Category: Anxiety

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Surviving the Death Talk With My Kid

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The first time death came up, my son was asking about an old photo of my dog Jupiter. Jupiter, an American bulldog I rescued from L.A. just before my now-husband and I moved in together, died just a couple of months before my son was born. For several weeks I cried, unmoving, on the sofa. Agonizing over my loss and worried that my joy about giving birth was being overshadowed by my sorrow, I was nervous that heartbreak was seeping deep into my bones.

When he asked, I was so excited to tell my son, who was 4 at the time, all about this amazing dog’s life. It turned out he was far more interested in his death.

Like so many other hard conversations we’d had before, I initially tried to be as matter-of-fact about dying as I could be. I described how Jupe had been in a lot of pain, that the doctor said he was likely very ill, and that the kindest thing we could do for him would be to relieve him of that pain as peacefully and quickly as possible. “What was he feeling when he died?” my son asked. I wasn’t sure how to answer. In that awful, quiet moment, I only knew how I felt, and I was shattered. So I told him truthfully that I didn’t know what it feels like to die, but as I’ve done a million times before with things I’m not sure of, I promised we could get some books from the library and try to find out. But I knew deep down he wasn’t interested in hypotheticals and esoteric explanations about death. He wanted to know it, to see it up close and poke at it in the same way he investigated the bugs in our backyard.

The books at the library were unsatisfying, but he didn’t have to wait long to find out what the real thing felt like. The next year for our family was anchored by death, and the “what ifs” were left far behind.

Just a few months after our conversation about Jupiter, my husband’s father died. He flew home to be with his family in the very darkest part of the morning, and I sat up waiting for the sun to rise, hoping the light would help me make sense of what was happening, both for me and for the kids. My daughter was just a toddler, but my son — he was that very curious, very aware 4-year-old who would wonder where Daddy had gone and why.< This time I didn’t feel the need to explain as much; I just let him see for himself how death reshapes the room as my grief filled our tiny home like my tears were a million heavy glass balls. Loss was no longer something atmospheric, it was grounded by this now-empty hole in my husband; it became a window through his heart that he tried to hide but couldn’t. Now that death was suddenly tangible, we started talking about it a lot more, but it wasn’t until my mother-in-law died eight months later that the real, unraveling questions about it came. “Does everybody die?” Yes. “Will you and Daddy die?” Someday, yes. “Will I die?!” Yes, but … “When?” Not for a long time. “Is there anything after we die?” I don’t know.

Those were hard. I wanted to tell him the truth — I think kids are owed at least that much. My husband actually had to stop me from answering “When will I die” with something a little too honest. I just felt he deserved at least my attempt at the full picture of what it means to be alive, of the true price of this incredible experience. That a long life is not promised, it’s only what we hope for, and when and how we die is something no one knows. That death is arbitrary and often meaningless, and how finite our lives really are. Would I be denying him something fundamental by not making all of those things clear? Or was it actually cruel to burst that bubble of innocence for a kid who adamantly believes in Santa and the Easter Bunny? So instead I told him how lucky we are that before we die we get to taste mangos and read our favorite books. That we get to swim in the salty ocean and collect smooth, green glass on the beach.

I worried a lot that first year if I’d been too forthcoming. I didn’t want him to feel burdened by this idea of loss, and I didn’t want him to be afraid. But I also wanted to offer an explanation for why it sometimes felt like the roof of our house was sagging under with grief. I remember when my own dad’s dad died, I was quite a few years older than my son, but my parents shielded my sisters and I from what was happening. All we knew was that suddenly everything felt different around the house and our once stoic dad was felled by a pain we couldn’t understand. I thought and still do think when the emotional tenor of the household changes so dramatically and instantly, it’s important to let everyone know why. Especially since the aftermath of death can feel like a punctuated silence. You’re not sure what to say or how to say it; grief can feel invisible, so naming it, talking about it is a necessary flare to send up, to be clear that this house is in mourning.

I reminded myself of what a privilege it is to watch each other grow and that in the inevitability of death is also a promise to relish life.

Sometimes it felt like he was prodding at us like a couple of worms he’d dug up, seeing which questions would make us recoil or squirm. He often recited that his grandparents had died like it was an animal fact or something he’d learned at school, as a reminder to himself that yes, something had changed this year, we really were different.

