Case Study TitleGW1-300
Select your mentorSteffany Moonaz
Agreement I have read and understand the Case Study Submission guidelines
Intake summary

This is a group class for “Yoga Therapy to manage Stress in College”
- Group has 4 18-year-old males, ready to start college in Fall’23.
- All of them are athletes, playing at least one sport
- One of them has a knee injury, knee hurts in extension.
- Two of them have shoulder injury
- One has had cleft lip/palette surgery and is awaiting surgery for deviated septum.
- All are anxious to go away for college.

Care Plan outline

- A short presentation on stress and it’s physiology, Sympathetic and Parasympathetic nervous system, vagus nerve.
- Having a conversation about what stress means for them.
- Some ways to tone the vagus nerve.
- Easy and accessible way to start the relaxation response through breathing.
- ‘Ha’ breath pranayama
- Nadi-shuddhi pranayama to calm the mind.
- Some stretches on the chair that can be done anytime.
- Eye movements – to release the stress on eye muscles after/during use of media.
- Concept of ‘Ahimsa’ not just towards others but also towards your own self.
- Yoga nidra and sound bath for relaxation.

Resources and references that informed your Care Plan

1. Qi X, Tong J, Chen S, He Z, Zhu X. Comparing the Psychological Effects of Meditation- and Breathing-Focused Yoga Practice in Undergraduate Students. Front Psychol. 2020 Nov 12;11:560152. doi: 10.3389/fpsyg.2020.560152. PMID: 33281662; PMCID: PMC7689363. Comparing the Psychological Effects of Meditation- and Breathing-Focused Yoga Practice in Undergraduate Students - PMC (nih.gov)
2. Pandi-Perumal SR, Spence DW, Srivastava N, Kanchibhotla D, Kumar K, Sharma GS, Gupta R, Batmanabane G. The Origin and Clinical Relevance of Yoga Nidra. Sleep Vigil. 2022;6(1):61-84. doi: 10.1007/s41782-022-00202-7. Epub 2022 Apr 23. PMID: 35496325; PMCID: PMC9033521. The Origin and Clinical Relevance of Yoga Nidra - PMC (nih.gov)
3. Janjhua Y, Chaudhary R, Sharma N, Kumar K. A study on effect of yoga on emotional regulation, self-esteem, and feelings of adolescents. J Family Med Prim Care. 2020 Jul 30;9(7):3381-3386. doi: 10.4103/jfmpc.jfmpc_153_20. PMID: 33102300; PMCID: PMC7567196. A study on effect of yoga on emotional regulation, self-esteem, and feelings of adolescents - PMC (nih.gov)
4. Alire E, Brems C, Bell K, Chiswell A. The Role of Yoga in Treating Stress-Related Symptoms in Dental Hygiene Students. Int J Yoga. 2020 Sep-Dec;13(3):213-222. doi: 10.4103/ijoy.IJOY_5_20. Epub 2020 Sep 13. PMID: 33343151; PMCID: PMC7735503. The Role of Yoga in Treating Stress-Related Symptoms in Dental Hygiene Students - PMC (nih.gov)
5. Wimmer L, Bellingrath S, von Stockhausen L. Mindfulness Training for Improving Attention Regulation in University Students: Is It Effective? and Do Yoga and Homework Matter? Front Psychol. 2020 Apr 29;11:719. doi: 10.3389/fpsyg.2020.00719. PMID: 32411045; PMCID: PMC7202325. Mindfulness Training for Improving Attention Regulation in University Students: Is It Effective? and Do Yoga and Homework Matter? - PMC (nih.gov)
6. Guo S, Liu F, Shen J, Wei M, Yang Y. Comparative efficacy of seven exercise interventions for symptoms of depression in college students: A network of meta-analysis. Medicine (Baltimore). 2020 Nov 20;99(47):e23058. doi: 10.1097/MD.0000000000023058. PMID: 33217806; PMCID: PMC7676569. Comparative efficacy of seven exercise interventions for symptoms of depression in college students - PMC (nih.gov)
7. Kamath A, Urval RP, Shenoy AK. Effect of Alternate Nostril Breathing Exercise on Experimentally Induced Anxiety in Healthy Volunteers Using the Simulated Public Speaking Model: A Randomized Controlled Pilot Study. Biomed Res Int. 2017;2017:2450670. doi: 10.1155/2017/2450670. Epub 2017 Oct 11. PMID: 29159176; PMCID: PMC5660749. Effect of Alternate Nostril Breathing Exercise on Experimentally Induced Anxiety in Healthy Volunteers Using the Simulated Public Speaking Model: A Randomized Controlled Pilot Study - PubMed (nih.gov)

Session 1
Session 1 Complete?
  • Yes
Session 1 - Activities

Only 3 students made it to the class.
Check-in - One of them had the knee injury. We did a chair practice of some JAPA movements. Talked about stress and its physiology, stress response and relaxation response. Talked about ‘Ahimsa’ (non-harming). Most of the practice was focused on the Annamaya kosha and connecting breath with the movements. Connecting mind and body through the breath. Extended exhalation. ‘Toe-yoga’ with pompoms. ‘Ha’ breath with pompoms. Ended with restorative shavasana, tense and release, relaxation and a 5-minute sound bath. And Bhramari at the end.

