Breathing Exercises

Which breathing exercise to choose

Box breathing (in 4, hold 4, out 4, hold 4) is the most structured. The even square is easy to explain and easy to remember, which makes it a good first skill for adults and teens who like a clear count. If holding the breath feels uncomfortable, use the short-hold or no-hold setting.
4-7-8 breathing uses a long exhale (in for 4, hold for 7, out for 8). Many people use it to wind down at night. The long hold can feel like too much at first, so start with the easier pace and fewer rounds.
Rainbow breathing lets a child trace a rainbow, a star or a figure eight: breathe in along one color and out along the next. It gives a young child something to look at and a reason to slow down.
Bubble breathing is a game: press and hold while breathing out slowly to blow a big bubble. Breathe out too fast and the bubble pops, so the child practices a long, gentle exhale without being told to.

How slow breathing helps

All four slow the breath well below the usual resting rate of 12 to 20 breaths a minute, and two of them stretch the exhale. A systematic review of slow breathing studies found it linked to greater heart rate variability and to feeling more relaxed and less anxious (Zaccaro and colleagues, 2018). A meta-analysis of randomized trials found that breathwork lowered self-reported stress compared with control conditions, with small to moderate effects on anxiety and depression as well, while noting that the trials varied widely in quality (Fincham and colleagues, 2023). In a month-long randomized study, five minutes a day of exhale-focused breathing (cyclic sighing) improved mood and lowered breathing rate more than mindfulness meditation did (Balban and colleagues, 2023).
Breathing exercises are a coping skill, not a treatment on their own. They work best practiced when calm, so the skill is there when it is needed.

Using breathing exercises in therapy sessions

Rate tension before and after: each adult exercise asks for an optional 0 to 10 rating, which turns a vague “I feel a bit better” into something you can talk about. Practice together on screen first, then send the link as homework with a simple plan: one round, once a day, at the same time. For children, let them choose the shape or the bubble color; choice keeps them in the game long enough to slow down.

When to stop

Stop and breathe normally if a client feels dizzy, lightheaded or short of breath. Box breathing has a no-hold setting, 4-7-8 has easier paces with a shorter hold, and the two children’s games use no holds at all. People with a heart or lung condition, or who are pregnant, should check with their doctor before practicing long breath holds. Some people, especially those who notice panic in the body, find close attention to the breath uncomfortable at first: start with shorter rounds, keep the eyes open and let them stop at any time.
Looking for something to print? The deep breathing worksheet covers the same skill on paper.

Sources

1. Zaccaro A., Piarulli A., Laurino M., 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. 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, 432. https://doi.org/10.1038/s41598-022-27247-y
3. Balban M. Y., Neri E., Kogon M. M., 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