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TechniqueModerate evidenceStress

Box breathing (4-4-4-4)

Slow paced breathing at ~6 breaths/min raises vagal tone and shifts the autonomic balance.

Why

Slow paced breathing at ~6 breaths/min raises vagal tone and shifts the autonomic balance. Free, instant, no contraindications.

The technique

  1. 1

    Inhale slowly through the nose for 4 seconds.

  2. 2

    Hold the breath in, relaxed, for 4 seconds.

  3. 3

    Exhale slowly through the nose or pursed lips for 4 seconds.

  4. 4

    Hold the breath out, relaxed, for 4 seconds, then repeat.

Evidence

At a glance

Laborde 2022 Neurosci Biobehav Rev meta-analysis (223 studies): paced breathing at ~6 breaths/min, the rhythm box-breathing produces, reliably increases vagally-mediated HRV both during and immediately after practice. Free, instant, no known contraindications; effect size acute and modest, cumulative effects emerge with regular practice.