Physical Grounding Tool: Box Breathing

While so much about therapy is about the therapist-client relationship, having and knowing specific tools are important as well and integrated into the way I practice therapy. I want to introduce a grounding method that is one of my personal favourites, and one that I love practicing with my clients as well. 

It is called box breathing or the four-square breathing method. 

Imagine the four sides of a box. 

1st Side: Inhale to a count of four (four seconds)

2nd Side: Hold that air in your lungs for a count of four

3rd Side: Exhale for four counts

4th Side: Keep your lungs empty (or keep that "non-breath") for four counts, before repeating this pattern again. 

After multiple rounds of this, or approximately 5-10 minutes, when you are ready, let your breath return to normal. That’s it!

I tell my clients that one of my favourite things about this grounding method is that it is subtle—which makes it versatile. You can be sitting with a group of people, and unless someone was paying very close attention to you, no one would know you were using this method.

Some important notes:

1. You can practice this with the stopwatch app on your phone as you start out to help you keep pace and then do it without the stopwatch once your body has internalised the pace (see below for more resources). 

2. Remember to do each of these steps for the full four counts (e.g., don’t breathe in quickly for 2 seconds and then unintentionally hold your breath for 6 seconds. Try take the full 4 seconds to complete each step). 

3. Practice diaphragmatic, deep, breathing. Deep breathing engages the parasympathetic nervous system that tells your body that it can calm down. In contrast, shallow (or chest) breathing can sometimes induce panic, increase panic, or keep the panic at the same level. You can read up more about diaphragmatic breathing if you are interested, but essentially you want to ensure that your stomach is rising/filling before your chest does. You can place your hand on your stomach if it helps.

A few personal notes about this method that I like to tell my clients: 

• The body is not used to breathing this way, so when you first start, it may feel like it is suffocating. Have patience with yourself and your body as it adapts. 

• This method is based on the belief that the rhythm of the box/square steps is what is soothing as well. 

• Practice this when you are not triggered or feeling anxious. This is so that when you are feeling anxious, your body knows what to do and may feel the benefits of this method quicker. 

• Not all methods of grounding work for everyone. Every body is different. So take note: if this method regularly increases your anxiety, it just means this may not be the best method for you and your body. 

• Once you feel like you have gotten this down, feel free to experiment and tweak this to whatever works for you. For example, you can breathe in for 4 seconds and hold it for 6 seconds, breathe out for 4 seconds, and hold the exhale for 6 seconds. Note: Some people argue that the ratio is important, but I would recommend just seeing what works best for you.

I hope you find this post useful! 

Here are some additional resources/tips:

1. Breathe Easy Free App. Instead of a stopwatch or numbers, it uses the movement of a shape to help guide your breath. The timings for each side of the box can be customised too. 

2. You can find YouTube videos such as this to help guide you as well.