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Despite its significance, few behavioral interventions specifically address the stress\u2010related pathology underlying AUD, including stress\u2010induced drinking. To address this gap, this study developed and piloted a novel digital intervention, <jats:italic>Emotion Regulation<\/jats:italic> via <jats:italic>Breathing for Alcohol Misuse (EBA),<\/jats:italic> targeting stress and alcohol misuse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>EBA integrates breathing\u2010based stress regulation techniques with cognitive\u2010behavioral strategies to address stress and hazardous drinking, delivered through telehealth and smartphone applications. The effectiveness of EBA was assessed pre\u2010 and post\u2010intervention for stress and alcohol\u2010related behaviors across two separate samples of individuals with Alcohol Use Disorder (AUD), each receiving a different EBA intervention dose. Study 1 included 27 individuals with AUD who completed a brief 4\u2010week EBA intervention, followed by a 30\u2010day monitoring period. Study 2 involved 64 individuals with AUD who completed an 8\u2010week EBA intervention, with a 90\u2010day follow\u2010up. During the intervention periods, participants engaged in brief daily self\u2010guided breathing exercises via a smartphone app.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Results demonstrated significant postintervention reductions in alcohol misuse severity, consumption, and cravings, as well as decreases in stress, anxiety, and depressed mood compared to baseline (<jats:italic>ps<\/jats:italic>\u2009&lt;\u20090.001), alongside improved self\u2010control (<jats:italic>ps<\/jats:italic>\u2009&lt;\u20090.001). These improvements were maintained throughout the follow\u2010up periods (<jats:italic>ps<\/jats:italic>\u2009&lt;\u20090.001) in both studies. Furthermore, reductions in stress and anxiety, along with improved self\u2010control during the intervention, were associated with decreased alcohol misuse severity (<jats:italic>ps<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The findings demonstrate the promising initial effectiveness of EBA in reducing stress\u2010 and alcohol\u2010related behaviors. Sustained improvements observed during follow\u2010up highlight the intervention's potential as a viable treatment option. These positive findings support the need for efficacy testing in future randomized controlled trials to establish EBA as an effective treatment approach for managing AUD, particularly in addressing stress\u2010related alcohol misuse.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.70131","type":"journal-article","created":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T07:28:45Z","timestamp":1754724525000},"page":"2076-2091","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Integrating breathing\u2010based stress reduction to address stress and alcohol misuse: A novel digital intervention delivered via telehealth and smartphone application"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6641-0495","authenticated-orcid":false,"given":"Dongju","family":"Seo","sequence":"first","affiliation":[{"name":"Department of Psychiatry Yale University School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7679-3196","authenticated-orcid":false,"given":"Justin J.","family":"Choi","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa M.","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Yale University School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3012-4349","authenticated-orcid":false,"given":"Rajita","family":"Sinha","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Yale University School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,9]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"e1","article-title":"Telemedicine and its role in revolutionizing healthcare delivery","volume":"5","author":"Alvandi M.","year":"2017","journal-title":"The American Journal of Accountable Care"},{"key":"e_1_2_8_3_1","unstructured":"Babor T.F. 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