Atlas›Domain X · Body, movement, breath & physical›Guide 167
Guide X-167

Wim Hof method

Wim HofNetherlands
A 21 · L 71 · M 89 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the Wim Hof Method (WHM) as Innerfire BV publishes it on wimhofmethod.com in 2026 (the "practice the method", FAQ, safety-warnings, science and Academy pages). The research is described from the Radboud University Medical Center endotoxin studies (Kox et al. 2014) and an independent systematic review (Almahayni & Hammond 2024). The method is taught by certified WHM instructors; this guide is written for a psychotherapist who screens, prepares, refers and integrates. It is not written for teaching the breathing or cold practice. [source: WHM practice page; WHM Academy page]

  • What it is. A commercial self-training method developed by the Dutch athlete Wim Hof ("the Iceman"). It is sold through Innerfire BV, a company DutchNews describes as owned by Hof and his son. The company presents it as three pillars: breathing, cold exposure, and a third pillar it currently calls "mindset" (older materials call it "commitment"). Delivery is through free and paid video courses, an app, and certified instructors' workshops and retreats. [source: WHM practice page; DutchNews 2024]
  • Core idea of change (as the developer states it). The company says people can learn to influence their autonomic nervous system and immune response. It frames the breathing as a way to "calm the nervous system" and the cold as resilience training ("train your body to adapt under stress"). Citing the Radboud work, it states that "the breathing technique was the active component". These are the developer's claims. Research findings are summarised below; they are not established clinical effects. [source: WHM practice page; WHM science page]
  • Research findings, descriptively. In Kox et al. (2014, PNAS; the same trial was also presented as a conference abstract in Intensive Care Medicine Experimental), healthy male volunteers were randomised to a short WHM training programme led by Wim Hof (12 trained) or to no training (12 controls). The programme combined a meditation component, cyclic hyperventilation followed by breath retention, and cold exposure including ice-water immersion. Both groups then received an experimental intravenous endotoxin challenge. In the trained group the breathing produced intermittent respiratory alkalosis and hypoxia and a marked rise in plasma adrenaline (epinephrine). The anti-inflammatory cytokine IL-10 rose earlier and higher, pro-inflammatory TNF-α, IL-6 and IL-8 were lower, and flu-like symptoms and fever were blunted. The authors concluded that voluntary sympathetic activation can attenuate the innate immune response in humans. [source: Kox et al. ICMx 2014 abstract; Pharmazeutische Zeitung report of the PNAS paper, May 2014; WHM science page] Later work listed on the company's own science page includes a Radboud study of outcome expectancies (van Middendorp et al. 2015). It also lists a pilot (Zwaag et al. 2022) that the company summarises as finding breathing plus cold most effective, and trials in depression, multiple sclerosis, spondyloarthritis and spinal cord injury, some with null mental-health outcomes. These are the company's summaries. [source: WHM science page; uncertain: individual papers not verified] An independent systematic review of eight trials (Almahayni & Hammond 2024, PLOS ONE) found raised adrenaline in several studies and an anti-inflammatory cytokine pattern in two, with mixed exercise results. It judged the trials small with high risk of bias and called for robust confirmatory research before the method can be recommended. [source: Scimex summary of Almahayni & Hammond 2024]
  • Status. WHM is not a psychotherapy and not a treatment for any physical disease. Health claims belong to the developer. The breathing is a form of intense hyperventilation-and-retention breathwork. For conscious-connected and Holotropic-type breathwork see the Domain VII Holotropic Breathwork guide. [synthesis]

2. Framework

A. The method as the developer publishes it (descriptive only). [source: WHM practice page; WHM FAQ; WHM safety warnings]

