Distraction grounding techniques are best used for tolerating and surviving a crisis situation that you cannot deal with at the moment. It is about moving you away from the extreme feelings, body sensations, and thoughts of the moment. It is important that you do not over-rely on distraction techniques as they take you out of the present moment. Distraction grounding techniques are to get you through the present crisis until you are able to use other skills to deal with the problem.
Distraction grounding techniques can be useful for:
Pick and number and try to come up with as many equations that will get you to that number (addition, subtraction, multiplication, division, etc.)
Count your breaths.
Categories
List as many items you can think of in a category (dogs, cities, fruits, etc.). Make sure you are able to list at least 10 or switch to a different category.
Pay attention to your surrounding and make lists of items in your surrounding that fit into different categories.
Go down the alphabet and for each letter list girls’ names and then boys’ names. You also can do the alphabet strategy for other categories like countries and fruits.
Reading
Read something backwards, letter-by-letter. Practice for at least a few minutes.
Recite a poem, story, or song.
Spell the weather, such as rain R-A-I-N.
Guessing/Memory Games
Look at people around you and guess their occupation.
Look at a photograph or picture for 5-10 seconds. Turn over the picture and recreate it in your mind or mentally list all the things you remember in the picture.
Emotions
Try to get in touch with a different emotion – the goal is to get out of the current emotion that you are feeling.
Listen to emotional music that evokes a different emotion.
Watch emotional movies, shows, films, or documentaries that evoke a different emotion.
Read emotional books/stories.
Comparisons
Think of a time when you felt differently and compare it to how you feel now.
Watch reality TV shows about others’ troubles or watch documentaries about disasters.
Activities
Focus on a task, movie/show, video/computer/mobile game, or surf the internet
Read a newspaper, magazine, or book.
Do a puzzle, colour in a colouring book, or doodle.
Visualization
Visualise yourself putting the problem on a shelf for you to come back to later.
Visualize a daily/common task that you enjoy and go through all the steps mentally that it takes to complete the task.
Sensorimotor Psychotherapy was developed by Pat Odgen and is a body-centred approach that focuses on the somatic symptoms of trauma. It holds that unresolved traumatic experiences end up trapped within the body. It is a combination of somatic therapies, attachment theory, neuroscience, cognitive techniques, and other techniques.
The focus of Sensorimotor Psychotherapy is to use a person’s physical, mental, and emotional states to manage and relieve the physical sensation that are connected to the trauma. Moreover, the details of the trauma do not necessarily need to be recalled for the treatment to be effective.
This is the official website. It is more for therapists desiring trainings, but it does have some information on the modality and it has a Therapist Directory in which you can look up officially trained therapists.
Somatic Experiencing (SE) was developed by Peter Levine and focuses on addressing the effects of trauma. It focuses on releasing people from where they may have been stuck in a traumatic event. For example, someone may develop chronic pain in a body part that was hit in a motor vehicle accident. The reason for that pain may not be physical but may be due to not going through certain processes that release the traumatic energy and therefore the energy stays in the body and creates tensions and pain.
Furthermore, the purpose of Somatic Experiencing is to help the body release the traumatic energy and to enable it to self-regulate.
Correspondingly, the focus of Somatic Experiencing is to help the client find places of safety so that the client can experience sensations relating to traumatic events in a safe way and be able to process the trauma.
Somatic Experiencing can be very helpful for trauma and other conditions that involve a nervous system dysfunction from trauma.
This is the official website for Somatic Experiencing. It has resources, information on trainings, and a place to look up therapists who have passed their official trainings.
This book is a simple little book that is a 12 phase Healing Trauma program. It provides the necessary information that is important to trauma healing but not all the science behind it (if you want the scientific background read Waking the Tiger or In an Unspoken Voice for that information). It includes a CD with 12 guided Somatic Experiencing exercises. There are a variety of exercises or modifications that you can use for each of the 12 phases.