Session 1 - Homework assignment to client/group

Practice extended exhale during the day. Paying attention throughout the day if they are being non-harming towards themselves, in not just physical but also thoughts and feelings.

Session 1 - Client/Group progress summary

They felt great after the class. One of them slept and didn’t wake up even after the class ended. We let him stay and rest and get up only when he was ready.

Session 1 - Reflection and Self-evaluation

I realized that movement along with the breath helps this group. If I keep talking before we move, I lose their attention. So, next session, we’ll start with some warm-ups and I’ll sprinkle our conversation in the middle.

Session 1 - Plan for Session 2

Talk about ‘Ahimsa’ again. Keep practicing extended exhale and add ‘HA’ breath. Strengthening asana practice.

Session 2
Session 2 Complete?
  • Yes
Session 2 - Activities

All 4 students were in the class.
Check-in – We recapped about the stress, it’s physiology, stress response, relaxation response. Some practices to tone Vagus nerve. One of them had hurt his knee again while playing basketball. He had the hurt knee from before. We talked about ‘Ahimsa’- towards ourselves. Had a discussion about what it would mean to be non-harming towards ourselves. We were moving dynamically and discussing the above. Was not able to teach “HA” breath, but did a lot of emphasis on Extended Exhalation. Stretches using the chair – Sun salutation. Moving with the breath and checking -in how a movement or stretch feels in the body.
Yoga Nidra and Sound bath. Bhramari breath to end the class.

Session 2 - Homework assignment to client/group

Practice ‘Ahimsa’ throughout the day. Paying attention to where you tend to harm yourself- not just body, but also mind and spirit. For example, what are the words that you use for yourself every day?

Session 2 - Client/Group progress summary

All of them felt calm and relaxed after the class. I encouraged them to use breathing techniques during the day, even when they are in the gym, lifting weights, and notice if they feel any difference in their performance.

Session 2 - Reflection and Self-evaluation

I think the session went well. I saw that the student with the hurt knee, did not take the modifications, so I will make sure to demo the modified option, in order to encourage him to pay attention to his pain.

Session 2 - Plan for Session 3

“HA” breath. Adding a little more challenge to their asana practice, like practicing holding the stretch for 3-4 breaths (extended exhalation breaths).

Session 3
Session 3 Complete?
  • Yes
Session 3 - Activities

Only 3 students were in the class today. The student with the hurt knee was absent. He said he was giving a rest to his knee.
Check-in. I focused more on strength today. Holding the stretch for 3-4 extended exhales. Breath awareness, asking them to imagine breathing into their back when in child’s pose. Imagine breathing into the sides in side stretches. Used yoga strap for some stretches. Restorative shavasana, with legs on the bolster.
Tense and release, yoga nidra and a sound bath. Bhramari breath to end the class.

Session 3 - Homework assignment to client/group

Keep practicing Ahimsa, towards themselves, even when it comes to making new friends in college. Eye exercises, after being in front of a screen for more than couple of hours. Practicing extended exhalation before bedtime.

Session 3 - Client/Group progress summary

They feel relaxed after the session. They said that they did practice extended exhalation during their gym time and they were able to lift for longer time.

Session 3 - Reflection and Self-evaluation

I think the session went great! I feel like I’m starting to understand the group sessions a little better each time. Sometimes I feel they only come for the sound baths 😊, but maybe that’s what their body and mind need right now. I’m learning to let go of my expectation of a session.

Finishing up
Overall Final Self-evaluation, reflection

I’m starting to understand the group session dynamics a little bit better. When I looked at the videos, I realized that I can’t hear the sound, so I started using Bluetooth ear piece, which helped.
I realized that since it’s summer and all of them are in vacation mindset, it would be hard to ask them to practice the breathing techniques when they feel stressed, because, according to them, they are not stressed right now. I asked them to download ‘Insight timer’ app to listen to sound baths or other guided relaxation, when feeling stressed.

Future session plan

Keep reminding about Ahimsa. Practicing extended exhalation, HA breath. Building more flexibility and strength through asanas and breath connection. Deep relaxation though yoga nidra and sound bath.

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