Breathing practice is the most portable and perhaps the most powerful body-based form of stress management. Slow and deep breathing engages the parasympathetic nervous system to tone down the stress response and enhances the relaxation response restoring the body’s natural capacity to heal, and improving mood, sleep, and overall health.

Breath Awareness practice will be given to my client. It not only promotes deep breathing but also helps him to notice if breathing is restricted or tight. It enables him to recognize any holding patterns and provides the opportunity to explore where can be relaxed. He can make the practice part of a daily check-in using an audio file provided

Male, 68 years old. Criminal Appellate Attorney, working 80 percent time. Overall health is good, an avid biker. Primary source of current stress is caretaking for his wife, who had an early onset of Lewy Body dementia and requires round-the-clock care since 2021. Has been doing a few yoga stretches as part of a warm-up. Never really had a yoga session before, but he feels it could help both with body and stress issues to sustain health and improve QOL

• Conduct a brief oral intake to assess his needs and limitations. Ask how his stress level is and his mood.
• Client education: Mechanisms of stress response and effects of yogic approach on physical/emotional level
• Lead brief centering for physical and psychological self-check-in
• Lead simple standing asana to counter long hours of desk work with instructions to keep him relaxed and comfortable as much as possible
• Guide into the Breath Awareness practice to stimulate the vagus nerve and activates the relaxation response of the parasympathetic (rest and digest) nervous system. I will find him in a comfortable physical position of his choice, either seated or lying on his back
• Lead brief meditation
• Explain the benefits of Breath Awareness and make the practice part of a daily check-in and use it as a tool to let go and relax anytime feelings of stress and anxiety arise

Hatha: Langhana-focused asana and the Breath Awareness practice were introduced to help my client move the body gently and slowly and to activate the parasympathetic nervous system to induce a relaxation response
Jnana: Breath Awareness practice also increases interoceptive awareness. As regular practice develops, he can actively relax the parts he holds tension and ultimately build resilience to stress response
Raja: Book 2 Sutra 46 can expand beyond the discussion of Asana. The sutra supports this salient point; the skill to know when it is to exert effort and when it is to be in a relaxed state consciously is the key to staying sustainable. It is particularly relevant for my client, who has to be available 24/7 to be to care for his wife and stay resilient despite physical and emotional burdens. The teaching dovetailed with Jnana yoga which cultivates discriminative faculty

The client arrived late at the session due to a meeting with a hospice nurse that went overtime. Reported a good mood from the meeting. While unsettling energy was present initially, he focused on the tasks. Notable kyphosis and limited ROM at GH joints in bilateral arm flexion/abduction. Self-claimed “reverse breather,” although it was not confirmed in this virtual session. He chose to stay in a chair for Breath Awareness practice. No noticeable breathing difficulty or unusual movement of the abdomen. The practice part of the session concluded with a brief meditation during which he recounted that he had held an image of their daughters as a focal point. Reviewed the physical and psychological benefits of deep diaphragmatic breathing at the conclusion of the session and how it can help to reduce stress.

I encouraged him to pay attention to the quality of his breath throughout the day and engage in deep breathing when a stressful feeling arises. Provided a recording of a guided Breath Awareness Practice script for home practice that can be listened to on a mobile device. Emailed a link to a full text of a scientific paper on yoga and stress reduction of caregivers, whose summary I shared with him at the session

Applied all my intended plans with a minor change to extend the Asana portion. I led the guided Breath Awareness practice successfully, with an awareness of him possibly being a reverse breather. That said, I still achieved the goal since he maintained deep, slow breathing, and the focus of the Breath Awareness practice is more on awareness. Overall, I successfully created a supportive environment that was free of pressure throughout the session.

Initially planned for 45 minutes, the session was extended to one hour as I added more standing asanas on the spot, which he appeared to enjoy. Q&A and feedback had to be cut down short. Although my client had only a limited time available for the session, we should have scheduled it for at least an hour.

What went well:
• My client seemed to be fascinated by the effects of the yogic approach on stress I introduced at the beginning of the session, in that it addresses stress at both physical and emotional levels. This is an encouraging sign that he may be motivated to incorporate the practice into his daily routine.

What could have been done differently:
• Brief stretching could have been helpful *before* the centering to get his nervous energy out of the system
• Also, if the time allows, I would discuss the importance of making a conscious effort to develop a keen awareness of his mental and physical capabilities by observing himself under stress. We could discuss how the essential teaching of Book 2 Sutra 46 can be adopted in his daily life, although I would use reframed language. Working with the client in collaboration, I could identify stressful scenarios and discuss how to address them best before he completely depletes himself. This customized approach would be more beneficial and more adaptable to his life situation.