Breathing exercises for stress and anxiety: what works

Which breathing exercises help with stress?

Almost all the calming exercises share one pattern: they slow your breathing right down and make the out-breath at least as long as the in-breath. Pick whichever you find easiest to stick with:

• Cyclic sighing: two quick breaths in, one long breath out. Did best in the largest trial.
• Resonance breathing: in for 5, out for 5, about six breaths a minute. The pace used in most research.
• Diaphragmatic breathing: slow, low breaths into your tummy. The basis of the NHS advice.
• Box breathing: four equal steps with holds. Popular for focus under pressure.
• 4-7-8 breathing: a long hold and a very long out-breath. Some find the counts too long at first.

The NHS’s own advice is simple: breathe in gently through your nose, low into your belly, counting to five if that helps, then out gently for a count of five, for at least five minutes.

Using it in the moment and every day

There are two ways to use breathing for stress. In the moment, two or three minutes of slow breathing before a difficult conversation, an exam or a hospital appointment can take the edge off. As a daily habit, five to ten minutes a day, at the same time each day, is what most trials tested, and the effect on your general stress level builds up over weeks. The breathe-along guide can pace you for either.

What the research shows

A 2023 meta-analysis pooled randomised trials of breathwork. In 12 trials with 785 people, breathwork reduced stress compared with control groups by a small to moderate amount. Across larger sets of trials it also reduced anxiety and symptoms of depression by similar amounts. The reviewers judged many of the trials to be at moderate or high risk of bias, and the trials varied in what they called breathwork, so the true effect may be smaller.

The best single trial, from Stanford University in 2023, randomly assigned 108 people to five minutes a day of cyclic sighing, box breathing, fast cyclic hyperventilation or mindfulness meditation for a month. All four improved mood, but the breathing exercises raised positive mood more than mindfulness did, and cyclic sighing did best. A smaller trial in China found eight weeks of slow diaphragmatic breathing reduced negative mood and stress hormone levels.

Heart rate variability biofeedback, which uses a sensor to train you to breathe at about six breaths a minute, has also been studied. A 2017 review found a large fall in self-reported stress and anxiety, though most trials were small.

Overall, we grade the evidence as moderate: the trials point the same way, but many are small and short.

When breathing exercises aren’t enough

If anxiety is affecting your work, sleep or relationships most days, or you have been feeling this way for weeks, talk to your GP. You can also refer yourself to NHS Talking Therapies in England. Talking therapies such as cognitive behavioural therapy have much stronger evidence for anxiety disorders than breathing exercises, and breathing techniques are often taught as part of them.

If you have sudden attacks of intense fear with a racing heart and breathlessness, see breathing during a panic attack.