One of the most common questions I ask myself when beginning stabilisation work is not:
“Which stabilisation technique should I use?”
but rather:
“What exactly is this client struggling with?”
Clients may all arrive in therapy feeling overwhelmed, yet the processes driving their overwhelm can look very different. How they present in sessions may be quite different from how they experience distress between sessions.
One client may spend hours worrying about future events. Another may find themselves caught in rumination about the past. Someone else may be struggling with panic sensations in their body, while another is waking repeatedly during the night and unable to return to sleep. They will already be using ways of coping or stabilising themselves. Our job is to understand what those strategies are and where the gaps may be. I have written previously about using a stabilisation formulation to explore coping, regulation and resilience, which you can read here.
Although stabilisation is often discussed as a single stage of therapy, I have found it more helpful to think about it as a collection of skills and approaches that can be matched to the client’s presentation. Different difficulties may require different starting points.
Importantly, stabilisation is rarely something we complete and move on from. More often it becomes something we return to repeatedly throughout therapy and beyond as new challenges emerge and formulations evolve. This article explores how I think about stabilisation when working with trauma presentations, and how different patterns of distress may benefit from different starting points.
Stabilisation Is Not One Thing
Typically, most of us are not taught how to experience emotions without fearing, judging or trying to avoid them. Yet allowing emotions is only one part of the process. We also need to know how to feel okay while those emotions are present.
This is where stabilisation becomes so important in trauma-informed work. As therapists, we have many tools available to us within sessions. Between sessions, however, it is helpful to understand what clients are already doing to cope, regulate and manage distress so we can identify both existing strengths and any gaps that may need attention.
When therapists talk about stabilisation, they may be referring to many different things: grounding, breathwork, mindfulness, attention shifting, self-compassion, movement, imagery, sleep strategies and nervous system education.
All of these can be helpful. The challenge is deciding where to begin.
I have found it useful to think less about the technique itself and more about what may be maintaining the client’s distress. The same stabilisation strategy will not be equally helpful for every client.
When Clients Are Focused on Bodily Sensations
Some clients become highly focused on their physical symptoms and what they mean. They may monitor:
- heart rate
- breathing
- dizziness
- tension
- sensations associated with anxiety or panic
In these situations, asking the client to focus further on bodily sensations may not be the most helpful starting point. Instead, I often find it useful to help clients practise shifting attention externally through grounding exercises.
This might involve noticing colours in the room, describing the environment, tracing the outline of an object, orienting to sounds, or using other present-moment awareness exercises. Often, a combination of these approaches can help clients practise shifting attention more flexibly.
The aim is not distraction but to help develop flexibility in where attention is directed.
When Clients Are Over-Worrying
Some clients spend much of their time focused on future threats. Their attention is continually pulled towards “what if?” scenarios and their nervous system can remain activated as a result.
Before introducing stabilisation strategies, I often find it helpful to explore whether the worry is about something within the client’s control. If action is possible, problem-solving may be appropriate. If not, attention-shifting strategies, grounding or nervous system regulation practices may be more helpful.
For some clients, a few longer out-breaths or diaphragmatic breathing can help reduce physiological arousal. For others, learning to disengage from repetitive worry and redirect attention towards the present moment may be the more useful starting point.
When Clients Are Ruminating
Rumination often pulls attention towards the past. Clients may repeatedly replay conversations, mistakes, losses or traumatic experiences.
Present-moment awareness practices can be particularly helpful here. Depending on the client, this might include grounding through the senses, external awareness exercises or attention training.
The goal is not to suppress thoughts but to increase flexibility in where attention can rest.
When Sleep Becomes the Problem
Sleep difficulties are one of the most common difficulties I encounter in trauma work. Clients often describe waking during the night and becoming trapped in cycles of thinking, problem-solving or monitoring whether they are falling asleep.
If a client has been awake for a prolonged period, I will often discuss:
- getting out of bed or the bedroom completely
- reducing stimulation (no caffeine, vaping, nicotine, blue light/screens)
- reading something low-demand, such as a recipe book, in low lighting
- allowing boredom to emerge
Many clients find this counterintuitive initially, as it takes some time to ‘work’. The aim really is to settle the nervous system until sleep becomes preferable to the mind.
When Clients Benefit from Psychoeducation
Sometimes clients engage particularly well when they understand the physiology behind stabilisation. For these clients, psychoeducation can help increase motivation and normalise their experiences.
This might include discussions about:
- sympathetic activation
- parasympathetic regulation and the vagus nerve
- diaphragmatic breathing and the phrenic nerve
- the window of tolerance / the polyvagal ladder
Other clients are far less interested in the science and simply want practical strategies that help them feel better. Of course, both approaches are entirely valid and dependent on the client’s preference.
The Importance of Formulation
Before introducing any stabilisation strategy, I find it helpful to understand what clients are already doing when distressed. Many have become reliant on particular people, places, activities, substances, avoidance and distraction to help manage their difficult feelings.
I have no judgement attached to their strategies and I encourage them not to judge themselves as they often developed for understandable reasons.
The task is not to remove coping strategies but to understand them and gradually expand the client’s options.
You can download the formulation template I use for these conversations here. This is something I use as a starting point. Please feel free to change/edit/amend for your own clients based on your own training and experience.
Final Thoughts
Not all stabilisation strategies work for every client. The most helpful intervention is often not the newest or most popular technique, but the one that best matches the client’s current difficulties, strengths and needs.
For some clients that may be grounding. For others it may be breathwork, self-compassion, attention training, sleep support or psychoeducation. Or even a combination of all of these.
Stabilisation is rarely about finding the perfect technique. More often it involves helping clients develop a growing toolbox of ways to return to themselves when life inevitably becomes difficult.
Free Resources
Many of the stabilisation approaches discussed in this article begin with understanding how clients are already coping and where additional support may be helpful. To support these conversations, you can download my free Stabilisation Formulation Template.
For some clients, stabilisation also benefits from regular practice between sessions. I have also written about how slow bilateral auditory stimulation may support stabilisation and nervous system regulation between sessions, which you can read here.
Structured audio resources may provide an additional way of supporting grounding, attention-shifting and nervous system regulation outside of therapy.
Download the free Stabilisation Formulation Template
Explore the Willow Tree Wellbeing Audio Library
Try a 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 trauma-informed stabilisation, nervous system regulation and the practical application of these concepts within therapy. She develops clinically informed audio resources to support stabilisation and regulation within trauma-informed practice.
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