• 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.

As part of the therapeutic care plan, I revised poses, selecting those specifically designed to build upper body strength and promote gentle chest opening to support respiratory function. These postures were chosen to improve posture, enhance rib cage mobility, and encourage fuller, more efficient breathing. Emphasis was placed on slow, mindful transitions, supported positioning, and the integration of Dirgha (three-part) breathing to safely expand the chest and increase lung capacity while respecting the client’s physical limitations and fatigue levels.

Supportive breath pacing, extended pauses, & gentle reassurance helped CMS stay present without feeling pressured. He learned Dirgha Swasam and once learned applied it with support during centering, asana, and relaxation, showing improved awareness of rib cage expansion and smoother breath transitions. He practiced chest-opening postures with mindful pacing, gradually increasing tolerance and range when cued while maintaining safe alignment.

Client reported implementing breathing techniques a few days per week, noting a new awareness with his breathing, posture, and reduced anticipatory tension around exertion. He remained receptive to cues, integrated feedback effectively, and demonstrated steady gains in breath–movement coordination. Overall, he progressed toward the goal with dedication, consistency, and a positive, self-directed approach to home practice.

The client showed consistent progress toward his physical yoga therapy goals despite limitations from Idiopathic Pulmonary Fibrosis. Over sessions, he demonstrated improved tolerance for gentle movement, increased confidence in transitioning between postures, and greater engagement without fear of overexertion. Chest-opening and postural practices supported upright alignment, reducing forward collapse and allowing more efficient breathing mechanics. He began to notice increased ease and mobility in the upper body, particularly in the rib cage and shoulders, and reported that movements felt “easier” when paired with pacing and breath awareness. The client remained attentive to therapeutic cues, practiced techniques consistently, and demonstrated commitment to integrating breath, posture, and movement into daily routines, reinforcing both physical capacity and mindful engagement with his body.

Work at the energetic level was central to supporting this client’s experience with Idiopathic Pulmonary Fibrosis, as his respiratory limitations directly affected both his physical capacity and his mental–emotional state. Throughout practice, consistent attention was given to breath awareness as a way to regulate his nervous system, reduce anxiety around shortness of breath, and build trust in his body’s capacity to move safely.

Supportive pacing, extended pauses, and gentle reassurance were essential in helping him remain present without feeling pressured to “perform” the breath correctly. Over time, he demonstrated increased awareness of when he was holding his breath and began to self-correct with verbal reminders to soften, slow, and allow the breath to move naturally.

Work at the level of the Pranamaya Kosha naturally flowed into the Manomaya Kosha, as changes in breathing directly influenced the client’s emotional state and thought patterns. As he developed greater breath awareness and learned to soften effort, regulate pace, and release habitual breath-holding, his nervous system settled. This shift in pranic flow supported improved emotional regulation, reduced anticipatory tension around exertion, and increased his ability to remain calm and grounded despite respiratory limitation.

The intention was to guide CMS from effort and control toward acceptance, trust, and letting go—both in his breathing and in his relationship with his diagnosis. As his breath became more accessible and less fear-driven, his mental state reflected greater ease and stability. The practice supported mental resilience, reduced anxiety-based breathing patterns, and fostered a more spacious

The client demonstrated progress in cultivating vairāgya, the practice of detachment from expectations, outcomes, and attachment to the past. Throughout sessions, he engaged in guided meditations and reflective exercises exploring impermanence and the breath as a metaphor for life’s constant change.

He showed increased ability to accept the limitations imposed by his illness without resistance or self-judgment. When prompted to notice thoughts of fear or grief, he was able to observe them without becoming identified with them, reflecting growing awareness and mental flexibility.

The client reported decreased frustration related to respiratory limitations and exhibited a calmer, more centered demeanor. Overall, he is gradually shifting focus from outcomes to inner stability and peace, demonstrating meaningful progress at the wisdom/Vijnanamaya Kosha level.

We focused on cultivating abhyāsa (consistent, gentle practice) & vairāgya (letting go) to enhance breath awareness, relaxation, & emotional steadiness. CMS practiced repeated small steps—breathwork, softening the body, & inward attention—without striving for perfection, releasing attachment to past abilities & expectations. Spiritual orientation was integrated by connecting practice to his sense of self, family, & personal values, fostering inner stability, presence, & meaning. He reflected on how the practice supported relationships, self-worth, & daily life, noticing sensations & thoughts w/out judgment to strengthen self-trust. Verbal cues & reassurance reinforced that each breath & movement was meaningful. Integrating abhyāsa & vairāgya helped him release tension, reduce frustration, & increase acceptance. Over sessions, he demonstrated improved inward focus, emotional regulation, & the ability to connect practice to personal meaning, supporting both mental & physical well-being.

The client shared that his practice has helped him approach daily life with greater awareness. He noted that focusing on breath & chest expansion increased his bodily awareness & confidence. He wanted to engage in small, consistent steps—practicing deep, mindful breathing, softening the body, & turning attention inward—while releasing attachment to past abilities & expectations. These practices supported improved respiratory function, & fostered a more grounded approach to his internal experiences.

He shared concern about staying consistent. We explored daily breath work, mindful routine integration, & visual cues. He recognized that small, repeated steps—softening the body, observing sensations—would build self-trust and sustain benefits. He reported that he would try to integrate this into his daily life by practicing deep breathing most mornings, taking brief mindfulness pauses during meals, and using chest-opening stretches while preparing for daily activities.

A. Seated in a chair, scan the body from the crown of the head to the soles of the feet, allowing yourself to relax. Reverse the scan.
a. Practice alternate nostril breathing or 3-part breath.
b. When your mind wanders, acknowledge the thought, let it go, then return to your breath.
c. When you’re ready, let go of the breath.

B. Either seated or in a restorative pose scan the body from the crown of the head to the soles of the feet, allowing yourself to relax. Reverse the scan.
a. Reflection, while resting in a restorative pose ask yourself, how might I find moments of peace today?
b. When your mind wanders, acknowledge the thought, let it go, then return to the question.

By consulting with the client, his physicians, and reviewing IPF research, I felt relatively well-prepared to support him. Moving forward, I would develop a way to assess upper body strength during intakes with all clients, as several clients’ limitations have been greater than anticipated. I also recognize that I could have encouraged this client more assertively to begin yoga therapy soon after his diagnosis. Earlier engagement might have allowed for a longer, more consistent program, supporting greater progress in strength, breath awareness, and overall wellness.

I had questions about the best ways to integrate breathwork and gentle asanas for a client with progressive pulmonary limitations. It was helpful to speak directly with the client’s doctors, which clarified safety considerations and medical priorities. My mentor provided excellent guidance, offering practical ideas, professional motivation, and reassurance, which enhanced my confidence in delivering effective, tailored yoga therapy sessions.

Working with this client, who has Idiopathic Pulmonary Fibrosis (IPF), I found myself balancing my genuine desire to help with maintaining professional boundaries and managing my own emotional responses to his potentially terminal diagnosis. It was at times a struggle to remain objective while focusing on providing compassionate, patient-centered care that supported his autonomy, well-being, and overall quality of life. I valued the opportunity to work with this client.