  • Breathing pillar. Repeated rounds of deep breathing are each followed by a breath hold after exhaling, then a single deep recovery inhale with a short hold, then release. The rounds repeat. The published exercise is structured by counts and holds; this guide gives none of them. The company presents it as learnable in one session, done seated or lying down on dry land. It says lightheadedness and tingling are "normal", especially at first. [source: WHM practice page; WHM safety warnings]
  • Cold pillar. The company says to begin by finishing an ordinary shower cold and to build up gradually in temperature and duration while you "listen to your body". It says no ice bath is needed to begin, and it warns that irresponsible practice can cause serious harm, including hypothermia. In the FAQ, it says to breathe normally during any cold exposure in water and never to use the breathing technique there. [source: WHM practice page; WHM safety warnings; WHM FAQ]
  • Mindset / commitment pillar. Described as mental training of attention, willpower and intention, applied during breathing and cold practice and carried into daily life. [source: WHM practice page]
  • Delivery formats. A free three-lesson Master Class, a Fundamentals Video Course organised by weekly themes, a Classic multi-week video course, the WHM app (guided routines, tracking), and in-person workshops, weekends, group courses, one-to-one sessions and retreats run by certified instructors. [source: WHM practice page; WHM Academy page]
  • Who teaches. Certified Fundamentals Instructors complete an online foundation course, an online Instructor Video Course (science, core protocols, safety measures, best practice) and an in-person training with assessment of teaching ability. Advanced Instructors complete a further training in nature. A guideline of prior teaching or coaching experience applies, and no health-care degree is required. Instructors are self-employed. The Academy page states no recertification rule and draws no line between instructor work and clinical treatment. [source: WHM Academy page]

B. The psychotherapist's framework (when a client uses or wants WHM). [synthesis, built from the developer's contraindications and safety warnings]

  • Phase 1, screening and decision (usually within an ordinary session). Goal: decide whether WHM is reasonable for this client now, and whether medical clearance is needed. Move on only when the medical and psychiatric screen is complete and any clearance is documented.
  • Phase 2, preparation and informed consent (one session or part of one). Goal: the client understands the effects (hyperventilation symptoms, adrenaline surge, emotion), the absolute water and driving rules, and the cold-shock risk. Move on when the client can state the safety rules back in their own words and has a plan for where, and with whom, they will practise.
  • Phase 3, referral and parallel practice. The client learns the method from the official course or a certified instructor, not from the therapist, unless the therapist is themselves certified and has thought through the dual role. Sessions monitor effects, adherence to the safety rules, and any misuse (pushing, competing, solo cold-water practice).
  • Phase 4, integration and review (ongoing; review at each natural break). Goal: link what the client notices (arousal, discomfort tolerance, mood) to the treatment goals, and decide together whether to continue, adapt to a gentler breathing practice, or stop.

3. Guiding principles

  • Water and driving are absolute exclusions. Never discuss the breathing as something to do before or during swimming, diving, bathing, showering, cold plunges or driving, or anywhere a blackout could injure. [source: WHM safety warnings; WHM practice page]
  • Breathing and cold are kept apart. The company's own FAQ says to breathe normally during water-based cold exposure; reinforce this every time cold comes up. [source: WHM FAQ]
  • Screen before endorsing. Use the developer's contraindication list as the minimum, and add the wider breathwork cautions below. [source: WHM FAQ; synthesis]
  • Fainting is a stop signal, not a milestone. The company says fainting means you "went too far". Treat any loss of consciousness as a reason to stop and get a medical review. [source: WHM safety warnings; synthesis]
  • Gradual, without force. The developer says to practise "without force" and to "listen to your body". Therapeutic meaning: no challenge framing, no competing, no chasing personal records. [source: WHM safety warnings]
  • The therapist does not set doses. No breath-hold timings, round counts, cold temperatures or exposure durations come from the therapist. Questions about technique go to the official materials or a certified instructor. [synthesis]
  • Claims are attributed. Present immune and health effects as research findings or as the developer's claims. Never present the method as a treatment for illness, and never suggest changing medicines. [source: Almahayni & Hammond 2024 via Scimex; synthesis]
  • Roles stay clear. Psychotherapy is the frame; WHM is an adjunct the client chooses. A therapist who is also an instructor should state which role they are in, and should consider not combining the roles with the same client. [synthesis]
  • Arousal is the active ingredient, so it is a clinical risk. Kox et al. documented respiratory alkalosis, hypoxia and an adrenaline surge. For clients with panic, trauma or psychosis, that physiology can be destabilising. [source: Kox et al. ICMx 2014; synthesis]
  • Never alone near risk. Recommend that no part of the cold pillar is ever done alone, and that the client knows cold-shock self-rescue. [source: Float to Live (University of Portsmouth); synthesis]

