If you are suffering from anxiety, you’re not alone—and you’re not powerless. When our thoughts spiral, grounding techniques rooted in cognitive behavioral therapy (CBT) can help bring us back to the present moment. These tools gently shift the focus away from fear and into your body and surroundings. In this post, I share 10 grounding techniques recommended at CBT for Anxiety in San Diego. These are simple, practical tools that anyone can use—no special equipment or training is needed.
1. 5-4-3-2-1 Sensory Check-In
When using CBT for anxiety, this classic grounding tool helps connect you with the present through your five senses.
5 things you can see
4 things you can touch
3 things you can hear
2 things you can smell
1 thing you can taste
Try it slowly and mindfully. It’s a great way to interrupt racing thoughts.
Box breathing, a technique used by U.S. Navy SEALs to regulate during times of extreme stress, is another ‘here and now’ technique to manage extreme anxiety, panic disorder, and stress.
Wherever you are, quietly name 10 things you see around you. Try not to rush—look at the colors, shapes, and textures.
5. Move Your Body
Movement helps release anxious energy. You don’t need a full workout—even walking around the room, stretching, or shaking out your hands can help.
Progressive Muscle Relaxation (PMR) is another favorite technique I teach as part of CBT for anxiety in San Diego. It involves tensing and relaxing one muscle group at a time, helping the body release stored tension. There is no ‘perfect’ way to do this; even tensing and releasing one muscle over time is helpful. Here is a video that you can use to try this technique.
6. Feel Your Feet
Sit or stand and gently press your feet into the ground. Notice the pressure, temperature, and sensation. Remind yourself: I am here. I am safe. The statement, “feet on the ground, roots into the ground,” is a mantra that many find helpful in this practice.
7. Repeat a Grounding Phrase
Choose a simple mantra like:
“This feeling is uncomfortable, but I can handle it.” This is an essential key to managing anxiety with CBT. Remember, anxiety is a feeling, but it’s amazing how much humans can manage if we face the emotions head-on.
“I’m safe right now.” Saying it aloud or silently can help anchor you.
8. Hold an Object
Find something textured or comforting to hold—a smooth stone, a favorite keychain, or a piece of fabric. Focus on how it feels in your hand.
9. Count Backwards
Start at 100 and count down by 7s. The mental effort needed will help distract your brain from anxious thoughts.
10. Engage with Nature
Step outside if you can. Notice the breeze, the sun, the smell of the air. Even looking out a window at the sky or trees can be calming.
You’re Not Alone: Finding CBT for Anxiety in San Diego
Anxiety can feel overwhelming, but it’s also manageable and treatable. These grounding techniques are often the first step I share with clients who begin CBT for anxiety in San Diego
I help clients navigate anxiety, panic, OCD, insomnia, and phobias using evidence-based approaches in a warm, supportive environment. If you’re ready to feel more grounded and in control, reach out today to schedule a free consultation.
CBT Tips for Beating Perfectionism: Managing Holiday Stress and Setting Intentions for 2025
The combination of extra demands and the typical stress around the holidays can lead many to fall into the trap of rigid thinking and believing that life should be flawless. If you’re already prone to anxiety, the season’s pressures can intensify these feelings. Perfectionism is something that cognitive-behavioral therapists encounter frequently, especially during this time of year. Here are some effective CBT-based tips to help you manage your stress and perfectionism during the rest of 2023 and into the New Year.
1. Do Not Strive for Flawless
Perfectionism often manifests as self-imposed expectations followed by harsh judgments about yourself, others, or situations. When you’re constantly with yourself, you notice every small mistake and build a list of perceived failures. Focusing on these mistakes can lead to self-criticism and a tendency to see only the negative aspects of yourself. This thought pattern can lead to feelings of depression, low self-esteem, and frustration—none of which are helpful to you or the people who care about you.
