{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T18:29:57Z","timestamp":1783708197997,"version":"3.55.0"},"reference-count":71,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001791","name":"Griffith University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001791","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Stress and Health"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      Paramedicine students experience disproportionately high rates of anxiety, depression, stress, and insomnia compared to the general population, placing them at risk of post\u2010traumatic stress disorder and long\u2010term psychological distress. Breathwork has emerged as a promising self\u2010regulation intervention that may enhance resilience and wellbeing while reducing symptoms of mental illness. This randomised controlled trial (RCT) evaluated the effectiveness of the A52 Breath Method, a structured breathwork protocol, in improving mental health and resilience among student paramedics. A single\u2010blind parallel\u2010group mixed\u2010methods RCT was conducted with 98 student paramedics from two Australian universities, randomised to either a 12\u2010week breathwork intervention or control, with results interpreted in light of differential attrition. The intervention involved twice\u2010daily practice of slow, diaphragmatic breathing (5\u2010s inhale, 5\u2010s exhale, 2\u2010s hold) with video and guided audio instruction. Outcomes included changes in anxiety, depression, stress (DASS\u201021), insomnia (ISI), resilience (RS\u201014), and psychological wellbeing (RPWB\u201018), between baseline and post\u2010intervention. Analyses included 2\u00a0\u00d7\u00a02 mixed factorial ANOVA, ANCOVA for baseline differences, and correlation analyses. At post\u2010intervention, participants in the breathwork group reported significantly lower stress, anxiety, and depression scores, and higher resilience compared to controls (all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05), with medium to large effect sizes. Insomnia and psychological wellbeing showed non\u2010significant changes. Qualitative feedback highlighted perceived benefits for self\u2010regulation, including emotional regulation and perceived psychological safety and control\u2013although challenges to practice engagement was noted. The A52 Breath Method significantly reduced reported symptoms of psychological distress and enhanced resilience in student paramedics, even during exam stress. Breathwork shows promise as a scalable, upstream intervention to support mental health in paramedic student training.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      Registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12625000101482 on 30\/01\/2025. Available at:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=388884%26showOriginal=true%26isReview=true\">https:\/\/www.anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=388884&amp;showOriginal=true&amp;isReview=true<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/smi.70161","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T20:04:35Z","timestamp":1773000275000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Examining the Effectiveness of Breathwork to Improve Resilience and Psychological Wellbeing While Reducing Anxiety, Depression, Stress, and Insomnia in Paramedicine Students: A Single\u2010Blind Randomised Controlled Trial"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4621-3607","authenticated-orcid":false,"given":"Abbie","family":"Little","sequence":"first","affiliation":[{"name":"Griffith University  Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4077-6933","authenticated-orcid":false,"given":"Matthew","family":"Stainer","sequence":"additional","affiliation":[{"name":"Griffith University  Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3969-2481","authenticated-orcid":false,"given":"Alex (Sandy)","family":"MacQuarrie","sequence":"additional","affiliation":[{"name":"Bond University  Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9288-535X","authenticated-orcid":false,"given":"Nicola","family":"Wiseman","sequence":"additional","affiliation":[{"name":"Griffith University  Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8445-4477","authenticated-orcid":false,"given":"Brian","family":"Haskins","sequence":"additional","affiliation":[{"name":"Victoria University  Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/00223891.2014.951445"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejtd.2024.100492"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00127\u2010024\u201002755\u20106"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci13020256"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1389\u20109457(00)00065\u20104"},{"key":"e_1_2_13_7_1","volume-title":"Physiology, Bohr Effect","author":"Benner A.","year":"2018"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(84)91226\u20101"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1628806"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2013.01.001"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13835"},{"issue":"10","key":"e_1_2_13_13_1","first-page":"662","article-title":"Effect of Short\u2010Term Practice of Pranayamic Breathing Exercises on Cognition, Anxiety, General Well Being and Heart Rate Variability","volume":"111","author":"Chandla S. 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