4. Intervention inventory

The developer publishes three practices: the breathing exercise, graded cold exposure, and mindset training (Section 2A). Teaching them is the work of the official courses and certified instructors, so the inventory below sets out the psychotherapist's procedures around a client's WHM practice. The breathing exercise combines hyperventilation with breath retention. That combination causes the blackout and drowning risk described in the Harm account, and every item below keeps it on dry land. [source: WHM practice page; WHM safety warnings; synthesis]

4.1 Medical and psychiatric screening

  • Purpose / when: before endorsing or discussing WHM practice, whenever a client mentions starting it, and again if health changes.
  • Steps:
    1. Ask about the conditions the developer advises against practising with: coronary heart disease (including angina), heart failure or previous stroke, high blood pressure treated with prescription medication, epilepsy, kidney failure, cold urticaria, Raynaud's syndrome (type II), and the period shortly after surgery. Ask about pregnancy, which the company advises against. Ask about migraine, where the company urges caution with ice baths. [source: WHM FAQ; WHM safety warnings]
    2. Ask the wider breathwork questions the developer does not list: panic disorder, psychosis or bipolar disorder, severe PTSD or dissociation, current suicidality, glaucoma or retinal problems, asthma or COPD, and fainting history. [synthesis: general intense-breathwork caution; not on the WHM list]
    3. Ask about alcohol and other substance use, and about swimming and open-water habits (cold-water swimming, ice baths, saunas, free-diving, spearfishing). [synthesis]
    4. For people under 16, the company asks for parental supervision. Involve parents and safeguarding thinking. [source: WHM FAQ]
    5. If any medical item is positive, ask the client to get clearance from their own doctor before practising, and document it. [source: WHM safety warnings; WHM FAQ]
  • Example language (illustrative): "Before we talk about how this might fit your goals, I'd like to run through some health questions. The method's own website lists conditions where it advises people not to do it, and I add a few that matter for intense breathing generally."
  • Watch for: minimising ("it's only breathing"); a client who has already practised despite a contraindication; undisclosed panic or dissociative episodes during earlier breathwork. It is working when the client answers fully and agrees to seek clearance where needed.

4.2 Informed consent and the safety rules

  • Purpose / when: after screening and before any practice. Repeat it whenever the client's context changes (a holiday by water, a new ice-bath habit, a retreat).
  • Steps:
    1. Explain the expected effects as the developer and researchers describe them: lightheadedness, tingling, involuntary hand and foot contractions from CO2 changes, possible fainting, a strong adrenaline surge, and intense emotion. [source: WHM FAQ; WHM safety warnings; Kox et al. ICMx 2014]
    2. State the rules in the developer's own terms: never before or during diving, driving, swimming or bathing, never in the shower, and never anywhere a blackout could cause injury. Practise seated or lying down on a couch or floor. [source: WHM safety warnings; WHM practice page]
    3. Explain why. Hyperventilation lowers carbon dioxide and delays the urge to breathe, so oxygen can fall to the point of unconsciousness without warning. In water this is silent and can be fatal. [source: NPR 2015 on the CDC report; Live Science 2024]
    4. Agree a personal plan: where they will practise, never in water or a vehicle, with someone nearby if possible, and never combining the breathing with a cold plunge. [synthesis]
    5. Ask the client to explain the rules back in their own words; record the conversation. [synthesis]
  • Example language (illustrative): "The breathing part has one rule that matters more than any other: it only ever happens sitting or lying down on dry land. Not in a bath, not in the shower, not in a pool, not before swimming, not in a car. The reason is that it can switch off the warning signal that tells you to breathe, and people have drowned without struggling."
  • Watch for: the client planning to "breathe first, then get in"; plans to practise alone in a bath; adolescents copying online videos. It is working when the client's own plan includes the water and driving exclusions without prompting.

