Breathing Through Anxiety: Evidence Based Techniques to Calm the Body and Regain Control

Article Summary

Breathing exercises can reduce some of the physical and psychological symptoms of anxiety by slowing respiratory rate, limiting overbreathing and influencing communication between the cardiovascular, respiratory and nervous systems. This article explains the science behind anxious breathing, evaluates the available evidence and provides practical breathing methods that can be used safely alongside appropriate medical and psychological care.

Why Breathing Changes When We Feel Anxious

Anxiety is not limited to worried thoughts. It involves a coordinated physiological response designed to prepare the body for possible danger.

When the brain identifies a threat, whether the threat is immediate, anticipated or incorrectly perceived, the sympathetic nervous system becomes more active. Heart rate may increase, muscles tighten, attention narrows and breathing often becomes faster, deeper or more irregular.

These changes are useful when the body needs to run, fight or respond quickly. They are less helpful when someone is sitting at a desk, standing in a queue or trying to sleep.

Breathing may move higher into the chest, become more frequent or include repeated sighing and gasping. The person may feel unable to get a satisfying breath and respond by taking even larger breaths. Unfortunately, repeatedly breathing more air than the body requires can intensify dizziness, tingling, light headedness, chest tightness and feelings of unreality.

This can create a self reinforcing cycle:

1. Anxiety changes the breathing pattern.
2. Altered breathing produces uncomfortable physical sensations.
3. The sensations are interpreted as evidence of danger.
4. Fear increases.
5. Breathing becomes even more disrupted.

Breathing exercises aim to interrupt this cycle. They do not remove every source of anxiety, but they can help reduce physiological arousal and create enough space for other coping strategies to become available.

Breathing, Oxygen and Carbon Dioxide

People are often told to “take a big deep breath” when anxious. This advice sounds sensible, but it can be unhelpful if the person is already overbreathing.

The problem during anxious overbreathing is not usually a lack of oxygen. Blood oxygen levels are generally already adequate. Breathing too quickly or too deeply can reduce carbon dioxide levels in the blood. This can contribute to dizziness, tingling, weakness, visual changes, chest discomfort and a sense of detachment.

These symptoms are frightening, but they do not necessarily mean that the person is in physical danger. The body may simply be reacting to a change in breathing chemistry.

Helpful breathing is therefore usually slow, gentle and quiet rather than enormous. The goal is not to fill the lungs as much as possible. It is to allow breathing to become more efficient and proportionate to the body’s current needs.

How Slow Breathing May Influence the Nervous System

Breathing is unusual because it operates automatically but can also be deliberately changed. This makes it one of the few direct ways of influencing an automatic bodily system.

Slow breathing may affect anxiety through several overlapping processes.

Respiratory Sinus Arrhythmia

Heart rate naturally increases slightly during inhalation and decreases during exhalation. This variation is known as respiratory sinus arrhythmia. Slow, comfortable breathing can make this pattern more organised and may support flexible autonomic regulation.

The Baroreflex

The baroreflex helps regulate blood pressure from one heartbeat to the next. Breathing at approximately five to six breaths per minute may strengthen the coordination between breathing, heart rate and blood pressure in some people. This is one reason similar breathing rates are used in heart rate variability biofeedback (Lehrer & Gevirtz, 2014).

Attention and Interoception

Anxiety draws attention towards possible danger. Following a simple breathing rhythm gives the mind a neutral task and may reduce repetitive monitoring of thoughts and symptoms.

Breathing also changes how a person relates to internal sensations. With practice, sensations such as a racing heart or tight chest may become less frightening because they are experienced as temporary bodily events rather than immediate proof of catastrophe.

Muscle Tension and Respiratory Effort

Anxious breathing frequently involves the upper chest, shoulders and neck. Gentle diaphragmatic breathing may reduce unnecessary muscular effort and make breathing feel more comfortable.

These mechanisms are plausible and supported to varying degrees, but statements that breathing simply “switches on the vagus nerve” or immediately moves everyone into a parasympathetic state are too simplistic. Autonomic regulation is complex, and individual responses differ.

What Does the Research Show?

Systematic reviews suggest that slow breathing and structured breathwork can produce small to moderate improvements in stress, anxiety and emotional wellbeing. However, studies vary considerably in breathing method, duration, participant group and research quality (Fincham et al., 2023; Zaccaro et al., 2018).

