Online Guided Self-help Intervention for Sexual Distress Following Sexual Assault: A Single Case Experimental Study
Phase: NA
Conditions: Sexual Assault, Sexual Dysfunction, Sex Disorder
Sponsor: Royal Holloway University

 
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Guided Self Help Following Sexual Assault 
4 WEEKLY SESSIONS SCRIPTS & HANDOUTS 
 
    
                                                                           
 
 
 

 
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Contents 
Session 1 – Introduction & Psychoeducation ........................................................................ 3 
Script ......................................................................................................................................... 3 
Handout .................................................................................................................................... 6 
Aims of session 1 ....................................................................................................................... 6 
Mindful Breathing Exercise ....................................................................................................... 6 
Reflection: What would you like from your sex life?................................................................ 6 
How difficult experiences get in the way .................................................................................. 6 
The brains alarm system ............................................................................................................ 7 
Reflection: What makes sex enjoyable for you?........................................................................ 7 
Sex & Emotions: Three Systems ............................................................................................... 8 
Three Systems after Trauma ................................................................................................... 8 
A Compassionate Approach ...................................................................................................... 9 
Week 1 Practice: ........................................................................................................................ 9 
Session 2 – Being in the present moment and Grounding techniques .............................. 10 
Script ....................................................................................................................................... 10 
Session 2: Handout ................................................................................................................. 15 
Living Everyday on Autopilot ................................................................................................. 15 
What is Mindfulness? .............................................................................................................. 15 
How can mindfulness and being present help after trauma? ................................................... 16 
Everyday Mindfulness ............................................................................................................. 16 
Practice: being present with mindfulness ................................................................................ 16 
Managing flashbacks during sex .............................................................................................. 17 
54321 Grounding ..................................................................................................................... 17 
Week 2 Practice: ...................................................................................................................... 18 
Session 3 – Desire and the sensual self ................................................................................. 19 
Script ....................................................................................................................................... 19 
Session 3: Handout ................................................................................................................. 23 
Re-learning Sex ........................................................................................................................ 23 
Desire in Relationship .............................................................................................................. 23 
Inner Sex Critic ........................................................................................................................ 24 
Compassionate Self Exercise ................................................................................................... 25 
Activities to build on sensual self ............................................................................................ 25 
Practice: Compassionate Letter Writing .................................................................................. 25 
Session 4 – Psychosexual techniques and relationships with others.................................. 26 
Script ....................................................................................................................................... 26 
Session 4: Handout ................................................................................................................. 30 
Exercise: Compassionate Colour ............................................................................................. 30 
Conditions for good sex ........................................................................................................... 30 
Relationships ............................................................................................................................ 30 
Activities involving physical touch ......................................................................................... 31 
Week 4 Practice: ...................................................................................................................... 31 
Appendix ................................................................................................................................. 32 
Appendix E ............................................................................................................................. 37 

 
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Session 1 – Introduction & Psychoeducation  
Script 
Introduction:  
Hello and welcome to the first session of guided self-help for sexual distress. Over the next 4 
sessions we hope to cultivate a more compassionate view towards yourself by deepening your 
understanding of yourself and your difficulties, and how your experience of sexual trauma is 
affecting your sex life and the it affects your mind and body. 
 
We have based this information from scientific research and throughout the sessions, we will 
also be going through a range of exercises for you to practice and ask for you to note down any 
reflections you feel comfortable writing. You have the choice of which exercises you want to 
try and which you would prefer to opt out of. It is completely okay to step away from any of 
the exercises over the next 4 weeks, you do what feels right for you. Even choosing to sign up 
for this 4 week intervention is a big step and we hope that this guide will help you feel more 
confident in returning to sex and treat yourself with more kindness when approaching sex even 
if it feels like it may be difficult. 
 
Breathing exercise: 
Breathing is a great form of mindfulness which cultivates our ability to be present in the 
moment. We will learn more about mindfulness in the next session. To help you prepare for 
today’s session I would like to bring you to the present moment, let’s get into a comfortable 
position and start by taking a deep breathe and relaxing any tension you may feel in your body. 
Take yourself away from any distractions and if you feel comfortable to do so. you can close 
your eyes and take a minute or two to allow your attention to settle on your breathing – not 
really thinking about anything in particular. Alternatively, or when you are ready, take one last 
deep breathe, stretch wiggle your finger and toes and bring yourself back in to the room.  
 
 
Reflection:  
To begin the session, I would like you to think about how you want to feel about your sex life 
and what about sex is important to you. Is it pleasure? Connection? Is not important to you. 
Take as much time as you need to reflect on this.  If how you want to feel about your sex life 
is a 10 on a scale of 0 to 10, how close are you to feeling the way you want about your sex 
life?. What number would you rate your sex life currently from 0 to 10.  
 
 
How difficult experiences get in the way: 
Research has shown how it is common and understandable for sexual trauma to affect 
someone’s experiences of sex. For some people this changes the way they have sex or can lead 
to increased anxiety & fear of having sex and discomfort during sex. On the handout are a list 
of common experiences survivors of sexual trauma encounter when returning to sex. These 
experiences are understandable after trauma which is a violation of your safety and this is the 
way your brain is trying to protect you from being hurt again but it overcompensates, causing 
these symptoms. If you have any of these experiences currently, it is not your fault! You did 
not choose or want to react in these ways but our brains automatic response is to keep you safe.  
 

 
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 The main task of all living things is survival and humans have evolved in many ways to detect  
and respond to threat to ensure we survive. The brain has also evolved to detect threat. The 
amygdala is the part of the brain that protects us from threat – it is the human built in threat 
alarm system. To protect us, the amygdala is constantly looking out for threat and lives by the 
rule ‘better safe than sorry’ so any small signs of danger can cause the alarm system to go off 
and our brain is told that we are in danger and prepares our body and mind to defend itself. 
This response occurs so quickly and automatically that sometimes it sets off our threat system 
before we are conscious of what is happening.  
 
For example, if we are in a forest and see something moving on the ground we might feel 
scared and jump back before we realise it’s a harmless bird. The role of the amygdala is to keep 
us safe and to react quickly before the thinking part of our brain identifies the movement as 
something that isn’t dangerous. 
 
Unfortunately, the amygdala is unable to distinguish between danger in the present from past 
events we remember in our minds. This is why the threat system may be activated when you 
have memories of trauma even if you rationally know you are in a safe place. Your brains is 
trying to keep you safe and prevent anything frightening from happening again. During the 
trauma, the amygdala collects information so that it can recognise warning signs in the future 
to prevent the event from occurring again. Anything that even vaguely reminds the amygdala 
of the original traumatic event, including the act of sex in a safe place on your own or with a 
trusted partner can  trigger the threat system, When the ‘alarm system’ goes off  because our 
threat system is triggered, it can interfere with the ability to have sex. I hope you will be 
reassured that many of the difficulties you experience are the results of the way the human 
brain is designed and to deal with threat.   
 
The way our bodies respond sexually is related to a whole range of factors, many of which are 
outside our control such as the response of  the threat system. One thing we can do to reduce 
the emphasis on the threat system is to activate our soothing system. 
 
The soothing system is part of the three systems model and is linked to feelings of being safe 
and soothed. It is associated with being relaxed, connecting to others and experiencing 
compassion. Often for sex to be enjoyable we need : human connection, feeling safe, feeling 
wanted and our wishes respected. And a feeling of safety and no active threat. – these are all 
factors associated with the soothing system which is needed for arousal and enjoyable sex.  
 
