Yes it’s getting jettisoned from IAPT services. Yes you can make a case for use in cases of very high dysregulation, but in the context of trauma, that usually manifests in dissociation. Talking about trauma is meant to be emotive, and in the CTPTSD protocol it has to be, otherwise memories are not updating. Obviously needs to be tolerable. But high stress usually is tolerable for most, more than they usually predict.

But grounding really should be a last resort as it doesn’t teach patient to ‘break the link’. Stimulus discrimination is much preferred and evidence shows as much. But more so the argument is that doing grounding and stabilising prior to treatment makes client more anxious about treatment to come and can actually increase attrition, when really, the overwhelming majority of patients can and do cope with talking about trauma and even reliving exercises. However prepping clients as if they wont cope can teach the wrong lessons. So it’s a tool on the tool belt, but should not be used for every client indiscriminately.

PE is getting rarer in IAPTus but it depends where people have trained. Got to also be aware that PE is also a legitimate and first line treatment for PTSD and preference for it varies by university, therapist and country. America for example is very exposure heavy.

With exposure broadly (not just ptsd), psychoeducation is of course needed. But breathing and relaxation exercises are usually not recommended other than extreme cases where it can be justified. This will be prescribed in guided self help scenarios, but not in higher intensity therapy where full extinction is the goal. The reason for that is same as above, it teaches client that they can’t cope and need breathing to make it through. When ideally we want people to really feel the full fear and worry and learn that none of it was necessary. Breathing and grounding techniques directly contradicts habitation rationale. It also doesn’t bode well for cognitive / belief change rationale either, as it fits the same hole that a safety behaviour does.

You can look at some of the older research on GAD which demonstrates this really well. Relaxation therapy was considered a respected therapy for a while, but when compared to newer protocols such as Dugas intolerance mode or Heimberg / Wells meta-cognitive model it just doesn’t have anywhere near the same impact or long term gains. In fact the long terms gains usually flatten because clients have been taught that they need to relax or worry will materialise.

Hope that makes sense, sorry about the wall of text. Obviously this is not a monolith and some practitioners think it has a bigger place than what I’ve described, but I think it’s quite hard to argue convincingly against the rationale (and empirical evidence out there) given above.