I aim to introduce/provide opportunities to apply the 4 elements of Stress Management with an emphasis on 2) Relieving and 4) Coping. I will teach the client how to build a supported savasana, guide them through Breath Awareness, & adapted Deep Relaxation w/imagery [borrowing from “Rehearsing low stress in work/performance”]. [SMTT Manual p111-7].

Short-term goal = empower the client by giving her a set of tools she can use. Success would sound/look like the client feeling she has a way to cope the next time sleep is challenging. Longer-term goal: Instead of tossing & turning/getting up to do work/”feeling like she failed sleep,” she utilizes a Stress Management tool from Deep Relaxation.

At 46 years young, the client describes herself as “having too many top-priority things & not getting them done as fast as I expect them to get done.” She is seeking “ways to accept/forgive herself for not meeting her expectations” and recognizes that the expectations she isn’t meeting are her own. She suffers with chronic, frequent migraines, persistent early morning waking, & wears a mouth guard to reduce the impact of teeth grinding at night. She identified work as her current chief stressor.

The plan was to start with a general introduction to stress emphasizing Lazarus and Folkman’s Transactional Model highlighting appraisal and conscious choice (Kabat-Zin, FCL, p.292-4). The second half of the session was devoted to introducing and practicing coping strategies to engage the parasympathetic division of her nervous system: teaching how to build a supported savasana using household items, guided Breath Awareness, and adapted Deep Relaxation w/imagery (SMTT Manual, p.111-7).

Hatha: We learned how to gradually relax body and mind through a step-by-step process of Adapted Deep Relaxation. This process includes Progressive Muscle Relaxation, Body Scan, and Guided Imagery that activate the relaxation response [opposite of the stress response] while helping repair body and mind. The processes are adapted from the traditional IY approach: started the Body Scan from the head, ended with the toes because starting w/head helps reduce mental agitation (SMTT Manual, p. 113). By giving the mind a neutral focus, Guided Imagery further reduces unhelpful thoughts that could disrupt the relaxation response (SMTT Manual, p. 186).
Raja: Adapted Yoga Philosophy from William James “The greatest weapon against stress is our ability to choose one thought over another” helped establish that while the client may not be in control of sleep she IS in control of her response.

After a brief intro to the psychology of stress, benefits of yoga for stress management were connected to the client’s chief concern of persistent early morning waking and the bidirectional relationship between sleep and stress was recognized.
When discussing the interconnectedness of sleep, stress, and peace, the client began to cry. I made the judgement call that now was not the time for Deep Relaxation. We took some slow exhales, discussed how our expectations for ourselves can be a source of stress [pressure] and while we may not be able to control all stressors, we do have the power to define our expectations and treat ourselves with compassion. I guided the client through a gentle supine hatha flow to displace the agita/release tension: Constructive Rest -> Apanasana -> Supta Bhadrasana -> Apanasana -> Supta Dandasana -> Apanasana . Supported savasana and Deep Relaxation followed.

Advice to client included: Consider talking with your primary care physician to rule out/manage any biomedical causes for persistent early morning waking (e.g., medical conditions, treatments, pain).
Next time you wake up earlier than planned: Meet yourself with compassion rather than negative talk or pressure. Consider any of the tools practiced today including: reframing (lower expectations from “Must sleep now” to “Sleep is not the goal, high quality rest, is”), gentle movement, supported savasana, PMR, body scan, and watching your breath (SMTT Manual, p.115).
Be aware of your thoughts and aim to choose thoughts that move you toward rather than away from peace (William James).
Be aware of your environment and behaviors before going to sleep and notice: Are they moving you toward peace or away? Consider what is within your power to adapt.

An adapted version of the plan was applied so I could meet the client where she was. When she cried, I recalled from SMTT that one of the best ways to address stress is to start in the body [rather than in the mind] via simple, repetitive movements. We worked from supine position to maximize support and reduce effort.
Regarding the goal, she ended the session expressing gratitude for “making a safe space to be vulnerable, hearing her own words and experiencing the emotion from the receiving end of them.”
Client reorganized bed room and sent photos of her efforts to make her bedroom a place for sleep and shared plans for establishing bedtime routine [swapping TV for more sattvic reading] and stated intentions to follow up with her Primary Care Physician. Goal achievement = partial: Tools were delivered and received; implementation is in progress.

The client cried when she learned that peace, not stress was her true nature. I absolutely adapted from there and was grateful I had the SMTT training to know that when the mind was overwhelmed, we could switch gears and find ease through slow exhales and mindful movement. We connected what she was feeling with what we just discussed about the stress response and it allowed the learning to go deep.
She grew teary again when I validated her instinct that her challenges with sleep are important as I shared this: “We can be more resistant to stress, more resilient, if we build up our resources and enhance our physical and psychological well-being in general (e.g., via regular exercise, meditation, adequate sleep, and the deep connectedness of interpersonal intimacy, to name four of the most important ones) during times when we are not particularly taxed or overwhelmed (Kabat-Zinn, 2013).

Lessons learned that I would recall for future include: “even slight sleep deprivation can affect memory, judgement, and mood” (APA, 2013). The client’s emotions were close to the surface in part, due to her struggles with sleep. Doing this again, I would prepare a handout for the client describing any practices we do [images for the postures, photos of supported savasana set-up w/options, and perhaps a recording of the guided imagery]. This would remove the pressure of “needing to remember it all” make it is easier for her to focus on the here and now.
The client reported “feeling less tension and lighter” directly after Deep Relaxation. Given her texts that followed, I believe her concerns were validated, she is motivated to seek medical care, better appreciates the relationship between stress and sleep, and is empowered to take steps to reduce pressure and increase relaxation.