>The next summer, my son got really into space. We started talking about all the different galaxies and planets and stars, the bigness of everything around us and the smallness of us. And I told him, a few weeks after the memorial for his grandparents, that he, too, is made of stardust, that part of what’s out there is also in both of us. He loved the idea of being a part of something so huge and the thought that when you died, you might still leave something behind. I knew he’d been seeking that kind of comfort since our very first conversation about it, but I couldn’t promise him something I didn’t know to be true. In stardust though, I was finally able to say with confidence that after we die, we don’t just disappear.

It’s been a couple of years now, and we don’t talk about death as frequently. Some light has come back into our house, and I’ve noticed that my son isn’t as scared of the idea anymore. He understands how momentous death can be, but along the way, because we always answered his questions openly, honestly, and with care, it has become something normal. It’s as much a part of life as anything else, and he’s seen that firsthand now. The only thing that has really changed is that he won’t let me kill bugs in the house anymore because he says they deserve a long life too.

Complete Article ↪HERE↩!

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‘I will reflect on my own death – and try to conquer my fears’

— The thing I’ll do differently in 2023

‘It is death that makes life meaningful’ … Monica Ali.

I don’t want to be mawkish or indulgent. But I want to consider my mortality in order to live well in the years I have left

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Have you ever spent time seriously contemplating your own death? I haven’t. I’m 55, in good health, exercise regularly, eat well and – barring the proverbial bus – have no reason to think death is imminent. Thoughts of my own mortality naturally arise from time to time but they’re easy to banish. After all, both my parents are still alive, forming a kind of metaphysical barrier. Not my turn yet! But one thing I will do differently in the coming years is to begin reflecting on my demise. Does that sound mawkish? Self-indulgent? Pointless?

Well, I won’t be picking out a coffin or selecting music for the funeral or tearfully imagining the mourners gathering. All that would be a waste of time and, like everyone else, I’m busy. With work, family, friends, travel, trips to the theatre, galleries, restaurants and so on. What I mean to say is that I have not lost my appetite for life. Why, then, do I wish to begin meditating on death?

For two reasons: in order to live well during whatever years I have left; and to begin to confront and maybe even conquer the fear that, thus far, has stopped me from having more than a fleeting engagement with the knowledge that death is the inevitable outcome of life.

There’s a well-worn trope about living each day as if it’s your last, or if you only had one year to live you wouldn’t choose to spend it at the office. That doesn’t quite chime with me. If I only had a year to live, I’d still choose to work. (I might try to write faster!) Nevertheless, it is death that makes life meaningful. In Howards End, EM Forster puts it like this: “Death destroys man: the idea of Death saves him.” The value of our days floats on the metaphysical stock market of ideas that we hold in our minds.

The idea of ceasing to exist isn’t easy to contemplate. But I don’t believe in reincarnation or an afterlife. I don’t believe that raging against the dying of the light is going to achieve anything. And ignoring the issue isn’t going to make it go away. In fact, it makes the prospect more, rather than less, frightening.

I first read The Complete Essays by Michel de Montaigne when I was at college, but it’s only now that I’m ready to take on this piece of sage advice: “To begin depriving death of its greatest advantage over us, let us deprive death of its strangeness, let us frequent it, let us get used to it; let us have nothing more often in mind than death.”

How will I go about it, then, this new contemplative practice? Place a skull or some other memento mori on the shelf above my desk? Fly to Thailand or Sri Lanka and visit the Theravāda Buddhist monasteries where photos of corpses are displayed as aids to the maranasati (mindfulness of death) meditation? Walk around graveyards?

I’ve recently rented an office where I go to write. There’s a huge picture window under which I’ve placed the desk. The window overlooks a Victorian graveyard that’s still in use. When I sit down, all I can see are the trees. But when I stand I have a view of the tombstones and, in the distance, the crematorium.

One day I’ll be gone, my body consigned to the earth or turned to ash. Sooner or later I’ll be forgotten. Truly accepting that revivifies life. It doesn’t make every moment wonderful, but knowing I will die is a source of strength to endure the difficulties, and a spur to be more present for all that is good and precious in life.

Complete Article ↪HERE↩!

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The anxieties of growing old when you’re LGBTQ

Who would you call to bring you chicken soup? For many LGBTQ seniors who are alone, that’s no easy question.

A person holds an umbrella in the rainbow flag colors in the annual Gay Pride Parade, part of the Durban Pride Festival, on June 29, 2019, in Durban, South Africa.

