Therapy in a nutshell anxiety skills
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Meet Your Instructor
Hi, I’m Emma McAdam
I’m a licensed marriage and family therapist, and I love helping people change. I know that understanding mental health can be confusing and stressful. I also know that there’s hope! Your brain is wired to change, and deep healing is possible. My mission is to walk with people through that process.
I make mental health skills more accessible through YouTube videos and online courses. Therapy in a Nutshell is built around the idea that small and simple steps can turn into massive change and growth. I don’t just help people get feeling better; I help people get better at feeling.
I’ve been working in the field of change and growth since 2004. I got my Master’s degree in Marriage and Family Therapy from Utah State University, and I’m currently licensed in the state of Utah. I’ve worked in settings like juvenile corrections, wilderness therapy programs, residential treatment centers, and outpatient therapy.
The idea of repressed memories goes all the way back to Freud, through the 90’s when therapists accidentally implanted people with false memories, through the courtrooms, and into today where the idea of repressed memories is still popular among lay people and controversial among therapists and researchers. So today you’ll learn three skills for better understanding lost memories, aka dissociative amnesia or repressed memories (or at least my opinion about it). The idea of repressed memories goes all the way back to Freud, one of his first patients, Anna O had all sorts of unexplained physical symptoms, when she began talking with her doctor about her life, previously forgotten memories of trauma came back and as she talked about them, her physical symptoms went away. Freud developed the concept of repression, that current symptoms are all related to something that happened in the past, that we repress the memories to protect ourselves, and that we must analyze our psyche in order to uncover it, integrate it and then be freed from it. So that’s where the whole process of psychoanalysis came from, the idea of patients laying on a couch, talking about their childhood. But this concept of repressed memories has become very controversial, because of the way memory works. Most people assume that memory is like a video, your memory records things as they actually happened and stores those memories away, permanently. But memory doesn’t work like that, memories are highly influenced by our biases and how we’re feeling during or after an event. Even Freud learned that many of the things that his patients “remembered” weren’t actual events. Memories can be altered, implanted, influenced, and straight up created under suggestion. Lot’s of laboratory experiments have demonstrated that our memories are terribly fickle.
If you want to see for yourself how this can work, watch this YouTube video “Take This Test and Experience How False Memories Are Made”. https://www.youtube.com/watch?v=D5sk504Yc94
After I filmed this video on repressed memories and dissociative amnesia, the NYT published a very relevant article and two strong opinions on it: https://www.nytimes.com/2022/09/27/opinion/recovered-memory-therapy-mental-health.html
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Therapy in a Nutshell and the information provided by Emma McAdam are solely intended for informational and entertainment purposes and are not a substitute for advice, diagnosis, or treatment regarding medical or mental health conditions. Although Emma McAdam is a licensed marriage and family therapist, the views expressed on this site or any related content should not be taken for medical or psychiatric advice. Always consult your physician before making any decisions related to your physical or mental health. In therapy I use a combination of Acceptance and Commitment Therapy, Systems Theory, positive psychology, and a bio-psycho-social approach to treating mental illness and other challenges we all face in life. The ideas from my videos are frequently adapted from multiple sources. Many of them come from Acceptance and Commitment Therapy, especially the work of Steven Hayes, Jason Luoma, and Russ Harris. The sections on stress and the mind-body connection derive from the work of Stephen Porges (
Grounding is a practice that can help you pull away from flashbacks, unwanted memories, and negative or challenging emotions.
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What are grounding techniques?
Grounding techniques are exercises that may help you refocus on the present moment to distract yourself from anxious feelings.
You can use grounding techniques to help create space from distressing feelings in nearly any situation, but they’re especially helpful for improving:
- post-traumatic stress disorder (PTSD)
Physical grounding techniques
These techniques use your five senses or tangible objects — things you can touch — to help you move through distress.
1. Put your hands in water
Focus on the water’s temperature and how it feels on your fingertips, palms, and the backs of your hands. Does it feel the same in each part of your hand?
Use warm water first, then cold. Next, try cold water first, then warm. Does it feel different to switch from cold to warm water versus warm to cold?
2. Pick up or touch items near you
Are the things you touch soft or hard? Heavy or light? Warm or cool? Focus on the texture and color of each item. Challenge yourself to think of specific colors, such as crimson, burgundy, indigo, or turquoise, instead of simply red or blue.
3. Breathe deeply
Slowly inhale, then exhale. If it helps, you can say or think “in” and “out” with each breath. Feel each breath filling your lungs and note how it feels to push it back out.
