wellbeing was measured using the RPWB-18 (Ryff's Psychological Wellbeing Scale-18)
Neither outcome reached statistical significance at post-intervention
These null findings contrast with the significant improvements seen in stress, anxiety, depression, and resilience
Results
Qualitative feedback from participants highlighted perceived benefits for self-regulation, emotional regulation, and psychological safety and control.
The study used a mixed-methods RCT design, incorporating qualitative feedback alongside quantitative outcomes
Participants reported a perception of increased psychological safety and control
Challenges to practice engagement were also noted in qualitative feedback
These qualitative findings supported the quantitative results regarding self-regulation improvements
Methods
The breathwork intervention consisted of twice-daily practice of slow, diaphragmatic breathing over 12 weeks.
The specific protocol used was the A52 Breath Method, a structured breathwork protocol
Breathing pattern involved a 5-second inhale, 5-second exhale, and 2-second hold
Participants were provided video and guided audio instruction to support practice
The intervention ran for 12 weeks with twice-daily sessions
Background
Paramedicine students experience disproportionately high rates of anxiety, depression, stress, and insomnia compared to the general population.
This elevated burden places paramedicine students at risk of post-traumatic stress disorder and long-term psychological distress
The study recruited 98 student paramedics from two Australian universities
This population context motivated the investigation of breathwork as a scalable upstream intervention
The study framed breathwork as a self-regulation intervention that may enhance resilience and wellbeing
Methods
The study was registered prospectively with the Australian New Zealand Clinical Trials Registry.
Trial registration number: ACTRN12625000101482
Registered on 30/01/2025
Single-blind parallel-group design was used
Randomisation was to either a 12-week breathwork intervention or control condition
What This Means
This research suggests that a simple, structured breathing exercise practiced twice daily can meaningfully reduce stress, anxiety, and depression while improving resilience in student paramedics. The study assigned 98 Australian paramedicine students to either a 12-week breathing program (the A52 Breath Method, involving slow diaphragmatic breathing with a 5-second inhale, 5-second exhale, and 2-second hold) or a control condition. Those who practiced the breathwork reported significantly better mental health outcomes than those who did not, with effect sizes in the medium to large range—meaning the differences were practically meaningful, not just statistically detectable. Notably, these benefits were observed even during the high-stress period of exams.
Not all outcomes improved equally. Sleep problems (insomnia) and broader psychological wellbeing scores did not show statistically significant changes between the two groups. Students who practiced breathwork also described in their own words feeling better able to manage their emotions and feeling a greater sense of psychological safety and control, though some participants found it challenging to maintain a consistent practice routine.
This research suggests that breathwork could be a low-cost, scalable tool for supporting mental health in paramedic training programs, which is important because this student population faces unusually high rates of anxiety, depression, and stress that can persist into their careers. The finding that a straightforward, self-administered breathing technique can produce meaningful reductions in psychological distress points to potential value in embedding such practices into health profession curricula more broadly.
Little A, Stainer M, MacQuarrie A, Wiseman N, Haskins B. (2026). Examining the Effectiveness of Breathwork to Improve Resilience and Psychological Wellbeing While Reducing Anxiety, Depression, Stress, and Insomnia in Paramedicine Students: A Single-Blind Randomised Controlled Trial.. Stress and health : journal of the International Society for the Investigation of Stress. https://doi.org/10.1002/smi.70161