Using Grounding Techniques in Your Practice

1. “Grounding techniques are now commonly used by therapists working with clients that have experienced trauma. Key symptoms of post-traumatic stress disorder (PTSD) include flashbacks and varying degrees of detachment from the present moment. For some clients, intrusive memories and sensations can be so strong it’s as though the client is experiencing the trauma again in the present moment.

If you’re a therapist and your clients have experienced trauma, one problem they may experience is dissociation, which is a shift in their attention away from the present moment. This shift moves the client toward distressing memories and feeling threatened. This can be extremely distressing, both for clients and for therapists who are unfamiliar with dissociation.

Dissociation can involve:

• intrusive unwanted memories.

• intrusive thoughts and emotions.

• depersonalization.

• identity confusion.

• unexplained medical symptoms.

• loss of control.

• compartmentalization.

• identity alteration.

• multiple identities.

• reduced awareness of surroundings.

I recall a client who experienced daily panic attacks and frequent dissociation. Ellen’s daily functioning was severely impacted, and when she started treatment, she was considering quitting her job. Over several weeks we practiced grounding techniques, which she began to incorporate into her daily routine. Within a couple of months, she occasionally suffered from anxiety – but no longer had panic attacks. She was more present, and I partially attribute this to her daily practice of grounding techniques.

How do you treat clients who dissociate? In-session, having a basic knowledge of grounding techniques can help you defuse an escalating situation or calm a triggered client. Stabilization and the establishment of safety are two essential elements of treatment. This may include focusing on widening a client’s “window of tolerance,” and developing coping mechanisms by teaching skills such as grounding.

Grounding techniques help clients control symptoms by turning attention away from thoughts, memories, or worries, and refocusing on the present moment. Clients who experience dissociation, or distress that pulls them from the present moment, can be encouraged to try various grounding techniques, to see which method is most effective for them. There are many kinds of grounding exercises, including deep breathing, physical exercises, cognitive interventions, and meditation scripts.

What exactly is grounding? It is any method or technique that keeps your client in touch with reality, like touching the ground with their feet, drinking a cold beverage, or repeating their name, age, and so on.

By teaching grounding as a skills-development exercise, you can help your clients to manage dissociative reactions, reduce anxiety, and cope with stress.

Mental grounding techniques include cognitive, somatic, and behavioral exercises. These techniques can shift negative perceptions into more realistic or positive ones. They can help your client reframe difficult situations and cultivate acceptance without resistance. Here are eleven mental techniques:

Mindfulness allows clients to embrace a more mindful approach to everyday life. It refers to being present and aware of current thoughts, feelings, and bodily sensations. At the same time, it also means accepting the current reality without judging or trying to change it.

Meditation is the intentional practice of staying present with the mind and body and includes activities like breath work, intentional walks, or progressive muscle relaxation.

When clients objectively describe a situation, they separate facts from opinions. To do this exercise, your client acts as if they are a reporter who needs to stick to the facts and stay objective about a story.

The five senses exercise supports present-moment thinking by focusing on five things your client can see, four things they feel, three things they hear, two things they smell, and one thing they can taste.

Find a safe place exercise is a guided imagery exercise that promotes calmness and emotional security.

Name items in a category shifts the client into a task-oriented direction by thinking about all the items in a specific category.

Recite in order uses repetition as a helpful distraction technique. Doing so forces the client to focus on a specific task instead of the distress they are experiencing.

Affirmative safe words are simple reminders, such as “breathe” or “calm,” clients use in uncomfortable situations.

Visualizing anxiety involves imagining anxiety as a tangible item, like a rock. This exercise helps clients separate themselves from distressing thoughts.

Describe what’s around you is a series of questions that allow the client to focus on objects in the environment. Using their senses, they consciously stimulate their mind, decrease blood pressure, and reduce heart rate.

Doing math equations helps clients focus on mentally solving math problems to distract themselves.