 
Three Systems: 
We have already introduced how the threat system can interfere during sex. We also briefly 
talked about how the soothing system is what makes us feel safe during sex allowing for 
arousal. These two systems, described above, are part of a three systems model. The third 
system is the drive system and it’s involved in wanting and pursuing sex. From an evolutionary 
perspective, the principle aim of sex is reproduction. However, we know that is not everybody’s drive 
for sex today. 
 
After experiencing trauma, the threat system becomes more sensitive and is easily triggered, 
overruling the drive and soothing systems as your brain tries to protect you from being hurt 
again even if you are with a trusted partner. This may cause people to feel:  
 unsafe, scared of sex etc.  
 shame about what happened, disgusted with self or others.  

 
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 Some people worry that what happened to them was their fault, so might feel shame 
and feel undeserving of sex or closeness  
 Might have critical thoughts like “I’m disgusting” or “I’m not worth it”  
 
Our brains and bodies are not designed to have sex “perfectly” (e.g. in the way our culture 
currently says we should) … we’re evolved to survive…  
 
It is understandable that if someone has had a threatening or unwanted sexual experience, sex 
might be experienced as threatening. A new sexual encounter might automatically trigger 
memories of the unwanted sexual experience OR sex drive might increase – as the brain's way 
of managing the increased threat. This can be automatic and unconscious, and happen even 
if the person doesn’t want it to. The brain is doing what it thinks is helpful, even if it doesn’t 
feel helpful. 
 
Building Compassion: 
Over the next few weeks, we will work on acknowledging the difficulties and shame related to 
sex while building on the soothing system through different exercises. Increasing our soothing 
system will help increase our drive and alleviate the threat system. We do this by trying to be 
more compassion with ourselves. This includes 
 
 Understanding the way, we are and why we may act/feel this way – being wise about 
sex and our bodies   
 Treating ourselves with warmth and kindness  
 Being encouraging to ourselves  
 Being non-judgmental about our experiences  
 
Being compassionate will also allow us to be aware and engage with distress and difficulty 
without turning away from it and increase our motivation and courage to try to alleviate the 
distress. 
 
Practice:  
At the bottom of your handout there are some practice activities we encourage you to try 
throughout the week. It is perfectly okay to do all of them, some of them or none of them as 
long as you are doing what feels right for you. There is no pressure or need to be harsh with 
yourself if you were unable to incorporate these practices during the week, you are doing the 
best you can and being here for this first session is enough. Thank you for joining this week, 
this is a brief reminder to fill out the measures and questionnaires so that we can see how this 
intervention is helpful for survivors of sexual trauma. Thank you very much and I hope you 
found today’s session helpful, we will see you next week.  
 
 
 
 

 
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Handout 
Aims of session 1 
 
• 
To think about what you’d like from your sex life 
• 
To understand the links between difficult experiences and sex 
• 
To understand why our brains and bodies act the way they do 
• 
To build compassion towards the ways our minds and bodies behave 
Mindful Breathing Exercise 
Reflection: How would you like to feel about your sex life?  
 
 
 
 
How difficult experiences get in the way  
 
• 
Difficult / traumatic experiences can affect experiences of sex 
• 
For some people, this can lead to anxiety, fear, discomfort around sex, or change the 
way you have sex 
• 
This is very understandable as our brains are programmed to protect us and keep us 
safe – it’s not your fault!!! 
 
Listed below are common experiences survivors of sexual trauma have when returning 
to sex based on scientific research.  
 Decreased sexual satisfaction1 ,2  
 Decreased frequency of sex2,3  
 Fear of sex2 
 Difficulties with arousal/desire 
during sex2,4  
 Painful sex5  
 Lower sex drive  
 Higher sex drive5,6  
 Feelings of shame & self-blame6, 7  
 Avoidance of sex and/or 
connection 1 
 Flashbacks1 
 Difficulties in trusting others6 
 Difficulties with relationships and 
communications6
 
These difficulties can be unpleasant but are understandable & expected responses to trauma. Having these experience 
does not mean you want or choose to have them –it is just the brain’s automatic way of trying to protect us.  
 
1 Norris, J., & Feldman-Summers, S. (1981). 
Factors related to the psychological impacts of 
rape on the victim. Journal of Abnormal 
Psychology, 90(6), 562. 
 
2 Van Berlo, W., & Ensink, B. (2000). 
Problems with sexuality after sexual 
assault. Annual review of sex research, 11(1), 
235-257. 
 
3Feldman-Summers, S., Gordon, P. E., & 
Meagher, J. R. (1979). The impact of rape on 
sexual satisfaction. Journal of Abnormal Psychology, 88(1), 
101. 
 
4Becker, J. V., Skinner, L. J., Abel, G. G., Axelrod, R., & Cichon, J. 
(1984). Sexual problems of sexual assault survivors. Women & 
Health, 9(4), 5-20. 
 
5 Weaver, T. L. (2009). Impact of rape on female sexuality: Review 
of selected literature. Clinical Obstetrics and Gynecology, 52(4), 
702-711. 
 
6 O’Callaghan, E., Shepp, V., Ullman, S. E., & Kirkner, A. (2019). 
Navigating sex and sexuality after sexual assault: A qualitative 
study of survivors and informal support providers. The Journal of 
Sex Research, 56(8), 1045-1057. 
 
7 Hamrick, L. A., & Owens, G. P. (2019). Exploring the mediating 
role of self‐blame and coping in the relationships between self‐
compassion and distress in females following the sexual 
assault. Journal of clinical psychology, 75(4), 766-779. 
 

 
 
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The brains alarm system   
 
The amygdala is the part of the brain that protects us from threat – think of it as the brains 
alarm system. It is constantly looking out for threat and lives by the rule ‘better safe than sorry’ 
so any small signs of danger can cause the alarm system to go off and our brain is told that we 
are in danger and prepares our body and mind to defend itself. This responds occurs so quickly 
and automatically that sometimes it sets off our threat system before we are conscious of what 
is happening.  
 
When this alarm system goes off because our 
 system is triggered, it can interfere with 
our ability to become aroused and enjoy sex.  
 
What we need is to activate our 
 system. However, the way in which our bodies 
respond sexually is related to a whole range of factors – many of which are completely outside 
of our control.  
 
 
   
 Human connection, feeling safe, feeling wanted and our wishes respected – basic 
human needs related to the soothing system  
 
 A feeling of safety and no active threat  
However, when you have experienced trauma, your body and brain tries to protect yourself 
from being hurt again even when are with a trusted partner.  
 
 
 
Sex & Emotions: Three Systems   
 
We have already introduced how the threat system can interfere during sex. We also showed 
how the soothing system is what makes us feel safe during sex allowing for arousal, these two 
systems are part of the three systems model as seen above. The third system is the drive system 
and it’s involved in wanting and pursuing sex. From an evolutionary perspective, the principle aim 
of sex is reproduction. 

