Box Breathing: The Anti-Stress Technique Used by Military Personnel and Athletes

Stress and anxiety can affect sleep, the ability to concentrate, and the way the body reacts in tense moments. A breathing technique called "box breathing" (also known as four-square breathing) is used to help the body cope better with these situations, according to the BBC.

How to practise box breathing

The method involves four equal-length stages: inhaling, holding the breath, exhaling, and another breath-hold, followed by repeating the cycle. In the classic version, each stage lasts four seconds: you inhale for four seconds, hold your breath for four seconds, exhale for four seconds, then hold your breath again for four seconds.

Breathing coach Stuart Sandeman explains that the duration of each stage can be adjusted, provided all four intervals remain equal: "These seconds can be of different lengths, but they all need to stay the same."

The technique can be used before situations we know will cause us stress, such as an exam or a presentation. There is no set duration: some people feel the effects after a few minutes, whilst others prefer to continue the exercise for around 15 minutes.

What the science says about the effects of this technique

Breathing techniques have ancient origins, found in practices such as yoga and martial arts, but box breathing has also gained popularity in modern settings, being used by military personnel and athletes alike. According to Stuart Sandeman, members of the US Navy SEALs use this method before challenging situations, as it helps them focus their attention and regulate the body's stress response.

A study conducted by researchers at Texas State University and the University of Toronto Mississauga, published in June in the journal Comprehensive Psychoneuroendocrinology, suggests that box breathing may help limit significant increases in heart rate and other physiological stress indicators.

Dr Helen Garr, a GP who treats healthcare professionals experiencing mental health difficulties, says she frequently recommends this technique to her patients: "It is one of the most powerful evidence-based techniques we have for taking control of our stress response and our nervous system."

The role of the final pause in the exercise

According to Dr Garr, the stage in which the breath is held after exhaling plays an important role. When we hold our breath after exhaling, carbon dioxide levels in the body gradually rise, and the brain, monitoring this concentration, generates the natural urge to breathe.

The doctor explains that deliberately repeating this cycle can help the body become more accustomed to fluctuations in CO₂ levels and the associated discomfort, whilst also shifting the person's attention away from stressful thoughts and towards their own body.

Personal experiences with this technique

Maria Medina, a 31-year-old woman from Florida, discovered the technique during the COVID-19 pandemic, when she was studying for a master's degree whilst working full-time. She later used it again after devastating earthquakes struck her home city of La Guaira in Venezuela — she was over 1,500 miles away and was struggling to sleep due to worry about her family and friends. "In moments when I feel like I can't do much, like when I'm lying in bed at night staring at the ceiling, I know this will help me," she says.

Maria's immediate family survived the earthquakes, but friends of hers lost their homes and loved ones: "My best friend lost her house and I know people who lost their families and friends." She continues to use the technique when she has trouble sleeping: "I think we sometimes forget to breathe — that is, to truly breathe consciously — and we underestimate the power that this could bring to our bodies and minds."

Brittany Lamm, aged 28, practises box breathing in the mornings: "I do it every morning. In fact, I did it just before you called me." She discovered the technique online during a difficult period in her personal life, and later learned other breathing exercises which she incorporates into her work as a life coach, having a background in psychology and currently training to become a licensed therapist. She also uses these exercises at the start of sessions with clients: "If we're discussing emotionally heavy topics, such as what's happening in their relationship, it makes things a little easier for them."

However, Brittany cautions that it is not a one-size-fits-all solution: "Breathing techniques are not a universal solution. There are so many different types, suited to whatever you might be feeling or going through."

Controlled breathing can be a useful tool for managing everyday stress, but it does not replace professional assessment or treatment when anxiety, insomnia, or other symptoms become persistent or severe.