By practicing mindful eating my client can reduce the stress and symptoms of IBS. The attached article, "Irritable Bowel Syndrome: Yoga as Remedial Therapy," both outlines conventional management and suggests benefits yogic interventions. For the purposes of this session, I will focus on savasana, simple pranayama, and mindful eating.

To share with the client the physiological benefits of mindfulness (example - reducing the stress response) and to guide the client through a mindful eating exercise outlined in the following article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556586/. The goal is for the client to incorporate short pranayama prior to more mindfully eating.

Client is a 16 year old female diagnosed with IBS in December 2021. She is in overall good health. She battles depression and anxiety, and has sought regular treatment with a counselor since a week-long inpatient hospitalization in October 2018. She currently takes medication for anxiety, depression, sleep assistance and IBS symptom control.

My vision was to begin the session with 15-20 minutes of gentle asana, encouraging breath awareness. Often when the client first returns home from school, she gives herself 15-20 minutes to "decompress" by walking outside. My hope is that asana gives her yet another tool. Next I would share an overview of the benefits of mindfulness for IBS, looking at both the western scientific perspective and the eastern perspective, incorporating the koshas. Prior to beginning the exercise, I would introduce pranayama, but limit the practice to simple breath awareness. I would guide her through the mindful eating exercise, and then ask her to describe her experience. We would conclude the session with deep relaxation followed by pranayama, both nadi suddhi and bhramari breath, giving her options to explore.

I incorporated hatha yoga, beginning with gentle asana in standing and seated positions. During the mindful eating exercise, I incorporated aspects of pratyahara and dharana, encouraging the client to, at times, limit input from some senses in order to focus completely on the raisin. I returned to asana at the end of the practice, allowing the client to experience deep relaxation in savasana. I concluded with additional pranayama practices of nadi suddhi and bhramari.

The client was open and eager to learn about the eight limbs of yoga. The client loves to learn and currently plans to pursue a career in medicine with the military, so she was excited to gain a deeper understanding of IBS and explore the condition from an eastern perspective.

The client’s usual morning routine includes TV in the background or watching phone videos while eating. I encouraged the client to start her day technology-free. She could do 3-4 rounds of sun salutations, allowing her breath to guide the movement. I suggested she sit down to eat breakfast, beginning with 3-5 deep breaths, and allowing breakfast to be a mindfulness exercise. She has a short timed window for lunch at school, but suggested she still begin with 3-5 deep breaths, and enjoy time with friends while eating. Upon arriving home after school, she could incorporate any asanas that felt good prior to finishing homework. Dinner could provide another opportunity for breathwork and mindful eating.

The client at times feels overwhelmed with her demanding course load, and I encouraged her to incorporate pranayama throughout her day as needed, even if for a minute at a time.

Yes. The client enjoyed beginning the session with asana practice. While she felt energized, she also reported feeling a sense of calm when focusing on her breath. She asked many questions during my attempt to share a basic overview of the stress response in the body and the impact of mindfulness practices, such as breathwork and mindful eating. She thoroughly enjoyed savasana, and we talked about options for her to practice on the floor of her room, on the floor with her legs elevated on her bottom bunkbed, as well as practicing in bed to help her fall asleep.

She enjoyed the raisin exercise, and I explained how she could repeat this in some form at each meal - starting by focusing her attention on one element of the meal. As she becomes more comfortable and experienced in the practice, she could attempt the mindfulness exercise from the first bite to the last.

I did not anticipate my client’s excitement to ask questions and share thoughts, and quickly realized that I needed to give her more freedom and adjust the pace of our conversation accordingly. Following her energy and enthusiasm, I realized it would be challenging to perform the mindful eating exercise just once for the fullest benefit of the experience, so we performed it a total of three times. After each time she shared her experience and observations, and I encouraged her to mine for new insights as we repeated it.

In sharing bhramari breath, I offered two mudra options - the more tradition as well as the "helmet variation," sharing it often allowed me to feel more grounded.

I would definitely approach it with a mindset of improvisation. When initially crafting this plan, I had intended to focus on just the mindful eating. However, realizing both the variety of situations during the client's day where stress can aggravate her symptoms, as well as her enthusiasm and multi-focused energy, I felt that savasana and simple pranayama practices could be both engaging and beneficial for her.

Looking back at my own life experience, I wonder how my relationship with stress management would be different had I been introduced to similar tools at her age. It feel it is worth sharing these simple interventions with any future clients of similar age.

• Mindful-Eating_-The-Art-of-Presence-While-You-Eat.pdf
• Foundations-TCA-documentation.pdf
• Irritable-Bowel-Syndrome_-Yoga-as-Remedial-Therapy.pdf