4.3 Psychoeducation on hyperventilation effects and panic

  • Purpose / when: for any client practising the breathing, and especially clients with anxiety or panic, for whom the symptoms can mimic or trigger an attack.
  • Steps:
    1. Name the common sensations (tingling, lightheadedness, cramp-like tightening of hands or feet) and explain the CO2 mechanism. The company calls the contractions harmless without pre-existing conditions and advises medical review if they are painful. [source: WHM FAQ]
    2. Agree stop rules: stop and return to ordinary breathing on chest pain, palpitations, severe headache, visual change, confusion, painful cramping, panic escalating rather than settling, or any fainting. [synthesis]
    3. For panic clients, discuss with them whether the practice works as interoceptive exposure or as a safety behaviour. Prefer structured, therapist-led interoceptive exposure within CBT over unsupervised WHM. [synthesis]
    4. Agree that after any faint, practice is paused until a medical review. [synthesis; the company's own wording treats fainting as having "gone too far"]
  • Example language (illustrative): "Tingling and light-headedness come from breathing off a lot of carbon dioxide. They aren't dangerous in themselves when you're lying on the floor, but they are a sign of a big change in your body. If it turns into chest pain, a pounding heart that frightens you, or you feel yourself blacking out, stop and breathe normally. And let me know."
  • Watch for: catastrophic interpretations; avoidance spreading to ordinary exercise; or the opposite, chasing the "rush". It is working when the client can describe the symptoms calmly and follows the stop rules.

4.4 Cold-shock and cold-safety psychoeducation

  • Purpose / when: whenever the client takes up the cold pillar, cold-water swimming or ice baths.
  • Steps:
    1. Explain cold shock: sudden immersion triggers an involuntary gasp and loss of breathing control in the first minutes. One gasp underwater can begin drowning. Heart rate and blood pressure rise sharply, which strains the heart. Putting the face in the water can cause "autonomic conflict" with possible arrhythmias. [source: Float to Live (University of Portsmouth); Live Science 2024 quoting Tipton]
    2. Restate the developer's rules: build up gradually, skip cold when ill, take care with ice baths in migraine, observe the contraindications (e.g. Raynaud's, cold urticaria, heart disease), and breathe normally in water, never using the breathing technique there. [source: WHM FAQ; WHM safety warnings]
    3. Teach the Float to Live response for unplanned immersion: resist thrashing, lie back and float until breathing is under control, then call for help or swim to safety. [source: Float to Live]
    4. Recommend never doing cold-water exposure alone, and getting medical advice first for anyone with a cardiac history. [synthesis; Live Science 2024 citing NOAA on vulnerable people]
  • Example language (illustrative): "Cold water has its own risk, separate from the breathing. The first gasp is involuntary. So the rule is: plain, normal breathing in the cold, someone with you, and if you ever end up in cold water unexpectedly, float on your back until your breathing settles."
  • Watch for: stacking the breathing before a plunge; head-under immersion; practising alone; self-punishing endurance. It is working when the client keeps the cold practice separate from the breathing and never practises it alone.

4.5 Referral to official materials or a certified instructor

  • Purpose / when: the client wants to learn the method. The therapist directs them to the official materials and certified instructors rather than teaching it. [synthesis]
  • Steps:
    1. Point to the official Master Class or courses, or to an instructor in the official directory. Certification involves online modules covering safety measures and an in-person assessed training. [source: WHM practice page; WHM Academy page]
    2. Suggest the client ask the instructor how they screen health conditions, whether breathing is ever combined with water or ice baths, how they supervise cold exposure, and what they do if someone faints. [synthesis]
    3. With consent, share relevant clinical cautions with the instructor. [synthesis]
    4. Note that certification is a company credential, not a health-care qualification. The Academy page sets no health-care degree requirement and states no recertification rule. [source: WHM Academy page]
  • Example language (illustrative): "If you'd like to learn it properly, the official course or a certified instructor is the place. A good question to ask any instructor is whether they ever do the breathing in or next to the ice bath. The right answer is no."
  • Watch for: uncertified "Wim Hof-style" sessions; retreats that pair breathing with plunges; instructors who brush off health questions. It is working when the client picks an instructor whose answers match the published safety rules.