By Steven Petrow

Who would bring you chicken soup if you were sick? For most people of a certain age, that’s easy — a spouse or an adult child would step up.

For many LGBTQ people, however, it’s not a simple question at all.

“Many [would] have to think really hard about this,” said Imani Woody, an academic and community advocate who retired from AARP to start an organization serving LGBTQ seniors. She said chicken soup is a stand-in for having a social support system, which many of us need.

“Build your village right now,” Woody said.

A few years ago, I would have said that my then-husband would be my primary caregiver if I became ill or disabled. I’d have done the same for him. Now I’m 65 and divorced, and this issue — who can I call on? — is top of mind for me.

It’s also a serious concern for many LGBTQ people I know, whether single or partnered. Take one friend of mine, for example, who is 60 and a single gay man. He took care of his dying father last year (as I’d done four years earlier with my parents). During his dad’s lengthy illness, we talked about two questions that terrify us (and I don’t use that word lightly): “Who will take care of us when we need help?” “Where will we go when we can no longer take care of ourselves?”

Of course, aging is an equal opportunity challenge for straight and queer people alike. But in interviews with more than four dozen LGBTQ people, singled and partnered, I heard repeatedly about the anxieties faced by queer elders.

SAGE/Advocacy & Services for LGBT Elders, the National Resource Center on LGBTQ+ Aging, and Healthypeople.gov document the health challenges LGBTQ people face. We’re twice as likely as our straight counterparts to be single and live alone, which means more likely to be isolated and lonely. We’re four times less likely to have children. We’re more likely to face poverty and homelessness, and to have poor physical and mental health. Many of us report delaying or avoiding necessary medical care because we face discrimination or mistreatment by health-care providers. If you’re queer and trans or a person of color, these disparities are heightened further. (There are about 3 million LGBTQ people 50 and older.)

“It’s a very serious challenge for many LGBTQ older people,” said Michael Adams, chief executive of SAGE. “The harsh reality is that there just aren’t as many opportunities for older LGBTQ folks when it comes to creating, building and maintaining social connections. … We’re lacking the personal connections that often come with traditional family structures.”

In part, that’s because LGBTQ people have often found themselves rejected by family, friends and community in their younger years because of their sexual orientation or gender identity. To boot, we could not legally marry until 2015, when the Supreme Court ruled in favor of marriage equality. But even married queer folks can end up alone after a divorce or death, which often brings different challenges than those faced by straight people facing the same life-changing events.

An 80-year-old lesbian put it to me this way: For straight people, “If you were to go into a nursing home, you would not have to worry that people taking care of you did not approve of your orientation, or that the facility would not take you because they were a ‘religious’ community. These are real issues for the queer community.”

Another friend tells me he has no plans for the future except a guest room and a second bathroom. And another said he hopes by the time he needs care, there will be an LGBTQ senior community in his city. “Otherwise, I have nothing,” he said.

A former colleague of mine, a lesbian, told me she worries about the cost of senior living: “I dread it all. I won’t have any dough then, so it’s really up to fate.”

Senior living communities, which provide support for the aging, can be less than welcoming to those who are LGBTQ. Staff, some of whom have traditional views on sexuality, gender identity and marriage, also pose challenges to LGBTQ elders since many facilities lack the training and policies to discourage discrimination, which can lead to harassment, Adams said.

Patrick Mizelle, who lived in Georgia with his husband, told Kaiser Health News several years ago that he worried about how “churchy” or faith-based their local options seemed, and feared they would not be accepted as a couple. “Have I come this far only to go back in the closet and pretend we are brothers?” he asked.

Rather than take that risk, they moved across the country to a queer-friendly senior living complex in Portland, Ore. They are among the lucky ones in that they could afford both the move and the cost of this domestic situation.

How do you find a welcoming LGBTQ senior living arrangement? SAGE publishes a comprehensive list of long-term care facilities (organized by state and city, along with level of care) that it has found to be welcoming.

“We also have resources about the kinds of questions that a consumer can ask to figure out if a provider is paying attention to the steps that need to be taken to become more welcoming to LGBTQ older adults,” Adams said.

