Throughout my career I have been privileged to work with people of varying ages, presentations, histories and symptoms. A common theme for everyone has been the significance of grounding and mindfulness. Here are some thoughts of what grounding and mindfulness are, with some words of encouragement when it feels impossible and some specific ‘behaviorisms’ that I’ve found can make grounding more accessible to all.
WHAT IS GROUNDING?
Grounding is a set of simple strategies to detach from emotional pain (for example, drug cravings, self-harm impulses, anger, sadness). Distraction works by focusing outward on the external world rather than inward toward the self. You can also think of it as “distraction”, “centering”, “a safe place”, “looking outward”, or “healthy detachment”.
WHY DO GROUNDING?
When you are overwhelmed with emotional pain you need a way to detach so that you can gain control over your feelings and stay safe. As long as you are grounding, you cannot possibly use substances to hurt yourself! Grounding “anchors” you to present and to reality. Many people with PTSD, Bipolar Disorder and Substance Abuse issues struggle with either feeling too much (overwhelming emotions and memories) or too little (numbing and dissociation). In grounding you attain balance between the two – conscious of reality and able to tolerate it.
KEY IDEAS ABOUT EMOTIONAL PAIN
“No feeling is final” (Rilke) – No matter how miserable a feeling, it can change even if it feels like it never will. Pain is a feeling, it is not who you are – When you get caught up in it, you feel like you are your pain and that is all that exists. But it is only one part of your experience – the others are just hidden and can be found again through grounding and mindfulness.
GUIDELINES
Grounding and mindfulness can be done anytime, anywhere and no one needs to know. Use grounding when you are:
Faced with a trigger
Having a flashback
Dissociating
Having a substance craving
When your emotional pain goes above 6 (on a 1-10 scale)
Grounding puts healthy distance between you and these negative feelings.
TO PRACTICE GROUNDING:
Keep your eyes open, scan the room, and turn the light on to stay in touch with the present.
Rate your mood before and after to test whether it worked. Before grounding, rate your level of emotional pain (0-10, where 10 means “extreme pain”). Then re-rate it afterwards. Has it gone down?
No talking about negative feelings or journal writing – you want to distract away from negative feelings, not get in touch with them.
Stay neutral – no judgements of “good” or “bad”. For example, “The walls are blue; I dislike the color blue because it reminds of me depression”. Simply say, “the walls are blue”, and move on.
Focus on the present, not the past or future. I’ve heard that depression is being over reflective on the past and anxiety a result of thinking too much about the future. Be in the present.
Note that grounding is not the same as relaxation training. Grounding is much more active, focuses on distraction strategies, and is intended to help extreme negative feelings. It is believed to be more effective for DID and PTSD than relaxation training.
GROUNDING TOOLBOX – GROUNDING FROM EMOTIONAL PAIN
Describe your environment in detail using your senses: “The walls are white; there are five pink chairs, there is a wooden bookshelf against the wall…” Describe objects, sounds, textures, colors, smells, shapes, numbers and temperature. You can do this anywhere. For example, on the subway: “I’m on the subway. I’ll see the river soon. Those are the windows. This is the bench. The metal bar is silver. The subway map has four colors…”
Play a “categories” game with yourself. Try to think of “types of dogs”, “jazz musicians”, “states that begin with “A”, “cars”, “TV shows”, “writers”, “sports”, “songs”, “European cities.”
Do an age progression. If you have regressed to a younger age (e.g., 8 years old), you can slowly work your way backup (e.g., “I’m now 9”; “I’m now 10”; “I’m now 11”…) until you are back to your current age.
Describe an everyday activity in detail. For example, describe a meal that you cook (e.g., first I peel the potatoes and cut them into quarters, then I boil the water, I make an herb marinade of oregano, basil, garlic, and olive oil…”).
Use an image: Glide along on skates away from your pain; change the TV channel to a better show, think of a wall as a buffer between you and your pain.
Say a safety statement. ‘My name is ____; I am safe right now. I am in the present, not the past. I am located in ______the date is ______.