4. Savor a food or drink
Take small bites or sips of a food or beverage you enjoy, letting yourself fully taste each bite. Think about how it tastes and smells and the flavors that linger on your tongue.
5. Take a short walk
Concentrate on your steps — you can even count them. Notice the rhythm of your footsteps and how it feels to put your foot on the ground and then lift it again.
6. Hold a piece of ice
What does it feel like at first? How long does it take to start melting? How does the sensation change when the ice begins to melt?
7. Savor a scent
Is there a fragrance that appeals to you? This might be a cup of tea, an herb or spice, a favorite soap, or a scented candle. Inhale the fragrance slowly and deeply and try to note its qualities (sweet, spicy, citrusy, and so on).
8. Move your body
Do a few exercises or stretches. You could try:
- jumping jacks
- jumping up and down
- jumping rope
- jogging in place
- stretching different muscle groups one by one
Pay attention to how your body feels with each movement and when your hands or feet touch the floor or move through the air.
How does the floor feel against your feet and hands? If you jump rope, listen to the sound of the rope in the air and when it hits the ground.
9. Listen to your surroundings
Take a few moments to listen to the noises around you. Do you hear birds? Dogs barking? Machinery or traffic? If you hear people talking, what are they saying? Do you recognize the language?
Let the sounds wash over you and remind you where you are.
10. Feel your body
You can do this sitting or standing. Focus on how your body feels from head to toe, noticing each part. Consider:
- your hair on your shoulders or forehead
- the weight of your shirt on your shoulders
- whether your arms feel loose or stiff at your sides
- your heartbeat, and whether it’s rapid or steady
- whether your stomach feels full or you feel hungry
- whether your legs are crossed, or your feet are resting on the floor
Curl your fingers and wiggle your toes. Are you barefoot or in shoes? How does the floor feel against your feet?
11. Try the 5-4-3-2-1 method
Working backward from 5, use your senses to list things you notice around you. For example, you might start by listing:
- five things you hear
- four things you see
- three things you can touch from where you’re sitting
- two things you can smell
- one thing you can taste
Make an effort to notice the little things you might not always pay attention to, such as the color of the flecks in the carpet or the hum of your computer.
Mental grounding techniques
These grounding exercises use mental distractions to help redirect your thoughts away from distressing feelings and back to the present.
12. Play a memory game
Look at a detailed photograph or picture (like a cityscape or other “busy” scene) for 5 to 10 seconds. Then, turn the photograph face-down and recreate the photograph in your mind, in as much detail as possible. Or, you can mentally list all the things you remember from the picture.
13. Think in categories
Choose one or two broad categories, such as “musical instruments,” “ice cream flavors,” or “baseball teams.” Take a minute or so to mentally list as many things from each category as you can.
14. Use math and numbers
Even if you aren’t a math person, numbers may help center you.
- running through a times table in your head.
- counting backward from 100
- choosing a number and thinking of five ways you could make the number (6 + 11 = 17, 20 – 3 = 17, 8 × 2 + 1 = 17, etc.)
15. Recite something
Think of a poem, song, or book passage you know by heart. Recite it quietly to yourself or in your head.
If you say the words aloud, focus on the shape of each word on your lips and in your mouth. If you say the words in your head, visualize each word as you’d see it on a page.
16. Make yourself laugh
Make up a silly joke — the kind you’d find on a candy wrapper or popsicle stick.
You might also watch your favorite funny animal video, a clip from a comedian or TV show you enjoy, or anything else you know will make you laugh.
17. Use an anchoring phrase
This might be something like, “I’m Full Name. I’m X years old. I live in City, State. Today is Friday, June 3. It’s 10:04 in the morning. I’m sitting at my desk at work. There’s no one else in the room.”
You can expand on the phrase by adding details until you feel calm, such as, “It’s raining lightly, but I can still see the sun. It’s my break time. I’m thirsty, so I’m going to make a cup of tea.”
18. Visualize a daily task you enjoy or don’t mind doing
If you like doing laundry, for example, think about how you’d put away a finished load.
“The clothes feel warm coming out of the dryer. They’re soft and a little stiff at the same time. They feel light in the basket, even though they spill over the top. I’m spreading them out over the bed so they won’t wrinkle. I’m folding the towels first, shaking them out before folding them into halves, then thirds,” and so on.
19. Describe a common task
Think of an activity you do often or can do very well, such as making coffee, locking up your office, or tuning a guitar. Go through the process step-by-step, as if you’re giving someone else instructions on how to do it.
