Anxiety and Box Breathing

In our daily lives, there are many moments when everyone may feel anxious, overwhelmed by stress, or unable to cope. When this happens, practicing breathing techniques is a simple way to relax, which can help you feel calm and reduce feelings of stress or anxiety. It can also assist you in controlling and managing your emotions.

There are many different breathing exercises that can be used to relieve anxiety and stress. In this article, we will explore a simple and effective technique called "Box Breathing" and explain the scientific principles behind it.

Yup, just breath like a square box: 1,2,3,4

What is Box Breathing?

Box Breathing (also known as Square Breathing) is a type of conscious breathing technique that can be used to help reduce the body's "fight or flight" response. It is also called "Square" or "Four-Square" breathing. The practice involves inhaling and exhaling for four equal counts, while imagining each count as one side of a square box.

Therefore, box breathing is a very practical and effective relaxation technique when you are under stress, feeling anxious, or in a state of panic. It can also help you manage your emotions in difficult situations. By consciously regulating your breathing in this way, you can activate the body's natural relaxation response, trigger the parasympathetic nervous response, which is the "rest and digest" state. This helps regulate your breathing, allows you to regain a sense of calm, and soothes the nervous system.

Since box breathing is an extremely simple technique, it means you can easily practice it anywhere, such as while working at your desk, on a train, or even in a café. It is called box breathing because this technique encourages you to visualize a box in your mind while you are breathing. By focusing on this visual image and the breathing pattern, it sends a signal to the body to relax, which helps lower the heart rate and reduce anxiety.

What are the steps of Box Breathing?

Box breathing is a relaxation technique that can help reduce stress and anxiety. All you need to do is focus on your breath when you inhale, hold your breath for a few seconds, exhale slowly, and then pause for a few more seconds. When you do this, it will help your body and mind relax.

Here are the steps:

1. Get into a comfortable position. Ideally, your back should be supported, and your feet should be flat on the ground.

2. Close your eyes, inhale through your nose while counting from 1 to 4, and focus on the feeling of your breath.

3. Pause and hold your breath, also counting from 1 to 4.

4. Exhale slowly, counting from 1 to 4.

5. Pause and hold your breath again, counting from 1 to 4.

6. Repeat the above process at least three times, or until you feel calm.

7. This method is also applicable when you feel low in energy or tired.

For the best results, it is recommended to repeat these steps for 5 minutes, or adjust the time according to your actual needs. If it is difficult for you at the beginning, you can shorten the count to "3", and gradually extend the count as you keep practicing.

You can also use guided breathing exercises, which usually come with visual guidance and may even include healing music. The following video is a simple 5-minute guided box breathing exercise (with a longer exhalation time, which you can follow along with).

Why does extending the exhalation time help relieve anxiety?

Extending the exhalation time can help you calm down because it activates the parasympathetic nervous system. The parasympathetic nervous response is responsible for relaxing the body and putting it into the "rest and digest" state.

When you extend the exhalation time, it's like sending a signal to your brain that everything is okay and there's no need to panic. This helps reduce stress levels, activates the body's relaxation response, and makes you feel more calm and relaxed. In addition, when you focus on your breath while activating the parasympathetic nervous response, it allows you to be more in tune with your body's feelings and be aware of your emotional state in each moment.

Therefore, extending the exhalation time when practicing box breathing can train your brain to be more sensitive to your body's sensations and learn to calm your emotions through breathing in a timely manner before engaging in daily activities or facing stressful situations.

The scientific principle of how Box Breathing works

As mentioned before, box breathing works by activating the body's natural relaxation response. When you inhale deeply and slowly, your heart rate slows down, your blood pressure drops, and your body relaxes. This is because when you inhale through your nose, it activates the parasympathetic nervous system, which in turn slows down the heart rate and reduces stress. At the same time, exhaling slowly helps relax tense muscles and alleviates the physical discomfort caused by anxiety or stress. Eventually, it allows you to feel relaxed both physically and mentally again and regain control of your emotions.

