Breathing exercises for anxiety: Do they work?

If anxiety symptoms regularly affect your day-to-day life, you may have an anxiety disorder.  

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) lists four anxiety disorders, including:

• Generalized anxiety disorder: intense worry across many situations and persistent over time
• Panic disorder: frequent or occasional panic attacks or intense fear of experiencing one
• Social anxiety disorder: intense fear and discomfort regarding social situations
• Specific phobias: intense fear and rejection of something that may or may not be a real threat

Anxiety disorders may have a range of symptoms. Some result from physical changes caused by the stress response. These symptoms may include shortness of breath and increased heart rate.

Modulating your breathing may help you decrease discomfort and reduce emotional anxiety symptoms.

What is the link between breathing and anxiety?

The relationship between breathing and anxiety is two-directional. This means that each one can affect the other.

Anxiety often leads to a rapid breathing rate that may develop into shortness of breath. And experiencing shortness of breath or regularly breathing in a shallow way may make anxiety symptoms worse.

Anxiety activates your stress response, commonly known as fight or flight. This mechanism prepares your body to face or flee a perceived threat. Your brain will send a message to your heart and lungs to increase their rhythm so your muscles gain agility and strength.

Prolonged anxiety may prepare your body but with no threat to face or flee, you may be left with heart palpitations and shortness of breath.

Because anxiety often responds to what you are thinking, you may stop the stress response by sending the message that there is nothing to face or flee at the moment. Purposely slowing down your breathing may signal this to your brain, which may relieve other symptoms of anxiety.

In this way, breathing exercises may activate your relaxation response. Research from 2018 and 2019 suggests that practicing breathing exercises regularly may reduce overall anxiety symptoms and manage chronic stress.

Diaphragmatic breathing

Research from 2017 shows that diaphragmatic breathing, also known as deep breathing, reduces stress and anxiety symptoms.

Deep breathing exercises for anxiety involve intentionally shifting your breathing from your chest into your belly.

You may practice diaphragmatic breathing by following these steps:

1. Sit comfortably in a chair and slightly lean forward.
2. Rest your elbows softly on your knees.
3. Breathe in slowly through your nose while pushing your abdomen muscles out.
4. Breathe out slowly through your mouth and gently tuck your abdomen muscles in.
5. Repeat until you feel relaxed.

Focus on pushing your abdomen out every time you inhale and tucking it in as you exhale. Your chest should not move as you breathe in or out.

You can practice deep breathing at any time of the day and as many times as needed.

Practicing deep breathing every day may help you reduce the chance of anxiety symptoms. Doing it as you feel your anxiety rise may help you calm down quickly.

Cyclic sighing

Sighing involves a long and deep exhale. Research from 2023 suggests that cyclic sighing may improve mood and reduce breathing rate.  

You can practice cyclic sighing by following these steps:

1. Sit or lie down in a comfortable position.
2. Breathe in slowly through your nose once.
3. Take a second, deeper breath through your nose until you feel your lungs completely full.
4. Hold your breath in for 3 seconds.
5. Exhale slowly through your mouth until you feel your lungs have no air left.
6. Repeat until you feel calm and relaxed.

Repeating this exercise for 5 minutes every day may help you prevent anxiety episodes and may make you feel relaxed quickly.

Box breathing

To reduce anxiety using box breathing exercises, experts recommend that you follow each of these steps to the count of four:

1. Breathe in slowly through your nose.
2. Hold your breath.
3. Breathe out slowly.
4. Hold your breath.
5. Repeat.

As you follow these steps, you can imagine you are drawing the lines of a square (or one-dimensional box). Each line would take 4 seconds to draw: one by breathing in, one by holding your breath in, one by exhaling, and the last one by holding your breath out.

As with the other breathing exercises for anxiety, you may use box breathing every day to manage and prevent stress or to calm down again in moments of high anxiety.

Treatment for anxiety

Breathing exercises for anxiety are an effective and natural way to calm down. But if you experience severe anxiety symptoms or your anxiety is interfering with your daily life, professional support is highly advised.

A healthcare professional may recommend talk therapy such as cognitive behavioral therapy or acceptance and commitment therapy.  

They may also suggest the use of some medications such as:

• selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft)
• serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor). duloxetine (Cymbalta), and desvenlafaxine (Pristiq)
• tricyclic antidepressants like imipramine (Tofranil)
• short-term benzodiazepines like alprazolam (Xanax)

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Summary

Breathing exercises can be everyday coping tools for anxiety symptoms. 

Deep breathing, box breathing, and cycling sighing may activate a relaxation response in the body, which can reduce physical and mental symptoms of anxiety quickly. 

Breathing exercises do not replace professional support, though. Seeking the help of a mental health professional is highly advised and may bring long-term anxiety relief.

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