4.6 Monitoring practice between sessions

  • Purpose / when: while the client practises, to track effects and safety without setting targets.
  • Steps:
    1. Invite a brief diary: setting (room, position, alone or not), sensations, mood before and after, sleep, any faint or near-faint, any water or cold context. No hold times, round counts or exposure records. [synthesis]
    2. Review it briefly at the start of sessions; ask directly about water, driving and fainting. [synthesis]
    3. Note escalation: competing with apps or friends, extending practice, using it to manage distress compulsively. [synthesis]
  • Example language (illustrative): "I'm not interested in how long you held anything. I'm interested in where you were, how you felt afterwards, and whether anything worried you."
  • Watch for: fixation on numbers, leaderboards and personal bests; secrecy about water practice; sleep loss or agitation. It is working when the diary shows dry-land practice, stable mood and no faints.

4.7 Integrating WHM experiences into psychotherapy

  • Purpose / when: the client reports emotional, bodily or meaning-laden experiences from practice, or uses the "mindset" pillar language of willpower and commitment.
  • Steps:
    1. Explore the experience descriptively: what happened in the body, what emotion arose, what it meant to them. [synthesis]
    2. Link it to treatment goals, for example tolerance of discomfort, self-efficacy, or the difference between willpower and self-compassion. [synthesis]
    3. Attribute claims about "controlling" the immune or nervous system to the developer and the research. Correct over-reaching beliefs, such as using it instead of medical treatment. [source: WHM science page; Almahayni & Hammond 2024 via Scimex]
    4. If intense altered states or re-experiencing of trauma arise, slow down, ground, and reconsider whether this breathing suits the client (see Domain VII Holotropic Breathwork guide for intense breathwork integration). [synthesis]
    5. Work with any perfectionist or punitive "push through" stance that the commitment framing may feed. [synthesis]
  • Example language (illustrative): "You said the cold made you feel you could face anything. Let's look at that. What part of that feeling is useful for the situations we're working on, and is there any part that tells you to ignore pain or warning signs?"
  • Watch for: grandiosity or elation after practice; dissociation; self-harm-like use of cold; abandoning medication. It is working when insights carry over into daily coping without riskier practice.

4.8 Adapting, substituting or stopping

  • Purpose / when: a contraindication is present, the client destabilises, or the practice becomes risky or compulsive.
  • Steps:
    1. Offer gentler, therapist-deliverable options: slow-paced or resonance breathing, cyclic sighing, diaphragmatic breathing (see the separate breathwork guides in this domain). [synthesis]
    2. For the cold pillar, suggest stopping or limiting it to the company's own entry point, a cold finish to an ordinary shower, with normal breathing and medical clearance where relevant. [source: WHM practice page; WHM FAQ]
    3. If the client stops, review what they valued and find safer ways to keep it (energy, ritual, a sense of mastery). [synthesis]
  • Example language (illustrative): "With your heart history, this particular breathing isn't one I'd encourage. But what you liked about it, the feeling of taking charge of your state, we can build with a slower breathing practice we can do together here."
  • Watch for: feeling deprived or defiant; continuing in secret. It is working when the client adopts a safer alternative and keeps the gains they valued.

