Understanding Stabilisation Across Trauma Therapies
A pattern I often notice in trauma work is that clients can leave sessions feeling calmer, more grounded, and settled, only to find that, a few days later, their nervous system feels overwhelmed again.
The therapeutic work may have gone well in session. The client may understand their formulation, recognise triggers, and have practised grounding or regulation strategies successfully in the room. Yet between sessions, when stressors increase, accessing those same strategies can become much harder.
This is not a lack of motivation or insight. Often, it reflects the reality of working with a nervous system that has spent prolonged periods in survival mode. Supporting regulation between sessions therefore becomes an important part of trauma-informed therapy.
Why Stabilisation Matters Across Trauma Therapies
Across therapeutic approaches, a consistent aim in trauma-informed work is helping clients remain within a manageable range of arousal – often described as the window of tolerance, a concept developed by Dan Siegel in The Developing Mind (1999).
When clients move outside this window and into hyperarousal, such as overwhelm, anxiety or panic, or into hypoarousal, such as shutdown, numbness or disconnection, their capacity to engage with therapeutic work can become limited.
This is relevant across therapeutic models. CBT therapists, counsellors, counselling psychologists, clinical psychologists, EMDR therapists and integrative practitioners may use different language or frameworks, but many are ultimately working towards similar goals: helping clients feel safer in their bodies, more present, more emotionally regulated and better able to remain within their window of tolerance.
Grounding, mindfulness, stabilisation, self-as-observer work, breathwork and attention-shifting strategies may originate from different therapeutic approaches, yet they often share a common aim: supporting nervous system regulation and helping clients move out of survival states and back towards steadiness, calm and stability.
What Is Slow Bilateral Stimulation?
Bilateral stimulation involves alternating sensory input from left to right. This may be visual, tactile or auditory. In the context of slow bilateral auditory stimulation, the client listens to gentle sounds that move rhythmically between the left and right ear, usually through headphones.
Although bilateral stimulation is most commonly associated with EMDR, this article is not focused on trauma processing. Here, I am referring specifically to slow, rhythm-based bilateral auditory input as a stabilisation and regulation tool.
Used in this way, the aim is not to access or process traumatic material. The aim is to support grounding, emotional regulation and a greater sense of steadiness within the nervous system.
Slow bilateral auditory stimulation may be one additional stabilisation tool within this wider therapeutic landscape.
How Slow Bilateral Stimulation May Support Regulation?
The precise mechanisms behind bilateral stimulation are still being explored, and it is important not to overstate the evidence. However, research within the EMDR field has explored links between bilateral stimulation and reductions in subjective distress, physiological arousal and emotional intensity (Lee & Cuijpers, 2013; Sack et al., 2008; van den Hout & Engelhard, 2012).
Several theories may help explain why slow bilateral rhythm can feel regulating for some clients, including the orienting response, dual attention and working memory theory. In simple terms, gentle rhythmic stimulation may help support present-moment awareness, provide an external attentional anchor and reduce overwhelm by engaging attention in a structured, repetitive way.
You can read more about the proposed mechanisms of bilateral stimulation in EMDR here
Supporting Between-Session Regulation in Trauma Therapy
Many clients can engage with stabilisation strategies during therapy sessions, but find them harder to use independently when distressed. Cognitive strategies can be difficult to access when arousal is high. Purely internal practices may also be challenging for clients who are overwhelmed, dissociative or not yet confident in self-regulation.
This is where structured sensory support can be helpful. Slow bilateral audio may offer:
- an external anchor
- a repeatable regulation practice
- a non-verbal route into grounding
- a way of supporting continuity between sessions
- a gentle reminder of the stabilisation work practised in therapy
This does not replace clinical work. It sits alongside it.
How Slow Bilateral Stimulation May Fit Across Therapeutic Models
Cognitive Behavioural Therapy (CBT)
Within CBT-informed approaches, slow bilateral audio may help support continuity of stabilisation work between sessions, particularly for clients who struggle to access cognitive strategies when emotionally overwhelmed.