 
 
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Three Systems after Trauma  
 
After experiencing trauma, the threat system becomes more sensitive and is easily triggered, 
overruling the drive and soothing systems. This causes people to feel  
 unsafe, scared of sex etc.  
 shame about what happened, disgusted with self or others.  
 Some people worry that what happened to them was their fault, so might feel shame 
and feel undeserving of sex or closeness  
 Might have self-blaming  
 
 critical thoughts like “I’m disgusting” or “I’m not worth it”  
 
  
Our brains and bodies are not designed to have sex “perfectly” (e.g. in the way our culture 
currently says we should) … we’re evolved to survive…  
 
 
 
 
A Compassionate Approach  
 
 
It is understandable that if 
someone has had a threatening 
or unwanted sexual 
experience, sex might be 
experienced as threatening
A new sexual encounter might 
automatically trigger 
memories of the unwanted 
sexual experience
,Sex drive might increase – as 
the brain's way of managing 
the increased threat - this can 
be an automatic process and 
happens even if the person 
does not want it to 
The brain is doing what it 
thinks is helpful, even if it 
doesn’t feel helpful

 
 
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Increasing our soothing system will help increase our drive and alleviate the threat system. We 
do this by trying to be more compassion with ourselves. This includes 
 
 Understanding the way, we are and why we may act/feel this way – being wise about 
sex and our bodies   
 Treating ourselves with warmth and kindness  
 Being encouraging to ourselves  
 Being non-judgmental about our experiences  
 
Being compassionate will also allow us to be aware and engage with distress & difficulty 
without turning away from it and increase our motivation and courage to try to alleviate the 
distress 
 
Week 1 Practice:  
 
How does the threat system get in the way of your sex life?  
 
 
 
 
Acknowledging these difficulties and the emotions such as anger/shame that come along with 
them is the first step in building the soothing system to allow yourself to let go of some of these 
difficult feelings. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
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Session 2 – Being in the present moment and Grounding techniques 
Script 
 
Hello and welcome to the second session. Today’s session focuses on being in the present 
moment. These days we are so busy multitasking and doing many things that we may not be 
living our lives fully present. Additionally, we also know that the experience of trauma can 
make it even harder to be present because our minds may be elsewhere thinking about past 
events and at times, you may get involuntarily pulled into flashbacks or trauma memories 
without wanting to experience these memories. 
 
In this session, we will learn about being present also known as mindfulness and learning about 
grounding techniques. As with each week, the core of these sessions is to build compassion 
towards the way our minds and bodies behave. We will practice some mindfulness exercises 
and I invite you to participate in whatever way feels right for you. With each exercise, you can 
choose if you want to try it and even if you choose not to, that’s okay. You have showed up 
today and that can be enough.  
 
Mindfulness - Living Everyday on Autopilot 
We do many things every day without thinking or being aware of what we are doing. Think 
about times you are travel between two places and don’t really remember the journey. Still,  
before you know it, you’ve arrived at your destination. We call this autopilot mode. In many 
ways, it can help us – routine tasks can be done easily, without thought. However, it also means 
we do many things without much awareness of what is happening and fail to be fully present 
and get the most from the experience. Living in autopilot also means our minds are less focused 
on what we are doing, and instead, it may be elsewhere. If you’ve had an experience of sexual 
assault, your mind may wander onto things associated with that experience even when you are 
doing something completely different. However, it is also common to think about the past 
experience of sexual assault when you are intimate with a partner.  In the same way a task such 
as making a cup of tea becomes an automatic habit, so can worrying thoughts, unhelpful 
behaviours, and difficult feelings become an automatic habit if we are not conscious of being 
in the present.  
 
Mindfulness offers a way to step out of autopilot and the unhelpful habits that come with it. It 
can help us get more from our day to day experience – to be more present in the things that we 
do. But it can also allow us to step back from difficult emotions – to be less caught up in them.  
 
Mindfulness can be described as: awareness of present momentwith acceptance. So, what 
do we mean by this? If we take each of the three phrases underlined above in turn, we can 
understand this statement better.  
 
Awareness can be broken down into three steps: 
  
Stop or slow down  
When we are acting in autopilot we respond to situations, thoughts and emotions in automatic 
ways. The first step towards being more mindful, is to stop or slow down what you were doing 
– give yourself some space. Giving yourself some space can allow your mind to settle and 
provides a basis for reacting in a different way. 
 

 
 
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Observe 
The next step is to observe what is going on for us. To do this, we first focus our attention on 
something – this can be on anything – e.g. and object around us, sounds that are going on 
around us. Most commonly, we can focus our attention on our breath. As we do so, we begin 
to notice the things that take our attention away from our breath. We notice where our attention 
goes.  
 
Return 
Once we have noticed that we have become distracted, that something has taken our attention 
away from our breath, we can note what has taken our attention away, and then return our 
attention back to our breath.  
 
Present Moment  
Sometimes we can be completely absorbed in the activity we are doing. However sometimes 
many things can take our attention away from our present experience. Mindfulness is a way to 
bring us back to the present moment.  
 
Acceptance 
The present moment is affected by how we view or judge it. To accept the present is to 
experience it without judging it. It is to see things in the moment as they are, not as we might 
want or expect them to be, or what we fear they might become. We are accepting our 
experience, pleasant or unpleasant, as it is.  
 
 
How can mindfulness help after trauma?  
Studies have found that mindfulness helps reduce distracting thoughts, increases focus on 
physical sensation, and is helpful for sexual difficulties. It helps us learn to be in the moment 
by being aware of our physical sensations. And we want to build on compassion and activate 
our soothing system which we can do through mindfulness. 
 
However, some survivors of sexual trauma may find mindfulness difficult or triggering and 
dissociates. Mindfulness may be quite distressing if it means sitting with sensations and 
emotions that are usually avoided. and If your mind ‘shuts off’ during your experience of 
trauma, the feeling of ‘shutting off’ can occur again when you’re faced with similar or difficult 
emotions.  If you experience these difficulties, it’s okay. It’s a protective mechanism to keep 
you safe. You can opt-out of the mindfulness exercise and practice being present in a different 
way. One way to do this is through everyday mindfulness. 
 
Everyday Mindfulness 
In any task we do, we can be mindful and present. Choose a routine task and each day for the 
next week; see if you can remember to pay attention while doing it. You do not have to slow it 
down or even enjoy it. Simply do what you normally do, but see if you can be fully alive to it 
as you do so.   
 
Examples like: Brushing your teeth. Drinking a hot drink.  
 
We are going to now have a short mindfulness practice – if you know mindfulness is difficult 
for you because of your experience of sexual trauma, you can skip the practice and I invite you 

 
 
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to do anything you find soothing or if you feel up for it, practice one of the everyday 
mindfulness activities instead. However, if you would like to give the activity a go, then 
continue and remember you have control and can stop and move on from this exercise at any 
point.  
 
 
To begin, find a comfortable sitting position and if you feel comfortable, closing your eyes.  
 
Mindfulness Attention Practice – based on Paul Gilbert’s exercise. From Compassionate-
Mind Guide to Recovering from Trauma and PTSD Deborah A. Lee 
 
“Sit quietly for a moment and focus on your breathing. Allow the breath to come down into 
your diaphragm slowly and evenly and then leave your body slowly and evenly. If you find this 
difficult you may simply want to try to focus on the sensation of your breath coming in and 
leaving through your nose. Try spending two minutes simply concentrating on the experience 
of breathing in and out. If you don’t like focusing on your breathing or you don’t like closing 
your eyes, you could use a pebble or a shell and try to focus your attention on the experience 
of looking at it and feeling it or look at a blank wall.  
 
  As you focus on your in breath and out breath You may notice that within just a few moments 
your mind will have wandered off on to something else. This is called mind wandering. If there 
are things that are worrying us, our minds easily get pulled into thinking about them and away 
from the present moment. This can also happen if there are things we are looking forward to 
(like a party), or if there are things that we need to do (e.g., pay a bill, or remember to call a 
friend), and we can find our minds skipping to them. This is very typical of how our minds are, 
and indeed recent research evidence suggests that it is our natural state. 
 