4.9 Responding to an adverse event

  • Purpose / when: the client reports fainting, injury, a cold-water emergency, or a frightening psychological reaction.
  • Steps:
    1. Assess immediate safety and medical need. Refer for medical review after any loss of consciousness, any immersion incident, chest symptoms or neurological symptoms. [synthesis]
    2. Pause practice until reviewed; document. [synthesis]
    3. Screen for acute stress, panic sensitisation and shame. [synthesis]
    4. With consent, inform the instructor or the company if teaching contributed. [synthesis]
  • Example language (illustrative): "Blacking out is your body's emergency brake, not a sign you're doing it right. Let's get you checked by a doctor before anything else, and stop the breathing until then."
  • Watch for: the client reframing the faint as an achievement; unreported near-drownings. It is working when the client gets a medical review and the practice changes.

5. Handling problems

The developer's materials address safety but not psychotherapy problems. Except where a source is cited, the guidance in this section is [synthesis].

  • The client intends to practise in or near water (bath, pool, shower, ice bath, open water) or before swimming or driving. This is the highest-risk problem. Name it directly, restate the developer's own warning against practising "before or during diving, driving, swimming, or bathing", and explain silent blackout. Ask for a specific commitment, and revisit it at each session. [source: WHM safety warnings; NPR 2015] If the client is a minor, involve parents and follow safeguarding procedures. [source: WHM FAQ; synthesis]
  • The client copies videos rather than the written guidance. The journalist Scott Carney is reported as saying the method is safe if followed from the written website guidance but dangerous if Hof's videos are treated as examples. The company has said a widely shared video is "not part of the standard curriculum". Ask what the client watches, and redirect them to the written safety rules. [source: Live Science 2024]
  • Pushing, competing, record-chasing. Reframe the practice away from performance. Remove numbers from monitoring, and point to the developer's own "without force" and "listen to your body". Explore the perfectionism or self-punishment underneath. [source: WHM safety warnings; synthesis]
  • Panic triggered or sensitised. Stop WHM breathing. Return to structured interoceptive exposure and slow breathing within CBT. Normalise the symptoms without endorsing avoidance. [synthesis]
  • Overwhelm, dissociation, re-experiencing. Ground (orienting, feet on floor, naming surroundings) and pause the practice. Re-screen for PTSD and dissociative disorders, and consider whether intense breathwork is suitable at all (see Domain VII Holotropic Breathwork guide). [synthesis]
  • Elevated mood, reduced sleep, unusual beliefs after practice. Assess for hypomania or emerging psychosis, stop the practice, and liaise with the prescriber or psychiatrist. [synthesis]
  • Using WHM instead of medical treatment. Attribute the immune findings to small laboratory studies. Note the independent review's judgement of small trials with high risk of bias, and never advise changing medication; refer back to the prescriber. [source: Almahayni & Hammond 2024 via Scimex; synthesis]
  • Non-adherence to the safety rules after agreement. Explore the function (thrill, proving toughness, social pressure in a group). Bring in a support person with consent. If risk to life persists, document and treat it as a risk-management issue. [synthesis]
  • Rupture: the client feels judged or "medicalised". Acknowledge what they value in the method. Separate the person from the risk, and explain that the cautions come from the developer's own warnings as well as from medicine. [synthesis]
  • The therapist is also a certified instructor. The client may feel pressure to adopt the method. Disclose the dual role and offer referral to another instructor. Keep the psychotherapy contract primary, and check your own professional code on combining roles. [synthesis]
  • Group or retreat context. Social pressure and the novelty of the setting raise risk. Advise the client to check, before booking, that breathing is never done in or beside water and that cold exposure is supervised. [synthesis]