When perfectionist thoughts start to take over, it’s important to counter them with a CBT technique called a “positive data log.” This involves intentionally writing down “good enough” events or situations where things turned out fine despite being imperfect. By recognizing these moments, you can train yourself to view things more flexibly and objectively. Over time, this can help you develop a more balanced perspective on life’s imperfections.
2. Stop Comparing
In today’s world of social media, unrealistic advertising, and other perfection-driven messages, it’s easy to fall into the trap of comparing your life to an idealized version of others’ lives. For perfectionists, it’s even harder to step back and assess reality. When we compare ourselves, we often measure our lives against someone we perceive as “better” in some way.
If you find that certain people—whether co-workers, exes, or family members—are fueling your feelings of inadequacy, consider muting or unfollowing them during the holiday season. Remind yourself that social media rarely reflects reality accurately, and it’s okay to take a break from it, especially over the holidays.
3. Temper Family Expectations
The holidays can stir up a lot of emotional stress, and when combined with perfectionistic tendencies, they can lead to even more tension. There’s enough pressure around this time of year without the added weight of unrealistic expectations. It’s essential to recognize that while you can’t control your family’s actions or behaviors, you have control over how you react.
Trying to change others can be frustrating, like repeatedly entering the wrong PIN at the store checkout. As the stress builds, so does your frustration. Instead of insisting on changing others or holding onto unproductive expectations, focus on modifying your actions. Remember, you can’t control everything, but you can control your responses.
4. Beat Perfectionism by Shifting Perspectives—A CBT Experiment
On days when everything feels off-track, take a moment to pause and consider how much worse things could be. This simple shift in perspective can help break the cycle of negative thinking. Here are three more tricks to engage your positive lens:
Incorporate a Daily Gratitude Practice: According to CBT research, practicing gratitude can significantly improve mental health, sleep, and self-esteem. Each morning or evening, jot down 5 things you’re grateful for. Apps like the 5 Minute Journal make this easy and quick to integrate into your routine.
Acknowledge Your Power: CBT emphasizes our power to choose which thoughts to focus on. By intentionally directing your attention to positive thoughts and reframing challenges, you can gain greater control over your mental and emotional experience. This is key in fostering a more compassionate and empowered outlook on life.
Take a Breather: Meditation isn’t just for yoga retreats—it’s a powerful tool for managing perfectionism and anxiety. It doesn’t require an hour of quiet time or complex techniques. Check out this recent blog post, Can’t Meditate? Think Again: 10 of the Best CBT Hacks to Trick Your Brain into Bliss, for practical ways to incorporate mindfulness into your day.
Looking Ahead: 2025 and Beyond
As we wrap up 2023 and step into the New Year, it’s a great time to reflect on your mental health goals and set intentions for a more balanced, realistic approach to life. Remember, the holiday season doesn’t have to be perfect. Embrace the chaos, laugh at the mistakes, and prioritize moments of joy over flawless moments. Perfectionism can’t thrive in an environment where you celebrate progress, not perfection.
In Part 3, I’ll dive into CBT approaches for coping with loneliness over the holidays—another key issue many face at this time of year. As always, I’d love to hear how these tips work for you and if you’ve found other strategies to manage perfectionism.
Enjoy the rest of your month, and try experimenting with these new tools as you prepare for a positive and fulfilling start to 2024!
Video- How Does a Therapist Treat Anxiety Disorder? An Introduction to CBT Skills
If you are reading this, chances are you already know that symptoms of stress can feel overwhelming and, if untreated, can evolve into an anxiety disorder. The good news is understanding the biological roots can be the first step toward success. In this video, ‘Master Your Mind: Essential CBT Skills for Anxiety Symptoms,’ Dr. Rosalie Zuniga from Postpartum Wellness and I discuss what information I provide to clients in the first stages of anxiety treatment. If you want to know about the mind-body connection when you experience anxiety symptoms, check out the first part of this video to dive into the biology of stress. You can find more content in the second part if you’d like to try some practical strategies for managing anxiety disorder. Are you curious but not ready to watch the whole video? You can find an overview below.