    One aspect of practicing mindfulness is just learning to notice when our minds wander and 
bringing our attention gently and warmly back to what we want to focus on. Mindfulness is not 
making our minds pay attention or emptying our mind of thoughts. Telling ourselves off for not 
being able to pay attention is not being mindful either. Indeed, it is counterproductive, as 
noticing where our minds wander to can be very important in helping us to identify other issues 
that are bothering us. When our minds wander it is not a sign that we have failed to be mindful; 
it is a part of the very process of being mindful! It is the act of noticing and then returning the 
attention to the desired focus that is central to mindfulness. The very fact that you find this 
difficult is itself evidence that you are engaging in mindful practice!” 
 
We are about to draw this mindfulness practice to a close so just focusing on you breathe for 
a few more moments and then feeling the weight of your body on the chair or floor and when 
you are ready, bringing yourself back into the room and open your eyes.  
 
 
Before we move on I just want you to notice how you feel after that practice, you may feel 
relaxed, you may feel more tense or you may have noticed how you’re not use to being present 
and your mind continued to wander. It’s normal if this happens – Mindfulness is like a muscle 
and the more you practice the easier it gets. If you found the practice difficult as it triggered 
difficult feelings, you did your best to try out the exercise and should feel proud for being brave 
to do so. Instead of doing the mindfulness practice in future sessions, you can opt to do 
whatever you feel comfortable doing.  
 

 
 
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To finish the session today we will think about managing flashbacks during sex and grounding 
techniques you can use. Flashbacks are very common In any traumatic experience. And when 
you are a survivor sexual trauma, it is common for women to avoid sex because of the 
associations it brings up and the feelings, sensations and memories sex can trigger. It can be 
challenging to return to sex even if you are on your own or with a trusted partner. This is not 
because you chose or want to relive your past but experiencing flashbacks is understandably 
challenging and scary – it is not your fault that you experience them.  
 
To manage flashbacks during sex, it can be helpful to have a conversation with your partner 
when you’re not having sex. You can discuss why flashbacks occur and that they are not 
because of anything your partner has done wrong. You can also share or discuss the knowledge 
you’ve gained from this intervention with your partner. Remind your partner the confusion is 
not about them – it’s about the situation. We know these conversations can be difficult – we 
have included a short brief handout (appendix B in your handout sheets) that you could share 
with your partner if you find it difficult to discuss your traumatic experience and your level of 
comfort during sex (Appendix B).  
 
During this talk you can discuss with your partner the level of comfort with sex – are there any 
dos or don’ts specific to you? Anything you would prefer your partner to do/not do? This can 
start very simple e.g. holding hands, dancing, cuddling up in bed with a film. It can then branch 
into sexual things you feel comfortable with. We have included a sexual activities list and body 
map in your handout (Appendix C/D) to introduce the conversation. There is no pressure to do 
anything you are not comfortable doing, it’s okay if this conversation takes time.  
If you have been with the same partner prior to experiencing trauma, you may feel bad about 
having to change the way you have sex but it is not your fault. It may be more uncomfortable 
having these conversations with a casual partner but it’s an important one to have to ensure 
you feel safe and more confident.  
 
Du  ring the discussion, you can plan of action with your partner with the aim to activate your 
soothing system. The plan can include 
 
- Signal that flashback is occurring (e.g. specific arm pat, or word) 
 
- An Okay to pause and take some time 
 
- Might need to express emotion e.g. cry  
 
- Use grounding technique (next slide) 
 
- As part of grounding - discuss with partner in advance how you would like them to 
respond in this situation. E.g. you might like partner to say, “it’s okay, you are safe with me, I 
will not hurt you.” You might like them to hold you while you feel sad, or for them to sit and 
listen to how you feel.  
 
- Breathe 
This might occur a few times in sex before gradually over time you feel more comfortable and 
safe. Requires patience and compassion, both self-to-self and other-to-self.  
If you have found things that have worked you can use those, these are only some ideas, you 
might have different ideas  
 
Grounding Techniques are used to remind you where you are and that you are safe. It 
can be really helpful to discuss possible grounding techniques you can use with a sexual 
partner and communicate that with them. It can also be helpful to reflect on what you 
can use on your own. When thinking of grounding techniques, think about all 5 senses 
and how you can use your touch, smell, taste, sight and sound.  You can write you own 
ideas below. 

 
 
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- 
Grounding object 
- 
Sexual grounding object 
- 
A phrase or object that reminds you WHERE you are and that you are SAFE. E.g. Item 
of clothing, a particular object (e.g. a stress ball, a ring, a special item) Or a piece of 
paper with the phrase “you are at your home, you are not in danger, you are safe”.  
- 
Using 5 senses for grounding 
o Smell: essential oils. Candles 
o Taste: mint/gum/sour candy 
o Touch: weighted blanket, furry objects  
o You can also use the 54321-grounding technique included in your handout 
the 54321-grounding technique is simple, yet powerful. Like gradually 
attaching anchors to the boat, this method slowly pulls you back to 
earth. It involves you naming 5 things you can see, 4 things you can 
touch, 3 things you can hear, 2 things you can smell and 1 thing you 
can taste. 
 
 
With everything, there is no need to blame or be critical of yourself if you have to make a plan 
to be intimate and feel safe. Your threat system may activate when you are trying to have sex 
alone or with a partner because of your experience of trauma and that is not because you want 
or choose to have sexual distress – it’s how our brains have evolved and are hardwired. It may 
also be uncomfortable to have these conversations with a partner, and that’s understandable. It 
may be difficult to find the right words, feelings of shame or guilt, and some people may feel 
very vulnerable talking about this to anyone. If you experience any of this, it’s not your fault. 
You have the power to choose when you are ready to have these conversations.  
Practicing being present and having a plan should your threat system activate are ways we try 
to activate the soothe system to help you feel prepared and more confident in returning to sex.  
 
 
Week 2 Practice:  
1. Practise everyday mindfulness/ grounding technique - choose one task to focus on for 
the whole week.  
2. Listen to mindfulness audio every day to practice being in the present moment  
 
 
 
 
 
 
Session 2: Handout 
 

 
 
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Living Everyday on Autopilot 
We do many things every day without thinking or being aware of what we are doing. Think 
about times you are travelling between two places and you don’t really remember the journey 
but before you know it, you’ve arrived at your destination. We call this autopilot mode. In 
many ways it can help us – routine tasks can be done easily, without thought. However, it also 
means we end up doing many things without much awareness of what is happening and fail to 
be fully present and getting the most from the experience. Living in autopilot also means our 
minds are less focused on what we are doing and instead it may be elsewhere. If you have an 
experience of sexual assault, your mind may often wander onto things associated with that 
experience even when you may be doing something completely different. However, it is also 
common to think about the past experience of sexual assault when you are intimate with 
yourself or a partner.   
 
Mindfulness offers a way step out of autopilot and the unhelpful habits that come with it. It can 
help us to get more from our day to day experience – to be more present in the things that we 
do. But it can also help us to step back from difficult emotions – to be less caught up in them.  
What is Mindfulness? 
Mindfulness: awareness of present experience with acceptance. It’s intentional, 
accepting and non-judgmental focus of one's attention on the present moment 
 
Awareness  
1. Stop or slow down  
When we are acting in autopilot we respond to situations, thoughts and emotions in automatic 
ways. The first step towards being more mindful, is to stop or slow down what you were doing 
– give yourself some space. Giving yourself some space can allow your mind to settle and 
provides a basis for reacting in a different way. 
 
2. Observe 
The next step is to observe what is going on for us. To do this, we first focus our attention on 
something – this can be on anything – e.g. and object around us, sounds that are going on 
around us. Most commonly, we can focus our attention on our breath. As we do so, we begin 
to notice the things that take our attention away from our breath. We notice where our attention 
goes.  
 