SAGE also offers training to staff members at facilities that provide elder care, and has partnered with the Human Rights Campaign, the national LGBTQ lobbying and advocacy organization, in launching the Long-Term Care Equality Index, which sets out best practices to help make these facilities welcoming to the LGBTQ community. More than 75 facilities have made pledges to abide by these best practices. AARP also provides a list of affordable LGBTQ-welcoming senior housing.

What else can LGBTQ people do to find connection, to find a tribe? Many suggest the importance of developing intergenerational friendships early on in life, even as early as your 30s and 40s. Elders can impart wisdom and experience to younger LGBTQ people, who can provide help in return; as decades pass, the young ones become the elders.

Recently, the Modern Elder Academy, which refers to itself as a “midlife wisdom school,” and the founders of Death Over Dinner, launched a program called “Generations Over Dinner” expressly to connect people of all ages.

The Harvard Study of Adult Development, which began tracking more than 238 men (regardless of sexual orientation) in 1938 and continues to this day, has reported consistently that relationships are the critical ingredient in well-being, particularly as we age.

Put simply, the more connected we are, the more likely we are to be healthy and happy. To paraphrase Imani Woody: Start building those bridges.

Complete Article ↪HERE↩!

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How to Improve Death Anxiety Using CBT

By abraham smith

The fear of death has been shown to play a causal role in a variety of mental disorders. Although fear of death is transdiagnostic, it is a particularly prominent feature of fear of health. And that’s not exactly surprising. Aside from being a victim of violence or an accident, the vast majority of deaths are due to disease-related causes, right?

Well, most people don’t like the idea of ​​their death. But while it’s unsettling, they can, to a certain extent, accept that death is an inevitable part of life and more or less leave it at that. However, many people with health anxiety find that their fear of illness and infirmity stems, at least in part, from fears related to death and/or the dying process. Only recently have researchers and clinicians begun to address this issue in their understanding and treatment of health anxiety.

Western culture doesn’t help.

Denial and avoidance of death-related concepts only increases fear of it. As a society, we have a responsibility to promote the avoidance of death and dying. Death is something that is not accepted or openly discussed in our culture. In fact, there’s a whole movement against it, sometimes referred to as “death positivity,” which advocates for greater acceptance of death in our culture by encouraging people to speak openly about death and dying (acknowledging, understanding, and speaking about our fears about what we want and the organization or planning of our death). There are many examples of this movement taking place. In one, people hold death dinners to discuss mortality. More than 200,000 people attended these dinner parties. In a way, this “death positivity” movement fits well with the core principles of exposure therapy, which is to expose yourself to the feared stimulus in order to learn that it is not as frightening as one might think.

Treatment for fear of health includes treatment for fear of death.

If we’re trying to improve your fear of health without addressing your fear of death, we’re just putting the proverbial band-aid on your wound. Researchers refer to this as the “revolving door problem”. Essentially, if a client comes to me for health anxiety and I don’t address their fear of death in treatment, the problem will likely recur and they will return for treatment at some point in the future.

So how do we treat the fear of death?

In cognitive behavioral therapy (CBT), we use cognitive restructuring and exposure tasks to overcome fear of death. With cognitive restructuring, we help someone to question their maladaptive assumptions about death and dying (e.g., fears about the dying process, fears about the ‘ultimate goal’, fears about leaving loved ones behind). In exposure therapy we help to systematically expose oneself to death and dying in different ways, slowly and steadily seeing death as a normal part of life and not the “scary monster in the closet”.

For example, we would design expositional tasks (such as the following) to help you systematically familiarize yourself with the idea of ​​death:

  • Watch movies/read books that show scenes of dying people.
  • Go through hospice materials – many of them talk at length about the dying process.
  • Read about people who lost loved ones and cared for them during the dying process (find some books).
  • Write (and discuss) an imaginary story about your children’s lives after your death.
  • Write (and discuss) an imaginary story about you on your deathbed with loved ones around you.
  • Develop a plan for your dying process if you could choose. Where would you be, who would be there, what food and drink would you like to enjoy and what type of activities would you like to do?
  • Read more about death food.
  • Attend a death dinner and share how you would like to die if you died from a disease-related cause.

In summary, the main roles in treating fear of death with CBT are (a) to help you challenge rational fears through cognitive restructuring, and (b) to help you become more comfortable with death by addressing yourself Involve exposure tasks that normalize death avoiding it. Death isn’t something we look forward to, but it shouldn’t take over your life!

Complete Article ↪HERE↩!

