Stress Awareness Month: Overcome stress with box breathing

Stress Awareness Month is observed in April every year, aiming to raise awareness about the negative impacts of stress on our physical and mental health. The causes and consequences of stress vary across individuals, but it's imperative to take steps to manage stress levels through healthy coping mechanisms and stress-reducing activities such as exercise, meditation, and self-care.

One such practice which is often overlooked is breathing. Rooted in age-old traditions for generations, breath work has gained prominence as a therapeutic method owing to its documented positive impacts on health. "Box breathing, also referred to as square breathing, represents a method utilised for deliberate, slow inhalation and exhalation. Offering a structured approach to deliberate inhalation and exhalation, box breathing, emerges as a potent method for managing stress. Amidst various deep breathing techniques, box breathing stands out for its efficacy in inducing relaxation," explains Dr John Muchahary, consultant-pulmonology at Manipal Hospitals, Goa.

What is box breathing?
Widely recognised for its role in stress alleviation, box breathing serves as a valuable tool in stress management practices, adaptable for implementation before, during, or after tense situations. "This technique comprises four straightforward stages, with its name aimed at guiding individuals to envision a symmetrical box while executing the exercise. By following a simple four-step process, individuals can engage in box breathing to alleviate tension, shift focus away from anxiety-inducing scenarios, ensure sound sleep, reduce hyperventilation, refocus during hectic days, reduce panic and anxiety, lower blood pressure, and regulate ventilation," says Muchahary.

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Step 1
Inhale through the nose for a duration of 4 seconds. This initial inhalation sets the rhythm of the breathing exercise, allowing you to draw in a slow, steady breath.
Step 2
After completing the inhalation, hold your breath for 4 seconds. This brief pause allows for the retention of the inhaled air within your lungs, promoting oxygen absorption and activating the relaxation response.
Step 3
Exhale slowly and steadily for 4 seconds. Release the breath through your mouth or nose, focusing on expelling the air in a controlled manner. This phase facilitates the expulsion of carbon dioxide from the body, aiding in relaxation.
Step 4
After completing one cycle, repeat the sequence by starting again with step one. Aim to repeat the entire sequence of inhalation, breath-holding, exhalation, and another breath-holding period three to four times in total.
Repeat
By following these steps and repeating the sequence, you can engage in box breathing to promote relaxation, reduce stress, and restore a sense of calmness and focus.

Please note that the length of the steps can be adjusted to accommodate the individual (e.g., two seconds instead of four seconds for each step).

How does box breathing work?
"The deliberate pace of slow breathing enables the accumulation of CO2 in the bloodstream, thereby amplifying the cardio-inhibitory reaction of the vagus nerve and prompting the activation of the parasympathetic system upon exhalation. Through this mechanism, the technique effectively diminishes stress levels and enhances mood, indirectly offering relief for conditions such as Generalized Anxiety Disorder (GAD), Panic Disorder, Post-Traumatic Stress Disorder (PTSD), and depression. Furthermore, optimizing cardiopulmonary function proves pivotal for augmenting lung capacity and pulmonary ventilation while concurrently fortifying the respiratory system, thus mitigating respiratory fatigue. Additionally, some researchers postulate that the relaxation induced by this practice aids in managing attention-related symptoms in children diagnosed with Attention Hyperactivity Disorder (ADHD)," explains Muchahary.

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Who is it beneficial for?
Since this method enhances both performance and focus, serving as a potent stress reliever, its benefits extend to various individuals, particularly those grappling with specific respiratory conditions such as Chronic Obstructive Pulmonary Disease (COPD) and individuals who smoke Muchahary tell us.

"Individuals with conditions such as hyperventilation syndrome and COPD may benefit from box breathing as a way to manage their breathing patterns and alleviate symptoms. The structured nature of box breathing can help regulate ventilation and improve respiratory function in these patients," opines Muchahary.
He further adds, "This technique holds the capability to regulate and pacify the Autonomic Nervous System (ANS), subsequently reducing blood pressure and inducing an immediate sensation of tranquility. Additionally, it plays a role in stabilising body temperature, further contributing to its overall calming effects."

Major benefits of box breathing

Below, Muchahary lists seven benefits of box breathing:

Helps to deal with tension
Box breathing involves slow, deep breaths, which can help relax the body and alleviate tension. By focusing on controlled breathing, individuals may experience a reduction in physical and mental stress.

Counting during box breathing helps to shift the focus away from the panic-inducing scenario
Counting the breaths during box breathing serves as a distraction technique. It redirects attention away from anxiety-provoking situations and toward the rhythmic pattern of breathing, which can help individuals regain control over their thoughts and emotions.

Ensures sound sleep
Box breathing can promote relaxation and calmness, making it easier for individuals to fall asleep. By engaging in this breathing technique before bedtime, people may experience improved sleep quality and duration.

Helps reduce hyperventilation by instructing lungs to breathe rhythmically
Hyperventilation, or over-breathing, can lead to various symptoms such as dizziness, shortness of breath, and tingling sensations. Box breathing encourages slow and controlled breathing, which can help normalize breathing patterns and reduce the likelihood of hyperventilation.

Helps refocus when experiencing a hectic or stressful day
During times of stress or busyness, taking a moment to practice box breathing can provide a brief respite. It allows individuals to step back from the chaos and regain a sense of calmness and focus.

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Reduces panic and anxiety
Box breathing is often used as a relaxation technique to alleviate symptoms of panic and anxiety. Its rhythmic and controlled nature can activate the body's relaxation response, leading to decreased feelings of panic and anxiety.

Lowers blood pressure
Deep breathing techniques, including box breathing, have been shown to have a positive impact on blood pressure. By promoting relaxation and reducing stress, box breathing may help lower blood pressure levels over time.

"With its simplistic four-step process, box breathing remains easily accessible for individuals of all backgrounds. Among the array of breathing methods available, box breathing stands out as a valuable tool in alleviating everyday stress. While further research is warranted, existing studies present compelling evidence supporting the efficacy of box breathing in stress management, refocusing efforts, and fostering a positive emotional outlook and mental state," concludes Muchahary.