 
3. Return 
Once we have noticed that we have become distracted, that something has taken our attention 
away from our breath, we can note what has taken our attention away, and then return our 
attention back to our breath.  
 

 
 
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Present Moment  
Sometimes we can be completely absorbed in the activity we are doing. However sometimes 
many things can take our attention away from our present experience. Mindfulness is a way to 
bring us back to the present moment.  
 
Acceptance 
The present moment is affected by how we view or judge it. To accept the present is to 
experience it without judging it. It is to see things in the moment as they are, not as we might 
want or expect them to be, or what we fear they might become. We are accepting our 
experience, pleasant or unpleasant, as it is.  
 
How can mindfulness and being present help after trauma?  
 
Studies have found that mindfulness helps reduce distracting thoughts and increase focus on 
physical sensation and is helpful for sexual difficulties. It helps us learn to be in the moment 
by being aware of our physical sensations. Research has also shown that regular mindfulness 
practice increases genital response and psychological arousal.  
 
However, we also know it can be really difficult for survivors of sexual trauma to practice 
mindfulness and may make you feel more disconnected or cause you to dissociate. This is 
understandable as your brain is trying to protect you from experiencing difficult emotions. If 
you are struggling to practice mindfulness that’s okay. You can do other practices to be present!  
 
Everyday Mindfulness 
Choose a routine task and, each day for the next week; see if you can remember to pay attention 
while you are doing it. You do not have to slow it down or even enjoy it. 
 Examples of routine tasks: 
• Brushing your teeth 
• Drinking tea, coffee, juice 
• Walking to the shops 
• Having a shower 
• …………………… (your choice!) 
Practice: being present with mindfulness  
 
Reflection: How was that?  
 
 

 
 
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Managing flashbacks during sex 
 
 
Example actions to include  
- 
Using specific grounding techniques 
- 
A signal to inform your partner that you’re having a flashback or want to stop  
- 
Agreeing to pause if things begin to be difficult  
- 
Acknowledging difficult emotions (e.g. fear/anger/disgust/shame)  
- 
Breathing together and engaging soothing system  
 
Grounding Techniques are used to remind you where you are and that you are safe. It 
can be really helpful to discuss possible grounding techniques you can use with a sexual 
partner and communicate that with them. It can also be helpful to reflect on what you 
can use on your own. When thinking of grounding techniques, think about all 5 senses 
and how you can use your touch, smell, taste, sight and sound.  You can write you own 
ideas below. 
 
54321 Grounding 
Take a moment and take a few deep breaths invite your body back into the moment, slowing 
everything down. Then, become aware of your environment. 
• 
Look For 5 Things You Can See: Notice the wood grain on the desk in front of you. 
Or the precise shape of your fingernails. Become aware of the glossy green of the plant 
in the corner. Take your time to really look and acknowledge what you see. 
• 
Become Aware Of 4 Things You Can Touch: The satisfyingly rough texture of the 
car seat. Your cotton shirt against your neck. If you like, spend a moment literally 
touching these things. Maybe notice the sensation of gravity itself, or the floor beneath 
you. 
• 
Acknowledge 3 Things You Can Hear: Don’t judge, just hear. The distant traffic. 
The voices in the next room. As well as the space between sounds. 
Have a conversation 
with a partner or reflect 
on your own abour 
flashback
Agree on safe 
and unsafe 
behaviours 
during sex
Make a plan of 
action to deal 
with a 
flashback

 
 
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• 
Notice 2 Things You Can Smell: If at first you don’t feel like you can smell 
anything, simply try to sense the subtle fragrance of the air around you, or of your own 
skin. 
• 
Become Aware Of 1 Thing You Can Taste: The lingering suggestion of coffee on 
your tongue, maybe? 
 
Repeat this process as many times as necessary. Take your time and notice how you feel 
afterward. 
 
 
 
 
With everything, there is no need to blame or be critical toward yourself if you have to make a 
plan in order to be intimate and feel safe. Your threat system may activate when you are trying 
to have sex alone or with a partner because of your experience of trauma and that is not because 
you want or choose to have sexual distress – it’s the way our brains have evolved and are 
hardwired. Practicing mindfulness and having a plan ready should your threat system activate 
are ways we try to activate the soothe system to help you feel prepared and more confident in 
returning to sex.  
 
Week 2 Practice:  
3. Practise everyday mindfulness/ grounding technique - choose one task to focus on for 
the whole week.  
4. Listen to mindfulness audio every day to practice being in the present moment  
 
 
 
 
 
 
Specific Grounding Phrase 
e.g 'this is just a memory, 
and although it is painful it 
is not happening to me now. 
This is in the past- I am safe 
now
Using a grounding object 
e.g stressball, essential oils, 
weighted object 
Asking your partner to 
practice grounding 
techniques 
Practicing 54321 
Grounding

 
 
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Session 3 – Desire and the sensual self  
Script 
 
Welcome to session 3. This week we will focusing on a very important relationship, the 
relationship you have with yourself.  
 
To start the session, I would like you to reflect on all our beliefs about sex and how we learn 
about sex. If we start thinking about the natural behaviours we do as humans, such as walking 
and talking - these are things we naturally learnt to do. We needed a lot of support, coaching, 
guidance and patience from supportive caregivers to learn to walk. Even once we’ve learnt to 
walk, we might injure ourselves later in life (e.g. break a leg) and need to learn again. Recovery 
will be more effective with the help of compassion from others, patience and practice.  Sex 
isn’t any different to this – it’s also something we learn. There’s a myth that because sex is 
natural, we should instantly be ‘good’ at it. This isn’t the case. Learning about what our bodies 
need and enjoy, and what our partners find pleasurable can take time. We might even have 
events later in life which set us back (e.g. infections/menopause/illness/child birth/trauma). 
Following this, sex might require re-learning and we might have to change our beliefs about 
sex. Sex is not static – sex is something that shifts and develops/changes over time and is 
something you can work on.  
 
What are your beliefs about sex and where do they come from? Some example beliefs include  
• 
Sex should always end in an orgasm 
• 
If I’m in love, it should be easy 
• 
Sex is only done in marriage  
• 
Sex always involves vaginal penetration 
• 
Everyone else is having great sex 
• 
Sex should always be a deeply emotional experience OR the opposite, sex is only 
physical  
 
These beliefs can come from family, culture, religion and societal norms. However, these 
beliefs can be unhelpful and make you feel worse about yourself. Many sexual difficulties 
result from one’s own assumptions and expectations about sex. This is not because you are 
doing anything wrong, but we are taught to believe certain things about sex.  
 
Desire 
Similarly, we may have beliefs about desire arousal during sex.  
 
Desire and arousal arise due to complex brain processes. Emily Nagoski is a sex educator and 
researcher, she explains how we can think of the processes that are involved in desire as a 
sexual accelerator that notices all sexually relevant information in your environment to turn 
you on BUT we also have the sexual brakes which notices all the reasons not to be turned on 
right now and neurologically tells your sexual system to turn off.  
The process of being aroused is a two-way process of turning on the accelerator and turning 
off the brakes. Everyone accelerator and brakes have different sensitivities.  

 
 
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Difficulties with desire and arousal occurs if you cannot turn on the accelerator or more 
often, because there’s too much stimulation on the brake.  
 
Reflection: at this point it may be helpful to Reflect on what may turn on your sexual 
accelerator or what may cause your brakes to get stimulated – you may not have any answers 
and that’s okay – there is not right or wrong answers here. It is just something that may be 
helpful for some of you to think about.  
 