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Let’s talk about dying

The most unavoidable topic that everyone avoids

By Hannah Mirsky

No one talks about death. I didn’t for a long time.

Sometimes the words spilled out when I was with a friend, but I never felt satisfied. Other times it was late at night and I would mope out to the living room past midnight to sit with my mother and briefly discuss how much we missed those in our family who died.

That was it though. Death would be brought up, but the conversation never was discussed for too long.

In the summer going into seventh grade my grandmother died from pancreatic cancer, then my aunt ten months later from bladder cancer. Then my grandfather a few years later.

As I coped with the death of my family members, I began excessively planning out my future. I developed the ideal life from the city I’ll reside in, to the color I would paint my apartment walls. When I committed to college I vowed I would take every opportunity I could possibly get and fill each day with experiences that could help me with this vision.

But I worked so much when I got to college. It got to the point last fall that I lost a part of myself. There were no moments of peace in my day. I took a full course load, managed my school’s broadcast news department, worked an internship, another part-time job and choreographed for Quinnipiac University’s Tap Company. In every way, I was disconnected from the people around me and myself.

Yet during this particular semester, I was enrolled in a course called “Sociology of Death/Dying” where we discussed social interaction between the dying person, professional caregivers and loved ones. The class flowed like an open forum.

I joked that I would start and end my week with death since I only had that course on Mondays and Fridays. My friends didn’t laugh too much.

Three times a week I was forced to consider death in ways I hadn’t considered. For the first time, I was forced to confront the topic of death on a daily basis.

More than anything, this course revealed the significance of starting conversations about the dying process before death itself. While the person is dying, family and friends are often so wrapped up in trying to keep them around for a bit longer. However, the person dying may feel an obligation to fight for their family when it isn’t something they want. We begin making decisions not for ourselves anymore and we become alienated from the people that we should lean on the most.

Conversations need to begin with health workers and doctors, it needs to trickle down to the family.

Death is isolating in our world— a stigma that many don’t talk about directly. It wasn’t until I met a very close friend of mine when I was in Washington D.C. that I mentioned that I joked about death a lot. No one had ever told me that I brought it up that often.

Maybe, had I allowed myself to discuss how I felt about death when I was growing up, I wouldn’t weave it into my conversations so much now. However, death changes you. I don’t think I would be as articulate with how I spend my days or have had such a clear path. In a way, it helped me understand my priorities and know I don’t have forever to meet them. If I want something, I no longer wait.

It shouldn’t have taken so long for me to feel comfortable talking about death, but it is something many people still struggle with. Neglecting conversation on the certainty of something each one of us will go through ends up forcing us to not consider what we want in life.

Complete Article ↪HERE↩!

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And Finally

— Matters of Life and Death review – humility lessons from Henry Marsh

‘Darkly funny and self-lacerating’: Henry Marsh at home in Oxford, June 2022.

The ever candid neurosurgeon reflects on his own mortality, as well as the failings of his profession, in this enthralling third volume of memoirs

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“I am not a scientist,” says Henry Marsh on the first page of And Finally. “Most neurosurgeons are not neuroscientists – to claim that they all are would be like saying that all plumbers are metallurgists.”

Marsh, who worked as a highly regarded neurosurgeon for more than 40 years, has a penchant for truth-telling, unencumbered by faux modesty. It’s what made his previous books – Do No Harm and Admissions – interrogating a life in medicine, haunted by the “reproachful ghosts” of patients he’d failed, so refreshing and inspiring to read.

This latest autumnal instalment follows in the same vein. Philosophical and scientific conundrums about brain surgery permeate the book: to treat or not to treat patients; how honest to be in giving a prognosis; euthanasia v assisted dying. Along the way the 72-year-old author wrestles with the dilemma of becoming a patient himself.

The memoir’s subtitle and celestial cover design allude to the 1946 Powell and Pressburger film, A Matter of Life and Death. It’s befitting as Marsh reflects on his own mortality after a diagnosis of advanced prostate cancer. He is phlegmatic about his prospects. Sometimes, though, he confesses to paralysing anxiety – a result of his approach towards serious problems that his wife, Kate, calls “therapeutic catastrophising”.