The Biological Roots of Anxiety Disorders
Anxiety is more than an emotion; it’s an interplay of biology and psychology. The ‘fight, flight, freeze, fawn’ response is an instinct we have to stress or danger. This is also known as the ‘stress response’. In the modern world, this is not particularly useful. In very few situations, this phenomenon may be helpful (like if a bear is chasing you). However, when we ruminate about our fears, our brain believes we are actually in physical danger, and if it persists, it can evolve into an anxiety disorder.
Anxiety Symptoms
The symptoms of anxiety can vary but have some specific themes:
Excessive Worry: Constant, uncontrollable worry about everyday things.
Physical Anxiety Symptoms: These can include increased heart rate, sweating, trembling, dizziness, and shortness of breath.
Trouble Concentrating: Difficulty focusing on tasks or making decisions.
Sleep Problems: Trouble falling asleep, staying asleep, or restless sleep.
Avoidance: Avoiding situations that cause anxiety can impact daily life and activities.
Panic Attacks: Sudden episodes of intense fear or discomfort, often accompanied by physical symptoms like chest pain or a feeling of choking.
It’s the Thought that Counts
As you have learned, biological reactions to specific triggers creates the stress response. It’s just as important to recognize that avoidance of triggers and catastrophizing will feed the belief that we can’t handle our complex emotions, which leads to anxiety. Below is a helpful equation from Dr. Aaron Beck, the father of Cognitive Behavioral Therapy (CBT)
Dangerous Thinking + Helpless Thinking = Level of Anxiety Symptoms
Dangerous Thinking:
Imagine someone who experiences a setback at work, such as not receiving the promotion they expected. They might engage in dangerous thinking by catastrophizing the situation. For instance:
“I failed, which confirms I’m not good enough. What if people find out? Everyone at work will know I’m incompetent.”
Helpless Thinking:
Helpless thinking involves believing that whatever the imagined catastrophe is, they will not be able to handle it.
Using the same situation, this person may think, ‘I am so embarrassed, and now I have to go to work after this rejection. I’ll be in the bathroom crying all day. I will sit in silence in meetings, and I won’t be able to be of any use now because I’ll be a mess. I don’t think I’ll be able to date because I’ll just keep thinking about how inferior I am.’
CBT in Action:
The video ‘Transform Your Anxiety Symptoms: CBT Skills to Help You Feel Better’ discusses several interventions, such as ‘Decatastrophizing the Fear (Worst Case Scenario)’ and the ‘What Ifs’ to examine and test dangerous thoughts.
Although in a stressed state, we overpredict dangerous outcomes, the reality is that the worst case can happen. Our helpless thinking kicks in when we anticipate we can’t handle the worst-case scenario. I will ask my clients, ‘How could you cope in a healthy and strong way?’ ‘Is there a way you visualize managing the catastrophe in a way you would be proud of?’ My clients who come to me for anxiety treatment in San Diego often will hear me joke that we are not the fragile flowers we believe we are. All humans can survive and thrive under challenging circumstances, which is a vital understanding to manage anxious thoughts.
Where to Find More Information: Therapy in San Diego
For more details about this insightful session and to explore additional resources, visit Therapy in San Diego and Postpartum Wellness. If you are curious about your anxiety symptoms and wonder if you would benefit from treatment, head to Anxiety Treatment in San Diego – Assessment to see where you land on the anxiety disorder scale.
Small Steps, Big Impact: Emily’s Story of Reaching Her Goal
Emily had a burning desire to become a renowned painter, but she often felt overwhelmed and anxious by the enormity reaching her goal. She would head to art shows, wondering how anyone could reach such recognition. This left her feeling stuck as she continued working her well-paying, albeit unexciting, manager position at a Fortune 500 company. Her free time consisted of watching TV, going to the gym, and visiting art museums with good friends. Her life was not dull, but she knew she was avoiding going after what she wanted.