How to incorporate Box Breathing into daily life?

The key to incorporating box breathing into your daily life is regular practice. It is recommended to set aside a few minutes each day for this practice, find a comfortable environment, and focus on your breathing. If possible, you might choose to practice in a natural outdoor environment or in a quiet, undisturbed space. In addition, you can try adjusting the time length of each stage of the breathing cycle to make the practice more natural and easier over time. Through continuous practice, box breathing can become a powerful stress-reducing tool that helps you stay calm and relaxed throughout the day.

How often should you practice Box Breathing to relieve anxiety?

To achieve long-term results and fully exert its calming effect, deep breathing exercises need to be practiced daily. It is recommended to practice for at least 5 minutes a day, which can significantly help reduce stress and manage feelings of anxiety or panic. In addition, you can also break down box breathing into small practices of about 2 minutes each and incorporate them into your daily life, especially in moments when you feel stressed or overwhelmed.

When is the best time to practice Box Breathing to relieve anxiety?

The best time to practice box breathing is in the morning, before starting your daily activities. Through this practice, you can have the opportunity to relax your body and mind and concentrate your attention before embarking on a busy day. If you feel anxious or stressed in the morning, this practice can be particularly helpful. Research also indicates that incorporating box breathing into your morning routine can help maintain a lower stress level throughout the day.

If you often feel stressed in the evening, box breathing can also be an effective tool for relaxation before bed. Through practice, it can not only help you relieve the stress and anxiety accumulated during the day but also improve the quality of your sleep.

No matter when you choose to practice box breathing, it is an effective and simple way to manage stress and reduce anxiety. With continuous practice, you will find that your body and mind gradually become more relaxed, and you are less likely to feel anxious due to external factors.

How does Hypnotherapy work for Anxiety?

Anxiety is often very troubling, often accompanied by persistent worry and tension, which seriously affects all aspects of daily life. Hypnotherapy can help you address the thoughts and reactions that trigger anxiety while relaxing your body and mind, naturally breaking the troubling cycle of anxiety.

For clients with anxiety disorders, combining relaxation techniques such as box breathing and progressive muscle relaxation with hypnotherapy often yields better results. Because relaxation is the foundation for reducing stress and anxiety, a person cannot be in a state of relaxation and tension simultaneously. Therefore, the combination of breathing exercises and hypnotherapy has a significant effect on relieving symptoms of anxiety and stress.

In my hypnotherapy process, I use Solution-Focused Brief Therapy (SFBT) and combine it with hypnotherapy techniques. Through conversation, we will explore together the ideal life you desire after getting rid of anxiety. Then, through deeply relaxing hypnotherapy, we will alleviate stress and anxiety, and at the same time, inject positive suggestions into your subconscious mind to help you get rid of the anxiety response and focus on creating a positive and confident future.

If you need advice or assistance when facing stress or anxiety, you are welcome to contact us at any time to make an appointment for a free initial consultation. We can further understand your situation, assess whether hypnotherapy is suitable for you, and develop a personalized treatment plan. Take the first step towards change now!

References

Agnello R.N. (2025). Current Literature Review: Chronic Pain and the Use of Box Breathing Technique. American Journal of Biomedical Science & Research, 25(6). DOI: 10.34297/AJBSR.2025.25.003380. This review discusses box breathing’s potential to reduce chronic pain and improve emotional regulation via autonomic nervous system modulation

Andas A.M., Sansuwito T., Said F.M. (2023). The Effect of Box Breathing on Sleep Disorders in Elderly at Tresna Werdha Social Institution. Malaysian Journal of Medicine and Health Sciences, 19(SUPP9), 197-204. This controlled study demonstrated statistically significant improvement in sleep quality in elderly participants practicing box breathing

Brown R.P., Gerbarg P.L. (2023). Brief structured respiration practices enhance mood and reduce negative emotion including state anxiety. PMC, 2023. This research showed box breathing reduces negative emotions and anxiety while improving mood and regulating autonomic nervous system activity

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