It may also support attention-shifting and emotional regulation, particularly when clients are learning to recognise early signs of escalation and practise interrupting familiar patterns of threat response.
Acceptance and Commitment Therapy (ACT)
Within ACT-informed work, slow bilateral sound may provide a gentle external anchor during moments of cognitive or emotional intensity.
It may support present-moment awareness and noticing practices between sessions. Some clients may also find it helpful alongside mindfulness exercises or other experiential practices that have already been introduced within therapy.
Dialectical Behaviour Therapy (DBT)
Within DBT-informed work, slow bilateral audio may offer an additional sensory grounding tool for some clients between sessions, particularly where stabilisation and emotional regulation strategies have already been established within therapy.
Clinical judgement remains important, especially for clients who experience dissociation or significant emotional instability.
Compassion Focused Therapy (CFT)
Within CFT, slow rhythm may support practices associated with soothing, grounding and compassionate imagery.
The predictability of rhythm, combined with a calm auditory environment, may help create conditions that support safeness, settling and compassionate engagement.
Integrative and Counselling Approaches
For integrative therapists and counsellors, slow bilateral audio may offer some clients a structured way of returning to grounding and steadiness between sessions, particularly during periods of emotional overwhelm.
Using Audio Resources in Trauma-Informed Therapy
Many clients already use relaxation tracks, meditation apps, music or sleep sounds to support wellbeing and stress management. These can be helpful in the right context.
Trauma-informed use, however, often requires additional clinical consideration. Timing, pacing, client readiness, dissociation, emotional activation and the wider purpose of the intervention all matter.
In practice, the question is not simply, “Does this sound relaxing?” but:
- What is the purpose of this audio?
- When should it be used?
- Who is it suitable for?
- Could it increase distress for some clients?
- How does it fit within the wider therapy plan?
Used thoughtfully, slow bilateral audio may become one part of a structured, therapist-guided approach to between-session stabilisation and regulation.
Clinical Boundaries
Slow bilateral stimulation is one of many possible stabilisation tools and should always be used with clinical judgement. It may not be suitable for all clients or presentations, particularly where there is significant dissociation, instability, sensory sensitivity or increased distress in response to bilateral input.
In this context, slow bilateral stimulation is intended to support grounding and stabilisation, not trauma processing or to replace wider therapeutic work and formulation.
Final Thoughts on Slow Bilateral Stimulation Beyond EMDR
Slow bilateral stimulation is often associated with EMDR, but its potential relevance may extend more broadly when used carefully and specifically for stabilisation.
Across CBT, ACT, DBT, CFT, counselling and integrative approaches, many therapists are already helping clients build emotional regulation, present-moment awareness and distress tolerance. Slow bilateral auditory stimulation may offer one additional way of supporting that work.
In practice, many clients struggle most with maintaining regulation between sessions—particularly following difficult or activating work.
To support this phase of therapy, I also offer clinician-designed bilateral audio resources intended 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 free stabilisation audio
About the Author
Donna Dickinson is a BABCP-accredited CBT therapist and EMDR-trained psychotherapist with over 19 years of NHS experience in trauma-focused work. Her clinical interests include nervous system regulation and stabilisation in therapy. She develops clinically informed audio resources to support stabilisation and regulation within trauma-informed practice.
References:
Lee, C. W., & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy and Experimental Psychiatry, 44(2), 231–239.
Sack, M., Lempa, W., Steinmetz, A., Lamprecht, F., & Hofmann, A. (2008). Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR) in PTSD patients. Journal of Anxiety Disorders, 22(7), 1264–1271.
Siegel, D. J. (1999). The Developing Mind: Toward a Neurobiology of Interpersonal Experience. Guilford Press.
van den Hout, M., & Engelhard, I. (2012). How does EMDR work? Journal of Experimental Psychopathology, 3(5), 724–738.
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