Drawing and Box Breathing

Purpose and goals:

To promote emotional regulation, mindfulness, and present-moment awareness by synchronizing drawing or tracing movements with the structured breathing pattern of box breathing (inhale–hold–exhale–hold). This intervention externalizes breath into visual marks, making internal states more tangible and helping individuals regulate anxiety, overwhelm, and rumination through coordinated breath + movement.

• Support nervous system regulation by pairing rhythmic drawing with paced breathing.

• Increase mindfulness and interoceptive awareness by noticing breath, movement, and bodily sensations.

• Reduce anxiety and physiological arousal, consistent with findings from mindfulness-based art interventions (Zhu et al., 2025).

• Strengthen connection between breath, body, and creative expression.

• Offer a grounding tool clients can use independently outside of therapy.

Theoretical Rationale:

Mindfulness-Based Art Interventions Improve Anxiety (Zhu et al., 2025) This meta-analysis found that combining art-making with mindfulness practices significantly reduces anxiety in diverse populations. Coordinating breath with drawing increases attentional control, reduces cognitive load, and supports emotional flexibility.

• Box-breathing activates the parasympathetic nervous system, slows the heart rate, reduces cortisol, and supports vagal tone. Pairing it with drawing deepens focus and anchors attention in the present.

• Sensorimotor Integration can be achieved by drawing while breathing, which uses motor, cognitive, and emotional processing simultaneously, increasing self-regulation by engaging multiple brain regions.

• Making marks on paper that visually reflect breath strengthens interoceptive awareness and helps clients observe rather than react to internal sensations.

Art-Making:

Use any size paper. Choose between pencil, pen, markers, pastels, or color pencil. Variation to draw the box and then use one’s hand to trace the drawing of the box while breathing.

• Invite the client to sit comfortably with materials in front of them.

Prompt: We’ll pair drawing with a structured breath pattern called box breathing. The goal isn’t to make a beautiful drawing—it’s about connecting breath and movement.”

• Introduce the box breathing pattern:

Prompt: “You may draw a simple square to illustrate the cycle.”

• Begin the Drawing-Breathing Synchronization

Repeat this cycle for 3-5 minutes, depending on the client capacity.

Reflection:

After the breathing sequence, cue the client to pause and observe their artwork. Ask them to take a look at what emerged, and notice shapes, textures, spacing, or changes in pressure.

• What did you notice about your breathing during the exercise?

• How did your body feel before, during, and after?

• Did the act of drawing help anchor your attention?

• What emotions surfaced during the breathing and drawing?

• Did this exercise help you feel more present?