In this short post, we will explain the Box Breathing technique #boxbreathing. We will briefly describe the neuroscience and neurophysiology concepts governing how it can lower stress and anxiety and why we believe it can help in therapy.
The Technique
The box breathing technique consists of taking an inhaled breath for a set amount of time; a good starting point would be inhaling to the count of three. Then, you hold your breath for the same length of time, followed by exhaling and finally holding, for three seconds each. The cycle is repeated as often as you like or with a specified time limit, say, three to five minutes total. Once you feel you are mastering the count to three, you can do the same cycle using counts for four, five, or even six seconds.
The box breathing can be used as and when it is needed, in moments when we feel that we are becoming overwhelmed or emotionally triggered by something, a breather between two stressful tasks, or as part of a daily routine of breathwork practice. While using box breathing to counter a stressful situation is great, having it as part of a daily routine can yield long-term benefits for well-being.
The Science
Box breathing essentially slows down your body’s natural breathing pace.
Slowing down your breathing doesn’t sound like much, but slower breathing has several proven benefits on our health, the general state of arousal of our nervous system, and our mood. For millennia, practitioners of Pranayama (or Yogic breathing) have known about the impact of intentional breathing on mental states. Today, the meeting of Eastern experiential wisdom and modern neuroscience provides us with a clearer understanding of why and how this takes place.
Breathing is one of the few essential processes controlled by the autonomic nervous system (ANS) that is, in part, voluntary. When we consciously think about breathing, we can control it. If we stop thinking about it, like when we are asleep, the ANS, specifically the medulla in the brainstem, takes over for us. Breathing is fairly unique because other body processes are under very little conscious control. Think about your heart beating or your digestion. You cannot just suddenly decide for your heart to beat faster or your digestion to slow down.
Neuroscientist and veteran breathing researcher, Jack Feldman and his lab, have conducted experiments with mice that were genetically engineered to breathe slower than the control mice [1,2]. The mice who were engineered to breathe slower were dubbed “the meditating mice”. These “meditating mice” were unusually calm. They displayed less time exploring their environment and sniffing and spent instead time grooming themselves. This is thought to be linked to the influence of slower breathing on the amygdala. In the same study, the researchers have also found a link between slow breathing and the locus coeruleus, an area of the brainstem that regulates emotions.
Slower breathing and inhaling/exhaling techniques are likely to influence the mental states and the states of arousal also because the lungs, heart, and brain are linked through the vagus nerve, which is important in regulating the parasympathetic function - the branch of the ANS that slows down the heart rate and breathing also known as the “rest and digest” [4].
In a recent study, researchers from Andrew Huberman’s lab have compared several breathing protocols [3]. They used physiological measures such as resting heart rate and heart rate variability as well as subjective self-reports on people's well-being. Box breathing performed well in the study along with other techniques. This study has shown an interesting finding: that breathing techniques were more effective in reducing hyper-arousal states and anxiety than mindfulness. This suggests a promising development in using a combination of the two approaches to enhance the long-term mental health benefits that they both provide.
Therapeutic example
Let us now give you a real-life example of the use and effectiveness of the box breathing technique. When Simon came to see me for therapy he was in his forties and a physical and mental abuse survivor. He was first abused physically by his father from early childhood until his late teenage years. Later on, he was physically and mentally abused by his partner, who would regularly send him to hospital with broken bones and serious physical injury. While his life is better now, having escaped the abusive relationship several years ago, he was finding it difficult to move on and be happy. Unbeknownst to him until coming to therapy, Simon suffered from PTSD due to these difficult life experiences. After establishing the basic facts about Simon’s life and how much he has suffered while showing incredible resilience, I knew that before digging deeper I had to take Simon to a place of inner safety. One way forward was to teach him how to recognise the early somatic signs of hyper-arousal and recognise the triggers for it and then work towards learning to self-soothe in those situations. I have taught him box breathing. He took the exercise seriously and applied it in the way we discussed in our sessions and the result was nothing short of incredible. After teaching the box breathing to Simon, I have only seen him a couple of more times as he felt that the incredible heaviness that he was feeling in his body every time something triggered him was now completely in check. I am not saying that every client will have the same experience. After all, we are all different. However, the client will probably experience benefits from practising box breathing, as long as they engage with it properly. This will depend almost entirely on how well you, as the therapist, explain how to practise and why it is effective. Hopefully, this short article gives you all those elements.
As ever, please share with us any experience you might have using it, any insight or improvements or anything at all!
References
Li P, Janczewski WA, Yackle K, Kam K, Pagliardini S, Krasnow MA, Feldman JL. The peptidergic control circuit for sighing. Nature. 2016 Feb
https://www.scientificamerican.com/article/meditations-calming-effects-pinpointed-in-brain/
Balban MY, Neri E, Kogon MM, Weed L, Nouriani B, Jo B, Holl G, Zeitzer JM, Spiegel D, Huberman AD. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med. 2023 Jan 17
LeBouef T, Yaker Z, Whited L. Physiology, Autonomic Nervous System. [Updated 2023 May 1]. https://www.ncbi.nlm.nih.gov/books/NBK538516/
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