Despite its subject this is not a maudlin book; far from it. Divided into parts like a three-act play, it is often darkly funny, especially in the first act, Denial. Here, Marsh is self-lacerating and also self-forgiving when he reminisces about his medical mistakes. On one occasion he steels himself to admit to a patient that he’d operated on the wrong side of his brain. “Well, I quite understand, Mr Marsh,” the patient answers after a long silence. “I put in fitted kitchens for a living. I once put one in back to front. It’s easily done.”

Marsh is nonetheless fierce on himself throughout the book, as critical as he is of the arrogance of his profession. Now that he’s a patient, he sees clearly how he’s been demoted to an underclass; how some doctors behave as if patients are nothing more than walking pathology; and how they continue to practise medicine under the delusion (once also held by Marsh) that illness only affects patients, not doctors.

Elsewhere, he strikes a sadder personal note, recounting the end of a decades-long friendship with a conscientious Ukrainian neurosurgeon who figured prominently in his earlier memoirs. Working with him in poorly resourced Ukrainian hospitals had left Marsh feeling heroic. But he split from his colleague after discovering he’d been hiding from him a number of cases that had gone terribly wrong, with patients seriously harmed or dying after surgery.

It’s not stated whether Marsh also feels culpable, but certainly he agonises over his professional legacy. That anxiety folds into his nervousness about the future we are bequeathing to our children and grandchildren through inaction over climate change. In one startling passage, he recalls a journey in the Indus delta where he witnessed a catastrophic spectacle: “a flotilla of plastic rubbish … it had neither beginning nor end. It floated past us in complete silence … full of ominous purpose”.

The retired neurologist, who in medical parlance has “hung up his gloves”, has composed a richly discursive book. He charts his ambivalence about undergoing radiotherapy for his cancer, and is especially passionate when advancing the case for assisted dying. He’s scornful of the “dishonest fudge” around the issue that sees doctors accepting the unofficial practice of prescribing large doses of opiate painkillers, as a form of “terminal sedation”.

During Covid, and the cult of death it seemed to spawn, Marsh was animated by the fear his time could run out before he finished making a doll’s house for his granddaughters. Its construction – a mournful metaphor for innocence that a future governed by global warming will deny his grandchildren – is also an act of defiance.

And Finally sounds increasingly ominous about his prostate cancer as the memoir works its way towards a resolution; Marsh is plain-speaking without being dispassionate, almost as if volunteering his own medical history as a case study. Indeed his book reminds me of the mantra – focused on operations – that I first heard at medical school, for doctors embarking on a career in surgery: “see one; do one; teach one”. Henry Marsh may have retired from medicine but let’s hope he keeps producing books as good as this one, which enthral as well as teach.

Complete Article ↪HERE↩!

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3 Stress-Melting Benefits of Box Breathing

(And How to Try It on Your Own)

Try this basic, ancient breathing technique to slow down, reset, and lower stress.

By Lacey Muinos

Focusing on your breath during heightened states of alertness can be a powerful tool for reducing stress, calming anxiety, and cultivating mindfulness. There are many different breathing exercises to keep in your toolbox for when you need them, and one basic breathing technique known as box breathing is gaining mainstream momentum as people discover how straightforward it is and how helpful it can be in everyday life.

While it may seem new to you, the practice of slowing down your breathing with intention has ancient Ayurvedic roots. Box breathing has been used for thousands of years and in practices such as yoga and meditation to calm an anxious mind, engage the rest-and-digest state (the parasympathetic nervous system), and stay grounded in the present moment. It’s even used by Navy SEALs for keeping cool and laser-focused in high-stress, high-pressure situations.

But you don’t need to be a yogi, Zen master, or SEAL to incorporate breathwork like box breathing into your own routine. This uncomplicated, four-step breathing technique is easier than you might think and can be done anywhere and at any time—settle your nerves before a work presentation; slow your breathing while trying to fall asleep; or take a literal breather when you get angry or agitated. We spoke to breathwork pros to find out why this breathing method has resurfaced as an effective and science-backed solution to stress and anxiety.

What is box breathing?

Box breathing goes by many names: four-square breathing, square breathing, four-count breathing, Sama Vritti Pranayama, tactical breathing, and yogic breathing.

“Box breathing is a four-step breathing technique during which you breathe in, hold, breathe out, and then hold for the same number of counts throughout,” says Sophie Belle, a breathwork facilitator and founder of online breathwork studio Mind You Club. So each step of the breath cycle—inhale, hold, exhale, hold—makes up one side of the box. 