In an Unspoken Voice – Peter Levine
This book summarizes Peter Levine’s work in trauma. It explains the science behind the strategies of Somatic Experiencing, why some people develop PTSD and others don’t, what you can do to lessen the chances of developing PTSD after a traumatic event, and what you can do to release the trauma that has become trapped in the body after a traumatic event.
Internal Family Systems (IFS) Therapy was developed by Richard Schwartz in the 1990s after he began hearing clients speak about inner parts within themselves. These parts form an internal family, where some parts have certain goals while other parts have other goals. Each part has its own likes, dislikes, burdens, and history and is thought to play a role in achieving self-preservation. Parts can have healthy, productive or extreme roles and those with extreme roles may benefit from therapy.
There is a Self that is the seat of consciousness at the core of each person. The Self is often hidden by the different parts, especially the extreme or wounded parts which are trying to protect it. The goal is to unburden those parts and create a trusted, healthy, harmonious internal system that is coordinated by the Self.
Internal Family Systems has been found to be effective for the improvement of general and mental well-being. We can use it to treat:
Trauma
Physical, emotional, or sexual abuse
Compulsive behaviours
Depression
Bipolar
Body Image issues
Anxiety
Phobias
Substance dependency
Chronic pain
Internal Family Systems can be used to understand why certain behaviours keep happening and for more extreme behaviours (substance dependency, self-harm) figure out if those behaviours are still needed and what could be done instead. Furthermore, some of the parts may be living in the past when the circumstances were different and it can be used to bring those parts into the present where those extreme behaviours are not needed anymore. Internal Family Systems can be a powerful tool to work with trauma, especially developmental trauma.
This website is the official website for the practice of Internal Family Systems. It has resources, ways to find a formally trained IFS therapist, training and learning options, information about the theory, and research about IFS.
No Bad Parts – Richard Schwartz
This is a book written by the founder of Internal Family Systems, Richard Schwartz, for the general public. It explains the IFS theory and why it works for trauma and other struggles. It also includes techniques and exercises.
Cognitive-Behavioural Therapy (CBT) is a short-term type of behavioural therapy. It focuses on the relationship between beliefs, thoughts, feelings and behaviours. The assumption behind CBT is that by changing one corner of the triangle, you can change the other corners of the CBT triangle (see image below). For example, by changing the thought you have in a situation you also can change the emotion and behaviour you have in that situation. Awareness brought to the pattern of thoughts or emotions and then there is an effort to change that pattern. Short manageable goals promote that change.
The patterns are changed through the implementation of different skills, tools, strategies, and techniques. CBT usually involves homework through worksheets and other practices.
CBT can be used to better manage and cope with chronic conditions such as Chronic Pain, Chronic Fatigue Syndrome, Diabetes, and Irritable Bowel Syndrome.
Cognitive-Behaviour Therapy has been found to be effective for:
Depression
Anxiety
Mood Issues
Post-traumatic stress
Obsessions and compulsions
Chronic fatigue syndrome (CFS)
Irritable bowel syndrome (IBS)
Chronic Pain
Sleep Issues
Phobias
Disordered eating
Substance dependency
Sexual issues
Anger management
It can be very effective to lessen the suffering of people who have negative thought patterns or are prone to anxiety. It complements other modalities as well.
This is the website of the institute of one of the biggest influencers of Cognitive Behaviour Therapy. This website has a lot of information about CBT, possible trainings, and other resources.
Mind Over Mood – Christine A. Padesky & Dennis Greenberger
This is a great book on how to use CBT to improve the quality of your life by changing your thoughts and emotions. It has worksheets included with the book and has step-by-step plans that you can use.
Emotional neglect is often an inner torment of not being noticed. It’s about what didn’t happen for you. It can go unnoticed. Information about emotional neglect can be very validating later in life. There are ways to feel from emotional neglect and therapy can help that process.
What is Emotional Neglect?
