====== Stabilisation, Grounding and Therapeutic Pacing ====== Stabilisation, grounding and pacing describe related but different aspects of therapeutic work. Stabilisation may refer to practical safety and symptom management, to ordinary preparation for a procedure, or to a distinct phase of treatment. Grounding usually concerns attention to the present situation. Pacing concerns the amount, timing and progression of therapeutic activity. Using these terms precisely helps avoid presenting one preferred sequence as a universal requirement. This article focuses on adults and the debate about preparation before trauma-focused therapy. It does not provide a self-directed trauma-processing protocol. Findings about EMDR, cognitive processing therapy or other established interventions cannot be transferred automatically to IEMT or to a practitioner working outside the populations and settings studied. ===== Three meanings of stabilisation ===== The following editorial distinction clarifies what is being proposed. ^ Meaning ^ Typical purpose ^ Question for review ^ | Practical safety and support | Address current danger, urgent needs and access to appropriate care. | What immediate need requires action, and who is responsible? | | Preparation within treatment | Explain the procedure, establish consent and agree ways to pause or communicate difficulty. | Can the person participate meaningfully in the proposed work? | | A separate preparatory phase | Provide an additional programme of skills or symptom-focused work before trauma-focused treatment. | What is the rationale for this sequence and how will its value be evaluated? | Evidence against a routine additional skills phase does not establish that assessment, preparation or attention to danger can be omitted. Conversely, the value of basic preparation does not prove that every person needs a lengthy course before trauma-focused treatment. The relevant question is what additional element is being proposed, for whom and with what expected benefit. A request to become completely calm before treatment can also be difficult to operationalise. If the target difficulty includes recurrent distress, requiring its disappearance before addressing it risks making the entry criterion indistinguishable from the desired outcome. A more useful plan specifies the abilities and support needed for the actual intervention, while retaining a clear route to review. ===== What grounding is intended to do ===== The WHO's Doing What Matters in Times of Stress is an evidence-informed, field-tested self-help guide that includes grounding among its stress-management skills. Its purpose and format should be distinguished from a controlled trial of grounding alone as treatment for PTSD or a dissociative disorder. Inclusion in the guide is not evidence that a particular sensory exercise cures trauma-related illness. ((World Health Organization (2020). Doing What Matters in Times of Stress: An Illustrated Guide. ISBN 9789240003927. Official publication overview. [[https://www.who.int/westernpacific/publications/i/item/9789240003927|Read source]].)) Grounding can be understood as an invitation to notice aspects of the present environment or current activity when attention has become dominated by distressing internal experience. The intended function is orientation and participation, not the production of a special emotional state or proof of a nervous-system mechanism. An exercise should be explained in terms the person can evaluate from their experience. VA practical guidance for police encounters describes grounding as potentially useful but also potentially counterproductive. It advises stopping when it further frustrates the person. This is field guidance, not evidence establishing an optimal therapy technique. ((US Department of Veterans Affairs, National Center for PTSD. Strategies: PTSD in others. Police officer toolkit, grounding section. Checked 8 October 2026. [[https://www.ptsd.va.gov/professional/treat/care/toolkits/police/managingStrategies.asp|Read source]].)) In a consultation, the corresponding editorial principle is to ask whether the approach helps, rather than insist that the person perform it correctly or continue despite a worsening response. A person might prefer noticing the room to focusing inward, or prefer ordinary conversation to a structured exercise. These preferences can inform an agreed plan. Unexpected touch, painful stimulation or pressure to disclose should not be introduced under the label of grounding. A simple supportive intervention still requires attention to consent and the person's response. ===== Does everyone need a separate first phase? ===== In van Vliet and colleagues' 2021 randomised trial, 121 adults with PTSD following childhood abuse received either eight STAIR skills sessions followed by 16 EMDR sessions, or 16 EMDR sessions without the additional STAIR phase. The investigators found no significant between-group differences at post-treatment or follow-up on the studied outcomes. The trial excluded, among other circumstances, acute suicidality requiring crisis intervention and ongoing physical or sexual abuse. Its findings therefore do not settle care for people in those circumstances. Failure to find a difference is also not proof of equivalence in every population. ((van Vliet, N. I., et al. (2021). Phase-based treatment versus immediate trauma-focused treatment for post-traumatic stress disorder due to childhood abuse: randomised clinical trial. BJPsych Open, 7(6), e211. doi:10.1192/bjo.2021.1057. [[https://pmc.ncbi.nlm.nih.gov/articles/PMC8612023/|Read source]].)) Svircevic and Berle's 2025 meta-analysis included four randomised trials with 356 participants. The estimated advantage for phase-based treatment was small, and the treatment-completion comparison was imprecise, with its confidence interval including no difference. The limited trial base does not establish a universal benefit from adding a preparatory phase. It also leaves room for benefits in particular circumstances that the available studies were not equipped to identify. ((Svircevic, C. S., and Berle, D. (2025). Phase-Based Versus Trauma-Focused Therapy for Adult Survivors of Childhood Trauma: A Systematic Review and Meta-Analysis. Journal of Nervous and Mental Disease, 213(12), 339–345. doi:10.1097/NMD.0000000000001859. [[https://pubmed.ncbi.nlm.nih.gov/41277877/|Read source]].)) Lee and colleagues' 2026 systematic review, published online in April, examined a broader set of complex PTSD presentations and treatment structures. The authors reported: > Across most outcomes, we observed no significant differences between phase- and non-phase-based interventions Some subgroup results favoured multi-phase approaches for PTSD symptoms and phase-based or multi-phase approaches for affect regulation. However, the review combined a broader evidence base with a small set of direct comparisons; comparisons across different studies are not equivalent to randomisation between treatment sequences within one trial. Few trials, heterogeneous measures and a single outcome time point limited interpretation. The findings suggest unresolved questions about matching treatment to needs, rather than a definitive rule for every patient. ((Lee, Y., Park, S., and Cho, Y.