A Powerful Way to Quickly Lower Anxiety and Stress

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In my work with refugee families in different parts of the world, it became clear to me that the stressful conditions of everyday life—poverty, difficulty finding work, language barriers, social isolation, discrimination, and uncertainty about the future—were causing a lot of parents to feel incredibly stressed out. That elevated stress often made it hard for them to respond with warmth and patience to their children. It sometimes led parents to respond harshly to children’s worries and misbehaviors when they previously might have responded with patience and understanding.

In the intervention my colleagues and I developed to support refugee parents, called the Caregiver Support Intervention (CSI), we incorporated a number of simple evidence-based techniques for quickly lowering anxiety and stress. In the research we have done on the CSI, one technique has proven to be especially valued by parents and extremely useful in helping them quickly lower their stress and respond to their children with greater warmth and patience.

We call this technique “Counting the Breath,” but it’s more widely known among researchers, psychologists, yoga practitioners, and others as ratio breathing. It’s easy to learn but takes some practice to master.

I’m an enormous fan of ratio breathing, and not just in my work with refugees. I use it in my own mindfulness practice every day. I teach it to my psychotherapy clients to offer them a quick and easy way to lower their arousal during moments of stress or conflict, or to help quiet the mind for sleep. I also use it as a way to help clients find a place of calm before doing any sort of intense experiential work, such as Internal Family Systems, or “parts” therapy. When I taught yoga, I would often begin and end classes with a couple of moments of ratio breathing to help people settle into the class and later to help them quiet their minds and settle into the final resting pose of savasana. In fact, I learned ratio breathing from the wonderful yoga teacher Bo Forbes during a yoga therapy training many years ago.

What is ratio breathing?

Ratio breathing is a simple practice. For guided audio instructions, click here.

The practice is simple:

Breathe in to a count of 3, hold the breath for just a moment, then exhale more slowly, to count of 4, or 5, or 6. At the end of your exhale, hold for just a moment and then begin again. Keep your attention focused on the sensation of the breathing. If you notice your mind wandering, gently return your attention to the breath. Stress and anxiety can keep us stuck in endless thinking or rumination. Try and step back from thinking, focusing instead on the gentle sensation of the breath coming in, the brief pause, the longer, slower exhale, another brief pause, and another inhale...

There’s no “right” ratio of inhale to exhale; experiment and see what feels comfortable and helpful. In my audio recording, I guide you through 3:4 and 3:5 (inhale to exhale) ratios, but any ratio in which you extend your exhale longer than your inhale will be helpful. That’s the key element: Lengthening the exhale. I find most people prefer the 3:5 ratio, but as they start to relax, they often naturally extend their exhale to a count of 6 or even 7.

Continue for a couple of minutes. With practice, you may extend this to five minutes, or even longer. What's important to know is that even one to two minutes can be enough to quickly help you calm down and dial down the stress response.

An alternative if your mind keeps wandering during ratio breathing
If you find that your mind keeps wandering while you try ratio breathing, here's an option that may help: try humming on the exhale. The sound and physical sensation of the humming will help you focus your attention and quiet your mind, while allowing you to enjoy the benefits of an extended exhale. Moreover, there's evidence that the vibrations caused by humming may stimulate the same sort of vagal nerve and parasympathetic response as the long exhale.

What is the science behind ratio breathing?

There have been numerous studies documenting the beneficial effects of ratio breathing on stress, anxiety, sleep, heart rate variability, and mood. To learn more, click here, here, here, and here.

Why is ratio breathing so helpful? Briefly: When we inhale, we activate the sympathetic nervous system. That’s the part of our nervous system that signals danger and prepares us to fight, flee, or freeze. And when we exhale, we activate the parasympathetic nervous system (via the vagus nerve), which signals safety, shifting us out of fight-flee-or-freeze mode and into what’s commonly called “rest and digest” mode. By extending the exhale, we are simply shifting our nervous system into more of a parasympathetic state. We are dialing down the stress response and signaling to our brain through our breathing that it’s OK to relax and calm down.

When we are anxious or stressed, our breathing tends to become shallow, a reflection of our feeling threatened or unsafe in some way. Ratio breathing, which deepens and slows the breathing, signals just the opposite: that we are safe and can relax.

You may have encountered other versions of ratio breathing. Podcaster Andrew Huberman refers to it as “cyclical sighing,” a slight variation in which a deep inhale and a second smaller inhale are followed by a long sigh—an extended exhale. In yoga, there are versions of pranayama, or breathwork, that similarly adopt an extended exhale.

If you have a smartwatch or another type of heart rate monitor, it’s easy to see the effects of ratio breathing on your heart rate. Simply take a baseline reading, do one to two minutes of ratio breathing, and take another reading. It’s remarkable how quickly the practice can lower our heart rate. Why is that a big deal? Because it means we are lowering our stress and reactivity, which in turn means we’re stopping the release of stress hormones into the body, which over time can weaken our immune system and leave us exhausted, depressed, and vulnerable to illness. By lowering our arousal, we become more able to respond to challenging situations from a place of greater calm. And we become better able to step back from the worrying or self-critical thoughts that keep us locked in a state of anxiety and stress. The choices we make from a place of calm are invariably choices that serve us better than those made from a place of stress and alarm.