Box Breathing and How It Can Help With Stress

Our lives are filled with family obligations, work and school responsibilities, healthcare appointments, and busy schedules. Stress is a normal part of life. But sometimes, stress can get out of hand, especially when living with metastatic breast cancer. When that happens, we need a healthy way to cope.
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Box breathing is a simple yet effective tool to help you reduce stress and restore some balance in your body and mind. It may even be helpful in alleviating physical and emotional stress from metastatic breast cancer treatment and side effects.¹

What is box breathing?

Box breathing is a type of deep breathing technique. It gets its name because a box has 4 sides and this technique consists of 4 simple steps: breathing in for 4 counts, holding the breath for 4 counts, breathing out for 4 counts, holding the breath for 4 counts. Then you repeat the steps.^1,2

Other names for box breathing include:¹

• Square breathing
• 4-square breathing
• 4x4 breathing
• 4-4-4-4 breathing
• Equal breathing

How does box breathing help with stress?

Deep breathing techniques like box breathing stimulate the parasympathetic nervous system. The parasympathetic nervous system is the body’s "rest and digest" response. It activates when you are calm and relaxed. It is the opposite of the sympathetic nervous system – the "fight or flight" response – which activates when you are:^1-3

• Anxious
• Stressed
• Overwhelmed

Box breathing requires attention and focus. When you focus your mind on counting and your breath, it takes your mind off of whatever is causing you stress. This can help relax your body and ease your mind.^1,3

Breathing in this way is often done in conjunction with meditation and other mind-body practices like yoga and tai chi. This breathwork is so effective that even the Canadian Special Forces and the US Navy Seals use it to keep their “fight or flight” response at bay.^1,3

Box breathing can also help to:^1-3

• Increase relaxation
• Lower heart rate and blood pressure
• Calm the mind
• Lower cortisol (the stress hormone)
• Increase oxygen to the body
• Improve focus
• Develop healthy coping skills

How to practice box breathing

Box breathing can be done anywhere at any time. Here is how to practice it:^1,2

1. Exhale all the air out of your lungs.
2. Inhale through your nose as you silently count to 4.
3. Hold your breath for 4 seconds.
4. Exhale through your nose for 4 seconds.
5. Hold your breath for 4 seconds.
6. Repeat for 3 to 4 rounds, or as long as needed.

While practicing box breathing, be aware of your inhales and exhales. Notice the air filling your stomach and lungs. The more awareness you put into the practice, the more it becomes a kind of mindfulness meditation.¹

Feel free to modify the number of seconds you inhale, hold, and exhale your breath. If 4 seconds feels like too long, adjust it down to a number that feels comfortable.²

You do not have to be stressed to practice box breathing

Box breathing is a mindfulness tool that is accessible to everyone. You do not have to feel anxious or stressed in order to benefit from it. It can help to practice box breathing in a comfortable seated position. But explore what works best for you.¹