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
Find a comfortable position.
Inhale slowly through your nose for a count of 4.
Hold your breath for a count of 4.
Exhale slowly through your mouth for a count of 6.
Repeat 5-10 times or until you feel calmer.
B. Box Breathing
Inhale through your nose for a count of 4.
Hold your breath for a count of 4.
Exhale through your mouth for a count of 4.
Hold your breath for a count of 4.
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.
I am safe and in control.
I am deserving of love and respect.
I am strong and capable.
My feelings are valid.
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
Licensed Mental Health Counselor, Marriage & Family Therapist
❤️ Marriage & Family Therapist 💍 Gottman Relationship Counselor 🧠 Licensed Mental Health Counselor 🏫 Harvard Trained ❤️🩹 Emotion Focused Therapist 👂🏽 Non-Violent Communication Facilitator 🌎 National Certified Counselor👩🏼⚕️ Private Practitioner 📈 Entrepreneur, Author & Mentor 🎓Qualified Supervisor for State Licensure ⚖️ FL Supreme Court Family Law Mediator 🥅 Solution Focused ✌🏻Conflict Resolver 🥰 Self Compassion & Self Care Advocate 🧘🏼♀️ Mindfulness Meditating Yogi 🤔 Daily Intentions & Reflections 👩❤️👨 Attachment Theorist 🗣 Neuro Linguistic Programming Practitioner ✏️ Agile Learning Center Founder 📚 Self Directed Education Alliance 🧑🌾 Grower: Fruit Trees & Herbs 🍽 Psychology of Eating & Nutrition 👩🏫 Life Long Learner... 📍 Tampa, FL & Jurisdiction to practice in FL, CT, NC, SC, MD, VA