Written by Keunshea Fleming, CSW-I
Therapy is one hour. The other hundred and sixty-seven are where most of the actual work happens, and they are the reason between-session tools matter as much as they do. Grounding, breathwork, and practices like Reiki are not treatments for trauma — they are ways of getting your body back down to a workable level so that treatment has something to build on. Choosing two or three that genuinely work for you beats collecting twenty you will never use.
Why the week between sessions matters more than the session
Most people leave a session steadier than they arrived and then hit Wednesday.
Sessions do not carry across a week on their own. What carries is whether you have a way to interrupt a spiral at 9 p.m. on a Tuesday, when you are alone and there is no appointment for four days.
That is the entire purpose of the tools below. They are not trying to resolve anything. They are trying to keep a bad hour from becoming a bad week, and to keep you from reaching for the things that work fast and cost a lot.
Set the expectation accordingly. A grounding exercise that takes you from an eight to a six has worked. If you are judging these by whether they make you feel good, you will discard all of them within a month.
Grounding: what it is actually for
Grounding is anything that puts your attention on present sensory information. It is for the specific problem of being pulled out of now — into a memory, into a spiral, into a flashback, into the feeling of watching yourself from a distance.
The ones that hold up in practice tend to be physical rather than mental. Cold water on the wrists or face. Holding something frozen. Standing and pressing your feet into the floor hard enough to feel it in your legs. Naming out loud, actually out loud, five things you can see in the room.
Strong sensory input works better than gentle input when you are far gone — a sour candy, a strong smell, cold. Gentle works for the low-level stuff; it rarely reaches you at the top end.
Two things to know about why grounding fails. First, people try it too late, after twenty minutes of being under. It works best deployed early, which requires knowing your own first sign — for most people a physical one, like a change in the jaw, chest, or hands. Second, people practice it only in crisis. A tool you have never used calmly is not available to you in a bad moment. Run it once a day when you are fine, so the sequence is automatic.
Breathwork: one rule matters more than the rest
Ignore most of what you have seen about breathing patterns and remember this: make the exhale longer than the inhale.
That is the piece that reliably shifts the body toward settling. In through the nose for a count of four, out through the mouth for a count of six or eight, for a couple of minutes. The exact numbers do not matter. The ratio does.
Also true, and less often said: breathwork does not suit everyone, and for some people it makes things worse. If you have a trauma history involving choking, strangulation, drowning, or a respiratory event, attention on the breath can be a trigger rather than a relief. The same is true for many people with panic, for whom watching their own breathing quickly becomes monitoring their own breathing.
If that is you, use movement or cold instead. Walking, pushing against a wall, carrying something heavy across a room. There is no requirement to use the breath, and skipping it is not a failure of practice.
Anyone with a respiratory or cardiac condition should check with a physician before taking up any intensive breathing practice, which is a different thing from the simple long-exhale approach above.
Where Reiki fits between sessions
Reiki is a Japanese relaxation practice involving light touch or hands held just above the body while you lie still and fully clothed. As a between-sessions practice, its usefulness is straightforward: it is a scheduled hour in which your only task is to be at rest in a safe, predictable setting.
For people who cannot rest — which is most people carrying a trauma history — a scheduled rest with a clear structure and clear consent is worth more than another instruction to relax at home.
Being clear about the limits: it does not treat PTSD, it does not process memories, and it is not a substitute for therapy or medical care. It belongs in the same category as the rest of this list — support between sessions, not the work itself.
We offer Reiki in person in Las Vegas; our offices are on E Russell Road in the east valley and N Durango Drive in the northwest, and you can ask which one when you book. Because it is hands-on, it is one of the few things that does not translate to video, though therapy itself does — plenty of people pair in-person sessions with teletherapy depending on the week.
Building a list that is actually short
Here is the practical part. Pick three, not fifteen.
One for low-level activation — the background hum at your desk. Usually breath or a short walk.
One for high activation — panic, flashback, the point where thinking has stopped. This one should be physical and strong: cold, pressure, movement.
One for the aftermath, the flat, wrung-out hour once the spike has passed. Usually something warm and undemanding, with another person or an animal if that is available to you.
Write the three on something physical and keep it where you will find it — a card in a wallet, a note on a fridge. In a bad moment, remembering which tool to use is frequently the step that fails, not the tool.
Then practice them when you are calm. That is the instruction people skip, and it is the one that determines whether any of this is there when you need it.
When none of it works
Some nights nothing on the list touches it, and that is not evidence the tools are useless or that you did them wrong.
On those nights the goal changes from settling to getting through. Change rooms. Change temperature. Call someone, even briefly. Put on something you have watched before that requires nothing of you. Lower the demand until you reach morning.
And if the thought turns toward not wanting to be here, 988 is available by call or text at any hour, for exactly this.
Common questions
How long before these start working?
Most people notice something within a few uses, particularly with cold and long exhales. What takes longer is the habit — knowing which tool to reach for and reaching for it early enough, which is a skill rather than an effect.
Can these replace therapy?
No. They manage the state you are in; they do not address what produced it. Used alone they can become a way of coping with something indefinitely rather than working on it.
What if grounding makes me feel more anxious?
That happens, usually with the ones that direct attention inward. Switch to external and physical — naming objects in the room out loud, cold water, movement — and leave the inward-focused exercises alone for now.
Should I tell my therapist which ones I use?
Yes, including the ones that fail. What works and what backfires is useful clinical information, and it often reveals more about your particular pattern than a long conversation would.
If you want help assembling a short list that fits your actual week rather than a generic one, bring it into a session — it is a good use of an hour. You can read about how I work and go from there.