Unfortunately, the process gets more complex research has shown that if you are a stressed or 
in a threatened state of mind – your tricky brain will interpret almost any sensation as 
something to be avoided, as a potential threat and turn off the sexual accelerator while hitting 
hard on the sexual brakes .  Telling your sexual system to turn off leading to reduced or no 
desire.  
 
This is common for many individuals with or without an experience of sexual trauma and is 
not your fault. Some people may blame themselves for having increased or reduced desire 
after an experience of sexual assault but this is not something you have done to yourself. it’s 
how your brain works to protect you even when it is unhelpful –The main goal of this 
intervention is not necessarily to increase desire or arousal for sex but to understand why you 
may be experiencing some of your difficulties and treat yourself more kindly since your 
challenges are not your fault. However, if you want to work on your desire, we have included 
some ideas in your hand out if you are ready to try. 
 
 
 
Inner Sex Critic 
One thing that does hit the brakes are self-blaming self- critical thoughts. It is a very common 
experience for survivors of sexual assault to have an inner sex critic who may be harsh and 
blaming towards yourself – this voice tells you things such as:  
 
Why can’t you do this? 
There’s something wrong with you 
You’ll never have a proper relationship  
Everyone else finds sex easy 
You’ll never be able to enjoy sex  
It's all pointless 
You're weird 
It's your fault 
You don’t deserve to have enjoyable sex? 
 
The inner sex critic is part of the threat system, which is trying to protect you from getting hurt 
or experiencing trauma again. However … it often does more damage than good. The inner sex 
critic can take different forms at different times. Sometimes it repeats what others have said or 
societal messages or expectations. Listening to the inner critic can be very painful and shouting 
at it to "shut up" doesn't usually work. It is one of the reasons we covered mindfulness as being 
present in the moment and how it helps you acknowledge the inner sex critic without buying 
into what they are saying.  
 

 
 
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Mindfulness gives us a way to acknowledge the inner sex critic without buying into what they 
are saying. It can also be helpful to think about what you may say to a friend if they experience 
the same difficulty. Would you tell them it’s their fault they have sexual distress and weird that 
they can’t do it? It is also helpful to develop an inner compassionate self to help you be kinder 
with yourself and build resilience to the inner sex critic.   
 
We will now do a short exercise to develop your compassionate self developed by Paul 
Gilbert– as always if you do not feel comfortable doing this exercise, you can opt out before 
we begin and take some time now to do something nice for yourself. You also have the option 
to stop the exercise once we begin.  
 
Get into a comfortable position and begin by focusing on your breathe. When you feel that 
your body has slowed down (even slightly) and you are ready for your practice, imagine that 
you are a very deeply compassionate person. Think of all the qualities that you would ideally 
have as that compassionate person. First focus on your desires to become a compassionate 
person and to be able to think, act and feel compassionately. Next, imagine being wise and 
having wisdom – a wisdom that comes from your understanding about the nature of our lives, 
of our minds and bodies and that there’s so much that goes on inside of us which is not our 
fault but the result of evolution and experiences over which we had no control  
 
 Then when you are ready and have a sense of your wisdom, imagine having strength, maturity, 
authority. Explore your body posture – sit in a position in a way that matches your idea of being 
strong. Your facial expressions should also reflect your assertiveness and what it feels like to 
be confident. Remember you are imagining yourself as a person that understands one’s 
difficulties and those of others, in a non-judgmental way, and has confidence to be sensitive, 
with an ability to tolerate difficulties. 
 
 When you are ready, move on to focusing on qualities of warmth and gentle friendliness. 
Imagine being warm and kind. Create a compassionate facial expression. Imagine yourself 
speaking to someone and hear the warm tone of your voice; imagine reaching out to someone 
with warmth and know what that might be like. 
 
Then when you are ready switch to imagining a feeling of responsibility. Imagine that you have 
lost interest in condemning or blaming and are now wanting to do the best you can to help 
yourself and others move forward. Hold on to your compassion and facial expression of 
warmth, but just focus on this experience of taking up responsibility and committing yourself 
to being more compassionate with yourself.  
 
Remember, it doesn’t matter if you feel you have these qualities or not, just imagine that you 
have them. See in your mind yourself having them, and work through them steadily, playfully 
and slowly. Finally, imagine yourself having all of these qualities and incorporating them into 
the way you are with yourself and others. 
 
When you have finished, bring yourself gently back into the room. You might want to write 
down what it felt like to have these qualities and how it might affect the way you want to act 
in the future.  
 
If you like to take some time to write down how you feel after the exercise feel free to do so. 
Holding in mind your compassionate self, we would like to end the session thinking about your 
sensual self.  

 
 
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Sensual Self 
Sexual trauma influences your sexual identity with a partner but more importantly, with 
yourself. When you have an experience of trauma it can trigger feelings of shame or guilt for 
feeling sexual or good about yourself. You may also let the needs of others overshadow your 
own needs and it is important to turn towards yourself by doing things every day for no one 
else’s needs but your own.  
 
Redefining your sexual self builds more ownership of your body, and helps you be in touch 
with your feelings and needs.  
 
The sensual self is how you view sexually outside of relationships with other people/  It can 
help build confidence in yourself and if you would like to return to sex, it can help increase 
desire and motivation for sex. 
 
This could include wearing clothes that you enjoy, seeing someone on the street that you find 
attractive, moving your body in a way that feels good for you or wearing makeup that you 
love. Many of these things are part of the sexual self. These are also more gentle ways to 
explore your sexual self in small steps before considering being intimate with someone else. 
It may be helpful to think of rebuilding your sensual self as taking yourself on an adventure 
of learning more about yourself and what you enjoy.  
 
Remember it takes time to rebuild your sensual self and learn to prioritise yourself after 
sexual trauma, so don’t worry if this feels like a slow process, that’s normal.  
 
One way to work on the relationship with yourself and rebuild your sexual self is turning 
towards yourself with compassion and kindness. As a practice exercise for this week, I invite 
you to write yourself a compassionate letter. This letter is written by you and addressed to 
you.  
 
The idea behind the compassionate letter comes from Paul Gilbert to help people engage with 
their difficulties with a focus on understanding and warmth towards themselves. It is to turn 
towards yourself in a non-judgemental way with a position of kindness and understanding of 
your difficulties instead of being harsh or blaming of yourself.  (Appendix C). Towards the end 
of the compassionate letter you may also want to focus on being compassionate to your sensual 
self and consider how you can incorporate activities to build on yourself sensual self but what 
you decide to do is up to you,  
 
We know it may not be easy to be compassionate with yourself and it is understandable if you 
find this exercise difficult. Not many people are used to being kind to themselves but we 
encourage you to try to do this exercise and see what happens over time. Research has also 
found that expressive writing can help people deal with difficult life experiences. When writing 
the letter, we encourage you to be empathetic and warm – as if you were writing to a loved 
one. Avoid going into ‘I should or should not’, ‘why don’t you’ advice – be supportive and 
encouraging. We have included a guidance for this in this week’s handout and encourage you 
to try the exercise sometime this week. However, if you are not able to now it’s okay to opt out 
of the exercise. This letter will be your practice for this week, thank you for attending the 
session today, next week will be our final session.  
 

 
 
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Session 3: Handout 
 
Re-learning Sex  
Reflection: What are your beliefs about sex? Where do they come from?  
 
 
 
 
Desire in Relationship  
 
 
 
Emily Nagoski simplifies the complex sexual processes that occur during arousal into two 
mechanisms – the sexual accelerator and the brakes. The accelerator and brakes are constantly 
seeking out information from everything you hear, see, touch, taste, smell and imagine.  
 
