At the end of an intake session, it’s good to give a client something to walk out the door with that’s useful to them. For trauma survivors, the most basic effective coping mechanisms are what can be called grounding skills. You can find them described in dialectical behavior therapy and other, especially trauma-focused, treatments. There are three basic categories of grounding skills outlined in a book by Lisa Najavits entitled Seeking Safety.
This can be the simplest but most fundamental level of grounding skills. When somebody is caught up in their mind or emotions, a way to bring them back to the present moment is through physical sensations and their environment. If the person sits in a chair with arms, just gripping the arms of the chair and noticing the sensation of holding them, identifying all the places where their fingers touch the chair and so on, can be very grounding.
Another skill has the client digging their feet, their heels, into the ground and noticing that sensation. Again, it’s doing something that’s not harmful, but it provides a bit of physical pressure to bring attention to present sensations. They can also sit in a chair and feel the gravity holding their body in the chair, holding their feet to the ground.
One physical grounding skill is feeling a comforting object, whether it’s something soft, a smooth rock they carry around, or running their hands under warm water. Any of those things, or whatever else works for a particular person, can be considered physical grounding.
This is about trying to focus the mind on something other than whatever is triggering it, by purposefully shifting the attention. It can involve nonjudgmentally describing the current environment in detail. “I’m sitting in a room with purple walls with wooden accents. There are seven paintings on the walls,” and so on, in minute detail. If someone is being taken by their mind into an imaginary or historical scenario, this brings them back to the current environment.
You can also use categories, such as listing every type of dog you can think of, or naming every band that starts with the letter A. Or you can describe an everyday task like brushing your teeth or starting your car in great detail. Anything of such nature will purposefully turn the mind away from memories or imaginings to something present.
This might be having a favorite song ready to go on your phone. Or picturing people that you care about. Speaking a coping statement out loud that reminds you you’re safe and strong. Any such things can be effective.
Deborah was taken through those three categories of grounding skills, and talked about using them when she started to feel anxious and needed to take a step back from it. She had a relaxation app on her phone that she had used previously, but not recently, as sometimes it made her more anxious. It was agreed that she could use it experimentally if she wanted to, but perhaps trying it with her eyes open.
We often see that when trauma survivors do exercises with their eyes closed, it can be triggering for them from a safety perspective. This is especially true for those who have been in an uncontrollable situation or felt unsafe. So we teach them that they have control over keeping their eyes open or closed. You can encourage people to look down, let their eyes be unfocused, or look at something nonspecific, so they’re not distracted by what they see.
As noted, the problem with experiential avoidance is that people get themselves out of contact with the present moment. So how are grounding skills different from that? Are they not a way of promoting avoidance?
In some ways that’s true. We may suggest to a client that we work on reducing their avoidance because it’s one of the things that creates and maintains their problems. But at the same time, the immediate goal when they feel triggered or upset is that they can get through the moment without doing something to make the situation worse.
So while over time we may work on alternatives to avoidance, for now listening to a favorite song or running their hands under warm water is an adaptive form of avoidance. It’s not that all avoidance is bad, but that using avoidance on autopilot rather than mindfully can be problematic.