‘It really does work’ - Dr Amir Khan reveals 16-second breathing technique to alleviate stress

There’s no getting away from it - life is stressful. All of us experience times when life just feels harder, and sadly, stress has an impact on all aspects of our lives, from mood and sleep to appetite and relationships.

Being able to recognise when you’re stressed and having some tools to help lower your cortisol levels is really important. One way that GP Dr Amir Khan thinks we can all help ourselves is by using breathing techniques. Speaking to co-host Cherry Healey on their No Appointment Necessary podcast, he says: “The best way to talk to your nervous system is through breathing.”

When we’re stressed, our bodies release stress hormones such as cortisol and adrenaline as our body goes into “fight or flight” mode. We might feel our heart rate increase, or we get hot, our muscles tense, and our breathing quickens and becomes shallower. None of these things is good for our overall health and longevity, especially if you already have problems with high blood pressure.

This is why Dr Khan is encouraging us all to focus on our breathing to help relax us when the stress feels overwhelming. He’s not the only advocate of mindful breathing, though. There’s growing evidence from studies around the world that it can be an effective non-pharmacological alternative for improving our mental health.

“I think breathwork and deep breathing is a lost art,” he tells Cherry. “Deep breathing exercise switches on something called your parasympathetic nervous system, which is your rest and digest nervous system.” He says there’s one specific type of breathing which can “switch your body from panic mode to calm in minutes”, and that is box breathing.

What is box breathing?

Box breathing gets its name from the four steps it involves, which can be visualised as a box or a square. Dr Khan explains how to do this 16-second technique: “Imagine a box, a square, and we’re counting in four seconds, so each side of that square is four seconds."

You’ll know how and where you feel most comfortable doing breathwork. You may choose to do it lying down with your eyes closed, or sit or stand quietly.

Relax your body and mind. Let your shoulders drop and relax your jaw so you’re really letting your whole body unwind. It’s up to you how long you do box breathing for.

Box breathing is one of the better breathing exercises for stress relief, as you can do it anytime, but it's commonly done at night before sleep. Some studies, such as this one from 2019, have shown that deep breathing can help your body release the sleep hormone melatonin and help improve core sleep.

How to do box breathing

Box breathing works in four steps: "Four, four, four, four, and it really does work," says the doctor. Here's how to do it:

• Breathe in for four seconds
• Hold for four seconds
• Breathe out for four seconds
• Hold that for four seconds

Is there anyone who shouldn't box breathing?

As box breathing involves holding your breath for a long period, it may not be suitable for everyone. For example, those with high blood pressure are often advised against it.

If you experience a racing heart or breathlessness when doing breathwork, it could be a sign of underlying heart problems, rather than stress. Always speak to your doctor if you have any concerns.

Other breathing exercises to try

There are a number of other breathing exercises which can be effective at reducing stress, including the 4-7-8 technique. This is where you breathe in through your nose for four counts, hold your breath for seven and then exhale forcefully out of your mouth for eight. If you’re new to this type of breathing, you may feel dizzy, so it’s best to try it sitting down and only do three or four rounds at a time to begin with.

Alternate nostril breathing is something you might have tried during yoga, but it can be done at any time. This technique involves closing one nostril while inhaling through the other, closing that nostril and exhaling through the opposite nostril. It helps slow down your breath and breathe more deeply into your lungs.

A study in the International Journal of Yoga found that 30 minutes a day of alternate nostril breathing can significantly lower our stress levels. “The practice of pranayama (controlling your breath) is associated with increased vigour and has a positive effect on the mood. It can be used as a self-restraint technique for stabilising various effective states in an individual,” the authors said.