 
The process of being aroused is a two-way process of turning on the sexual accelerator and 
stepping off the brakes. Difficulties with arousal mostly arise as there’s too much stimulation 
to the brake and all kinds of things can hit the brake. 
 
 
Reflection: What are the things that hit your sexual accelerator – TURN ON  
 
 
 
 
What are the things that hits the brake – TURN OFF  
 
 
 
 
•notices all the sexually relevant information in the environment and TURNS ON arousal   
Sexual Accelerator
•notices all the relevant information and reasons not to be aroused and TURNS off arousal
Sexual Brakes

 
 
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However, it’s not just what the sexual accelerator and brake notices in your environment 
because research has shown that if you are a stressed out or in a threatened state of mind – your 
tricky brain will interpret almost any sensation as something to be avoided, as a potential threat 
and turn off the sexual accelerator while hitting hard on the sexual brakes .  
 
Ideas to release the brake  
• Begin with non-sexual touch either on your own or with a partner. There is no 
pressure for this touch to become sexual unless you feel comfortable for it to. 
Affection can signal to your brain that you are in a safe place and reduce stress.  
• Create a stress free environment for yourself when you want to have sex on your 
own or with your partner– this can look like whatever you want – lights on/off, 
having candles, calming music.  
• Practice being present in the moment and focus on the sensations you feel currently  
• Accepting yourself as you are and not being critical about what you are doing or 
how you look. This is much easier said than done but being self-blaming or listening 
to the inner self critic will hit the brakes.  
 
Inner Sex Critic 
Having an inner sex critic who criticises you is something that can step on the sexual brakes. 
If you experience an inner sex critic, this is not your fault, it is also really common for survivors 
of sexual assault to have an inner sex critic who tells you things such as:  
 
 
 
The inner sex critic is part of the threat system which is trying to protect you from getting hurt 
or experiencing trauma again. However … it often does more damage than good and can slam 
on the your brakes cause difficulties in desire and other areas of your sex life.  
 
Mindfulness gives us a way to acknowledge the inner sex critic without buying into what they 
are saying. It can also be helpful to think about what you may say to a friend if they experience 
the same difficulty. Would you tell them it’s their fault they have sexual distress and weird that 
they can’t do it?  
 
Why can’t you do 
this?
There’s something 
wrong with you
You’ll never have 
a proper 
relationship 
Everyone else 
finds sex easy
You’ll never be 
able to enjoy sex 
It's all pointless
You're weird
It's your fault

 
 
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Compassionate Self Exercise  
 
Reflection:  
 
 
 
 
 
Activities to build on sensual self  
Sexual trauma can change the way we view our selves sensually. Redefining your sensual self 
is an important step in gaining control over your body and becoming in tune with your 
emotional feelings. The sensual self is how you view sexually outside of relationships with 
other people/  It can help build confidence in yourself and if you would like to return to sex, it 
can help increase desire and motivation for sex.  
1. Turning towards yourself with compassion 
2. Doing things for yourself and not for others 
 Wearing clothes you love  
 Wearing make up that makes you feel confident 
 Using products you like the feel of such as a nice moisturiser or hair 
mask  
 Doing your hair in a way that you like  
 Wearing jewellery that makes you feel good  
 Getting a temporary tattoo that you like 
 
3. Appreciating your body  
 Moving your body in a way you like – exercise, dancing, walking.  
 Taking care of your body by stretching or pampering yourself with a face 
mask 
 Giving yourself massages  
 
Practice: Compassionate Letter Writing 
 
The idea behind the compassionate letter comes from Paul Gilbert to help people engage with 
their difficulties with a focus on understanding and warmth towards themselves. It is to turn 
towards yourself in a non-judgemental way with a position of kindness and understanding of 
your difficulties instead of being harsh or blaming of yourself. 
 
Session 3 Practice Ideas 
1. Listen back to the compassionate self audio throughout the week  
2. Just as we discussed being mindful everyday, try to practice being compassionate 
with yourself daily 
3. Gently explore your sensual self in any way that feels right for you  
4. If you feel ready, write yourself a compassionate letter using the guidance provided in 
Appendix C  
 

 
 
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Session 4 – Psychosexual techniques and relationships with others  
Script 
 
Welcome to the final session.  In the first session we covered your threat alarm system and how 
your body and brain tries to protect you after an experience of trauma. In the second session, 
we focused on being in the present moment through mindfulness and everyday mindfulness. 
We also covered grounding techniques which can be used to bring you back to the present 
moment. In the third session, we thought about the relationship you have with yourself and the 
tendency for people with experience of sexual trauma to develop a harsh inner critic. 
Throughout the last 3 sessions, we have woven in the idea of being kinder and more 
compassionate to yourself as a way to inhibit the threat system and trigger the soothing system. 
Being more understanding of yourself is an indirect way to aid in your confidence or motivation 
to return to sex. In our final session today, we will be introducing the conditions of good sex 
model and think more about your relationships with others as well as cover a range of 
psychosexual exercises that you can do alone or with a partner. As always, you have the choice 
to decide if you would like to try out these exercises. There is no pressure to do anything if you 
are not comfortable.  We have included the links to handout for the exercises in the email 
instead of including it in this material so you have the choice to view them if you are interested 
and comfortable.  
 
Let’s begin with a short exercise and start by being compassionate with yourself as you have 
done so well to attend each week. As always, you can opt of this exercise and do something 
nice for yourself instead such as just taking a few deep breaths or preparing a nice warm or 
cool drink.  
 
Compassionate Colour Exercise – by Paul Gilbert 
 
Sit in a comfortable position and if you feel comfortable, close your eyes. Beginning by 
focusing on your breath and when you’re ready,  imagine a colour that you associate with 
compassion, or a colour that conveys some sense of warmth and kindness. Again, it might only 
be a fleeting sense of colour but when you are ready, imagine your compassionate colour 
surrounding you. Then, imagine this entering through your heart area and slowly through your 
body. Or you might prefer to think of colour like a mist or light that just flows though you. As 
this happens try to focus on this colour as having wisdom, strength and warmth, with a key 
quality of total kindness. Create a facial expression of kindness on your own face as you do 
this exercise. Now, as you imagine the colour flowing through you focus on the feeling that 
the sole purpose of this colour is to help you, to strengthen you and support you. 
 
 
To begin this session, we want to introduce this model of good sex. The conditions for good 
sex triangle consists of being in the moment, physical touch and psychological arousal. The 
conditions that you feel are important for psychological arousal and physical touch differ from 
person to person. Each condition also impacts each other. This triangle is a good way for you 
to reflect on your sex life currently. It can help you understand which area you may have more 
difficulties  
 
In the last 4 weeks, we have covered being in the present moment and aspects of psychological 
arousal. Later we will think more about enjoying physical touch.  

 
 
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However, you can also see how communication with a sexual partner is an important condition 
and although we have briefly mentioned this in session 2 when we discussed grounding, we 
also want to think of how your relationship with others may change after sexual trauma.  
 
Relationship with others 
After traumatic sexual experiences, some people might notice a difference in their relationships 
or interactions with partner/s. – remember that this is not your doing but a common experience 
of anyone who has experienced trauma. Some partners may be understanding by responding 
with empathy and patience in relation to sexual intimacy 
Others may struggle to understand, and could take a less helpful stance  
If you are currently with a sexual partner/s, or would like to enter into a romantic or sexual 
relationship in the future, it can be helpful to reflect on the dynamics between you and your 
partner/s and consider the following: 
 How understood do you feel? How safe do you feel to engage in sex? How supportive 
is your partner of your needs and the pace you would like to take things?Are your 
‘conditions for enjoying sex and intimacy’ being met? 
 
