Why the exhale first

When you are anxious, the breath can feel fast and high in the chest. A longer exhale gives you something concrete to do at the moment the breath speeds up: count the out breath, make it slower than the in breath, and let the next inhale arrive on its own.

A 2018 review of 15 studies found that slow breathing, under 10 breaths a minute, went with higher heart rate variability and with reports of more comfort and relaxation and less anxiety in healthy people. None of the studies was a randomized controlled trial and most were small, so it is early evidence.2

The timer above runs 4 seconds in and 8 out, 5 breaths a minute: a simple version of the long-exhale idea.

3 exercises to try

1. Extended exhale: 4 in, 8 out

Breathe in through your nose for 4 seconds and out for 8. No holds: 12 seconds a cycle, 5 breaths a minute. If 8 is too long, use 3 and 6. Do it for 2 minutes.

2. Box breathing: 4-4-4-4

In, hold, out, hold: 4 equal steps of 4 seconds. The counts are easy to remember, which helps when your mind is busy. Some police academies teach the same pattern to recruits as combat or tactical breathing.3 The box breathing timer runs it.

3. 7-11 breathing

Breathe in for 7 seconds and out for 11, deep into your belly, with no holds. Student Minds, a UK charity, suggests it for stress, panic attacks and trouble sleeping. If 7 and 11 is too long, it suggests 3 and 5, as long as the out breath stays longer than the in breath.4 NHS staff guidance uses the same counts.5 The 7-11 timer paces it.

All 3 work sitting or standing, with the sound off at work or on a train.

In the moment

Start with the out breath. Breathe out gently, then let the inhale be a little slower than usual. Keep your shoulders down and your jaw loose. If counting both breaths is too much, count only the exhale.

Don't force a deep breath. A quiet, slow breath at a comfortable size is enough; a big one can leave you feeling air-hungry. Give it 2 minutes; 5 is a full practice.

If it is a panic attack, the NHS advice is to stay where you are if you can, breathe slowly and deeply, and remind yourself that the attack will pass and isn't life-threatening. Most panic attacks last 5 to 20 minutes.6

Practice on calm days

The NHS suggests breathing for at least 5 minutes as part of your daily routine, sitting, standing or lying down, and says you don't need to reach the full count at first.7

In the Stanford trial, people practiced for 5 minutes a day for a month, and the rise in positive mood grew with the number of days they practiced.1 Pick one exercise and keep to it for a week before trying another.

What the research does and doesn't show

In the 2023 Stanford trial, 108 people did 5 minutes a day of one of 3 breathing practices or mindfulness meditation for a month. Taken together, the breathing groups improved mood and lowered breathing rate more than meditation. Cyclic sighing, the exhale-focused practice, was the only one to improve mood significantly more than meditation on its own. Box breathing improved mood against its own starting point, but not significantly more than meditation, and the trial didn't compare the breathing practices with each other.1

Anxiety, rated just before and after each session, fell in the breathing and meditation groups alike, with no difference between them. The trial was exploratory, its groups were small, and it ran for 4 weeks with no follow-up.1

The evidence doesn't show that any breathing exercise treats an anxiety disorder.

If you need more than breathing

The NHS lists calming breathing exercises as one kind of self-help for generalized anxiety, alongside talking therapies such as cognitive behavioral therapy (CBT), which a doctor can refer you to.8 See a doctor if you feel anxious most of the time and it affects your everyday life, or if panic attacks keep coming back.8,6

In the US, call or text 988 for the Suicide and Crisis Lifeline. In the UK, call NHS 111 or Samaritans on 116 123. If you are in immediate danger, call your emergency number.

Questions

How fast does a breathing exercise work for anxiety?

In the Stanford trial, people rated their anxiety right before and right after each 5-minute session. On average it was lower afterward in every group, meditation included.1 The trial didn't test sessions shorter than 5 minutes.

Which breathing exercise is best for panic?

Student Minds suggests 7-11 breathing for panic attacks,4 and 4 in, 8 out is a shorter version of the same idea: a longer out breath and no holds. The NHS advice during an attack is to breathe slowly and deeply.6

Can I do this at work without anyone noticing?

Yes. Breathe through your nose, keep the counts in your head, and use the timer with sound off. The box and 7-11 patterns need no equipment once you know them.

Should I breathe through my nose or my mouth?

The NHS exercise is in through the nose and out through the mouth.7 Out through the nose works too and is quieter; pick whichever keeps the exhale smooth.

What if focusing on my breathing makes me more anxious?

Focusing on the breath can feel uncomfortable, especially if you have a breathing problem, and an NHS trust's staff leaflet suggests a grounding exercise instead.9 One version: name 5 things you can see, 5 you can hear and 5 you can feel against your body.10

Related timers

This guide isn’t medical advice.

Sources

  1. 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.The comparison of breathing exercises with mindfulness, the result for the exhale-focused practice, and anxiety before and after each session
  2. 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.The review of slow breathing and its limitations
  3. Huth, A. (2020). Why you should combat breathe before you leave. Police1, 20 May 2020.Police academy training in combat breathing, also called tactical or box breathing
  4. Student Minds. 7-11 breathing exercise. Published 1 July 2024.7-11 breathing for stress, panic and sleep, and the shorter 3 and 5 counts
  5. NHS Leadership Academy. Tool 2: Breathe your way to calm, 7/11 breathing.NHS staff guidance using the 7-11 counts
  6. NHS. Panic disorder. Reviewed 22 August 2023.What to do during a panic attack and how long attacks usually last
  7. NHS. Breathing exercises for stress. Reviewed 12 June 2026.Practicing for at least 5 minutes as a daily routine; in through the nose and out through the mouth
  8. NHS. Generalised anxiety disorder in adults. Reviewed 22 October 2024.Breathing exercises as self-help, talking therapies, and when anxiety warrants a doctor
  9. Sherwood Forest Hospitals NHS Foundation Trust. Breathing exercises (staff wellbeing leaflet).Grounding exercises when focusing on the breath is uncomfortable
  10. Ambitious about Autism. Breathing strategies to support wellbeing.The grounding exercise of noticing 5 things