Harm account

What was actually done

  • The practice linked to harm. The deaths reported by the press involve the WHM-style cycle of hyperventilation followed by breath retention done just before, or during, immersion in water: backyard pools, baths, ice baths or open water, often by someone alone. Underwater breath-holding videos of Hof circulated alongside it. The breathing structure is described here qualitatively only. [source: Outside 2023; Live Science 2024; DutchNews 2024]
  • Videos and messaging. Live Science (April 2024) reported concern from cold-water physiologist Mike Tipton about a 2021 Hof video. Tipton called its actions among the most dangerous things one can do in cold water. A company spokesperson, Isabelle Hof, said that video is not part of the standard curriculum and not an instructional guide. DutchNews reported critics' view that pictures of a submerged Hof contradict the course warnings and can cause confusion. Outside reported Innerfire's statement that it had removed videos showing breathing before water entry. [source: Live Science 2024; DutchNews 2024; Outside 2023]
  • The Long Beach case (California). Outside (Frederick Dreier, 30 June 2023) reported the following. A 17-year-old girl was found face down in her family's backyard pool in Long Beach on 10 August 2022, and paramedics could not revive her. The Los Angeles County medical examiner ruled the death accidental drowning, with clean toxicology and no sign of a heart abnormality. In December 2022 her father, a lawyer, sued Wim Hof, Innerfire BV and the girl's mother in a California superior court. The suit alleges she did Wim Hof breathing shortly before entering the pool and drowned in shallow water after becoming hypoxic, despite being an excellent swimmer. It claims negligence, fraudulent concealment, unfair business practices and false advertising, seeks $67 million, and asks for court-ordered warnings that the method "should never be done in water due to the risk of drowning and death". [source: Outside 2023]
  • The company's denial. Innerfire's CEO, Enahm Hof (Wim Hof's son), called the allegations "plainly not true". He said the company warns against doing the breathing before entering water on its website, in app pop-ups, in its FAQs and in its teacher academy. Hof and Innerfire first moved to dismiss on jurisdictional grounds. [source: Outside 2023] Scott Carney's blog reported that the court denied the jurisdictional dismissal. [source: Scott Carney blog, post dated 21 October, year not shown; uncertain: no public court record of this ruling is cited] DutchNews (July 2024) reported that the California court then ruled in Hof's favour. The judge said no proof had been submitted that the girl was doing the breathing in the pool when she drowned, or that it caused her death. The father's lawyer said he would appeal. [source: DutchNews 2024; NL Times, 3 July 2024, citing the Volkskrant and both sides' lawyers; uncertain: these are press reports, not court records, and the outcome of any appeal is unknown]
  • Other reported deaths. Live Science reports that the Dutch newspaper Het Parool reported in 2016 that at least three people had died after combining WHM breathing with water immersion. DutchNews (2024) states that about a dozen drownings have been linked to the exercises. Carney has documented 18 linked deaths on his blog and told Live Science of 31, mostly drownings, drawn from news reports and private accounts; Live Science notes none had been confirmed in court as involving the method. Outside reports that the nonprofit Underwater Hypoxic Blackout Prevention was contacted in 2022 by the family of a man who drowned in a backyard ice bath while doing similar breathing. Carney's blog relays a Volkskrant investigation reporting that bereaved families said Innerfire ignored injury and death reports for years. Enahm Hof, quoted in the same post, said the company has warned of the risk in its official videos since 2015. [source: Live Science 2024; DutchNews 2024; Outside 2023; Scott Carney blog; uncertain: counts are not independently verified and the Volkskrant article itself is not verified]