A randomised controlled study comparing several brief daily breathing and mindfulness practices found that structured breathing improved mood and reduced respiratory rate. Cyclic sighing, which emphasised longer exhalations, produced particularly promising results within that study. However, one trial does not establish that this method is best for every person or every anxiety condition (Balban et al., 2023).

Heart rate variability biofeedback, which often incorporates slow paced breathing, has also been associated with reductions in self reported stress and anxiety. Further well controlled research is still needed to determine which components are responsible for improvement and who benefits most (Goessl et al., 2017).

The most balanced conclusion is that breathing exercises are low cost, accessible tools that may reduce anxiety symptoms for many people. They are not a cure for every anxiety disorder, and they should not replace assessment or evidence based treatment when anxiety is persistent or significantly affecting daily life.

Evidence Based Breathing Practices

1. Gentle Slow Breathing

This is a straightforward starting method for general anxiety and physiological tension.

Sit in a supported position with both feet on the floor. Allow the shoulders and jaw to soften.

Breathe gently through the nose for approximately four seconds. Breathe out slowly for approximately six seconds. Continue for one to three minutes.

The breath should be quiet and comfortable. Avoid forcing the abdomen outward or filling the lungs completely. If a four and six rhythm feels uncomfortable, try three seconds in and four seconds out.

A breathing rate near five or six breaths per minute is often used in research and biofeedback practice, but there is no need to force an exact rate. Comfort and regularity are more important than achieving a perfect number.

2. Diaphragmatic Breathing

The diaphragm is the primary muscle involved in breathing. Diaphragmatic breathing encourages the lower ribcage and abdomen to move more freely while reducing unnecessary upper chest effort.

Place one hand on the upper chest and the other around the lower ribs or abdomen. Breathe in gently through the nose and notice the lower hand moving slightly. The upper chest may move, but it should not lift dramatically.

Allow the breath to leave slowly without pushing. Practise for two to five minutes.

Research suggests that diaphragmatic breathing may support attention and reduce negative affect and physiological stress, although findings should not be interpreted as proof that it treats all forms of anxiety (Ma et al., 2017).

Some people become more anxious when asked to monitor their abdomen or chest closely. If this happens, stop and use an externally focused grounding exercise instead.

3. The Physiological Sigh

A physiological sigh consists of two inhalations followed by a slow, extended exhalation. The second inhalation is smaller and tops up the first breath.

Breathe in gently through the nose. Take a second, smaller inhalation. Then release the air slowly and completely through the mouth.

One or two physiological sighs may help during a sudden moment of tension. Repeating large inhalations rapidly can cause light headedness, so this should remain controlled and gentle.

Cyclic sighing uses repeated versions of this pattern over a structured practice period. It showed encouraging results in one randomised study, but people who are vulnerable to hyperventilation may find repeated double inhalations uncomfortable and should choose a simpler method (Balban et al., 2023).

4. Extended Exhalation Breathing

Many people find a slightly longer exhalation soothing.

Breathe in gently for three or four seconds. Breathe out for five or six seconds. Pause naturally and allow the next breath to begin without forcing it.

Continue for four to ten breaths.

The exhalation should not be prolonged to the point of air hunger. The intention is to slow the rhythm, not to prove how long you can hold or control the breath.

Although longer exhalations are commonly used in relaxation practices, research has not established one universally superior inhalation to exhalation ratio. The best rhythm is one that slows breathing without creating strain.

5. Paced Breathing With a Visual or Audio Guide

Some people find counting stressful, particularly during intense anxiety. A breathing application, visual shape or quiet audio cue can guide the pace without requiring mental calculation.

Choose a gentle rhythm of approximately five to six breaths per minute. Follow the guide for five minutes once or twice daily.

The technology is not the active ingredient. It simply provides structure and consistency. Avoid programmes that encourage rapid breathing, prolonged breath holding or extreme practices unless they are being delivered by an appropriately qualified healthcare professional.

6. Box Breathing

Box breathing involves four equal phases:

1. Breathe in gently.
2. Pause.
3. Breathe out slowly.
4. Pause again.

Each phase is often counted for four seconds. However, equal counts and breath holding are not comfortable for everyone.