One Saturday, Emily decided that instead of grocery shopping and cleaning the house, she would focus on doing one thing that aligned with her dream. She grabbed her sketchbook and pencils and went outside to simply draw what she saw around her. No more, no less. After thirty minutes of sketching, Emily felt accomplished. She didn’t worry about creating a masterpiece; instead, she had fun improving her skills one drawing at a time, giving herself an internal ‘gold star’ for every improvement she made. It was her first small step to reach her goal.
As days turned into weeks, Emily’s confidence grew, and her anxiety waned. She started experimenting with different techniques and subjects, pushing herself to explore new styles and perspectives. Some days were challenging, and overwhelm would creep in, but Emily reminded herself to take smaller steps. She found that breaking tasks into manageable pieces made her anxiety more manageable and helped her stay focused on her goal.
Eventually, Emily’s hard work began to pay off. Her sketches caught the eye of a local art gallery owner who offered her a small exhibition space. Excited but anxious, Emily accepted the opportunity, knowing this was another critical step to reach her goal.
The night of her art show arrived, and Emily watched people admire her artwork. She felt a sense of pride, knowing that each piece represented countless small actions taken toward her dream. Some visitors even expressed interest in purchasing her work, leaving Emily feeling even more energized.
With each sale, Emily felt herself climbing higher on the ladder of success. She realized that reaching her goal wasn’t about making one giant leap but embracing the journey of growth and perseverance, one step at a time.
Years passed, and Emily’s reputation as an artist continued to flourish. She traveled the world, showcasing her paintings in prestigious galleries and sharing her story of reaching her goal. Young women would approach her in awe, asking how she accomplished such an outstanding reputation. Emily explained that the minuscule day-to-day work led her to success. As she learned, it wasn’t the height of the ladder that mattered but the patience and openness to understand that small steps are the key to managing anxiety and overwhelm.
The Science of Small Steps When Reaching Your Goals
BJ Fogg, behavioral researcher and founder of the Behavior Design Lab at Stanford University, asserts that our baby steps are the path to success in his book Tiny Habits: The Small Changes that Change Everything. “It’s easier to create habits and change than most people think, and it’s faster than most people think,” he explains. “It can even be fun if you do it correctly,” Fogg states in an interview with NPR.
Most of us have heard the old Chinese proverb, “A journey of a thousand miles begins with a single step.” This wisdom can help you visualize how to reach your goal. Imagine two ladders of the same height but with a different number of rungs. The ladder with more rungs allows for smaller, more manageable steps to the top. Oftentimes, we dismiss our small efforts as “not enough” or a waste of time. However, conceptualizing progress as climbing a ladder with many small rungs makes even the most daunting goals feel achievable.
While the idea of big goals may lead to overwhelm and shutdown, it’s the small, consistent actions taken toward them that pave the way to reach your goal. You can make significant strides throughout your journey by embracing the importance of tiny efforts.
In Emily’s story, we see how incremental actions enabled her to overcome anxiety, build confidence, and ultimately achieve what once seemed impossible. Let Emily’s journey inspire you to take that first small step today. No matter how ambitious your dreams may be, the key to success is to break them down into manageable pieces and keep moving forward, one small step at a time.
FYI- Many insurance companies are waiving copayments for their clients who want to receive online therapy. Please connect with your mental health insurance provider to see if you are eligible.
Have you ever spoken to a friend on FaceTime? Participated in a Zoom meeting for work? Chances are you have virtually connected with someone via video at some point. The world is becoming more virtual as technology improves, and many have smartphones that allow you to reach out to someone quite easily.
Now that much of the nation is practicing social distancing or are in places where many non-essential services are shut down due to COVID-19, we are staying home to flatten the curve and protect those who are more vulnerable to the virus. In the past, this could mean weeks of skipped therapy or inability to access help when we all need it the most. Online therapy can provide treatment while also addressing the anxieties, stressors, and fears this pandemic has caused.