Emotional Neglect is not about what happened to you but what did not happen. It is about your parents or caregivers not adequately responding to your emotional needs. This can happen from a parent having unrealistically high expectations and not listening attentively to invalidating a child’s emotional experiences to the point she/he feels self-doubt. Most of the time, it is not intentional. There are a lot of parents who do not adequately respond to their children’s emotional needs because their parents did not respond to their needs, trauma got in the way of their emotional development, or they got too busy or exhausted to be able to respond adequately to their children’s emotional needs.
In emotional neglect, children learn that their feelings are not important. With childhood emotional neglect the Amygdala (part of the brain that has a primary role in memory processing, decision making, and emotional responses) becomes bigger and more reactive. Emotional neglectful families often look normal, but members of the family may not receive the aspects of family that allow children to develop properly.
Signs and Symptoms of Emotional Neglect:
Depression
Anxiety
Insecure-avoidant or disorganized attachment patterns
Failure to thrive; poor academic performance
Aggression
Low self-esteem, low self-compassion
Apathy
Hyperactivity; disruptive & impulsive behaviour
Developmental delays
Substance misuse and risky behaviour; suicide attempts
Withdrawing from friends and family; anger towards parent; negativity during parent-child interactions
Appearing uncaring or indifferent
Shunning emotional closeness or intimacy; poor peer relationships and the avoidance of interaction with other children; significantly less positive social interaction
Self-blame, shame, humiliation, feelings of worthlessness
Less emotional knowledge; difficulty recognizing angry faces
Emotional unavailability, numbing out, or being cut off from one’s feelings; difficulty identifying or expressing feelings
Shunning intimacy
Depression
Feeling empty or hollow inside
Poor self-discipline
Anger and aggressive behaviours towards self or others
Difficulty trusting others or relying upon anyone else; trouble asking for help or support
Feeling deeply, personally flawed; hiding behind a mask; disconnected from self
Guilt and shame; easily embarrassed
Feeling like there’s something missing, but not sure what it is
Easily overwhelmed or discouraged; frequent feelings of worry, excessive fears, and dissatisfaction
Perfectionism with acute sensitivity to feelings of failure
Pronounced sensitivity to rejection
Lack of clarity regarding others’ expectations and your own expectations for yourself
Feel the need to people please
Lack of ability to empathize
Blame, judgmental, and critical towards self or others
Please note that the effects of emotional neglect can range from mild to severe and you might only have some of the previously noted effects and symptoms.
How a Therapist can Help You Recover from Emotional Neglect
Working on emotional intelligence
Identifying your needs and providing ideas and skills to help you meet them.
Helping you learn skills and techniques that help you challenge the thoughts and beliefs that are holding you back.
Encouraging you to be gentle with yourself through the process and normalizing the struggles
Encouraging you to believe that you are a unique, beautiful person but you just cannot feel it because you have either not learned to connect with that part of you or you have not had that belief instilled in you.
More Emotional Neglect Information
Dr. Jonice Webb – Running on Empty
Running on Empty is a good book for describing how emotional neglect happens and what it is like. It can be a very validating book for people who have been emotionally neglected in childhood.
Eye Movement Desensitization and Reprocessing (EMDR) therapy was developed by Francine Shapiro. It is a body-mind integrated therapy that has been proven to be highly effective for people who have experienced trauma.
Theory Behind EMDR
The Adaptive Information Processing (AIP) model was developed by Francine Shapiro to explain how EMDR works.
The AIP model hypothesizes that trauma interferes with the brain’s processing and that during trauma, our brain processes and stores memories incorrectly. Often, the way your brain stores trauma memories can prevent healthy healing.
Newer memories can link up to a traumatic experiences in the brain and reinforce that negative experience over and over again. This can disrupt the links between your senses and memories. It can create greater sensitivities in your mind to things you saw, heard, smelled or felt during a trauma-related event.
Furthermore, this incorrect storage makes it so that past events seem to be in the present. This experience may be triggered by emotions, negative cognitions, and physical sensations.
How it Heals Trauma
EMDR uses guided instructions and bilateral stimulation (eye movements, tones, or taps) to access memory networks in order to move them from a place of emotional activation to a more rational, logical place. It can help release the brain’s natural healing processes.
