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.

Abstract

Paramedicine students experience disproportionately high rates of anxiety, depression, stress, and insomnia compared to the general population, placing them at risk of post-traumatic stress disorder and long-term psychological distress. Breathwork has emerged as a promising self-regulation 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-blind parallel-group mixed-methods RCT was conducted with 98 student paramedics from two Australian universities, randomised to either a 12-week breathwork intervention or control, with results interpreted in light of differential attrition. The intervention involved twice-daily practice of slow, diaphragmatic breathing (5-s inhale, 5-s exhale, 2-s hold) with video and guided audio instruction. Outcomes included changes in anxiety, depression, stress (DASS-21), insomnia (ISI), resilience (RS-14), and psychological wellbeing (RPWB-18), between baseline and post-intervention. Analyses included 2 × 2 mixed factorial ANOVA, ANCOVA for baseline differences, and correlation analyses. At post-intervention, participants in the breathwork group reported significantly lower stress, anxiety, and depression scores, and higher resilience compared to controls (all p < 0.05), with medium to large effect sizes. Insomnia and psychological wellbeing showed non-significant changes. Qualitative feedback highlighted perceived benefits for self-regulation, including emotional regulation and perceived psychological safety and control-although 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. TRIAL REGISTRATION: Registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12625000101482 on 30/01/2025. Available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=388884&showOriginal=true&isReview=true.