Box breathing, sometimes called square breathing, is a simple tool for managing anxiety.

A racing heart, rapid breathing, and dizziness can make people with anxiety feel out of control. Controlled, slow breaths can support a regained sense of control, offering relief from anxiety and panic attacks.

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Practicing breathing techniques, such as box breahting, may help to ease anxiety and manage panic attacks.

Like the four corners of a square, box breathing requires only four steps, each of which requires participants to count to four.

To try box breathing, a person should get into a comfortable position that makes it easy to breathe freely. They should then follow these steps:

  1. Breathe in through the nose while counting to four. Continue inhaling for the entire 4 seconds. The breath should be slow and steady.
  2. Hold the breath in the lungs for another count of four.
  3. Exhale through the mouth while counting to four. As with the inhale, the exhale should be slow and steady.
  4. Continue repeating this pattern for 4 minutes.

People with a history of fainting, who feel dizzy during deep breathing, or who have cardiovascular health problems should talk to a doctor before trying any breathing technique.

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When practicing box breathing, it is important to relax the body and find a comfortable position. This may be a sitting position, or lying down.

Breathing is something that everyone does naturally, but people with anxiety sometimes develop unhealthy breathing habits, during stressful or anxiety-provoking situations.

To get the most out of box breathing, people should practice mindful breathing, remaining conscious of each breath and how it feels.

Some strategies to increase the effectiveness of box breathing include the following:

Practice diaphragmatic breathing

Deep breathing uses the diaphragm, the muscle that helps the lungs pull in oxygen. This technique is also called diaphragmatic breathing.

To master diaphragmatic breathing, a person needs to practice expanding their abdomen when inhaling and contracting it when exhaling.

Diaphragmatic breathing does not always feel natural to people who are used to chest breathing, which is a shallower form of breathing where it is the chest muscles that move mostly, during inhalation and exhalation.

People with anxiety should practice diaphragmatic breathing, as frequently as possible. Taking 5-10 deep breaths throughout the day can supplement box breathing. It also helps the body "remember" how to breathe correctly during a box breathing session.

Choose a comfortable position

Bad posture can make it harder to take deep breaths. Being slumped over reduces the amount of oxygen the lungs can take in. It also makes it more difficult to breathe into the abdomen.

People should choose a comfortable position, but not one that means they slump over. A comfortable chair with a sturdy back is an ideal location to try box breathing. Lying flat on the back also works well.

Relax the body

Some people with anxiety unconsciously tense up their muscles. This can cause muscle pain, make it more difficult to breathe, and make anxiety worse. Before or after a box breathing session, people should try a simple strategy called progressive muscle relaxation.

Beginning with the toes, slowly and steadily tense and then relax each muscle in the body. This exercise supports awareness of muscle tension and, similarly to controlled breathing, can help people with anxiety regain a sense of control over their bodies.

Try visualization

Just as box breathing can help people with anxiety slow their breaths, visualization exercises can help slow a flood of anxious thoughts.

Try visualizing a relaxing and peaceful scene. It can be an imaginary place or a place that has always felt safe. Beaches, mountains, and quiet rooms are popular places to visualize.

People who have lots of overwhelming thoughts while breathing can find visualization particularly helpful because it gives the brain something else on which to focus.

Know that practice makes perfect

Box breathing is a skill just like throwing a ball or typing. It takes time to perfect. At first, it can feel uncomfortable. Some people even get dizzy because they are not used to slow, deliberate breathing.

It is important to understand that the effects of breathing techniques tend to get better with practice. Try several sessions each day to perfect the technique.

It is hard to think clearly during an anxiety attack, especially when the mind is flooded with anxious thoughts. Practicing box breathing during times of calm can make the process easier and more familiar when anxiety strikes.

Some people may also find that visualizing a physical box helps. This makes it more difficult for the mind to jump from one anxious thought to another and serves as a cue for the breathing technique.

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Other methods for treating anxiety include group therapy, medication, and psychotherapy.

Anxiety is more than just an emotion. It is a physical experience, as well.

People experiencing panic attacks may hyperventilate or take only shallow, quick breaths. Some even hold their breaths without realizing that is what they are doing. This lack of oxygen can make anxiety worse, creating a vicious cycle of oxygen deprivation and anxiety.

When there is less oxygen in the blood, the brain gets less oxygen. That makes it hard to think clearly and may even affect vision. As a result, people experiencing intense anxiety can benefit from simple techniques that are easy to remember.

Box breathing does not require special skills or equipment, and its emphasis on four steps and four counts makes it easy to remember, even in the middle of a panic attack.

Breathing techniques, including box breathing, do not treat the underlying cause of anxiety. Breathing techniques can, however, give people with anxiety a greater sense of control over their anxiety and help them manage their situation with less difficulty.

Anxious people often fear having an anxiety attack. Knowing that a simple technique can reduce their anxiety may help them to feel more secure.

Someone with an anxiety disorder, such as post-traumatic stress disorder (PTSD), or panic disorder may need other treatments to get relief. Those treatments include:

  • Psychotherapy - therapy can address the causes of anxiety, including trauma. CBT, or cognitive behavioral therapy, which helps people understand and control automatic thoughts, is particularly helpful.
  • Medication - a wide range of medications can help with anxiety. Anti-anxiety drugs such as Xanax and Klonopin work on an "as needed" basis. Some people with anxiety also use anti-depressants. These drugs can take several days or weeks to work and must be taken each day.
  • Self-help groups - support groups offer people with anxiety the chance to discuss their feelings and learn from the experiences of others, facing similar difficulties.
  • Lifestyle remedies - a range of lifestyle remedies can help, including dietary changes such as avoiding caffeine. Some people with anxiety find that their symptoms improve with regular exercise.
  • Managing stress - stress reduction, self-care strategies to manage times of stress, support from friends, and positive self-talk can help with anxiety.
  • Clinical trials - some people with anxiety cannot find relief with traditional methods. Clinical drug trials offer the possibility of relief from experimental drugs. Some clinical trials also use new therapeutic techniques or lifestyle remedies to tackle anxiety.

Practicing box breathing helps people get better at it and to know when to try using it. This means that, over time, box breathing may more quickly reduce anxiety symptoms. As a result, it is possible to see improvements in anxiety over time by using this technique.