EMDR reprocessing can help desensitize and heal the mental injury from a targeted memory. It can help you to gain distance between the memory so you will no longer feel like you’re reliving it, and associated thoughts and emotions become more manageable.
Evidence-Based Treatment for PTSD
EMDR is an effective, evidence-based form of treatment for Post-Traumatic Stress Disorder (PTSD) and is recognized for its effectiveness by the American Psychiatric Association, the Department of Defense and Department of Veterans Affairs (US), and the World Health Organization. With EMDR, it is not necessary to discuss the details of a traumatic experience. It can effective with people from various ethnicities and backgrounds.
Various kinds of trauma (intergenerational, developmental, etc.)
Abuse and Assault (Physical, Emotional, and Sexual)
Grief and loss
Eating Disorders
Sleep problems associated with trauma
Advanced Trainings and Education
I have further education in specific EMDR techniques for the following conditions and situations:
Trauma-Related Dissociation – Trauma-Related Dissociation is a mental escape or a switching off when a person is so emotionally overwhelmed that they can’t cope. It can be “a process in which a person disconnects from their thoughts, feelings, memories, behaviors, physical sensations, or sense of identity.” (ISSTD, 2020)
Positive Affect Tolerance – If you find it difficult or uncomfortable to experience positive affect (emotions), you may benefit from increasing your positive affect tolerance. Low Positive Affect Tolerance is more common with people who experienced childhood emotional neglect or abuse.
EMDRIA is the international association for EMDR. It has guidelines for official trainings, reports on research, explanations of EMDR, as well as a place to look up EMDR trained therapists.
Getting Past Your Past – Francine Shapiro
This is a great book for people who aren’t mental health professionals. It has good explanations about trauma, EMDR, and techniques to use for trauma.
Dialectical Behaviour Therapy (DBT) was developed by Marsha Linehan while trying to find an effective treatment for suicidal and borderline personality disorder patients. She started with Cognitive Behaviour Therapy but found that it was lacking in certain areas. So she added aspects to the treatment and made changes to improve treatment results. This resulted in what is now known as DBT. Some of the changes she made were a balancing act between acceptance and change, adding validation, mindfulness, and interpersonal skills.
DBT: Building a Life Worth Living
The focus of Dialectical Behaviour Therapy is to “build a life worth living.” It is a collaborative type of therapy where the therapist and the client work together to enable the client to build a better life through collaboratively decided goals, therapy techniques, and skill-building.
Behind the DBT is biosocial theory, which believes that invalidating environments are at the root of emotional dysregulation. Emotion dysregulation involves being emotionally sensitive and emotionally reactive and having a slower return to baseline. There are several reasons for emotion dysregulation, such as biological disposition, attachment problems, loss, trauma, and invalidation. When you have frequent prolonged intense emotional reactions, it tends to create neural pathways that are sensitized to these types of reactions. These reactions can become more automatic as time goes on. The emotional reactions can become more and more intolerable as time goes on. Therefore, it can become more difficult to cope with them and choose effective behaviours to deal with them. DBT can help point clients in the right direction of choosing better behaviours to deal with intense emotions and learn how to tolerate them.
Dialectical Behaviour Therapy (DBT) works by moving back and forth between acceptance and change. It validates your past experiences yet encourages you to move forward. It offers skills that you can learn to deal better with the world around you and better manage your emotions. These are often skills that people who grew up in supportive environments learned. However, people who grew up in less supportive environments did not learn these skills or have deficiencies in these skills.
The skill-building in DBT can really help people to be able to better cope with their emotions, tolerate distress, improve their relationships, and better understand how they can improve how they feel about life. This therapy can work well with people who have had emotional neglect or developmental trauma because it focuses on the skills that were neglected in their childhood. There are other modalities that work well with the actual inner wounds from childhood and other trauma, so this form of therapy works well complementing those.
