Exercises

Understanding the importance of stabilizing techniques, grounding exercises, and practice.

Stabilization – to help the survivors to return to their window of tolerance.

  • An approach that helps to handle trauma-related reactions
  • We want you to teach the survivor how to stabilize herself
  • Grounding is a stabilization method for handling strong emotions of fear or flashbacks, when a memory ‘takes over’ and is experienced as if it happens here and now.

Grounding is an important therapeutic approach for handling dissociation or flashbacks and reducing the symptoms of anxiety and panic. It is important to practice the exercises again and again until the skill becomes automatic and can be called on even during moments of distress. The aim of grounding is to take the survivor out of whatever traumatic moment he is remembering and return into his window of tolerance. Using them, the survivor can reorient his awareness, and focus his attention on the present rather than the past.

Grounding exercises can help a survivor to reconnect:

  • With the present moment in time.
  • With the here and now.
  • With his body and reassert personal control.
  • To the safe context of the room in which he is.

They:

  • Ground the person by anchoring his body, enabling him to connect to reality.
  • Focus on breathing, increasing his awareness of the here and now.
  • Relax, creating calm.
  • Strengthen the body and waken it from numbness and weakness.

The exercises focus on the five senses that anchor us to our bodies and our surroundings. We need to check whether the survivor feels different and better afterwards. This implies that we also have to do a “scan” before we start the exercise. Since every person is unique, we need to make the tools and exercises as helpful as possible by adapting them to the needs of each survivor.

To discover the effects of these grounding exercises, we can ask these guiding questions:

  • What happens in your body?
  • What happens to your feelings?
  • What happens to your breathing?
  • What happens to your thoughts?
  • What happens in your heart?

Allow the survivor to decide where you (as helper) can sit, and how close you should be. Establish an escape route for him by suggesting that, if he prefers, you can continue later.

Explain to the survivor that, when he practises grounding exercise, he must make sure to:

  • Pick a moment that is peaceful and safe.
  • Be calm and ready to learn something new, practise over and over again for some time.

Always remember to invite the survivor to participate in a grounding exercise. Let it be an open invitation. If he does not feel ready to participate in an exercise, respect his wish.

Ten grounding techniques that can help the survivor reconnect with the here-and-now and get into a state of optimal arousal.

1. Safe place

This exercise can help survivors to calm down, subdue overactivation, and find a more balanced emotional state.

While doing this exercise, you can choose to keep your eyes open or closed.

  1. Think of a place that makes you feel calm and safe. It may be a place you’ve been to once, or a place you’ve seen in a movie, or heard of. It can be at home with yourself or with someone you know, or a place in nature. You can also create a place in your imagination.
  2. The place must suit you and your needs. You can constantly adapt it. No two people are alike: this is your place.
  3. It is a private place that no one else knows about or can find without your permission. You choose it and you decide whether you want to share it with others or not. The place should shut out all the stimuli of the present that are overwhelming and should be comfortable and richly equipped for all your needs. Everything is here that you require to be comfortable.
  4. Visualise this place in your imagination and imagine that you are there. Take time to imagine it in detail: its colours, shapes, smells, sounds. Imagine the sunshine, feel the wind and the temperature. Notice what it is like to stand, sit or lie there; feel how your body is in contact with it. Feel what it’s like when everyone is safe, everything is fine. In your safe place you can see, hear, feel, smell and feel exactly what you need to feel safe.
  5. You can go to this place whenever you want and as often as you want, and just by thinking about it you will feel safer and calmer.
  6. You might want or need more than one place. Work on this step by step. Notice what each memory or emotion needs.

2. Distinguish past and present

This exercise can help survivors to calm down and deal with overactivation.

Recall a mildly unpleasant incident, when you were a little anxious, restless or ashamed. What do you notice in your body? What happens in the muscles? What happens in the stomach? How does your breathing change? Does your heart rate accelerate or decelerate? Do you become hotter or colder? If there are changes in temperature, do they occur everywhere or in specific parts of your body?

  • Now turn your attention back to the room you are in. Notice the colour of the wall. Notice details of decoration. What is the temperature? What do you smell?
  • Does your breathing change when your attention changes?
  • Now try to pay attention to your current surroundings while remembering the mildly unpleasant event. Can you keep your attention on where you are physically now, while remembering the event?
  • End this exercise with your attention focused on your current surroundings.

3. Handling flashbacks by being attentive

This exercise can help survivors to calm down and deal with overactivation. [Example]

Right now, I feel (Insert the name of your feeling you have, often fear).

My sensations are that I am ______________________ (Name three bodily sensations.)

I remember _________ (Give one source of trauma, give no details.)

At the same time, I look around at where I am now: in (Write the current year.)

