Self-Soothing and Emotion Regulation Worksheet

This is a Self-Soothing and Emotion Regulation Worksheet to help you practice soothing your central nervous system.

Name: ___________________________ Date: ___________________________

1. Grounding Techniques to Reduce Dissociation

Purpose: To help you reconnect with the present moment and reduce feelings of dissociation.

Instructions: When you start to feel disconnected or spaced out, try the following grounding exercises.

A. Sensory Awareness

  • 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:

2. Breathing Exercises to Regulate Emotions

Purpose: To help you manage intense emotions and bring a sense of calm.

Instructions: Practice the following breathing techniques when you feel overwhelmed.

A. Deep Breathing

  1. Find a comfortable position.

  2. Inhale slowly through your nose for a count of 4.

  3. Hold your breath for a count of 4.

  4. Exhale slowly through your mouth for a count of 6.

  5. Repeat 5-10 times or until you feel calmer.

B. Box Breathing

  1. Inhale through your nose for a count of 4.

  2. Hold your breath for a count of 4.

  3. Exhale through your mouth for a count of 4.

  4. Hold your breath for a count of 4.

  5. Repeat 4-6 times or until you feel more regulated.

3. Self-Soothing Techniques to Feel Safe

Purpose: To help you create a sense of safety and comfort.

Instructions: Choose any of the following activities to practice when you need to self-soothe.

A. Physical Comfort

  • Wrap yourself in a cozy blanket.

  • Hold a soft stuffed animal or pillow.

  • Take a warm bath or shower.

B. Soothing Sounds

  • Listen to calming music or nature sounds.

  • Hum or sing a favorite song softly.

C. Gentle Movement

  • Practice gentle stretching or yoga.

  • Go for a slow, mindful walk.

D. Comforting Smells

  • Light a scented candle or use essential oils (lavender, chamomile).

  • Smell a favorite lotion or perfume.

4. Positive Affirmations

Purpose: To help you counter negative thoughts and foster a sense of self-worth.

Instructions: Repeat these affirmations to yourself daily, or whenever you need reassurance.

  1. I am safe and in control.

  2. I am deserving of love and respect.

  3. I am strong and capable.

  4. My feelings are valid.

  5. I am worthy of self-care and kindness.

5. Emergency Contact List

Purpose: To ensure you have support when you need it.

Instructions: Fill in the contact information for people and resources you can reach out to in times of need.

  • Therapist: ___________________________________ Phone: ______________________

  • Trusted Friend/Family Member: ___________________________ Phone: ______________

  • Crisis Hotline: _________________________________ Phone: ______________________

  • Emergency Services: ____________________________ Phone: ______________________

6. Reflection and Journaling

Purpose: To help you process your emotions and experiences.

Instructions: Use the space below to write about your thoughts, feelings, and any experiences you want to reflect on.

Daily Check-In

Purpose: To monitor your emotional state and practice self-care.

Instructions: Complete this check-in each day.

Date: ___________________________

How do I feel today?

  • Emotion(s): ________________________

  • Intensity (1-10): _____________________

What self-soothing technique will I use today?

What positive affirmation will I focus on today?

Remember:

You are taking important steps towards healing and self-care. Be gentle with yourself and use these techniques as tools to support your journey. Reach out for help whenever you need it.

Therapist Contact Information:
Name: _________________________
Phone: _________________________
Email: _________________________

Notes:

By Elizabeth Mahaney, LMHC, MFT, NCC, DCC, Ph.D

SOUTH TAMPA THERAPY, WELLNESS, MARRIAGE & FAMILY THERAPY

Book Appointment

Call or Text (813)240-3237

Licensed Mental Health Counselor, Marriage & Family Therapist

❀️ Marriage & Family Therapist πŸ’ Gottman Relationship Counselor 🧠 Licensed Mental Health Counselor 🏫 Harvard Trained β€οΈβ€πŸ©Ή Emotion Focused Therapist πŸ‘‚πŸ½ Non-Violent Communication Facilitator 🌎 National Certified CounselorπŸ‘©πŸΌβ€βš•οΈ Private Practitioner πŸ“ˆ Entrepreneur, Author & Mentor πŸŽ“Qualified Supervisor for State Licensure βš–οΈ FL Supreme Court Family Law Mediator πŸ₯… Solution Focused ✌🏻Conflict Resolver πŸ₯° Self Compassion & Self Care Advocate πŸ§˜πŸΌβ€β™€οΈ Mindfulness Meditating Yogi πŸ€” Daily Intentions & Reflections πŸ‘©β€β€οΈβ€πŸ‘¨ Attachment Theorist πŸ—£ Neuro Linguistic Programming Practitioner ✏️ Agile Learning Center Founder πŸ“š Self Directed Education Alliance πŸ§‘β€πŸŒΎ Grower: Fruit Trees & Herbs 🍽 Psychology of Eating & Nutrition πŸ‘©β€πŸ« Life Long Learner... πŸ“ Tampa, FL & Jurisdiction to practice in FL, CT, NC, SC, MD, VA

www.SouthTampaCounselor.com

SouthTampaTherapy@gmail.com

Previous
Previous

Curated List of Supplemental Evidence-Based Resources for Couples

Next
Next

Navigating Life’s Twists and Turns with the Briggs-Myers Personality Types