Prelude to Trauma Processing
DBT and DBT skills can often be used early in therapy as the relationship between the therapist and client is being established. It can be used to help bring more skills to you so that you can tolerate the distress and intense emotions that can come with processing trauma.
Conclusion
DBT can be effective in helping you establish the skills to tolerate the distress and emotion dysregulation that can come from trauma and chronic pain. It can be a stepping stone to trauma processing or the healing of neuroplastic pain.
Trauma can be a difficult condition to deal with and the effects of it can effect every aspect of your life. Moreover, it often doesn’t just affect you because it can affect your interactions with other people. Often one of the barriers to healing from trauma is not knowing what it is, which can limit the usefulness of trauma resources.
What is Trauma?
You experience trauma when your nervous system gets overwhelmed. The nervous system can become overwhelmed from too much too soon, too much for too long, and not enough for too long. When the nervous system is overwhelmed, things (emotions, thoughts, self-beliefs, etc.) do not get stored or processed in the brain properly, and everyday things trigger them to manifest like they are happening in the present when the emotion, physical sensation, and/or perception is actually coming from the past. Not all trauma reaches the level of Post-Traumatic Stress Disorder (PTSD), but all trauma has the potential to cause suffering.
Traumatic memories are “less likely to be recalled in a clear, coherent narrative” and more likely to be “remembered in the form of sensory elements without words, ” such as emotions, changes in breathing or heart rate, body sensations, tensing, or feelings overwhelmed (Fisher, 2021).
Trauma can be very individual and unique. So what works for one person may not work for another.
Trauma therapy should involve some type of retraining of the brain through the overcoming or changing of beliefs that are preventing the natural healing process of the brain and nervous system to operate properly. This retraining can be done through cognitive, somatic, and/or mindfulness techniques. Two therapeutic modalities that are evidence-based for Post-Traumatic Stress Disorder (PTSD) are Cognitive Processing Therapy and Eye Movement Desensitization Reprocessing (EMDR) Therapy. Other trauma therapies have worked for other people and can be effective but do not have the same amount of research to get them to the level that is needed to be considered evidence-based.
Trauma Resources:
Trauma Resources: Recommended Reading
Peter A. Levine – Healing Trauma
This book has a good summary of trauma plus it comes with a CD that has 12 Guided Somatic Experiencing exercises.
Bessel Van der Kolk – The Body Keeps the Score
This is an incredible book that describes the experience of trauma, how trauma affects the brain, and different treatments for trauma that have been successful. Bessel Van der Kolk is one of the top experts in trauma. This book has been an NYT bestseller and can probably be borrowed from your local library.
Transforming the Living Legacy of Trauma – Janina Fisher
This is an incredible workbook that has the essential psychoeducation about trauma as well as step-by-step strategies to start to heal the trauma and cope better with triggers. Janina Fisher is one of the top experts on trauma.
Getting Unstuck from PTSD – Patricia A. Resick, Shannon Wiltsey Stirman, and Stefanie T. LoSavio
This is a self-help workbook that is based on Cognitive Processing Therapy, which is an evidence-based psychotherapy for post-traumatic stress disorder.
Chronic pain is really difficult for you to live with. It is different and treated differently from acute pain. Moreover, it can affect almost every part of your life. However, counselling and other chronic pain resources can help you deal with your chronic pain. Additionally, it can bring pain reduction, lower the level of suffering and impact it has on your daily life.
What is Chronic Pain?
Chronic Pain is essentially pain that continues after an injury is healed or should be healed. However, it can also occur for people who have experienced nerve damage or other injuries that never fully heal. Normally, it is not considered chronic pain unless the pain has been persistent for 3 months or more.
Chronic Pain is different from acute pain and needs to be treated differently. The nervous system is much more involved in chronic pain. Additionally, it is often increased or caused by an overactive nervous system. The body uses pain to alert you to danger, but for many with chronic pain, the alert system is extra sensitive and either overreacting to stimuli or reacting to stimuli that are not dangerous. Moreover, the level of pain that someone experiences with chronic pain is often representative to the amount of danger versus safety that their brain is interpreting.
