EMDR Therapy for Anxiety: Grounded, Present, Connected

If clients are grounded. present and connected, they get optimum results in EMDR therapy for anxiety. They feel better. Anxiety and PTSD symptoms get better when I do EMDR with them. So, I check in during EMDR processing and I ask, “How grounded are you?”

3 images of woman 1: reaching forward, of head, 2: hand next to body, 3: hand behind head

No Words

Sometimes, when you’re deep in EMDR processing, it’s easier to gesture than talk. So EMDR therapists sometimes ask clients to talk with their hands instead of their words. Many of us use Jim Knipe’s Back of Head Scale. If you’re all the way present, you stick your fingers way out in front of you to show that you’re all the way here. If you put your hand behind your head, you’re not present; you’re super spaced out.

3 images of woman, 1: hand at side of head, cupping ear; 2: hand half way extended to the side, 3: hand extended all the way to the side
Natasha’s Side of Head Scale

EMDR Online

When it came time to do EMDR for anxiety online (yes, way back in 2018, before the pandemic), I adapted Jim Knipe’s Back of Head Scale and invented Natasha’s Side of Head Scale. Online, it’s harder to see where your fingers are if you reach out in front of you; it’s easier to see if you reach sideways. Thus, I use Natasha’s Side of Head Scale where, if you touch your head, as if you were cupping your ear, you’re all the way grounded. If you put your hand all the way out to your side, you’re spaced out, way out. If you put your hand in between, you give a sense of where you are on the scale of very grounded to very spaced out.

New Idea, Polyvagal Theory

However, a new idea has made me reflect more deeply about being present. As a result, I recognized that there’s grounded, there’s being present in the here and now and there’s being present in the relationship between therapist and client. Dr. Stephen Porges’s work on Polyvagal Theory talks about the power of connecting to another person and how it helps deal with crisis.

Fight, Flight or Freeze

Porges’s Polyvagal Theory explains the neurobiology of dysregulation and describes the neurobiological aspects of the vagus nerve:

The Dorsal Vagal Complex stimulates a freeze response, aka freeze-or-faint.

The Ventral Vagal Complex stimulates social attempts to connect and fend off danger, aka Tend and Befriend.

Instituto Cuatro Ciclos hosted a talk by Dr. Porges and Dr. Sue Carter about his research in neurobiology and her research into the neurochemistry of safety, trust, bonding and the biological imperative to connect in order to co-regulate in order to reach a calm state after a crisis.

People have lost the capacity to feel safe, to trust

In a video posted on Instituto Cuatro Ciclos’s YouTube channel, Porges says that when he began to research “the world of trauma… people who have been traumatized tell you what they have lost. They have lost the capacity to feel safe, to trust, to be in proximity to another. This has a neurobiological substrate.” [°In biology, a substrate is the surface on which an organism—such as a plant, fungus, or animal—lives.° Wikipedia] Well, Drs. Porges and Carter have been studying this substrate all their professional lives.

Threat Cues

The neurobiological substrate “is the substrate therapists work on to reduce the threat-cues of being close with others,” Porges said. The thing is, we are constantly scanning our environment for danger. And we get that we are in danger when we see, feel or otherwise perceive things that Porges calls threat cues. He means that if people are unkind or violent with us, we learn that people are dangerous. We feel like we are being threatened when we are with people. And our emergency response system goes into… fight, flight or freeze. This can be at the root of anxiety. My reason for using EMDR therapy for anxiety is to create a confidence that you can be safe. EMDR therapy can help you unlearn unnecessary emergency responses and learn, for the first time, to actually feel safe when you ARE safe.

How to Calm Back Down

We need our tribe to calm back down, Porges’s research suggests. He says that in order to get out of the fight, flight or freeze response and tell our emergency response system that the emergency is over and we can calm back down, we need a trusted other with whom we can co-regulate. In EMDR therapy for anxiety, we check to see how present, grounded and connected you are.

People Help People Fight off Threats

My favorite Porges quote is this: “In the history of human beings, we have used social interaction and connectedness as a way of mitigating threat… We are co-regulators.” When we connect, we create safety and help each other reach a calm state of being. And in EMDR therapy for anxiety, your therapist helps you learn how to regulate your anxiety by helping you co-regulate with your therapist first.

Grounded, Present, Connected

Thus, I made a connection between Jim Knipe’s Back of Head Scale and co-regulation. When you say you’re present by showing you’re here in the space between you and your therapist, you’re showing you’re grounded, present AND connected. To be honest, my heart cracked open because I was so touched to realize that when you reach your hand out into the space between you and your therapist you say, “I’m all the way here, with you.” What a lovely motion to express that a beautiful, human need for connection is being met. And so, I will try it Jim’s way and see how it translates to the online space.

Hope for the Future

Also, I look forward to the day when the pandemic is over and I can be in a space with my clients, feeling them reach into the space between us to say, I’m all the way here and clients can feel me welcome them and co-regulate with them in person, to reach a happy, peaceful state.

Like, Comment, and Share!

Was this blog helpful? What were your takeaways? Please post them in the comments. And share!


I welcome reposting provided you credit me in the comments, letsdealwithit.com. If reposting on Instagram, please credit @letsdealwithittherapy in the image and in the comments. And thank you!

Contact Me!

I’m Natasha Walter-Fisk, LMFT, LPC. My specialty is helping women manage stress and anxiety and recover from painful, challenging experiences. If you’re not doing well, please get professional help. If you’d like to schedule a free 20-minute consultation, check out my website, see if you feel like we would be a good fit, then if so, click the scheduling button below or email me at my confidential email, natwalterfisk@protonmail.com. I work online with English speaking clients living in California, Colorado, Europe, the Middle East and around the world. Next Step To Choosing Your Therapist: Free 20-minute consultation


Instituto Cuatro Ciclos’s video of Dr. Stephen Porges and Dr. Sue Carter talking about his research in neurobiology and her research into the neurochemistry of safety, trust, bonding and the biological imperative to connect in order to co-regulate.

Mattias’s graphic presentation of the polyvagal theory on YouTube.com gives a broad picture of the neutral, fight or flight, freeze; and positively engaged states of the nervous system.

Dr. Stephen Porges’s website

Per Wikipedia, “the tend-and-befriend theoretical model was originally developed by Dr. Shelley E. Taylor and her research team at the University of California, Los Angeles and first described in a Psychological Review article published in the year 2000.” Dr. Candace Pert in Molecules of Emotion, published in 2009, describes the chemical basis of many human interactions.

Definition of substrate from Wikipedia

Therapists might be interested in Jim Knipe’s presentation, Brain Therapy and PTSD with Jim Knipe PhD: 2015 IDA Brain IDEAS Symposium

And in closing… Again, Like, Comment, and Share!

Was this blog helpful? What were your takeaways? Please post them in the comments. And share generously!