In _________, (Write your location now.)

I can see___________________________, (Describe things you see now, in the place you are in.)

Therefore, I know that ___ (Name the trauma again) is not happening now.

4. Progressive muscle relaxation

This exercise can help survivors to reduce their overactivation and find a more balanced emotional state.

When you are scared or anxious, your body becomes tense. This can cause symptoms such as pain in the neck, shoulders, back, tight jaw, tension in the arms and legs. To train yourself in progressive muscle relaxation, tighten specific muscle groups and then release them. Focus on the feelings of tension and then the feelings of relaxation in each muscle group. You should exercise one part of the body at a time: head and face, neck and shoulders, back, abdomen, pelvis, arms and hands, legs and feet. Find your pace.

Instruction:

  • Sit or lie down in a place that is quiet and feels safe. Make sure you will not be disturbed. Tighten and release the tension in each muscle group twice. Allow a short pause between each cycle. When tightening a muscle group, hold the tension for approximately five seconds and relax for approximately ten seconds.
  • Start by focusing on your hands. Tighten your fists, feel the muscles tighten for five seconds, and relax for ten seconds. Notice the difference between tension and relaxation. Do the same thing again.
  • Turn to the arms. Pull your forearms towards your shoulders. Feel the tension in the muscles of your upper arms for five seconds, then release; relax for ten seconds. Notice the difference between tension and relaxation. Repeat.
  • Tighten the triceps (the muscle on the underside of the arm) by stretching your arm straight out and fixing your elbows. Feel the tension in the triceps (five seconds), then let go, relax your arms. Focus on the difference between tension and relaxation. Repeat. When your arms are slack, just let them lie next to you, or let them rest on your armrests.
  • Concentrate on the face. Tighten the muscles in the forehead by raising the eyebrows as high as you can. Feel the tension in your face and eyebrows, hold and release. Concentrate on the difference between tension and relaxation. Repeat.
  • Open your mouth as wide as possible. Hold. Relax. Repeat.
  • Focus on the muscles of the neck. Bend your head to your chest. Turn your head slowly to the left, return to the centre line, then put your head back as far as it will go. Return the head to its normal position. Then bend your head to your chest again. This time, turn your head to the right, return to the centre line, then put your head back as far as it will go. Return the head to its normal position. Because the neck often concentrates a lot of tension, repeat this exercise slowly and thoroughly. Throughout, notice the difference between tension and relaxation.
  • Focus on the shoulders. Raise them, as if to touch your ears. Hold and feel the tension and let go. Notice the sensations of tension and relaxation in the shoulders. Repeat.
  • Focus on the shoulder blades, pulling them backwards as if they could touch each other. Tense them and relax them. Notice the difference. Repeat.
  • Stretch your back by sitting very upright, tightly, then let go. Relax. Repeat, focusing on the different experiences of tension and relaxation.
  • Tighten your buttocks. Hold and then release the tension. Repeat.
  • Hold your breath. Pull in your stomach, tighten it, let go. Repeat and feel the difference in the stomach.
  • Focus on the legs. Stretch them, feel the tension in the thigh muscles, hold, and then relax. Feel the difference between tension and relaxation. Repeat.
  • Straighten your legs and point your toes back towards you. Feel the tension in your legs; then feel the relaxation when you let go. Repeat.
  • Finally, focus on your feet. Point your toes down as far as you can and feel the tension in the muscles of your feet. Tighten and release. Notice the different sensations when you tighten and relax the muscles in your feet.
  • Now do a mental scan of the whole body and look for tension that is left. If a muscle group is still tight, return to this area again.
  • Now imagine that relaxation spreads throughout your body. The body may feel warm, a little heavier, safe, relaxed. 

5. Attentive presence

This exercise can help survivors to calm down and get anchored in the here and now.

  • Sit in a comfortable position. Sit with your back straight and let your shoulders relax.
  • Choose whether you want your eyes open or closed. If you have your eyes open, try to let your gaze focus approximately half a metre in front of you.
  • Notice how the body feels against the surface: feet on the floor, thighs against the seat, etc.
  • Notice your breathing. Feel your breath enter and leave your lungs. Choose whether you want to focus on the air in your nostrils or the air in your lungs. Breathe in; breathe out.
  • Keep your attention on your breath and follow it in and out.
  • Notice what thoughts are flowing through your head. What feelings do you have? Acknowledge the feelings. What are your bodily sensations right now? Feel for any tension or discomfort.
  • Every time you notice something else entering your consciousness, notice it (“greet it”), and kindly but firmly bring your attention back to your breath.

Try as well as you can to see your thoughts as mental events, perhaps by naming them. Accept all thoughts, images and feelings that arise. Try not to push any thoughts away or become involved in them. Leave them alone and concentrate on your breathing.

