Breathing Strategies to Lower Anxiety

• Does slow breathing help with anxiety?
• Which breathing skills does the research support?

By Dr. Douglas Cowan, Psy.D., MFT

“Just breathe” is common advice, and it is fair to ask whether it does anything.

Research suggests that certain kinds of slow breathing can help. Breathing is something you can control on purpose, even when much else feels out of your control, and it is free, private, and always with you. This article shows you two skills and what the research says about them. If you would rather start by doing it, open our guided breathing exercise in another tab and follow along as you read.

What the research suggests

Breathing is unusual among body functions. It runs automatically, and you can also change it on purpose. That is part of why researchers study it as a way to influence the body’s stress response.

A systematic review of slow-breathing studies found that slow breathing was linked with higher heart rate variability, which is a sign that the body’s calming systems are more active (1). Researchers think the vagus nerve, which connects the brain to the heart, lungs, and gut, is one route for these effects. This area of research is still developing.

Make the exhale longer

In a 2023 Stanford-led trial, people were assigned to five minutes a day of one of three breathing exercises or to mindfulness meditation for a month. Breathwork, and especially cyclic sighing, which stresses a long exhale, improved mood more than mindfulness meditation did, and cyclic sighing lowered breathing rate the most (2). A 2023 review of controlled trials found that breathwork lowered stress (3). A small trial in healthy adults found that practicing belly (diaphragmatic) breathing improved attention and lowered a stress hormone (4).

These studies were mostly done with healthy volunteers and stress, so the results do not show that breathing will treat an anxiety disorder on its own. They do suggest that the skill is safe, cheap, and useful alongside other care.

Skill 1: The double sigh (for a spike)

Use this when anxiety jumps.

1. Breathe in through your nose.
2. Before you breathe out, take a second, smaller sip of air on top of the first.
3. Breathe out through your mouth, slow and long, until the lungs feel empty.

Do it one to three times. It takes less than a minute, and nobody around you has to notice. The long exhale is the part to focus on.

Skill 2: The 4-4-6 pattern (for daily practice)

Use this to build your calm baseline.

1. Breathe in through your nose for four counts.
2. Pause for four counts.
3. Breathe out slowly through your mouth for six counts.

Keep the exhale longer than the inhale. If holding your breath feels uncomfortable, shorten the pause or skip it. If four and six feel awkward, try “in for four, out for eight.”

Try it right now. Our free interactive breathing exercise guides you through a slow, steady pace on screen, so you can simply follow along. It takes about five minutes. If you want a different kind of calm, try our grounding exercise.

Practice when you are calm

The trial that found benefits used five minutes a day for a month (2). Practicing at a calm time, such as the morning, makes the skill familiar, so it is easier to find when you need it. A skill you use daily is already there on a hard day.

You can also use it before bed, before a hard conversation, and before a test.

Start today

• This week: do the 4-4-6 pattern for five minutes each morning.
• When anxiety rises: do one to three double sighs and notice what shifts.
• Make it a game for kids: “Who can do the biggest sigh?” Practice at a calm time so it is familiar later.
• Stack it: breathe before a therapy visit, a CES session, or a mindfulness practice.
• Keep it simple: the technique you will actually use is the right one.

If you have a lung or heart condition, or if breath work makes you feel dizzy or more anxious, slow down and talk with your doctor or therapist about a gentler version.

Small gains add up, and your nervous system is built to keep them.

You can start with the next breath.

This article is for education and is not a substitute for professional diagnosis or treatment. If you are in crisis, call or text 988 in the United States.

References

1. Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., et al. (2018). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353. https://doi.org/10.3389/fnhum.2018.00353
2. Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895. https://doi.org/10.1016/j.xcrm.2022.100895
3. Fincham, G. W., Strauss, C., Montero-Marin, J., & Cavanagh, K. (2023). Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-022-27247-y
4. Ma, X., Yue, Z., Gong, Z., Zhang, H., Duan, N., Shi, Y., et al. (2017). The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in Psychology, 8, 874. https://doi.org/10.3389/fpsyg.2017.00874