Recent research reflects that online therapy can be just as effective and, sometimes, more convenient in our busy lives. Also, virtual therapy can feel more comfortable for some as it is conducted in your environment. As with traditional therapy, you receive the same treatment and can discuss what you need to with your therapist as if you were face to face.
Let’s talk about the benefits of online therapy
1 It doesn’t just have to be on video
If you aren’t comfortable with video, online therapy offers other methods. Some therapists offer text-based therapy, allowing you to contact them weekly. This can be especially useful for those with social anxiety, panic, and agoraphobia. Second, there is audio therapy – in this method, you and your therapist will meet on Zoom or the telephone. To augment services, online therapy can fold in mental health apps as well.
2 No commute
Commuting for therapy appointments can be cumbersome. Add the costs associated (transportation, parking, childcare and missing work for appointments) it can become a financial and scheduling burden. Many people don’t begin therapy or stop going because of the difficulties in traveling to their therapist. Online therapy removes these hindrances and makes it easier to find a time that is convenient for yourself and your therapist.
3 Great if you are uniquely abled
If you have accessibility issues or physical limitations including being housebound, online therapy is an excellent choice for you.
4 Still covered by insurance
Many insurances cover online therapy sessions, however, it always good to contact your healthcare insurance to see if they are covered under your policy.
5 As always, it is confidential
As with your visits to your therapist are private and confidential, so are your online visits! Online therapy is completely confidential and the same rules that apply offline are still applied online. The therapy itself can sometimes cause stigma around mental health; online therapy reduces this. That way you are more comfortable with the sessions and your communication during them.
Also, communication online is encrypted through an HIPAA compliant platform called VSee. VSee is free for the you and can be downloaded onto your phone or computer.
6 Your therapist must be licensed in the state you live in
Some may be licensed in more than one state. So, you know you are getting quality healthcare by a reputable and credited provider to meet your mental health needs. This also means they are aware and comply with all Health Insurance Portability and Accountability Act (HIPAA), ethic and legal practices.
7 You can have access to a specialist that you cannot find locally
You may want a certain type of therapy such as cognitive-behavioral therapy (CBT), dialectical behavioral therapy or other evidence-based treatment. Oftentimes, therapists formally trained and specialized in these modalities for panic, anxiety, and other diagnoses are much easier accessed virtually. You may more likely to find a suitable and qualified therapist if you go beyond the location you would stay in to visit a therapist in an office.
Online therapy isn’t the best choice for everyone, and some mental health disorders may be better treated in person. Clients who are actively at risk of harm to self or others are not suitable for teletherapy services. If you are feeling suicidal, it is better to be seen in person. That said, during the quarantine many therapists are allowing for online sessions regardless.
Many of my clients are finding that treatment for their anxiety and worry during this time of uncertainty has been surprisingly easy, and it is a great way for your counselor to see where you live, meet your pets and maybe even family members. If you’re interested in learning more- please don’t hesitate to reach out!
Here’s to all of us taking great care of ourselves, and making it through to the other side stronger and thriving!
Ambiguity, a sense of uncertainty about what’s going on or what might happen, is part of life. This blog post explores dealing with the unknowns in life and how to handle them.
When Your Environment is Ambiguous
Wow, what a week. Coronavirus or COVID-19 is all over the news, and it seems that panic has set in. It is understandable to be anxious when uncertainty is all around us. Our world has been thrown off, and a new normal is here for the near future.
Human distaste for the unknown is well-grounded in experimental psychology, and research has shown that when given a choice, most of us feel calmer knowing that something terrible will happen shortly vs. it possibly happening. This phenomenon is apparent even if it causes us intense stress. Daniel Gilbert, author of the best-selling book Stumbling on Happiness, writes:
“Consider an experiment by researchers at Maastricht University in the Netherlands who gave subjects a series of 20 electric shocks. Some subjects knew they would receive an intense shock on every trial. Others knew they would receive 17 mild shocks and 3 intense shocks, but they didn’t know which of the 20 trials the intense shocks would come. The results showed that subjects who thought there was a small chance of receiving an intense shock were more afraid — they sweated more profusely, their hearts beat faster than subjects who knew for sure that they’d receive an intense shock”.
