This article clarifies what stabilisation means in trauma therapy and how therapists can support nervous system regulation during early-stage work. It is important to distinguish stabilisation from trauma processing. Trauma stabilisation refers to the process of helping clients develop emotional regulation, safety, coping and tolerance of their emotions before engaging in trauma processing. Trauma processing, by contrast, involves the structured activation and reworking of distressing memories within a contained therapeutic framework. When these are blurred, there is a risk of either premature exposure or avoidance.
Why stabilisation matters
At the start of the therapeutic journey, clients often arrive autonomically dysregulated. Dysregulation may also emerge at various points throughout therapy. Stabilisation refers to the range of interventions that support clients in returning to a regulated and tolerable state of arousal. Stabilisation is a useful life skill for both clients and clinicians, but is particularly important in trauma-focused work. Stabilisation supports the restoration of prefrontal regulatory capacity when autonomic arousal has narrowed attention and amplified the threat response. While cortical and limbic systems are not mutually exclusive, heightened threat activation can temporarily reduce reflective functioning and executive control.
Slower forms of bilateral auditory stimulation have also been explored in relation to regulation and stabilisation within therapy. You can read more about this here: here
What dysregulation looks like clinically
Clinically we can help clients to feel more settled with what are often described as tools or strategies but are really life skills. Nervous systems are not designed to remain in hyperarousal for long periods – they are designed to help us manage threat then return to homeostasis. Most individuals are not explicitly taught how to regulate their internal states. When we encounter a stressful working or home environment, an accident, difficult relationships, or a traumatic event, anxiety and stress may persist beyond the immediate threat, leading to a sustained dysregulated pattern.
When a client is dysregulated, there are obvious ways this presents. They can become very tearful and unable to stop crying, they can dissociate completely (as if they are not in the therapy room at all), reliving past threatening situations, they may begin panicking and/or hyperventilating. More subtle ways include tension in shoulders, breath holding, fidgeting or picking at hands/fingers, restless legs, foot tapping, and poor eye contact.
As therapists we can learn more by directly questioning: ‘When was the last time you remember feeling calm and relaxed?’ Often the answer to this question can help direct stabilisation.
Common stabilisation approaches
Psychoeducation:
Vagus Nerve – Stimulating the tone of the vagus nerve allows the nervous system to calm within a few minutes. The Vagus Nerve is the longest nerve in the body and travels to many of our major organs. Increased vagal tone is associated with improved autonomic flexibility and regulation.
Phrenic Nerve – this nerve sends signals between the diaphragm and the brain. When the diaphragm is utilised in breathing (termed diaphragmatic breathing), the phrenic nerve sends a calming signal to the brain that the body is safe. This in turn reduces the stimulation of stress hormones such as epinephrine and cortisol.
Breathing to calm and breathing to stimulate – Breathwork is often cited as a way of calming hyperarousal, however, certain breathing patterns (e.g. double inhalation followed by extended exhalation) may be useful in stimulating alertness in hypoaroused presentations.
The benefits of visualisation (e.g. peaceful place in EMDR) – Imagery engages cortical networks associated with memory and representation. Some people think they cannot do this so a way to help is to ask them to describe their kitchen/living room/favourite clothing item. They can often recite much detail. If they can describe these details, it suggests that imagery-based techniques may be accessible to them. In Phase 2 of EMDR (the preparation phase), clients may develop a “peaceful place” resource by imagining a calming setting while engaging their senses (sight, sound, smell, touch, and felt sense). Slow bilateral stimulation (BLS) may then be used to strengthen the association between this imagery and a felt sense of safety (Shapiro, 2001; Parnell, 2007).
Specific Tools:
Breathwork – longer outbreaths are helpful for clients who breath-hold when stressed. A few cycles only are recommended here so as not to disturb oxygen and carbon dioxide balance.
Breathing patterns (e.g., square breathing: count of 4 in, 4 hold, 4 out, 4 hold, repeat) – helpful for creating space between themselves and the stressor. This can also be helpful for people who find visualising stressful, as they could find the shape of a square in their immediate surroundings and use this to aid them with the counts.
