Anxiety is chronic and ongoing—your nervous system is in a sustained state of elevated arousal, causing persistent worry, muscle tension, and shallow breathing throughout the day. A panic attack is acute and intense—a sudden surge of overwhelming fear with rapid heartbeat, hyperventilation, and feeling like you might die or lose control. For chronic anxiety, box breathing (4-4-4-4) works well because it's sustainable for longer sessions. For panic attacks, the physiological sigh (double-inhale, long exhale) often works faster because it rapidly offloads CO₂ and interrupts the acute hyperventilation cycle.

Box breathing is a powerful self-regulation tool, but it's not a replacement for medication or therapy. Think of it as a complementary skill, like exercise or sleep hygiene. Studies show breathwork produces small-to-moderate reductions in anxiety symptoms—meaningful, but not miracle-level. If you're on medication, continue it and add box breathing as a daily practice. If you want to reduce medication, work with your doctor to create a plan. Many people find breathwork most effective when combined with cognitive-behavioral therapy (CBT) and lifestyle changes (exercise, sleep, caffeine reduction).

For chronic anxiety, practice twice daily: once in the morning (to set a calm baseline for the day) and once before bed (to prevent anxious rumination). Each session should be 3-5 minutes (10-15 cycles). Also use it 'in the moment' whenever you notice anxiety rising—before meetings, during stressful tasks, or when you catch yourself spiraling into worry. The key is consistency: daily practice 'trains' your nervous system to respond faster when you need it. Most studies showing anxiety benefits used 5-10 minutes daily for 4-8 weeks.

The holds serve two purposes: (1) They allow CO₂ to build up slightly in your blood, which signals to your brain that you're safe—you wouldn't hold your breath if you were in actual danger. This breaks the hyperventilation cycle common in anxiety. (2) The holds give your racing mind a clear structure to follow, interrupting the rumination loop. However, if holds make you feel MORE anxious (some people don't like the sensation), skip them entirely and just do 4-second inhale, 4-second exhale with no pauses. The slow pace is what matters most.

This is common and doesn't mean you did anything wrong. Possible causes: (1) You held your breath too forcefully—holds should be gentle pauses, not straining. Try shorter holds (2 seconds) or skip holds entirely. (2) You breathed too deeply—anxiety often makes people take big gulps of air, which can trigger more panic. Keep breaths small, quiet, and smooth. (3) You focused too hard on 'doing it right'—this activates your anxious perfectionism. Use a guided visualizer (like the one on this page) so you don't have to think about counting. (4) You're in the middle of a panic attack—switch to physiological sighs (double-inhale, long exhale) for acute episodes; box breathing works better for ongoing anxiety.

You may notice a subtle shift within the first 1-3 minutes of practice (lower heart rate, less chest tightness). However, the biggest benefits come from consistent daily practice over weeks. Studies show 4-8 weeks of regular slow breathing produces measurable reductions in anxiety symptoms, resting heart rate, and stress hormone levels. Think of it like strength training—one session helps a bit, but the real changes happen with sustained practice. Most people report noticeable anxiety reduction after 2-3 weeks of twice-daily practice.