20. Imagine yourself leaving the painful feelings behind
- gathering the emotions, balling them up, and putting them into a box
- walking, swimming, biking, or jogging away from painful feelings
- your thoughts as a song or TV show you dislike, changing the channel or turning down the volume — they’re still there, but you don’t have to listen to them.
21. Describe what’s around you
Spend a few minutes taking in your surroundings and noting what you see. Use all five senses to provide as much detail as possible.
“This bench is red, but the bench over there is green. It’s warm under my jeans since I’m in the sun. It feels rough, but there aren’t any splinters. The air smells like smoke. I hear kids laughing and dogs barking.”
Soothing grounding techniques
You can use these techniques to comfort yourself in times of emotional distress. These exercises can help promote good feelings that may help the negative feelings fade or seem less overwhelming.
22. Picture the voice or face of someone you love
If you feel upset or distressed, visualize someone positive in your life. Imagine their face or think of what their voice sounds like. Imagine them telling you that the moment is tough, but that you’ll get through it.
23. Practice self-kindness
Repeat kind, compassionate phrases to yourself:
- “You’re having a rough time, but you’ll make it through.”
- “You’re strong, and you can move through this pain.”
- “You’re trying hard, and you’re doing your best.”
Say it, either aloud or in your head, as many times as you need.
24. Sit with your pet
If you’re at home and have a pet, spend a few moments just sitting with them. If they’re of the furry variety, pet them, focusing on how their fur feels. Consider their markings or unique characteristics. If you have a smaller pet you can hold, concentrate on how they feel in your hand.
Not at home? Think of your favorite things about your pet or how they would comfort you if they were there.
25. List favorites
List three favorite things in several different categories, such as:
26. Visualize your favorite place
Think of your favorite place, whether it’s the home of a loved one or a foreign country. Using each of your senses, imagine the noises you hear, the objects you see, and the scents you can smell.
Try to recall the last time you went there. Think about what you did there and how it felt at the time.
27. Plan an activity
This might be something you do alone or with a friend or loved one. Think of what you’ll do and when. Maybe you’ll go to dinner, take a walk on the beach, see a movie you’ve been looking forward to, or visit a museum.
Focus on the details, such as what you’ll wear, when you’ll go, and how you’ll get there.
28. Touch something comforting
This could be your favorite blanket, a much-loved T-shirt, a smooth stone, or anything that feels good to touch. Think about how it feels under your fingers or in your hand.
If you have a favorite sweater, scarf, or pair of socks, put them on and spend a moment thinking about the sensation of the fabric on your skin.
29. List positive things
Write or mentally list four or five things in your life that bring you joy, visualizing each of them briefly.
30. Listen to music
Put on your favorite song, but pretend you’re listening to it for the first time. Focus on the melody and lyrics (if there are any).
Does the song give you chills or create any other physical sensations? Pay attention to the parts that stand out most to you.
How do grounding techniques work?
While there’s little research explaining how grounding techniques work, the techniques represent a common strategy for managing PTSD and anxiety.
Grounding techniques use tools such as visualization and senses including sight, hearing, and smell to help distract you from a variety of possible feelings and thoughts.
During a panic attack or traumatic flashback, your emotions can take over your thoughts and physical responses. Focusing on the present through grounding techniques can help interrupt your body’s response and return your brain and feelings to a place of safety.
When to use grounding techniques
Use grounding techniques to help you manage feelings like:
- traumatic flashbacks
- painful emotions, like anger
It’s best to try doing a grounding exercise when you first start to feel bad. Don’t wait for distress to reach a level that’s harder to handle. If the technique doesn’t work at first, try to stick with it for a bit before moving on to another.
Grounding yourself isn’t always easy. It may take some time to find the techniques that work best for you in different situations.
Here are some additional tips to help you get the most out of these techniques:
- Practice. It can help to practice grounding even when you aren’t dissociating or experiencing distress. If you get used to an exercise before you need to use it, it may take less effort when you want to use it to cope in the moment.
- Avoid assigning values. For example, if you’re grounding yourself by describing your environment, concentrate on the basics of your surroundings, rather than how you feel about them.
- Check in with yourself. Before and after a grounding exercise, rate your distress as a number between 1 and 10. What level is your distress when you begin? How much did it decrease after the exercise? This can help you get a better idea of whether a particular technique is working for you.
Grounding techniques can be powerful tools to help you cope with distressing thoughts in the moment. If you’re having trouble using grounding techniques, a therapist may be able to assist.
It’s also important to get help from a therapist so you can address the root cause of your distress. If you don’t have one yet, check out our guide to affordable therapy.