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Notes from the clinic

The long exhale

One breathing pattern, four seconds in and six seconds out, and why the exhale is the half that matters.

Ruth Neufeld in an oatmeal knit cardigan, silver-streaked hair in a loose bun, warm plaster wall and morning light

Ruth Neufeld, Registered Clinical Counsellor

May 2026 · 3 min read

Four in, two held, six out.

If you learn one thing about breath, learn this: the inhale accelerates and the exhale brakes. A slow exhale nudges heart rate down through machinery older than worry itself, which is why the exhale, not the inhale, is where a calming breath earns its name.

The inhale accelerates. The exhale brakes.

The pattern

In through the nose for about four seconds. A brief pause, two seconds, nothing strained. Out slowly for about six, like fogging a window you care about. That is one breath. Five or six of them is about a minute, which is usually enough to notice the shift.

The counts are guides, not rules. The only requirement is that the exhale outlasts the inhale. If four-two-six feels like arithmetic, just breathe out slower than you breathed in and let the numbers go.

When it is most useful

Before a difficult phone call. In the parking lot after work, before walking into the second job of home. At 2 a.m., when the mind has opinions. The pattern is portable, invisible, and free, which makes it the most prescribed tool in my room.

When a note is not enough.

Notes cover patterns. Appointments cover you. If this one hit close to home, an assessment is the sensible next step.

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