Someone who experiences air hunger, panic, pregnancy related breathlessness, respiratory illness or cardiovascular difficulties may find the pauses unpleasant. A gentler alternative is to omit the holds and use a comfortable inhalation followed by a slightly longer exhalation.

Box breathing is popular, but it has less direct clinical evidence for anxiety than slow paced breathing and heart rate variability biofeedback. It should be offered as an option rather than presented as the best method.

7. Breathing Combined With Orienting

Breathing exercises can be more effective when attention is also directed towards evidence of present safety.

Keep the eyes open and look slowly around the room. Name five neutral objects. Feel the support beneath your feet or body.

Then take four gentle breaths, allowing each exhalation to be slightly slower than the inhalation.

Use a simple statement:

“My alarm system has activated. I can feel it without treating it as an emergency.”

This is particularly useful when closing the eyes or focusing entirely on internal sensations feels unsafe.

8. Breathing During a Panic Wave

When panic begins, trying to force the sensations away can increase fear. Instead, reduce effort.

Place both feet on the ground. Let the next breath leave slowly. Allow a small, gentle inhalation through the nose rather than gasping for air.

Repeat:

“Slow and gentle. I do not need a huge breath.”

Look around and identify where you are, what time it is and what you were doing before the wave began.

The goal is not to make the panic disappear immediately. The goal is to prevent escalating it through overbreathing, catastrophic interpretation and urgent escape.

9. Breathing Before Sleep

Breathing practice can become part of a wind down routine when worry or physical tension interferes with sleep.

Lie or sit comfortably and allow breathing to settle. Use a gentle four second inhalation and six second exhalation for approximately five minutes.

If counting keeps the mind too alert, silently use the words “in” and “out” instead. Do not treat the exercise as a test of whether you can fall asleep. Its purpose is to reduce effort and create conditions that support rest.

Persistent insomnia may require cognitive behavioural therapy for insomnia rather than relaxation exercises alone.

10. Heart Rate Variability Biofeedback

Heart rate variability biofeedback uses a sensor and visual feedback to help a person practise breathing at a rate that strengthens coordination between breathing and heart rhythm.

The ideal rate differs between individuals and is sometimes called the resonance frequency. It is commonly close to six breaths per minute but may be slightly faster or slower.

Research indicates that heart rate variability biofeedback may reduce stress and anxiety, but equipment quality and practitioner training vary (Goessl et al., 2017). It may be particularly useful for someone who wants structured feedback rather than relying entirely on subjective sensations.

Practise When You Are Calm

Breathing exercises are skills rather than emergency tricks. Learning them only during severe panic is similar to learning to swim after falling into deep water.

Practise for two to five minutes at a predictable time each day. Begin while sitting comfortably and gradually use the skill in mildly stressful situations.

A simple progression may involve:

1. Practising while relaxed at home.
2. Practising after noticing mild tension.
3. Practising before a predictable stressor.
4. Using the technique during an early anxiety wave.
5. Using it while remaining in a situation that would usually be avoided.

The aim is to build familiarity rather than achieve perfect calm.

Breathing Should Support Exposure, Not Become a Safety Behaviour

Breathing can become unhelpful when someone believes they cannot cope unless the exercise immediately removes all anxiety. The person may begin checking every breath, carrying breathing tools everywhere or avoiding situations where the technique cannot be performed privately.

Within cognitive behavioural treatment, breathing is most useful when it helps a person remain present and discover that anxiety can rise and fall without catastrophe. It should support engagement with life rather than become another rule that anxiety imposes.

A helpful mindset is:

“I am using my breath to stay with this experience, not to guarantee that I will feel nothing.”

What If Focusing on Breathing Makes Anxiety Worse?

Breath awareness is not calming for everyone. People with panic disorder, respiratory illness, trauma histories or strong sensitivity to internal sensations may feel more distressed when asked to focus on breathing.

Possible alternatives include:

1. Keep the eyes open.
2. Notice objects and sounds in the environment.
3. Press the feet into the floor.
4. Hold a cool object.
5. Walk slowly while breathing naturally.
6. Count external objects instead of breaths.
7. Practise with a psychologist, physiotherapist or appropriately trained clinician.

A strategy is not failing because it needs adaptation. The goal is nervous system regulation, not compliance with one particular technique.

Common Breathing Mistakes

Taking Repeated Huge Breaths

More air is not always better. If breathing is already excessive, repeated large inhalations can worsen dizziness and tingling.

