Grounding Skills — Fillable Worksheet

Double Board Certified Counseling Services, Inc. • Mark Zauss, LMHC, LPC, CCMHC, NBCC, BC-TMC, ADHD-CCSP, C-DBT, CCTP

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Not for emergencies. If you are in crisis or thinking of self-harm, call 988 (US) or local emergency services.

1) Quick Grounding Plan (NAME → ORIENT → BREATHE → GROUND → ENGAGE)

NAME it (what’s happening) Pre-distress (SUDS 0–10) Calm word

ORIENT (3 facts about place/time) BREATHE plan (box / 4-7-8 / 4-6) ENGAGE (tiny next action)

Breathing Pacer 60s

2) 5-4-3-2-1 Senses

List items for each sense as you scan your surroundings.

5 things I can see 4 things I can feel (touch)

3 things I can hear 2 things I can smell

1 thing I can taste

3) Grounding Anchors & Coping Statements

Reassurance statements (realistic) Values/identity anchors

Environment anchor (place/visual) Body anchor (posture/pressure)

Carry or place one anchor where you can see/use it this week

4) My Grounding Toolkit

Visuals (see) Touch items (feel) Sounds (hear)

Scents (smell) Tastes (taste) People/contacts

5) Grounding Practice Log

Date & time	Trigger/situation	Skill used	Minutes	Pre SUDS	Post SUDS	Notes	Remove

Add Log Row

6) Wrap-Up

Post-distress (SUDS 0–10) What helped most? Next tweak

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