Chronic pain is a holistic condition that can be impacted by many things, such as physical activity, problems within muscles and joints, nutrition, sleep, stress, temperature, past trauma, emotions, and thought patterns. Essentially, anything that the brain can interpret as dangerous can be a trigger for chronic pain. With Chronic Pain, a person may have to pace themselves and plan ahead to avoid pain increases.
How can Counselling Help with Chronic Pain?
Counselling can help a person…
Figure out how to cope with the pain
Plan strategies to minimize pain increases
Figure out priorities
Change thought patterns
Identification of the cause behind pain increases
Manage emotions
Create boundaries to better manage pain.
Learn skills to help them communicate their needs.
Find validation for the struggles with chronic pain.
Reduce the level of pain you feel.
Improve other co-occurring conditions that may be affecting your pain like depression, anxiety, trauma, grief, substance use disorders, and suicidality.
Recently, research has found that certain psychological techniques have the ability to resolve or significantly improve chronic pain, especially neuroplastic pain. Pain Reprocessing Therapy and Emotional Awareness and Expression Therapy are the therapeutic modalities with the most notable research about their effect on chronic pain. These types of pain therapies work because they focus on reducing the danger that the brain interprets. Because if we can let the brain know that the things it is interpreting as dangerous are really safe, than the pain will go down.
Pain BC is a non-profit based in BC. It is has a huge number of resources for self-management of pain, education opportunities for health professionals, and supports for those with chronic pain. It is a truly amazing website to support those with chronic pain.
Tame the Beast is a website that is a collaboration between a pain scientist (LM), a pain physiotherapist (DM) and a professional communicator (SC). It shares a number of pain stories as well as providing pain education.
Pain Revolution is an Australian website that has a lot of information for pain education, as well as handouts explaining pain. It has a good number of resources on it.
Chronic Pain Centre of Excellence for Canadian Veterans is has monthly webinars about chronic pain, resources for those with chronic pain and those supporting those with chronic pain.
Chronic Pain Resources: Reading
Rethink Chronic Pain – Dr Gaetan Brouillard
Rethink Chronic Pain is a book written by Dr Gaetan Brouillard, who is a Pain Specialist based in Montreal. This book takes on a multifaceted approach to pain including an explanation of pain, the biological and environmental causes of pain, nutritional influences of pain, natural supplements for pain, ways to treat pain through complementary health approaches (reflexology, acupuncture, etc.), and psychology.It is great in offering some ideas of what next to try and educating on what could be going on with your pain situation.
Change Your Brain, Change Your Pain – Mark Grant
Mark Grant is a Psychotherapist that has specialized in EMDR treatment of chronic pain. This book is great of educating the reader on the connection between chronic pain and trauma. It also offers 15 audio downloads that readers can use to help heal their pain. Headphones are required to get the most out of the audio tracks as they are set up for bilateral stimulation (different sounds to each ear). There are a number of tracks that are set up for using with a trusted partner, for those tracks you may not get as much out of the experience if you don’t have a trusted partner.
Explain Pain – David S. Butler & G. Lorimer Moseley
Explain pain is an excellent book by one of the top researchers in chronic pain. It does a good job on explaining the mechanisms behind chronic pain and what adjustments a person with chronic pain can make to reduce their level of pain.
The Way Out – Alan Gordon & Alon Ziv
The Way Out is an excellent book by the person who helped develop Pain Reprocessing Therapy. It has humour, techniques, and understanding for those suffering from chronic pain.
8 Steps to Conquer Chronic Pain – Dr Andrea Furlan
An excellent book that covers all the basics of chronic pain. It contains a process to tackle your chronic pain but can also be read for information. Dr Andrea Furlan is a respected pain specialist in Toronto, Ontario Canada.
Madeleine Eames is a psychotherapist and mindfulness teacher in Kelowna, BC and has many videos about the chronic pain and psychological and mindfulness resources.