Physical grounding techniques are structured, specific exercises that engage the senses or use specific items to provide relief. They may require more preparation and time than mental grounding techniques but are extremely helpful in managing distress.

Savor a food or beverage involves mindfully enjoying a food or beverage, focusing on the sensations involved.

The holding ice technique involves the client holding ice cubes in their hand or tracing them along their arms or legs.

Sprinting involves your client setting a timer and running as fast as they can for thirty seconds. Repeat 1-2 times.

Breathwork is a conscious exercise where the client controls how they breathe, deactivating the sympathetic nervous system while activating the parasympathetic nervous system.

Smelling something is a soothing way to calm down using pleasant scents.

Designate a safe object to serve as a grounding item. The client keeps the item in their pocket or purse and holds onto it as needed.

Clench and release the fists make clients physically aware they are using those muscles.

Feet on the floor exercise refers to shifting as much weight as possible to the feet and “grounding” them into the earth.

Create a grounding space is a designated place – either an entire room or a small section – where the client can spend time when they feel overwhelmed.

Take a shower or bath to get in touch with the body, allowing the heat to be physically relaxing.

Soothing grounding techniques allow your client to calm themselves through self-soothing activities. Here are some examples.

Seek humor to diffuse intense emotions. Laughter is an appropriate response to managing overall well-being.

Coloring can help the client focus on a pleasant task, promoting a sense of calmness and mindfulness.

Listing favorite things reminds the client of all the things that bring them joy.

Spending time with a pet can help reduce feelings of anxiety in the body.

Plan an activity to enjoy later may include things like planning a hike, preparing a meal, going to a concert, or anything else that would be beneficial.

Listening to music can be therapeutic and act as a distraction.

Practice self-compassion and positive self-talk involve writing down how your client contributes to the world and all their favorite qualities about themselves. They can look at the list frequently and it will help to ground them.

Carefully graded exposure to triggers may be attempted in session and combined with the use of grounding techniques to help clients to practice their skills.

Try the following grounding exercises in session:

Ask the client to state what they observe. You might say, “You seem to be afraid/angry/upset. This might be related to what happened in the past. Right now, you’re safe. Let’s try to stay in the present moment. Take a slow deep breath, relax your shoulders, and place your feet solidly on the floor. Let’s talk about what day it is. Describe what you see around you. What else can you do to feel okay in your body right now?”

Help the client decrease the intensity of what they are experiencing.

• Ask your client to turn down their “emotional dial,” where they imagine turning down the volume on their emotions.

• Ask your client to clench and unclench their fists.

• Do a guided imagery meditation with your client so they can visualize a safe place.

• Use strengths-based questions, such as “How did you cope with that?” or “What strengths did you possess to survive what happened to you?”

Distract the client.

• Ask the client to focus on the external environment and name shapes, colors, and so on.

• Ask the client to focus on recent or future events.

• Help the client use affirmative self-talk.

• Use counting or making lists to return the focus to the current moment.

• Use somatosensory techniques (toe-wiggling, touching an object).

Ask the client to use breathing techniques.

• Ask the client to inhale through the nose and exhale through the mouth.

• Ask your client to place their hands on their abdomen and watch the hands go up and down while the belly expands and contracts.

Grounding exercises are an effective way for clients to calm themselves, get present, and reduce distress during emotionally escalated moments. Regularly practicing these skills can decrease anxiety, trauma symptoms, dissociation, and intense cravings. It is important your clients consistently practice grounding techniques, implementing them in calm situations so the techniques feel more natural when they are distressed. Encourage clients to try a range of techniques to discover which are most effective for them.

Resource: Najavits, L. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. Guilford Publications.

Click here to get the free worksheet, “Using Your Senses to Feel Grounded,” to help teach clients grounding techniques.

Find many more worksheets on the various aspects of teaching grounding tools with a free trial at www.BetweenSessions.com, where you will also have access to our Virtual Counseling Room “Grounding Techniques.”