-E. (2026). Phase-based versus non-phase-based psychological interventions for complex PTSD: a systematic review and meta-analysis. European Journal of Psychotraumatology, 17(1), 2644112. doi:10.1080/20008066.2026.2644112. Published online 8 April 2026. [[https://pubmed.ncbi.nlm.nih.gov/41949043/|Read source]].)) ===== Why the population and comparison matter ===== A trial comparing an additional skills programme plus trauma therapy with trauma therapy alone addresses the incremental value of that programme. It does not compare thoughtful care with an absence of preparation. Similarly, evidence that both groups improve does not establish that every component of either treatment caused the improvement. The design determines which conclusion is justified. Length and burden also matter. An additional phase may require more appointments, expense and delay before a different part of treatment begins. Those costs should be weighed against an explicitly stated purpose. Equally, omitting a useful intervention solely to shorten treatment would not be justified by a general preference for speed. The decision needs a person-specific rationale and a way of noticing whether the plan is working. Specialist DID guidance has a different scope. The ISSTD's 2011 consensus recommends a phase-oriented approach addressing safety and stabilisation, trauma work and integration or rehabilitation. That consensus should not be treated as evidence that everyone with PTSD needs the same sequence; PTSD trials should not be treated as decisive trials of DID care either. ((International Society for the Study of Trauma and Dissociation (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115–187. doi:10.1080/15299732.2011.537247. [[https://www.isst-d.org/wp-content/uploads/2025/12/GUIDELINES_REVISED2011.pdf|Read source]].)) A 2025 systematic review by Griffiths and colleagues found encouraging outcomes across treatments for DID and other specified dissociative disorder, while calling for stronger controlled research. Its findings support continued investigation rather than a claim that phase-oriented treatment has conclusively outperformed alternatives. ((Griffiths, T. A., Dimitrova, L. I., Linington, M., Terhune, D. B., and Reinders, A. A. T. S. (2025). Effectiveness of phase-oriented treatment for trauma-related dissociative disorders: a systematic review. European Journal of Psychotraumatology, 16(1), 2545734. doi:10.1080/20008066.2025.2545734. [[https://pubmed.ncbi.nlm.nih.gov/40891466/|Read source]].)) NICE's PTSD guideline recommends allowing additional time when needed to establish trust and addressing barriers to trauma-focused therapy, including dissociation and emotional dysregulation. It also recognises the relevance of the person's circumstances. This supports attention to individual needs without turning a particular duration of preparatory work into a requirement for every client. ((National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder. NICE guideline NG116, recommendations. Current online version checked 8 October 2026. [[https://www.nice.org.uk/guidance/ng116/chapter/recommendations|Read source]].)) ===== Making readiness specific ===== Readiness is most useful when it refers to observable, relevant conditions rather than an unexplained impression. The following questions are an editorial aid to discussion, not a validated readiness scale or an exhaustive eligibility test. * Does the person understand the proposed work and want to undertake it? * Is there a way to communicate difficulty, pause and reconsider the plan? * What current practical or clinical issue would interfere with participation? * Does the practitioner have the competence and support needed for this presentation? * What will be reviewed between sessions, and what would trigger another assessment? The answers need not produce a binary ready/not-ready label. They may identify a specific adjustment, a need for consultation, a different intervention or an urgent assessment. A plan that says to improve regulation indefinitely is less accountable than one that identifies the problem being addressed and when its progress will be reviewed. The person's preference is relevant but does not replace clinical judgement or competence. Likewise, a practitioner's confidence is not sufficient evidence of suitability. Shared decisions require both a meaningful choice and a defensible explanation of the available options. ===== Pacing and review ===== Pacing can concern session length, the amount attempted, transitions between activities and the interval before review. It should respond to participation and functioning rather than an assumption that stronger emotional activation necessarily means more effective treatment. A decrease in visible emotion is also not automatically a sign of successful processing. The person's account and subsequent experience remain important. An editorial review note might record what was attempted, how the person experienced it, whether they could remain engaged, what happened afterwards and what modification was agreed. This separates observation from interpretation. It also permits a later reviewer to understand why the next session followed a particular plan. Consider a fictional client, Leila, who can discuss the proposed treatment and use an agreed pause signal but is exhausted after a recent change in caring responsibilities. The issue is not necessarily a need for a formal stabilisation programme. A revised schedule or session plan might be considered. By contrast, a new urgent safety concern would require the relevant assessment and response. The same word, readiness, should not conceal these different decisions. In another fictional example, preparatory sessions continue for months without an agreed target or review. The appropriate question is what the phase is achieving and what evidence would support continuing, modifying or ending it. This is an accountability question, not an argument that skills work lacks value. ===== Evidence and editorial scope ===== Sources were checked on 8 October 2026, including reviews published in 2025 and 2026. The research does not establish one optimal sequence for all complex presentations, and the practical examples are editorial illustrations. This article is not a clinical practice guideline, does not validate an IEMT stabilisation protocol and has not undergone independent clinical peer review. ===== See also ===== * [[dissociation_depersonalisation_derealisation|Dissociation, Depersonalisation and Derealisation]] * [[assessment_suitability_referral|Assessment, Suitability and Referral]] * [[informed_consent_shared_decision_making|Informed Consent and Shared Decision-Making]] * [[adverse_effects_deterioration_non_response|Adverse Effects, Deterioration and Non-Response]] * [[emotional_learning|Emotional Learning]] * [[start_here|Start Here]] Brief quoted extracts remain attributable to their original authors and rights holders.