Polyvagal Theory: The use of vagal regulation techniques/exercises and pranayama regulate the autonomic nervous system.

To provide easy and realistic interventions such vagal regulation and pranayama techniques that the client can use either at work or home to help reduce anxiety and stress levels. We will meet for 25 mins once a week for 4 weeks. We will reassess anxiety/stress levels and effectiveness of practices shared on a weekly basis and at the end of 4 wks.

RA is a 46 year old man with a hx of major depressive disorder, ADHD, GAD. He is currently under the care of a primary therapist and psychiatrist. Client is currently taking Linisopril for HBP, Lexipro for mood and Klonopin PRN. Client reports "feeling very stressed and anxious especially at work". He describes being prone to anxiety attacks during stressful work situations since the onset of the pandemic and is looking for simple interventions an to help him manage his anxiety at work.

Helping the client understand the basic responses of the nervous system and the core principles of polyvagal theory. The plan was to work alongside the client to help him identify daily stressors and understand how they can contribute to potential imbalances. To work in tandem to create measurable and attainable goals to aid him in potentially reducing anxiety and stress levels over a 4 week period of time.

Hatha: Pranayama and Meditation
Raja: Meditation, Pranayama, Svadhyaya (self-inquiry), Tapas (self-discipline) and concentration/dharana
Jhana: Primary practices: Meditation and Svadhyaya
Bhakti:Mantra
Karma: mindfulness, ahimsa
Japa: Chanting, mantra

All of the branches mentioned above have therapeutic properties that can help regulate the nervous system.

At the beginning of our sessions, client reported severe anxiety and autonomic dysregulation. Client reported being stuck inside fight or flight responses that usually lasted for extensive periods of time and eventually lead to a crash of sorts with more depressive symptoms. During work with client, I made sure that he was being seen by a licensed therapist and was also attending his regular psychiatric appointments for medication management. Client reported benefiting greatly from new skills and interventions. Client choose the mantra "I am here, I am safe" to incorporate into japa and his daily journaling as reflection. I process he reported was very valuable as an outlet for "mental clutter". Client shared that he liked the portability and simplicity of a lot of his breath work and grounding skills.

I encouraged the client to continue working with their therapist and psychiatric provider to insure a continuity of care and medication management. Client was also gently encouraged to spend more time connecting with supportive friends and family as connection regulating for the nervous system. Client was also interested in continuing to work with me and incorporating asana and movement into our work. We continued to meet one time per week and expanded into 60 minute sessions. I also encouraged the client to keep attending his OP provider appointments, using and applying learned skills as well as at home routines of cold water exposure, journaling and mantra and japa.

I applied the plan with a few minor adjustments. Goal was achieved based on client feedback and weekly evaluation‘s with noted improvements in overall stress and anxiety levels, ability to use coping skills in the present moment, quality of life and quality of sleep. All major areas which client was driving for improvement in. A few elements of the plan in the summaries to follow where either omitted or modified in order to maximize time with client and help him meet his personal needs and goals.

I did adapt my plan with the addition of Japa and mantra. During initial session client mentioned that they were interested in japa after reading an article about how repetition and rhythm benefit the nervous system. This was a pleasant surprise and it was also wonderful to see how open and eager this client was to apply quick solutions like pranayama to everyday stressors. I also learned that not all yoga therapy sessions have to be asana focused. This client's immediate needs were very specific given the amount of stress and anxiety that the client was experiencing. I also asked the client to be compliant with his own personal therapy and psychiatric appointments leading up to our work together and during. I learned that this was vital for the clients overall mental health stabilization and for us to be able to work together efficiently.

If faced with the same situation in the future I would probably approach it in the same manner but perhaps explain a little bit more about the yoga therapy and it’s approaches, the different branches of yoga, the koshas system, ect before our first session. Since working with this client, I now share a pre-prepared document explaining the above before working with clients. It has been very helpful to have clients read through at their leisure so they are not overwhelmed during intake sessions and can be very effective with client coming with pre-prepared questions and ideas to help enhance our time together.
I had also planned for the client to incorporate mindful and meditative walks using the 5,4,3,2, 1 mindfulness technique. Unfortunately the client was not able to incorporate given the amount of stressors and limited time he had in his day. I learned that sometimes less is more especially with a client experiencing such heightened amounts of stress. I was also able to send the client this video before our work together which greatly helped him understand his nervous system, poly vagal theory and how it applies to trauma.