Pranayama; remedial pranayama

I would do an intake and then give two options for practice: belly breathing lying down (Lying on your back, knees bent feet on the floor to support the lower back or with a bolster or other support under knees, hands to the belly to feel it expand on the inhale/fall on the exhale) and extending the exhale; and connecting movement to breath while opening and closing arms, walking or standing. I would ask that they attempt one or both practices for 5 total minutes daily, keeping a practice log of attempts and problems along the way. I would check in weekly or more if needed for about a month. Depending on the intake and the progress after a week or two, I would add a couple stretches for the "breathing muscles" - side bends, twists, wall stretches. (unless those should be given first)

27yo client who says they "can't" do breathing exercises. They have high anxiety and a lot of job stress. Medical history includes autoimmune disease/disorders (current) and major abdominal surgery (>10 years ago). Current health is good/well-managed conditions. Client practices asana and guided meditation.

I envisioned giving the client simple breathing practices (like those we learned from Swami Vidyananda in Foundation of IY Therapy) that they may be willing to try. I kept the goals as simple as possible and the time commitment very low to increase compliance.
I planned to teach the client different breathing practices, after intake and discussion. I recommended that the client keep a diary and briefly note daily if the practice was done, and note any physical/mental/emotional response to the practice.
The practices included deep breathing while lying down, in order to avoid the complaint of lightheadedness or physical manifestations of anxiety that the client has experienced in the past while practicing in an upright position. The second was a moving meditation - walking with breath - intended to begin to connect breath to movement and movement to breath in a low-structure way. We added a third option - brahmari breath - when the client mentioned enjoying that practice at some point in the past.
Client was asked to keep a very brief diary, noting practice and feelings/thoughts/sensations or anything that came up for them.
Check-ins will be weekly and adjustments made at that time.

Pranayama is in the Hatha branch of Integral Yoga.
There are many pranayama practices to choose from. In this case we used adaptive practices and an old favorite (brahmari). Breathing practices connect body and mind, and calm them in the process. Pranayama practices will continue to aid the practitioner in relaxation, and the focus which leads to meditation.
There is research and evidence to support the benefits of pranayama and other hatha practices for their impacts on heath and well-being. Here is an article from NIH supporting the use of these practices for many common health concerns:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415184/

Client was willing, yet hesitant. Client has had negative experiences with breathing practices in the past, yet wants to try again. (These negative experiences include physical manifestations of increased anxiety: increased heart rate, feeling lightheaded)
After the first week, client reported practicing 5/7 days, though the next week they expressed discouragement. With the motivational chart, their enthusiasm was higher than at the beginning, and they practiced 6/7 days.

I suggested they continue with the simple, brief practices. I will check back in periodically and am available for future instruction or support.

I applied the plan, adding the third option for breath practice as noted above. At the first meeting to go over the intake and introduce the plan, I asked the client to practice the breathing practices with me and observed their tension. I decided to go ahead and offer some stretches to help them relax the breathing muscles and hopefully relax a little and increase their chances for success.
The goal of practicing for 5 minutes daily was achieved 5/7 days the first week. and 6/7 days the third week. The client did not wish to share their practice for the second week except to share that it did not go well.
For this client, the fact that they participated was great, and the third week they reported practicing all 3 breaths at some point during the week and stretching 5/7 days.

I adapted several times. At the first meeting, I offered the third option for practice and added the stretches. After the second week, the client reported being discouraged and unmotivated, so I offered a motivational sort of chart to remind them of their successes daily.
I saw the need to be flexible and remain open-minded. I looked for tools that might fit the individual client. I thought about what might be difficult, boring, or ineffective versus what was really important which was for this client to have a positive experience with pranayama and open the door to continued practice.
As much as I know, believe in, and love the practices, I can't force them on anyone, or make them feel the same way, but I can be creative and find a path in, and encourage them to find the path that brings them abundant health and peace.

In the future, I would like to be able to allow more time to work with the client, perhaps 6 weeks or more for the client to be able to establish a lasting habit.
The adaptations went well. The client who "can't" do pranayama found some enjoyment with the practices. Now, when the practices come up in their yoga practice, they may attempt them rather than dismissing them. Or, more importantly, they have some tools to adapt the practices to ones they find more easeful.