Box breathing: what is it, benefits, and how it works

Yael Cooperman, MD - Contributor Avatar

Reviewed by Yael Cooperman, MD, Ro, 

Written by Alyson Powell Key 

Yael Cooperman, MD - Contributor Avatar

Reviewed by Yael Cooperman, MD, Ro, 

Written by Alyson Powell Key 

last updated: Aug 19, 2021

2 min read

Relaxation techniques have been around for ages, and while some require equipment, tools, lotions, or potions, there are some you can do on your own with no equipment at all. 

If you’re looking for a simple method to help relieve stress, box breathing may be for you. Learn how box breathing works, why it’s effective, and how often you need to practice to see results.


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What is box breathing?

Box breathing is a type of deep breathing exercise. It's shown to ease stress, and there’s evidence that it may help treat anxiety, depression, and certain types of pain (Norelli, 2020).

A lot of breathing techniques widely used today originate in Eastern traditions. Mindful breathing techniques are an essential part of meditation and yoga.

If it’s your first time doing box breathing, it involves just four easy steps. Here’s how to do it:

  • Step one: Count to four as you take a deep breath in through your nose.

  • Step two: Hold your breath for four seconds. 

  • Step three: Count to four while exhaling out of your mouth.

  • Step four: At the bottom of the exhale, hold your breath for four seconds. 

  • Repeat steps one through four as needed.

As the name suggests, box breathing involves calling to mind a box with four equal sides. You can tweak the length of your breaths to fit your needs. For example, you may want to shorten each breath count to two instead of four.

What are the benefits of box breathing?

For those living with stress, anxiety, and pain, techniques like box breathing can benefit your overall wellness. 

Research shows that continued, elevated stress levels can harm your physical and mental health. It contributes to high blood pressure, mental health issues, and other health problems.

Stress can also impact the areas of your brain responsible for controlling emotions, decision-making, and high-level cognitive skills. That’s why it’s critical to employ relaxation techniques like box breathing to keep stress at manageable levels (Zaccaro, 2018).

Deep breathing techniques are a well-established way to relieve stress, balance blood pressure, and lower levels of cortisol, a hormone your body releases in response to stress. Cortisol is closely linked to a complex system in our body that regulates our metabolism, immune system, and other important functions. Some research suggests that cortisol may play a role in anxiety disorders and panic attacks (Ma, 2017; Thau, 2021).

Research also shows that slow breathing also benefits the autonomic nervous system (Ma, 2017). This system is responsible for controlling heart rate, blood pressure, breathing, digestion, and sexual arousal (Waxenbaum, 2020). 

Stress causes part of this system to switch on, resulting in the classic fight-or-flight response. Chronic stress triggers this system even when there isn’t a viable threat, which is why stress reduction strategies like box breathing can be a big help.

Box breathing tips

To get the most out of box breathing, you’ll need to practice regularly and incorporate it into a more comprehensive stress management plan.  

People who participated in research studies on deep breathing found that practicing breathwork during 15-minute sessions over a period of months was a big help in making it a habit. Other tips for box breathing and relaxation techniques include being in a comfortable and quiet environment. 


If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

  • Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., Wei, G. X., & Li, Y. F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology , 8, 874. doi: 10.3389/fpsyg.2017.00874. Retrieved from

  • Norelli , S. K., Long, A., & Krepps, J. M. (2020). Relaxation Techniques. In StatPearls . StatPearls Publishing. Retrieved from

  • Thau, L., Gandhi, J., & Sharma, S. (2021). Physiology, Cortisol. In StatPearls . StatPearls Publishing. Retrieved from

  • Waxenbaum, J. (2020, Aug 10). StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved July 14, 2021 from

  • Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Frontiers in Human Neuroscience , 12, 353. doi: 10.3389/fnhum.2018.00353. Retrieved from

How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

August 19, 2021

Written by

Alyson Powell Key

Fact checked by

Yael Cooperman, MD

About the medical reviewer

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.