Box Breathing, 4-7-8 and Paced Breathing Compared
Box breathing, 4-7-8 and paced breathing side by side: what each is, the few trials that compared them, what is not known, and why none is a winner.
Content last updated . This page has not been medically reviewed.
Quick answer
No source we read shows that one of these is better for everyone. The head-to-head studies are small, use students or volunteers, and measure short-term effects. People know which breathing they are doing, so expectation may explain part of any change.
What each one is
- Box breathing uses equal lengths for each phase. One trial defined it as equal inhalations, breath retentions and exhalations. [2] Details are on the box breathing page.
- 4-7-8 breathing is a counted pattern. Cleveland Clinic says it was popularized in 2015 by Andrew Weil, MD, and has roots in the yogic practice of pranayama. [3] It also warns that starting out may cause a little lightheadedness or shortness of breath. [3] See 4-7-8 breathing.
- Paced or slow breathing means deliberately slowing the breath rate. It is the form most studied. Reviews call it voluntary slow breathing. [4] See paced and resonance-frequency breathing.
What studies that compared them found
| Question | What the source found | Strength of evidence |
|---|---|---|
| Square vs 4-7-8 vs 6 breaths a minute (84 college students, one session) | Breathing at 6 a minute raised heart rate variability (HRV) more than square or 4-7-8 breathing. None changed blood pressure or mood meaningfully. 6 a minute led to mild over-breathing. [5] | Mixed; one small study |
| Box breathing vs prolonged exhalation vs normal breathing before a stress test (66 people) | Box and prolonged exhalation both lessened rises in heart rate, anxiety and one saliva marker. HRV, cortisol and thinking tests did not change. [6] | Promising but limited |
| 4-7-8 vs alternate-nostril breathing vs resting (34 students) | Effects on stress and mood differed by sex. No significant main effects on usual HRV measures. [7] | Insufficient evidence |
| Box breathing vs cyclic sighing vs another pattern vs mindfulness meditation (daily, one month) | Breathwork improved mood more than meditation, especially exhale-focused cyclic sighing. Box breathing was not singled out. [2] | Promising but limited |
The authors of the 84-student study wrote that square and 4-7-8 breathing are popularly promoted but have little empirical support. [5] One author of the one-month mood study reported becoming an advisor to a wearable-device company in 2022. [2]
Paced breathing: the broader evidence
Larger reviews are mostly about slow breathing in general, not these named patterns. A review of 223 studies found higher vagally mediated HRV with voluntary slow breathing. [4] A review of 12 trials found breathwork was linked to lower stress (g = -0.35), mostly at moderate risk of bias, and urged caution about a mismatch between hype and evidence. [8] That review's lead author trained as a breath teacher. [8] NCCIH describes a 2019 review of 17 studies in which slow breathing gave a modest drop in blood pressure, with short follow-up and high risk of bias, and a 2019 review of 4 studies (398 people) in which paced breathing helped hot flashes. [9]What is not known
Proper evidence not found for a long-term head-to-head trial of box vs 4-7-8 vs paced breathing, or for any of them preventing or treating disease. We searched PubMed titles for box breathing, 4-7-8 and slow breathing and read the trials above. Changes in HRV are a body measure, not proof of a health benefit.Frequently asked questions
Which is best for anxiety: box breathing, 4-7-8 or paced breathing?
We did not find a trial showing one is best. In one 84-student study, 6 breaths a minute raised HRV more than square or 4-7-8 breathing, but none changed mood meaningfully. [5]
Is 4-7-8 breathing proven to help sleep?
Proper evidence not found in the trials we read. Cleveland Clinic links it with calming the mind and better sleep, but we did not read a trial of sleep outcomes. [3]
Is box breathing a military technique with proven results?
We did not read a primary source on its origin. A randomized stress-test trial found short-term reductions in some stress markers compared with normal breathing. [6]
Can slow breathing cause dizziness?
Yes. Over-breathing can cause lightheadedness and tingling, and one study found mild over-breathing at 6 breaths a minute. [1] [5]
Should I do these breathing practices instead of treatment?
No. NCCIH advises seeing a health care provider if depression or anxiety persists. [9] For urgent mental-health distress in the US, call or text 988.
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Safety first
If you have trouble breathing, chest pain, or feel faint, or if rapid breathing is happening for the first time, get urgent care (in the US, call 911). MedlinePlus says first-time rapid breathing may be a medical emergency. [1] This page compares three kinds of slow breathing for information only. Two of them (box breathing and 4-7-8) include pauses in their pattern, so we do not give counts or how-to steps for them. If you ever try a gentle version, keep it comfortable, sit down, and stop if you feel dizzy, tingly, faint or anxious. Never do it while driving, bathing, swimming, near water or at heights. See breathwork safety.
Who should check first
NCCIH reports rare cases where relaxation techniques caused or worsened symptoms in people with epilepsy, certain psychiatric conditions, or a history of abuse or trauma. [9] Pauses add reasons for care with asthma, COPD, heart conditions, panic disorder and pregnancy, but the sources we read do not say who must avoid them, so ask your clinician. Never change medicines or delay care because of a breathing exercise. For goal-level guidance, see breathing exercises for stress.
References
- MedlinePlus Medical Encyclopedia, Hyperventilation. Read 2026-10-22.
- Balban MY et al. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med 2023. PubMed. Read 2026-10-22.
- Cleveland Clinic, 4-7-8 Breathing Method for Sleep and Relaxation. Read 2026-10-22.
- Laborde S et al. Effects of voluntary slow breathing on heart rate and heart rate variability: systematic review and meta-analysis. Neurosci Biobehav Rev 2022. PubMed. Read 2026-10-22.
- Marchant J et al. Comparing the effects of square, 4-7-8, and 6 breaths-per-minute breathing conditions on HRV, CO2 levels and mood. Appl Psychophysiol Biofeedback 2025. PubMed. Read 2026-10-22.
- McAllister MJ et al. Box breathing and prolonged exhalation reduces markers of physiological stress reactivity in response to a virtual Trier Social Stress Test. Compr Psychoneuroendocrinol 2026. PubMed. Read 2026-10-22.
- Acute psychophysiological effects of 4-7-8 and Nadi Shodhana breathing: a randomized crossover study. Appl Psychophysiol Biofeedback 2026. PubMed. Read 2026-10-22.
- Fincham GW et al. Effect of breathwork on stress and mental health: a meta-analysis of randomised-controlled trials. Sci Rep 2023. PubMed. Read 2026-10-22.
- NCCIH, Relaxation Techniques: What You Need To Know. U.S. National Institutes of Health. Read 2026-10-22.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.