• Dr. Michelle Matoff

Stress Reduction Technique in Minutes

Dr. Michelle Matoff Psy.D, LCSW, CBC

There is evidence that deliberate breathing techniques have the ability to calm and focus the mind. Four X Four breathing (also called Box Breathing) involves inhaling through the nose to the count of four, holding the breath at the end of the count of four with your lungs and diaphragm expanded, and then exhaling the breath through the mouth in a four count. The cycle is repeated with fluidity four times. (Hence four inhales to the count of four, hold for the count of four, exhale to the count of four and repeat four times).

This technique is used in meditation practices. One type of meditative breath control is called Pranayama which means to draw out the breath for vital renewed energy. There are many types of Pranayama breath work. To reduce stress, Navy Seals have adopted the Four X Four breathing strategy for calmness under duress.

Box Breathing works by striking a balance between the autonomic nervous system (involuntary control of body functions such as breathing and blood pressure); the sympathetic (fight or flight) and the parasympathetic (rest and digest). When balance is achieved, people often describe a state of calmness and relaxation. In our high stress world, we are often stuck in the sympathetic system, overly alert, agitated, anxious, stressed, with poor sleep and reduced brain functions causing symptoms like brain fog or forgetfulness. Box breathing is just one tool you can use to try and regain balance between these two.

Box Breathing works by building up CO₂ in the blood. The increase in CO₂. The slow holding of breath allows CO₂ to build up in the blood. An increased blood CO₂ stimulates your parasympathetic nervous system response and inhibits the sympathetic response. This produces a calm and relaxed feeling in the mind and body and improved emotional responsiveness to situations (fewer reactionary comebacks with interpersonal interactions).

Since Four X Four breathing can reduce stress and improve your mood, this makes it an exceptional treatment strategy for conditions such as anxiety (Chandla et al., 2013) depression (Brown & Gerbarg, 2005), panic disorder (Friedman et al., 1998), PTSD (Sahar et al., 2001). There is some research that also suggests 4X4 breathing can help with pain management (Tekur et al., 2012) and insomnia (Chervin et al., 2006).

And yes…. there is an app that can help you stay on track! Box Breathing App can help track your practice.

Please add your thoughts and experiences on this topic in the comment section of this blog. This blog is intended as a forum for responders to raise issues, share experiences, and promote dialogue on important issues of contemporary life. Please like or follow my Facebook page For additional information about me and my practice, please visit my website at\


Brown, R. P., and Gerbarg, P. L. (2005). Sudarshan kriya yogic breathing in the treatment of stress, anxiety, and depression: Part II—Clinical applications and guidelines. J. Altern. Complement. Med. 11, 711–717. doi:10.1089/acm.2005.11.711

Chandla, S. S., Sood, S., Dogra, R., Das, S., Shukla, S. K., and Gupta, S. (2013). Effect of short-term practice of pranayamic breathing exercises on cognition, anxiety, general wellbeing and heart rate variability. J. Indian Med. Assoc. 111, 662–665.

Chervin, R. D., Ruzicka, D. L., Giordani, B. J., Weatherly, R. A., Dillon, J. E., Hodges, E. K., et al. (2006). Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics 117, e769–e778. doi:10.1542/peds.2005-1837

Friedman, B. H., and Thayer, J. F. (1998). Autonomic balance revisited: Panic anxiety and heart rate variability. J. Psychosomat. Res. 44, 133–151. doi:10.1016/S0022-3999(97)00202-X

Sahar, T., Shalev, A. Y., and Porges, S. W. (2001). Vagal modulation of responses to mental challenge in posttraumatic stress disorder. Biol. Psychiatry 49, 637–643. doi:10.1016/S0006-3223(00)01045-3

Tekur, P., Nagarathna, R., Chametcha, S., Hankey, A., and Nagendra, H. R. (2012). A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: an RCT. Complement. Ther. Med. 20, 107–118. doi:10.1016/j.ctim.2011.12.009

Zeidan, F., Johnson, S. K., Diamond, B. J., David, Z., and Goolkasian, P. (2010). Mindfulness meditation improves cognition: evidence of brief mental training. Conscious. Cogn. 19, 597–605. doi:10.1016/j.concog.2010.03.014

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