How it caused harm

  • Hypocapnia and silent (shallow-water) blackout. People normally feel the urge to breathe from rising carbon dioxide, not falling oxygen. Hyperventilating before a breath-hold blows off carbon dioxide and delays that urge, so oxygen can fall far enough for unconsciousness before the person feels any need to surface. Low CO2 also narrows cerebral blood vessels and reduces brain blood flow. Blackout can occur without water, but in water it leads to drowning. [source: NPR 2015; Live Science 2024]
  • No warning, no struggle. Victims usually do not struggle, so companions and lifeguards find it hard to notice. Britt Jackson of Underwater Hypoxic Blackout Prevention describes the pre-blackout feeling as euphoria rather than air hunger. Experienced and strong swimmers are not protected, and shallow water gives false security. [source: NPR 2015; Outside 2023]
  • The New York data. NPR (May 2015) reported a CDC report led by Christopher Boyd that documented 16 shallow-water blackouts in New York State from 1988 to 2011, four of them fatal. About a third came from games or spontaneous breath-holding contests among recreational swimmers. Boyd called it "an entirely preventable injury". These cases were not linked to WHM; they show the mechanism. [source: NPR 2015]
  • Cold shock. Sudden cold immersion triggers an involuntary gasp. A single gasp underwater can start drowning. It also causes loss of breathing control and a surge in heart rate and blood pressure, a risk for heart failure and stroke in vulnerable people. Face immersion adds a heart-slowing reflex to the heart-speeding cold response, an "autonomic conflict" that may cause arrhythmias. The developer itself warns of hypothermia from irresponsible cold practice. [source: Float to Live (University of Portsmouth); Live Science 2024 citing Tipton and NOAA; WHM safety warnings]
  • Who was most at risk. People who combined the breathing with water, especially cold water; people practising alone; adolescents and young people copying videos; people with cardiac or vascular conditions; competitive or record-chasing practitioners. [source: Live Science 2024; Outside 2023; NPR 2015; synthesis]
  • Psychological sequelae. None are documented in the sources reviewed beyond bereavement and the litigation itself. Clinically expect traumatic grief, blame within families (the father's suit named the mother as a defendant and she cross-complained), and, in survivors of near-drowning, possible hypoxic injury and post-traumatic stress. [source: Outside 2023; synthesis]

Recognising it today

  • Features and phrases. Social-media clips of power breathing followed by a plunge or an underwater hold. Ice-bath studios or retreats that guide breathing at the tub's edge or in the water. "Breathe, then get in" routines. Breath-hold timers and leaderboards. Challenge language ("push past", "go deeper", "beat your record"). Reframing fainting as progress. [synthesis; Live Science 2024 and Outside 2023 for the breathe-then-submerge pattern]
  • Rebrandings. "Wim Hof-style", "power breathing", "breath and ice", "cold-plunge breathwork", or free-diving-style hyperventilation offered by uncertified providers. [synthesis]
  • Red flags in a colleague's or a group's practice. Breathing taught in or beside a pool, hot tub, bath or ice bath. No health screening, and contraindications ignored. Participants left unsupervised. Competitive holds. Minors without guardians. Dismissing the company's own warnings. Health claims of cure. [source: WHM safety warnings; WHM FAQ; synthesis]
  • How the legitimate version differs. The developer's own rules: breathing only seated or lying on dry land, never in water, the shower or a vehicle. Normal breathing during any cold exposure in water. Gradual cold exposure. Screening and medical consultation for listed conditions. Parental supervision for under-16s. [source: WHM safety warnings; WHM FAQ; WHM practice page]

What to do instead and how to help those harmed

  • Safer alternatives. For arousal regulation, choose slow-paced or resonance breathing, cyclic sighing or diaphragmatic breathing, which a psychotherapist can deliver (see the other breathwork guides in this domain). Avoid any breath-holding or hyperventilation in water. For cold-water activity, use normal breathing and never go alone, with Float to Live as the emergency response and medical clearance for cardiac risk. [source: Float to Live; WHM FAQ; synthesis]
  • Assessing affected clients. For survivors of a blackout or near-drowning: get medical follow-up, and refer for neuropsychological assessment if there was prolonged unconsciousness or cognitive change. Screen for PTSD, panic and avoidance of water, and treat with evidence-based trauma therapy. [synthesis]
  • Bereaved families. Assess for traumatic and complicated grief and for guilt, especially in a parent who introduced the method. Recognise litigation stress and media exposure. Offer grief-focused therapy, and do not take sides in legal disputes. Keep careful records in case they are subpoenaed. [source: Outside 2023 for the family-litigation context; synthesis]
  • Ethical, reporting and legal duties. Treat practising breathing in water as a risk to life. Document advice given, and follow safeguarding procedures for minors. With consent, raise concerns with the provider, Innerfire (which certifies instructors), or the venue. Report unsafe commercial practice to consumer-protection or local authorities where relevant. Clinicians who promote or teach WHM should give the water warning explicitly, because the developer's disclaimers do not transfer liability away from the person who teaches. [synthesis; uncertain: specific regulatory routes vary by country and were not verified]

Sources

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