Forcing the Abdomen Outward

Diaphragmatic breathing should feel comfortable. The abdomen and lower ribs should move naturally rather than being pushed forcefully.

Holding the Breath for Too Long

Long breath holds may increase air hunger, fear and physical discomfort. They are not required for anxiety relief.

Breathing Too Slowly Too Soon

A very slow rhythm can feel suffocating to someone accustomed to rapid breathing. Begin with a modest change and reduce the pace gradually.

Expecting Immediate Emotional Calm

The body may settle before the mind does, or the change may be subtle. The purpose is to influence the physiological response, not to force all emotion to disappear.

Using Breathwork Instead of Addressing the Cause

Breathing cannot resolve unsafe circumstances, trauma, impossible workloads, relationship difficulties or untreated medical conditions. Regulation strategies are most effective when combined with action on the factors maintaining anxiety.

Safety Considerations

Stop the exercise and return to normal breathing if you become increasingly dizzy, faint, numb, confused or distressed.

Seek medical advice before using prolonged breath holding or intensive breathwork if you are pregnant or have a respiratory, cardiovascular or neurological condition. People with asthma or chronic lung conditions may require a breathing method tailored by a doctor or respiratory physiotherapist.

Breathing exercises should never be used to delay medical attention for new chest pain, significant breathing difficulty, fainting, a first suspected seizure, new neurological symptoms or any other possible emergency.

Breathing into a paper bag is not recommended. Breathlessness and rapid breathing can have medical causes, and rebreathing into a bag may be dangerous when anxiety is not the true cause.

When Breathing Exercises Are Not Enough

Breathing strategies can reduce symptoms, but persistent anxiety may require broader treatment. Evidence based psychological options include cognitive behavioural therapy, exposure based therapy, acceptance and commitment therapy, mindfulness informed treatment and trauma focused treatment where appropriate.

A GP or mental health professional should be consulted when anxiety is frequent, worsening, disrupting sleep or concentration, causing significant distress or leading to avoidance of work, travel, relationships or ordinary activities.

Medication may also be appropriate for some people and can be discussed with a qualified prescriber.

A Simple Starting Practice

For the next seven days, practise the following once or twice daily:

1. Sit with both feet supported.
2. Keep your eyes open.
3. Breathe in gently through the nose for four seconds.
4. Breathe out slowly for six seconds.
5. Continue for one to three minutes.
6. Stop if you feel dizzy or uncomfortable.
7. Record how you felt before and after without demanding a dramatic change.

The purpose of this practice is not to become perfectly calm. It is to build a familiar pathway back towards steadier breathing when anxiety begins to take over.

Support Through Collins Psychology

If you found this article helpful and would like to explore educational strategies more closely suited to your experiences, you are welcome to contact Collins Psychology. Collins Psychology provides evidence informed resources to help people understand anxiety, emotional regulation and the practical skills that can support meaningful change.

You can also access further free articles and resources through the Collins Psychology blog.

References

Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), Article 100895. https://doi.org/10.1016/j.xcrm.2022.100895

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, Article 432. https://doi.org/10.1038/s41598-022-27247-y

Goessl, V. C., Curtiss, J. E., & Hofmann, S. G. (2017). The effect of heart rate variability biofeedback training on stress and anxiety: A meta analysis. Psychological Medicine, 47(15), 2578–2586. https://doi.org/10.1017/S0033291717001003

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Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., Wei, G. X., & Li, Y. F. (2017). The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in Psychology, 8, Article 874. https://doi.org/10.3389/fpsyg.2017.00874

Meuret, A. E., Wilhelm, F. H., Ritz, T., & Roth, W. T. (2008). Feedback of end tidal carbon dioxide as a therapeutic approach for panic disorder. Journal of Psychiatric Research, 42(7), 560–568. https://doi.org/10.1016/j.jpsychires.2007.06.005

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Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How breath control can change your life: A systematic review on psychophysiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, Article 353. https://doi.org/10.3389/fnhum.2018.00353

Medical and Mental Health Disclaimer

This article is for general educational purposes only and is not a substitute for individual medical, psychological or psychiatric assessment, diagnosis or treatment. If you are experiencing new, severe or worsening symptoms, significant impairment, thoughts of self harm or concerns about your safety, seek support promptly from an appropriately qualified healthcare professional or emergency service.

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