Practicing box breathing involves slowing the breath by following a specific pattern:

  1. Inhale for four counts
  2. Hold your breath for four counts
  3. Exhale for four counts
  4. Pause for four counts

(You won’t always have a stopwatch on hand, so “counts” can refer to approximate seconds here.)

Not only does the box breathing physically alter your breath to become slower and deeper, but it also forces your mind to become focused on and conscious of your breath. This can be especially powerful during times of tension or distress, but also beneficial anytime, anywhere as a daily habit. “When we’re consciously breathing, we have the ability to regulate our body and take it from an overstimulated state of stress and nervousness to actual calm,” says breathwork specialist Ali Levine. “Box breathing is a way for you to consciously monitor your breath and pay attention to your rhythm—it’s a reset to your breath.”

The Benefits of Box Breathing

1 Reduces the body’s stress response.

Studies have shown that diaphragmatic breathing (in other words, taking big, deep, gentle breaths that fill your belly) counteracts both the physical and mental elements of stress. Deep breathing has even been shown to reduce the physiological consequences of stress in adults. “Box breathing is a simple, yet powerful way to take yourself from fight-or-flight mode back to a normal rhythm,” Levine says.

When you’re stressed or tense, one of the ways your system reacts is for your breathing to become faster and more shallow (this is all part of a normal, natural stress response). This kind of rapid breathing, known as hyperventilation—essentially where you exhale more than you inhale—lowers carbon dioxide levels in the body and makes you feel lightheaded. Slowing down your breathing helps to control hyperventilation. It restores the rhythm of your breathing, correcting those fast, shallow breaths associated with stress and anxiety.

During states of stress, another thing that happens is that your heart rate increases. This is when your body enters fight-or-flight mode, releasing adrenaline and cortisol, which cause your heart rate to speed up and blood pressure to rise. Slow breathing has been shown to have a profound effect on cardiovascular function. Box breathing activates the parasympathetic nervous system, which is the opposite of fight-or-flight mode, helping the body return to a rested state.

2 Halts unhelpful thought loops.

Box breathing comes with the enormous benefit of calming the mind. Stress and anxiety often come with a cluttered headspace and racing thoughts. “Box breathing focuses your mind, so it’s incredibly good for stress, rebalancing, and [attention],” Belle says. When your thoughts won’t stop swirling, it can feel impossible to quiet them. Using a mindfulness-based breathing exercise like box breathing forces you to bring your attention to something other than upsetting, overwhelming, or just plain obnoxious thoughts. It gives your brain something else to fixate on (what a relief!). And one of the best long-term side effects of doing something like box breathing is that the more you do it, the better your brain will become at redirecting attention away from unhelpful mental chatter. It’s actually a skill that gets sharper with practice.

3 Helps you focus on the present moment.

Anxiety typically involves worrying about the future or harping on the past. Box breathing is heavily associated with meditation and mindfulness, two of the best techniques for anchoring yourself in the current moment.

“The focus on the breath enables you to become very present,” Belle says. “This helps you to practice non-attachment to unhelpful thought patterns, which over time can lead to more positive automatic stress responses.”

How to Try Box Breathing on Your Own

This breathwork practice is rewarding and grounding—and it’s easy to get started. You don’t need any special equipment or even a secluded place, just your mind and your breath. Give it a try when you feel stressed or on a regular basis to encourage relaxation.

How to do it:

  1. Ground yourself (e.g. sit in a chair, sit on the floor, stand in a comfortable position). Sit or stand up straight (but not rigid) and relax your shoulders.
  2. Bring focus to your breath.
  3. Take a slow, deep breath in as you count to four, making the inhale last for all four counts. Feel your belly expand with air.
  4. Hold your breath for four counts. Try to think only about counting to four.
  5. Exhale through your mouth: Breathe out steadily for four counts, making the exhale last for all four counts. 
  6. Hold again for four more counts.
  7. Repeat this cycle as needed.

If you’ve never engaged in breathing techniques before, it will likely feel strange at first—that’s completely normal. “Don’t be disheartened if it feels difficult,” Belle says. “Just reset and reduce the counts or try again at another time when you have a bit more space to focus on the breath.” Instead of attempting to carve out time for box breathing, Belle recommends stacking this habit onto another daily activity that doesn’t require much effort, like waiting for the shower water to get hot or the kettle to boil.

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