If your attention is distracted one hundred times, your only task is still to return to your breathing. If you have thoughts like “I can’t do this very well” or “this was weird”, notice them and return your atte

6. Squeeze hug

This exercise soothes people who are upset. It can help a survivor who is in a state of ‘freeze’ (numb) to concentrate on the here-and-now. Cross your arms in front of you. With your right hand hold your left upper arm. With your left hand hold your right upper arm. Gently squeeze and pull your arms inwards. Hold the clamp for a while. Find the right pressure for you right now. Hold the tension and let go. Then squeeze again for a while and release. Stay there a moment.

7. Reorientation to the present

This exercise is helpful for a survivor who is a state of ‘freeze’ (numb). The helper assists the survivor to use their senses to re-orient themselves in the present and feel safe. The helper says:

  • Look around and name three things you see.
  • Look at one thing (a thing, a colour, etc.). Tell yourself what you see.
  • Name three things you hear.
  • Listen to a sound (music, voices, other sounds). Tell yourself what you hear.
  • Name three things you can touch.
  • Touch something (different textures, different objects).
  • Tell yourself what you know. Notice your state of mind.
  • Do you feel that you are more present in the room or less present after doing the exercise?
  • Do you feel calmer or more energetic?

8. Grounding the body

This exercise can help a survivor to subdue his overactivation and find a more balanced emotional state. It can also help a survivor who is in “freeze mode” to re-enter the tolerance window.

Sit on a chair. Feel your feet touch the ground. Tread the ground with your left foot on, then your right. Do it slowly: left, right, left. Do this several times. Feel your contact of your thighs and buttocks with the seat of the chair (5 seconds). Notice if your legs and buttocks now feel more present, or less. Slowly extend your spine and notice if it affects your breathing (10 seconds). Move your attention towards the hands and arms. Clasp your hands together. Do it in a way that feels comfortable for you. Clasp your hands and feel their strength and temperature. Unclasp them, take a break, and clasp your hands again. Release and rest your arms.

Now focus on the eyes. Look around the room. Find something that tells you that you are here, in this room. Remind yourself that you are here-and-now, and that you are safe. Notice how this exercise affects your breathing, presence, mood and strength.

9. Feeling the weight of your body

This exercise helps survivors who are in “freeze mode” to focus on the present. It activates muscles in the upper body and legs, which gives a feeling of physical strength. When we are overwhelmed, our muscles often go from extreme tension to collapse; they change from a state of active defence (fight and flight) to submission. The muscles become abnormally relaxed (hypotonic). When we are in contact with our own strength and can control our posture, it is easier to master our emotions and cope with reactions to previous experiences as well as feelings of being overwhelmed.

  • Make yourself comfortable in a sitting position.
  • Place your feet on the ground and feel the sensation. Pause for five seconds.
  • Feel the weight of your legs. Feel that sensation for five seconds.
  • Raise your feet gently and slowly, left foot then right foot, left, right, left, right.
  • Feel your buttocks and thighs where they touch the seat of the chair. Feel the sensation for five seconds.
  • Feel your back against the back of the chair. Stay in that position and notice the difference in how you feel.

10. Noticing and reducing anger

As a survivor, your anger and frustration can sometimes be caused by very real and inescapable problems. Not all anger is misplaced, and often it’s a healthy, natural response to these difficulties. Often, the most helpful thing to do is not to focus on finding the solution, but rather on how you handle and face the problem.

Here, the “window of tolerance “can be useful. The area between the two lines shows the optimal activation level. All people have an area or window where they are in balance, where their state of mind allows them to be present, concentrate, and learn new things.

If the person is above the window of tolerance, above the top line, we say he is overactivated. This means that he cannot cope.

Escape and fight are survival responses and are examples of overactivation. The heart beats harder and faster, breathing is more rapid. More blood flows to the brain, and brain activity suspends complex processing and focuses on the threat. The body is highly energised.

What helps getting him into the window and dealing with anger varies from person to person, and situation to situation. If he can approach it with his best intentions and efforts and make a serious attempt to face the anger head-on, he will be less likely to lose patience and fall into all-or-nothing thinking, even if the problem does not get solved right away.

If he is going above the window, and experiencing a fight-response, he can practice visualizing the “window of tolerance” when he feels the anger arising. In advance, you as a helper and the survivor can make a plan of what he can do to get back into the window.

Some examples can be:

  • Removing himself from the situation and go for a walk or a run to achieve a shift in mental and physical state.
  • Slowly counting backwards from 10 and focusing on his breathing.
  • Doing a grounding exercise, for example see 4. Progressive Muscle Relaxation.
  • Having a squeeze ball available for channelling the negative energy.

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