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Randomized Controlled Trial
. 2025 Jan 4;59(1):kaaf081.
doi: 10.1093/abm/kaaf081.

A randomized controlled pilot trial of low and high arousal resilience interventions for depressive symptoms

Elissa S Epel  1 , Brian P Don  2 , Stefanie E Mayer  1 , Robin Blades  1 , Ashley E Mason  1 , Elena Fromer  1 , Julia F O'Bryan  1 , Rebecca Dileo  3 , Joanna Y Guan  4 , Samantha J Schilf  1 , Sylvia S Cheng  5 , Aric A Prather  1 , Wendy Berry Mendes  6
Affiliations
Randomized Controlled Trial

A randomized controlled pilot trial of low and high arousal resilience interventions for depressive symptoms

Elissa S Epel et al. Ann Behav Med. .

Abstract

Background: To cope with chronic stress, which can contribute to depression, humans often pursue arousal-reducing activities. Yet, hormetic stressors (intermittent, acute stressors) might also reduce chronic stress.

Purpose: We compared the effects of arousal-reducing and arousal-enhancing interventions on depressive symptoms and perceived stress.

Methods: Female adults (N = 141; predominantly White, 63%, and Asian, 34%) reporting high perceived stress were randomized to 1 of 4 three-week stress resilience interventions in 2019-2020. Low arousal conditions included mindfulness meditation or slow breathing with warm showers (Control). Hormetic stress conditions included fast paced breathing with cold showers (the Wim Hof Method; WHM) or high-intensity interval training. We assessed depressive symptoms and perceived stress at baseline, postintervention, and 3 months later, and cortisol reactivity to a lab stressor.

Results: At postintervention, all 4 groups had decreases in depressive symptoms (15.93% reduction, r = .76, P < .001) and perceived stress (9.70% reduction, r = .48, P < .001), with no group differences. "As treated" analysis showed the WHM group had better maintenance of reduced depression 3 months later (r = .17, P < .01). The WHM group had greater increases in daily positive affect across days (r = .16, P ≤ .05) and at postintervention (r = .17, P < .015) compared to the control group. Groups were similar in cortisol reactivity pre- and postintervention.

Conclusions: All groups experienced reduced stress and depressive symptoms and did not differ from each other after 3 weeks. After 3 months, a post hoc analysis of adherent subjects showed the WHM group had more sustained improvements in depression and positive affect, a finding that needs replication with larger and more diverse samples.

Keywords: breathwork; depression; exercise; hormetic stress; meditation; resilience.

Plain language summary

Stress is pervasive and has a strong negative influence on mental health. This study examined whether a new intervention involving fast-paced breathing and cold exposure—a technique known as the Wim Hof Method—was effective in improving depression, stress, emotions, and stress hormone reactivity (cortisol), as compared to other common lifestyle stress reduction techniques (exercise, meditation, slow-paced breathing). In a sample of 141 women, we found that the Wim Hof method was equally effective, and sometimes slightly more effective in improving depression, and positive affect across the short term (3 weeks) and long term (3 months) as compared to the other stress reduction techniques. These findings suggest that the Wim Hof method may be a useful intervention for emotional well-being, especially for increasing positive emotions, although findings require replication among larger and more diverse groups of people.

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