Pranayam

By practicing daily for two weeks, beginning with a minimum of one minute per sitting at a 1:2 (inhalation:exhalation) breathing ratio with no retention the student will practice nadi suddhi to heighten the awareness of their breath, increase their breathing capacity, respiratory wellness, and calm their nerves.

21 year-old female; most relevant diagnoses: Trisomy 21, obstructive sleep apnea, general anxiety disorder (GAD), oppositional defiant disorder (ODD), hidradenitis suppurativa, hypotonia, and hearing loss. Student has a history of upper respiratory and ear infections. GAD and ODD were diagnosed in early teen years after one parent left the family. Student may be uncooperative, defiant, and confrontational toward peers, parents, teachers, and other authority figures. In addition, student exhibits anxiety and worry about a number of everyday events or activities. Student finds it difficult to control the worry which is associated with feeling keyed up or on edge; having difficulty concentrating; the mind going blank, and irritability. Student recognizes these disabilities and the behaviors associated with them and is keen to address them. Student is willing to practice daily with oversight. Current baseline is the unwilling practice of three-part breathing twice a month when prompted.

Client recognizes her disabilities, and behaviors associated with them. She is keen to address them, practice daily with oversight. Current baseline: Unwilling practice of 3-part breathing when prompted. Plan: Meeting daily for 2 weeks, she determines time in home to allow control, use direct instruction of Nadi Suddhi with fading prompts, sitting opposite one another for 5-15 mins. If behaviors occur, play UNO or dance before transitioning to teaching . She will eventually 'teach' me.

Hatha and Raja Yoga were used. Sutra 1.34 was shared and studied, using the wisdom of Swami Satchidananda in The Yoga Sutras of Patanjali: By regulating the prana, we regulate our minds, because the two always go together. If one is controlled, the other is automatically controlled as well.
Irregular currents of prana are responsible for physical illness and disquieted minds. When one sits quietly with eyes closed, focusing on the breath, one observes the slowing of breath and mind, becoming more peaceful and calm. The one-pointed focus granted by Nadi Suddhi purifies our very nature. This practice removes raja (aggressiveness and agitation) and tama (lethargy). Once the interrelationship between mind and breath is understood, integrating a regular Nadi Suddhi practice is effective and has a significant benefit on physiological parameters. (Int J Yoga. 2013 Jul-Dec; 6(2): 104–110)

Before the start of each session, client asked when the session would end. She accepted a vague answer of '5-15 minutes. Client wanted to immediately teach me. I proposed that once she had practiced four days, she could try. She agreed. When she needed support on the fifth day and each day thereafter, I prompted or took over the teaching of Nadi Suddhi, fading prompts when she was successful. She complied 75% of the time. During these times I would wait, modeling a calm breath, hand held still while she regrouped. This was a positive strategy.
We compared personal examples. It was evident she understood the Sutra's essence and how Nadi Shuddhi helps her with anxiety, irritation, and poor concentration. When asked to describe how she felt at the beginning and end of each session she was able to verbalize her physical and mental state. She voiced feeling better after each session.

To create structure, a sense of accomplishment, and to help client feel good about herself, I suggested we set up a daily routine. I would text her daily and she would let me know when we could meet to "breathe." Routines are important anchors that will help her maintain good mental health and reduce her anxiety. I explained that it would help keep her focused. I asked what her social worker (MSW) thought (I have consent to speak with her). She said she agreed that pranayam seemed to help. We meet daily for 15 minutes, taking turns leading the practice. She seems to enjoy being in control. I don't know if she will continue without support.

I did apply my intended plan. When she was adamant about teaching me, an increased level of patience was needed. She remained seated but wanted to control the session. I found that by sitting calmly while I waited for her to calm down helped her. She had no trouble spending 15 minutes or more on a practice. She became more amenable to prompts; smiled at positive verbal reinforcers. The hand mudra was tricky so 3 options were given. She wanted to do it "right" and did learn the proper mudra. She seemed to enjoy comparing situations where we were anxious, upset or unfocused and how we could have better responded had we used calming breathing techniques. The goal was achieved in that she is now able to practice for 3-5 minutes, then reflect on her mind and body's well-being. Long-term, I hope she will implement this daily preemptively and whenever she needs to calm herself.

I had to adapt to not being in control the entire time. She wanted to teach as well as be taught. This method worked with prompts and modifications to my teaching style. When she knew she had some control she was open to learning. I learned to be more flexible and patient when teaching someone who has little control over their home and school life but is strong-willed. My understanding of anxiety increased since I read multiple articles. I learned that within the brain, emotions arise from our limbic system, which evolved long before the cortex where our conscious thinking takes place. We can use positive self-talk, reframe the way we think and speak, and be aware of our thoughts and breath to help ourselves.

I knew the client in advance and had a very good understanding of her disabilities. That made planning easier. I would integrate some tension releasing asanas before starting each pranayama; I would talk about the goal of the sessions, and review that at the beginning of each session. I might also find some video clips or stories to share to make the sessions come more alive. I think, too, that I could offer this in small group. It would give the young adults the opportunity to share with others and maybe even make friends. It is always helpful to know that you are not alone, that there are others who may or do feel like you.