Overall good health. Exercises regularly and has a healthy diet. She has been working with a physical therapist for hip and low back pain, now the PT is more general, whole spine and back to strengthen and stretch. Client feels the stress around her neck and shoulders. When she feels the tension around her eyes, bridge of her nose, eyebrows, and forehead, she knows her stress level is very high. These sensations intensify her stress level. Bone spurs in right hip area.

Client feels a heavy, dense, dark ball of anxiety in her stomach, like it’s taking up almost all the space in her belly, “not leaving much room for anything else.” She does not sleep well, sometimes waking up in the night worrying, having a hard time falling back to sleep. She’s a chest breather and has difficulty linking breath to movement.

The client feels like she is responsible for everyone in her family. She is working through the process of letting go of her mother as her mom had said that she is not inclined to go through chemotherapy this time around.

Her faith is an important part of her life. She is Roman Catholic.

She is a self-described people pleaser. So much of her time and energy is dedicated to caring for others, she has little left to fulfill her own needs or gain perspective outside of daily demands.

o Patanjali’s yoga sutras 2.49 “That (firm posture) being acquired, the movements of inhalation and exhalation should be controlled. This is pranayama.” and 2.53 “As its result, the veil over the inner light is destroyed.
 To reestablish a sense of self effulgent, inner light.
o Serenity Prayer. God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.
 To bring her peace and remind her that there is wisdom in letting go of taking care of all her loved ones and giving over her efforts to a higher power.

o Exercise guidelines and/or contraindications where relevant. To avoid dizziness and lightheadedness, do not lift up from forward bends quickly and turn to the left when doing so. On advice from balance clinic specialist.
o Sullivan MB, Erb M, Schmalzl L, Moonaz S, Noggle Taylor J, Porges SW. Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience. Front Hum Neurosci. 2018;12:67. Published 2018 Feb 27. doi:10.3389/fnhum.2018.00067
 Incorporated effort to expand window of saatva/window of tolerance.
o Lemay V, Hoolahan J, Buchanan A. Impact of a Yoga and Meditation Intervention on Students' Stress and Anxiety Levels. Am J Pharm Educ. 2019;83(5):7001. doi:10.5688/ajpe7001
 Incorporate centered, mindful breath practices. Shamatha Meditation.
o Spindler, Beth, Trauma-Aware Yoga and Movement Therapeutics for Older Adults: Managing Common Conditions by Healing the Nervous System First, p.215, Polyvagal theory, the gunas, and the goal of life, Singing Dragon, 2023.
 Correlating Gunas with the polyvagal model. Helpful tool to further understand the stress response.

Any suggestions for other practices to reduce anxiety? Thank you for reviewing my work Sue.

• 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.