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Anxiety

Try Box Breathing to Reduce Anxiety and Stress

This simple breathing technique calms your mind and body.

Key points

  • A slow, controlled breathing technique with four equal parts can help you feel calm and focused.
  • Practicing box breathing regularly, even for a few minutes daily, helps improve your body's relaxation response, like working out a muscle.
Ivan Samkov/Pexels
Source: Ivan Samkov/Pexels

A simple breathing technique called "box breathing" can reduce anxiety and is useful when feeling overwhelmed or stressed. Equal breathing, or "box breathing," is an ancient yoga practice known as sama vritti pranayama. The name comes from the breath having equal parts and is a strategy Navy Seals use to stay calm and focused. Box breathing also goes by other names:

  • Equal breathing
  • Four-square breathing
  • Square breathing
  • 4×4 breathing
  • 4-4-4-4 breathing

Many yoga breathing techniques, known as pranayama, are effective tools for lowering anxiety. Focused breath control can increase attention, calm the body and mind, and lower stress. Box breathing is a useful technique for beginners and experienced practitioners alike.

Find a comfortable seated position. This exercise should not be painful or straining–if it is, stop it or try fewer counts. You can set a timer for five minutes to help you keep track of how long you are practicing box breathing, or simply do this technique regularly for a few minutes a day.

1. Breathe out slowly, releasing all the air in your lungs.

2. Breathe in through your nose, and slowly count to four in your mind. Notice your lungs filling with air.

3. Pause here and gently hold your breath as you slowly count to four in your mind.

4. Breathe out slowly for a count of four.

5. Pause here and gently hold your breath, and slowly count to four in your mind.

6. Repeat for five cycles or if you've set a timer until your timer finishes.

Box breathing can be done when you're feeling rushed or under pressure-- whether you are waiting in line, commuting on public transportation, or traveling on a flight. Like all breathing techniques, the more regularly you practice the skill, the more readily your body can access your calming system during times of stress. Think of it like working out your relaxation muscle so that it can be there for you when you most need it.

Yoga breathing is a useful tool as part of a broader set of "bottom-up approaches" to counteract the negative effects of stress and anxiety. Bottom-up approaches activate the body's natural underlying "relaxation response." Stress and anxiety put the mind and body in a state of panic, like a fire alarm, and activate the body's "fight or flight" response through the sympathetic nervous system, releasing a cascade of neurohormones and biochemicals throughout the entire body. Boxed breathing activates instead the parasympathetic nervous system, the counteracting system that steps to soften or shut down the alarm, leading to a calmer and more relaxed body and mind.

Marlynn Wei, MD, PLLC © Copyright 2023

References

Jayawardena R, Ranasinghe P, Ranawaka H, Gamage N, Dissanayake D, Misra A. Exploring the Therapeutic Benefits of Pranayama (Yogic Breathing): A Systematic Review. Int J Yoga. 2020 May-Aug;13(2):99-110. doi: 10.4103/ijoy.IJOY_37_19. Epub 2020 May 1. PMID: 32669763; PMCID: PMC7336946.

Novaes MM, Palhano-Fontes F, Onias H, Andrade KC, Lobão-Soares B, Arruda-Sanchez T, Kozasa EH, Santaella DF, de Araujo DB. Effects of Yoga Respiratory Practice (Bhastrika pranayama) on Anxiety, Affect, and Brain Functional Connectivity and Activity: A Randomized Controlled Trial. Front Psychiatry. 2020 May 21;11:467. doi: 10.3389/fpsyt.2020.00467. PMID: 32528330; PMCID: PMC7253694.

Sharma SK, Kala N, Telles S. Volitional Yoga Breathing Influences Attention and Anxiety: An Exploratory Randomized Crossover Study. Complement Med Res. 2022;29(2):120-126. English. doi: 10.1159/000519715. Epub 2021 Nov 16. PMID: 34784592.

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