Grounding is our go-to over mindfulness proper in PTSD, because sitting with the present can be stressful when your world feels full of threat. When a patient dissociates or freezes, name it and steer them to neutral, present details, and favor active, moving techniques over stillness. Do not fight dissociation, and do not lean on grounding as an escape from panic, or it stops working like any PRN.
When we reach for it
In PTSD, focus on grounding techniques rather than mindfulness proper, because mindfulness can become very stressful when the world you live in is full of threats and danger.
“I focus more on grounding techniques rather than mindfulness proper because the mindfulness can become a very stressful thing when the world you're living in is full of threats and danger”
24:30Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026
How we use it
When a patient seems to be dissociating, name it gently (I notice you're getting a little different there, this seems like a lot) and go over neutral, present things: their name, where they are, who you are, the color of the chair.
“i notice you're getting a little different there it seems like maybe you're being bothered or this is a lot for you uh let's just go over some things right now can you tell me your name okay where are you right now who am i What's the color of the chair that you're on”
16:16Psychodynamic Technique and Therapeutic Intervention: ContainmentApr 2026 You do not have to know a technique well. Search box breathing on YouTube and do it with the patient at the same time.
“I'll search box breathing on YouTube and then do the box breathing with the patient at the same time. So you don't even have to know it that well”
15:33Psychodynamic Technique and Therapeutic Intervention: ContainmentApr 2026
Talking to patients
Advise against fighting dissociation. Fighting it seems to pull people into a generalized fear or anxiety response that can make things worse.
“I probably advise against fighting it. Part of that fighting response seems to pull people into a generalized fear or anxiety response that might make things work”
36:27PTSD Medications: Integrating Pharmacotherapy, Therapy, and the Treatment Frame | Episode 22Apr 2025
Pitfalls
Grounding and mindfulness work pretty well the first few times as an escape from panic or distress, then stop working quickly, like any PRN used that way.
“Because frankly, at least the first time or the first few times, it works pretty well, grounding techniques and mindfulness, to escape panic or distress. It will stop working pretty quickly like any PRN if it's used that way”
39:40Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026
It also comes up on
From these episodes
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.