WAYS TO HANDLE ANXIETY
We can’t eliminate uncertainty in our lives, but we can manage our reactions to the unknown in healthy ways using one technique that the best cognitive behavioral therapists employ:
REST Technique or Radical Acceptance
When you become overwhelmed or anxious, your first instinct may be to act impulsively or panic. There is a healthier method – Take a REST.
Relax
Evaluate
Set an intention
Take action
Relax
Step one is to freeze and stop whatever you are doing literally. Breathe. Step away from the situation for a few seconds. Try to find a different perspective on what is happening and create a space between yourself and the impulsiveness you may feel. You can even tell yourself out loud to “Relax” or “Rest.” Slow your breathing and calm down before you decide on another action.
Evaluate
Ask yourself what is happening – what are the facts in the situation? You don’t need to solve an ambiguous problem or discover any answers. You only have to evaluate what is happening to your physical, mental, and emotional self. Move on to looking at other people around you. At this point, ask yourself, “How do I feel?” and “Are the people around me in immediate danger?” Think right here, right now.
Set an Intention
“Step three is to set an intention to do something.” You can also treat an intention as a goal or plan. Decide what you will do, pick a distraction or self-soothing skill, and ask yourself, “What do I need right now?” Whatever you choose isn’t permanent; it is only for now.
Distractors and soothers that help get you out of the uncertainty trap do not have to be expensive or time-intensive. Good examples of immediate coping skills are:
Count all the greens or blues in your vision.
Describe a wall or other item in detail.
Alphabetize movies, songs, cities, etc., in your head or on paper.
Breathe 4 seconds in, hold for 4 seconds, and out for 6.
Pay close attention to the living things around you
Clean, fix something, do anything where you move your body for 5 minutes.
Take Action
Lastly, take action. Mindfully move ahead slowly and meaningfully toward what you are doing. Slow and deliberate often helps us get what we want done faster than rushing through. Even if this is not the final solution to your problem, it is a healthy and effective way to thwart any impulsive behaviors or panic that may arise when you have a lot of ambiguity.
Once you start getting used to the REST technique, you will begin to identify when you are distressed and can implement these steps in a few seconds. You will be ready to spring your new habit into motion and “REST” when you feel like you are in a similar situation again.
Of course, suppose you follow the directions healthcare professionals gave for the coronavirus. In that case, you will feel like you have some control, and they are good precautionary habits in our current environment.
Also, make sure you stay connected with your support system via phone and video and limit your use of social media, which is less interactive and increases our anxieties.
References
Matthew McKay Ph.D., Jeffrey C. Wood PsyD, et al… The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, … (A New Harbinger Self-Help Workbook) New Harbinger Publications; Second Edition, Revised edition (October 1, 2019) Print.
The combination of extra demands and the typical stress around the holidays can lead many to fall into the trap of rigid thinking and believing that life should be flawless. If you’re already prone to anxiety, the season’s pressures can intensify these feelings. Perfectionism is something that cognitive-behavioral therapists encounter frequently, especially during this time of year. Here are some effective CBT-based tips to help you manage your stress and perfectionism during the rest of 2023 and into the New Year.
Emily had a burning desire to become a renowned painter, but she often felt overwhelmed and anxious by the enormity reaching her goal. She would head to art shows, wondering how anyone could reach such recognition. This left her feeling stuck as she continued working her well-paying, albeit unexciting, manager position at a Fortune 500 company. Her free time consisted of watching TV, going to the gym, and visiting art museums with good friends. Her life was not dull, but she knew she was avoiding going after what she wanted.
