Impact of Holotropic Breathwork on Nursing Student Mental Health

Study design overview The study is a non randomized interventional pilot trial assessing whether a single day of Holotropic Breathwork (HB) improves mental health among University of Nebraska Medical Center (UNMC) nursing students. Holotropic Breathwork involves self directed hyperventilation while lying down, accompanied by music and trained facilitators. HB has been studied among the general public and patients with substance use disorders, but it has not been trialed among nursing students. The study will examine changes in mystical experiences, challenging experiences, emotional breakthroughs and psychological insight (Aim 1) and will compare pre and post HB psychological, interpersonal and existential functioning (Aim 2). Up to 70 students will be enrolled (two sessions with ≤30 participants each). All sessions will take place at the UNMC College of Nursing in Lincoln.

Intervention

Participants will attend a day long HB workshop. Each workshop is led by at least two certified facilitators and two apprentices. The workshop follows a structured sequence:

• Opening circle and orientation: Participants introduce themselves and share their motivation. Facilitators give a 60 minute presentation covering the concept of the inner healer, the difference between holotropic and hylotropic states, a historical overview of altered states of consciousness, how HB was developed, and practical tips for the session. Participants agree to confidentiality, to remain on site until dismissed, and to avoid harming themselves or others. Facilitators explain the roles of "sitter" and "breather".
• Partner assignment: Each student chooses a partner. If pairs cannot be formed, facilitators assist; groups with two breathers and one sitter can be accommodated.
• Breathwork session (first group): The breather lies on a mat wearing eye shades. After a guided relaxation, participants gradually begin deep, rapid breathing. They may adjust the pace as needed. Purposefully selected music plays for two to three hours. Responses vary: some lie still, others move or vocalize. Sitters provide support (tissues, water, walking to the restroom) and avoid interfering unless requested. Facilitators manage the music, ensure safety and intervene only at the participant's request. At least two facilitators and apprentices maintain a 1 : 5 breather to staff ratio.
• Break and lunch: After the first breathwork session, facilitators conduct short one on one check ins to ensure participants feel ready to rejoin the group. A light lunch is served.
• Second breathwork session with role reversal: Partners switch roles so that the previous sitter experiences breathwork.
• Integration presentation: After both sessions, facilitators deliver a second 60 minute presentation on integration and self care. They explain formal and informal integration, self care practices, and recommend delaying major life decisions until after participants have time to reflect.
• Closing circle: Participants share their experiences without receiving feedback. Those needing additional processing can meet privately with a facilitator. Before leaving the campus, participants complete the post experience survey.

Participant eligibility