Read something, saying each word individually. Or read each letter backwards so that you focus on the letters instead of the words.
Use humor. Think of something funny to jolt yourself out of your mood.
Count to 10 or say the alphabet very s..l..o..w..l..y.
Repeat a saying to yourself. (e.g., the Serenity Prayer*).
GROUNDING TOOLBOX – GROUNDING FROM PHYSICAL PAIN
Run cool or warm water over your hands.
Grab tightly onto your chair as hard as you can.
Touch various objects around you: a pen. keys, your clothing, the table, the walls. Notice textures, colors, materials, weight, temperature. Compare objects you touch: Is one colder? Lighter?
Dip your heels into the floor—literally “grounding” them! Notice the tension centered in your heels as you do this. Remind yourself that you are connected to the ground.
Carry a ground object in your pocket—a small object (a small rock, clay, ring, piece of cloth or yarn) that you can touch whenever you feel triggered.
Jump up and down.
Notice your body: The weight of your body in the chair; wiggling your toes in your socks; the feel of your back against the chair. You are connected to the world.
Stretch. Extend your fingers, arms or legs as far as you can; roll your head around.
Walk slowly, noticing each footstep, saying “left,” “right” with each step.
Eat something. Describe the flavors in detail to yourself. Research shows that hypoglycemia mimics anxiety! Eat a banana and peanut butter, an apple with nuts or your favorite low glycemic fruit/grain/nut snack.
Focus on your breathing. Noticing each inhale and exhale. Repeat a pleasant word to yourself on each inhale (for example, a favorite, color or a soothing word such as “safe” or “easy”). Once you’ve developed efficient breathing patterns try maintaining an exhale for a 6 second count followed by an inhale of the same duration. Continue and repeat to stimulate the Vagus Nerve which has been scientifically linked as a treatment method for depression and anxiety.
GROUNDING TOOLBOX – SOOTHING GROUNDING
Say kind statements, as if you were talking to a small child. E.g.. “You are a good person going through a hard time. You’ll get through this.
Think of favorites. Think of your favorite color, animal, season, food, time of day, TV show.
Picture people you care about (e.g., your children; and look at photographs of them).
Remember the words to an inspiring song, quotation or poem that makes you feel better (e.g.. the Serenity Prayer).
Remember a safe place. Describe a place that you find very soothing (perhaps the beach or mountains, or a favorite room); focus on everything about that place—the sounds, colors, shapes, objects, textures.
Say a coping statement. “I can handle this”, “This feeling will pass.”
Plan out a safe treat for yourself, such as a piece of candy, a nice dinner, or a warm bath.
Think of things you are looking forward to in the next week. Perhaps time with a friend or going to a movie.
WHAT IF GROUNDING DOESN’T WORK?
Practice as often as possible. Even when you don’t “need” it, so that you’ll know it by heart.
Practice faster. Speeding up the pace gets you focused on the outside world quickly.
Try grounding for a long time (20-30 minutes). And, repeat, repeat, repeat.
Try to notice whether you do better with “physical” or “mental” grounding.
Create your own methods of grounding. Any method you make up may be worth much more than those you read here because it is yours.
Start grounding early in a negative mood cycle. Start when the substance craving just starts or when you have just started having a flashback.
Make up an index card on which you list your best grounding methods and how long to use them.
Have others assist you in grounding. Teach a friend or family member how grounding works so that s/he can help guide you in if you become overwhelmed. Maslow was right: belongingness is critical to good mental health and socializing with trusted friends/family is a powerful resiliency tool.
Prepare in advance. Locate a place at home, in your car, and at work where you have materials and reminders for grounding.
Create an cassette tape of grounding message that you can play when needed; and consider asking your therapist or someone close to you to record it if you want to hear someone else’s voice.
Think about why grounding works. Why might it be that focusing on the external world, you become more aware of an inner peacefulness? Notice the methods that work for you – why might those be more powerful for you than other methods?