This kosha addresses the physical body—its structure, tissues, and sensations. This client's primary diagnosis is Idiopathic Pulmonary Fibrosis (IPF). The focus will be on gentle, supportive movement to reduce tension, increase flexibility, and improve spinal mobility. The asanas and joint loosening movements will help to release physical discomfort and ease breathing by aligning the body to facilitate better airflow and posture. Annamayakosha also encompasses relaxation as the body learns to release tension from daily stressors.

The plan will be adapted to the client’s current energy levels and pulmonary capacity, allowing rest periods and modifications. Props such as chairs, bolsters, or straps will be used as needed to reduce physical strain.

Examples, seated cat-cow, supported bridge pose, side bends, gentle spinal twists, guided relaxation.

Pranamayakosha governs the breath and the vital energy (prana) circulating throughout the body. The aim for this client (with IPF) is to improve breath capacity, lung efficiency, and oxygenation through mindful breathing techniques. Breath-focused practices will help the client manage shortness of breath (dyspnea), reduce anxiety, and learn to control the breath to facilitate better lung function. Calming the breath also impacts the nervous system, encouraging relaxation.

Goal - To expand breath capacity and improve efficiency. Reduce dyspnea and anxiety through breath. Pursed-lip breathing, 3-part breath, breath ratios, simple breath observation.

Manomayakosha relates to the mind, emotions, and mental states. With IPF, managing the emotional and mental challenges of living with a chronic illness is crucial. This layer focuses on calming mental agitation, addressing fear and anxiety, and fostering a sense of mental resilience and acceptance. The mind-body connection in yoga therapy helps integrate the breath with emotional states, guiding the client towards mental clarity and inner peace.The client will be introduced to practices that may help to reduce mental agitation and anxiety, foster calming and resilience. I'll implement mindfulness cues during movement and breath, body scan, anchoring with sound or touch.

Anandamayakosha is the innermost layer, representing the blissful, spiritual self. Through this kosha, I hope to help the client foster a connection to inner peace, well-being, and a sense of spaciousness that transcends physical limitation. With yoga therapy he may be able to find a space of pure love, joy, and interconnectedness, beyond the physical and mental struggles. We'll aim to shift the focus from the illness itself to the wholeness of the client/the person, offering a sense of peace that supports healing and spiritual growth.

Yoga nidra, heart-centered meditation, chanting, silence, or visualization.

The wisdom kosha relates to the higher intelligence and self-awareness. In IPF, it will support the client in developing insight into their body’s response to illness, movement, and breath. This kosha will invite the client to explore the mind-body connection, fostering a deeper awareness of emotional responses, patterns of tension, and the relationship between their illness and their experience of self. It's also about cultivating the capacity for self-compassion and mindful reflection.

I will encourage the client to take small moments during practice to notice subtle changes in body or breath, fostering deeper self-awareness and acceptance, and introduce to the client intention-setting for their healing journey, focusing on acceptance, peace, or empowerment in relation to their illness.

Friedmann, Carroll. Practicing the Yoga Sutras. INTEGRAL YOGA PUBLICATION, 2024.

"The goal of this workbook is somewhat different than that of a commentary." The author wrote this book with the intention that the reader would learn about themselves and their mind while studying. One is encouraged to engage with this book on a daily basis—reading the sutras, reflecting on the accompanying questions, and evaluating one’s current state of mind through meditation and contemplation. As I study the Yoga Sutras, both with my sangha and in solitude, I aim to integrate the wisdom gained into my yoga therapy sessions with the client.

For example, it is noted that “the Yoga Sutras of Patanjali directly address the pain of existence, its cause, and its remedy” (Ibid., p. 5). I intend to explore the concepts of pain and suffering—first in a broad sense, and then, as trust is built, with greater specificity. Together, we might examine: Where does this suffering originate? Is it depleting prana and clouding awareness? Is fear, anxiety, or depression present?

Ultimately, our true source of happiness lies within the Self. The journey is about uncovering that truth, replacing negative patterns with positive ones. How have past experiences shaped this present moment? And more importantly, what can be done—through yoga, awareness, and practice—to initiate meaningful change?

Dowman, Leona M.a,b,c; Holland, Anne E.a,c,d. Pulmonary rehabilitation in idiopathic pulmonary fibrosis. Current Opinion in Pulmonary Medicine 30(5):p 516-522, September 2024. | DOI: 10.1097/MCP.0000000000001094

Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: A Network Meta-analysis
Cai, Yingying et al.
Archives of Physical Medicine and Rehabilitation, Volume 105, Issue 3, 558 - 570

https://patient.boehringer-ingelheim.com/de/aktiv-leben-mit-lungenfibrose/leben-mit-lungenfibrose/umgang/atemuebungen-fuer-die-lunge

"Idiopathic pulmonary fibrosis (IPF) is a serious chronic (long term) disease that affects the tissue surrounding the air sacs, or alveoli, in the lungs. This condition develops when that lung tissue becomes thick and stiff for unknown reasons. Over time, these changes can cause permanent scarring in the lungs, called fibrosis, that makes it progressively more difficult to breathe."
(https://www.nhlbi.nih.gov/health/idiopathic-pulmonary-fibrosis).

It has been difficult to find free current manuscripts on the topic of IPF and breathing techniques, and yoga. I've read what is available from foundations, nonprofits, Boehringer Ingelheim Pharma GmbH & Co, etc that post facts and advice. I've spoken directly to the client's doctors who are running the clinical trial in which he participates.

Focusing on breathing and movement is important, as well as addressing the five stages of grief and how to understand those feelings. I will introduce 2-3 recommended breathing techniques, gentle movement with chest openers and strengthening movements, as well as guided relaxation. We don't have enough sessions to go into the topic of grieving in-depth but I will ask about the client's well-being, state of mind, interoception.

I don't have a subscription to access manuscripts that require a fee or membership. Do you have a suggestion as to how I might acquire access without having to spend a large sum of money?

• Check in, centering, balanced hatha yoga set considering contraindications, relaxation (with imagery as appropriate),
• Balanced pranayama considering contraindications, meditation/centering.
• Include at least one suggestion from Karma, Bhakti, Raja, or Jnana Yoga tailored for this client.