Breathing: The Overlooked Power Tool for Stress, Focus, and Performance
Wade Fox, DO, FACEP, FAAEM
I’ll be honest, when malpractice counseling first suggested I read a book about breathing, I nearly laughed it off. I have weathered a lot of storms in medicine, but I never expected a book recommendation to shift my perspective so much. Still, I picked up James Nestor’s Breath: The New Science of a Lost Art, and what followed surprised me. I started to notice changes not just in how I handled stress, but in my focus, my energy, and even how I showed up for my teams and my family. It was humbling, and it made me realize how easy it is to overlook the basics, especially when life gets chaotic.
My journey has placed me on the front lines, leading teams through medical crises, coaching colleagues, and navigating my own high-stress moments in the emergency department. In these chaotic and unpredictable settings, I have learned that the simplest tools often make the biggest difference. For me, breathing — something so fundamental we rarely give it a second thought — has become one of those transformative tools. If a skeptical, battle-tested physician like myself can be convinced of its power, I believe it is worth sharing with you.
The Power of Breath
Breathing is automatic, but it is far from trivial. As both my clients and I have discovered — and as James Nestor’s Breath: The New Science of a Lost Art explores — most people do not breathe optimally, especially under stress. Nestor’s research and personal journey show that how we breathe — nose versus mouth, shallow versus deep, fast versus slow — directly affects our physical and mental health. In stressful moments, our breathing often becomes shallow and erratic, which can amplify anxiety and cloud our thinking. This is something I have experienced firsthand, both in the emergency department and in my own life, including high-pressure situations like leading a team through a crisis or managing daily challenges.
What We Get Wrong About Breathing
Modern life has led many of us to develop poor breathing habits. Nestor details how the shift from nasal to mouth breathing, driven by lifestyle changes, has contributed to issues like snoring, sleep apnea, anxiety, and hypertension. Nasal breathing filters, warms, and humidifies air, activates the diaphragm, and stimulates nitric oxide production, which supports immune function and blood flow. Slow, deep breathing activates the parasympathetic nervous system, promoting relaxation and recovery, while shallow, rapid breaths trigger the stress response.
Breathing Well: The Science and the Practice
Adopting proper breathing techniques can:
- Lower heart rate and blood pressure
- Reduce stress hormones
- Enhance clarity and decision-making
- Improve emotional regulation
- Boost physical endurance and performance
These benefits are not just theoretical. Elite performers, from athletes to Navy SEALs, use structured breathing methods to stay calm and focused in high-pressure situations. In my own practice, I have found that integrating conscious breathing techniques is more effective than any other stress management tool I have tried.
Box Breathing: A Simple, Effective Tool
One of the most effective techniques I use is “box breathing,” a practice favored by Navy SEALs for its simplicity and immediate impact. Here is how it works:
- Inhale through your nose for a count of four.
- Hold your breath for four counts.
- Exhale slowly through your mouth for four counts.
- Hold again for four counts.
Repeat this cycle for several minutes. The structure is as simple as tracing the edges of a box.
Box breathing interrupts the body’s fight-or-flight response, calming the nervous system and reducing adrenaline surges. This brings emotional balance, sharpens focus, steadies the hands, and improves physical control, whether you are making a critical decision, navigating a tough conversation, or steadying yourself during a challenging moment.
Impact and Takeaway: Making Breathing a Core Wellness Tool
Integrating conscious breathing techniques such as box breathing is a powerful, low-tech intervention that can benefit both you and those you serve. It requires no equipment or special training, just awareness and intention. Whether you are facing emotional turmoil, physical exertion, or the relentless pace of daily life, a few mindful breaths can help steady your mind and body, lower stress, and enhance your performance. As James Nestor reminds us, “You can’t be truly healthy if you’re not breathing properly.” Breathing is not just a background process; it is a lever for better health, resilience, and clarity. Consider making it an essential part of your wellness toolkit, for yourself and for those you care about.
How do you use proper breathing in your day-to-day? Share your story or your favorite technique in the comments and help build a healthier, more resilient community.
Wade C. Fox, DO, FACEP, FAAEM, is a board-certified emergency physician, elected member of the Board of Directors, and Regional Director for Vituity. With extensive hands-on clinical experience in high-acuity emergency settings, Dr. Fox has led award-winning emergency departments and served as Chief Medical Officer for Umpqua Health. As an innovator with Inflect Health, he bridges clinical care and real-world operational needs, bringing practical leadership, coaching, and system transformation to every conversation about health, resilience, and performance.