Counting breaths (forwards or backwards) – drawn from attention-based approaches, this technique shifts focus away from the stressor and towards a structured cognitive task. It can also be adapted in complexity; for example, if counting backwards from 100 is not sufficiently engaging, clients might count in 3s, 4s, or 7s to further occupy working memory and redirect attention.
Physical focus (e.g., progressive muscle relaxation) – systematically tensing and then releasing muscle groups helps clients develop awareness of held tension and the physiological contrast between tension and release. This can be particularly helpful for clients who report persistent aches or tightness in the shoulders, neck, or head. Practising this contrast supports recognition of early tension signals and encourages intentional release between sessions.
Changing focus of attention (e.g. Yoga Nidra, Attention Training Technique) – allowing the focus of attention to rest lightly on different areas of the body and changing focus more quickly. When clients find body-focused attention triggering, attentional shifting can instead involve directing awareness to external sensory cues (e.g., sounds in the room or visual details in the environment). This can be helpful when clients struggle to use progressive muscular relaxation and have difficulties focusing on their breathing.
These approaches share a common aim: increasing the client’s capacity to notice arousal shifts and return to a regulated state without activating trauma memory networks. The choice of intervention should be guided by individual presentation, preference, and phase of therapy rather than by protocol alone.
Where slow bilateral auditory input may fit
Bilateral stimulation is often used within stabilisation work in EMDR. If you’re interested in how it works more broadly and the main theories behind it, you can read a fuller explanation here. Slow bilateral auditory input may be incorporated within sessions where clinically indicated, particularly during stabilisation or resourcing phases in trauma-focused therapy. As with all stabilisation tools, its use should be guided by individual response rather than protocol-driven application. You can read more about the evidence for slow bilateral stimulation here. If a client responds well, working with them to create an out-of-session practice tailored to their needs may be helpful.
If you’re interested in simple ways to support regulation between sessions, I’ve created a short stabilisation audio using slow bilateral stimulation, you can access here as a free resource.
Ethical considerations
A small minority of individuals are unable to generate voluntary visual imagery (a phenomenon known as aphantasia), and it is estimated to affect approximately 2–3% of the population (Zeman et al., 2015). For these clients, somatic, auditory, or externally focused grounding strategies may be more accessible than imagery-based approaches.
Non-processing language in stabilisation outside of sessions is important – for example not using ‘notice that’ and instead, ‘Breathe into where you feel calm’ or ‘allow your body to settle’. Trauma processing remains an in-session intervention requiring appropriate containment and clinical oversight. Stabilisation, by contrast, refers to transferable life skills that can support regulation well beyond the therapeutic relationship.
Some clinicians incorporate adjunct tools, such as paced bilateral auditory input, within stabilisation work. When clearly differentiated from trauma reprocessing protocols and applied with clinical judgement, such tools may support regulation capacity without replacing therapeutic engagement or structured processing interventions.
Integrating This Into Practice
In practice, many clients struggle most with maintaining regulation between sessions—particularly following difficult or activating work.
To support this phase of therapy, I’ve developed clinician-designed bilateral audio resources for stabilisation and nervous system regulation between sessions.
• Explore the full audio library → Willow Tree Wellbeing Audio Library
• Or try a short stabilisation audio → Access a Free Stabilisation Audio Sample
Donna Dickinson is a BABCP accredited CBT therapist and EMDR-trained psychotherapist with over 19 years’ NHS experience in trauma-focused work. Her clinical interests include nervous system regulation and stabilisation approaches in therapy.
References:
Parnell, L. (2007). Tapping in: A step-by-step guide to activating your healing resources through bilateral stimulation. Sounds True.
Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures (2nd ed.). Guilford Press.
Zeman, A., Dewar, M., & Della Sala, S. (2015). Lives without imagery – Congenital aphantasia. Cortex, 73, 378–380.