If you find it difficult to be intimate with a partner, it may be helpful to first practice on your 
own  
 
 
Self-Practice – from sexualwellbeing for all 
Mindful Self-Practice is A good way to feel more in tune with your own body and develop 
your sensuality is through exploring physical touch. One way to do this is through 
masturbation. I know it may be a awkward topic but self-practice is a great way to get to know 
your body, find out what you like but also helps you regain some control over your body. This 
can also feel like a safer first step before being intimate with a partner. Being mindful during 
self-practice means trying to focus on the physical sensations instead of allowing your mind to 
wander worrying about performance or self-criticism. If you are interested to try self-practice 
we have included a link to a more detailed handout by sexualwellbeingforall. If you are not 
comfortable with masturbation that’s okay too, this can be about exploring touch in a way that 
feels safe for you and just getting to know your body. 
 
 
https://sexualwellbeingforall.files.wordpress.com/2019/05/mindful-self-practice-for-
those-with-a-vulva-1.pdf 
 

 
 
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Sensate Focus  
If you have a trusted partner who you want to try an exercise with, you can try sensate focus 
which is practicing intimacy without genital contact. Sensate Focus is a set of exercises geared 
towards couples where the focus of sex is shifted from pursuing a particular outcome (e.g. 
penetration or orgasm), to a slower appreciation of physical intimacy and sensations. Sensate 
focus does not involve penetrative sex or other sex acts that can feel uncomfortable, painful or 
triggering, as the idea is to instead engage in various forms of giving and receiving touch that 
feel comfortable, unpressured and at a pace that feels right for you. Removing the pressure to 
achieve orgasm or have penetrative sex allows the partners to connect more deeply within the 
present moment. Often, the pressure to “perform” during sex can lead to anxiety, tension and 
less enjoyment. Sensate focus is about being in the moment and using your five senses (hearing, 
seeing, touching, listening and tasting) to help you and your partner focus on the sensations 
that are produced by exploring each other’s bodies.  These exercises start with an agreement 
for no genital contact, and gradually progress through a series of stages at a pace that feels 
comfortable for both partners.  
  
Sensate focussing exercises are done in three stages. In order to get the maximum benefit, try 
to practice each stage 3 times per week for two or three weeks before advancing to the next 
stage – however, that is just a suggestion and you can do whatever feels best and right for you. 
Remember it is okay if you do not progress past the first stage, and if the first stage feels too 
much to start with it is okay to do adapt this, e.g. to start with doing this fully clothed or to 
specify parts of the body that you feel comfortable touching or being touched (e.g. just the 
hands or feet).  
 
For detailed information about this exercise visit  
https://sexualwellbeingforall.files.wordpress.com/2019/07/sensate-focus-2019.pdf 
 
Another way we can improve the conditions of sex is through psychological arousal and to do 
this we can use fantasies. Fantasies are internal images and stories which are very common for 
everyone to experience. Sexual fantasies can be used to help trigger sexual arousal. Often we 
cannot control sexual fantasies and it is common for violent fantasies to be experienced 
following sexual assault. This is not something you choose to experience, it is the way our 
brains process and codes our experiences. Even if you become aroused by an unwanted fantasy, 
it doesn’t mean you enjoy/enjoyed it or want it - tricky brain can make associations that we 
don’t necessarily want. This is termed arousal non-concordance when your brain is aroused by 
something you don’t want. It is common and okay.  
 
 Just like the inner critic, we cannot force violent fantasies away but we can learn to develop 
new fantasies as our brains able to learn new skills. . Some people may feel guilty about having 
unwanted fantasies but there is no such thing as wrong thoughts or feelings. What is more 
important is how you treat yourself when these difficulties arise. We can try be kinder to 
ourselves about the fantasies we have and  reduce the shame associated with the fantasies 
 
Sexual fantasies are normal and involves you trusting yourself and letting your imagination go.  
 
With any of these practices, they may feel like a big step and that’s understandable and okay, 
go at your own pace. 
 

 
 
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Returning to sex after trauma is understandably challenging and there is no reason to be critical 
or harsh with yourself if you’re finding it more difficult. As we mentioned in the first session, 
your tricky brain sets off your threat system thinking it is protecting you. It is also an experience 
many survivors of sexual trauma experience, there is nothing wrong with you if you have any 
difficulties or no difficulties returning to sex. Over the last four sessions we hope we have 
deepened your understanding of your difficulties and through that understanding you have 
learnt to be more compassionate with yourself as your current experience is not your fault.  
 
We hope that you have learnt some new skills as well to help you reduce the negative 
experience you may have during sex. We encourage you to continue practicing any of the 
exercises you found helpful throughout the four weeks. You will also be able to keep the 
handouts and refer back to them at any time.  
 
We would like to thank you for attending each week and for continuing to fill in the measures. 
Your participation will aid future research into providing resources for survivors of sexual 
trauma with difficulties returning to sex. Thank you for taking part in this study, please fill in 
measures for the week. Afterwhich, we will be in touch with you in four weeks to check in on 
how you are doing.   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
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Session 4: Handout 
Exercise: Compassionate Colour 
Reflections:  
 
 
 
Conditions for good sex  
 
 
 
Relationships  
After traumatic sexual experiences, some people might notice a difference in their relationships 
or interactions with partner/s.  
• 
Some partners may be understanding by responding with empathy and patience in 
relation to sexual intimacy 
• 
Others may struggle to understand, and could take a less helpful stance  
If you are currently with a sexual partner/s, or would like to enter into a romantic or sexual 
relationship in the future, it can be helpful to reflect on the dynamics between you and your 
partner/s and consider the following: 
• 
How understood do you feel?  
• 
How safe do you feel to engage in sex?  
• 
How supportive is your partner of your needs and the pace you would like to take 
things? 
• 
Are your ‘conditions for enjoying sex and intimacy’ being met?  
 
 
 

 
 
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Activities involving physical touch 
 
Self Practice or masturbation is another technique you can use to feel more in tune with your 
own body. It can help you regain some control over your body and understand more about 
what feels pleasureable for you. 
 
For detailed information about this exercise: 
https://sexualwellbeingforall.files.wordpress.com/2019/05/mindful-self-practice-for-those-
with-a-vulva-1.pdf 
 
Sensate Focus is a set of exercises geared towards couples where the focus of sex is shifted 
from pursuing orgasmic outcome, to a slower appreciation of physical intimacy and 
sensations. Removing the pressure to achieve orgasm allows the partners to connect more 
deeply within the present moment 
 
For detailed information about this exercise: 
https://sexualwellbeingforall.files.wordpress.com/2019/07/sensate-focus-2019.pdf 
 
 
Sexual Fantasies are images and stories that trigger arousal and helpful in providing 
conditions for good sex. You can use fantasies to help with arousal and desire. However, it is 
also common for violent fantasies to be experience after sexual trauma. Even if you become 
aroused by an unwanted fantasy, it doesn’t mean you enjoy/enjoyed it or want it - tricky brain 
can make associations that we don’t necessarily want. Some people may feel guilty about 
having unwanted fantasies but there is no such thing as wrong thoughts or feelings. What is 
more important is how you treat yourself when these difficulties arise.  
 
Using fantasies are a great way to elicit sexual arousal and is completely normal & natural 
healthy expression of your sexuality. Fantasies can be about whatever you want and you can 
use then during self practice or with a partner – try it if you are comfortable and if you aren’t 
that’s alright.  
 
Week 4 Practice:  
If you feel comfortable, try any or all of the exercises covered in this session throughout the 
week. There is no need to force yourself if you don’t feel ready – you are in control and have 
the choice.  
 
 
Thank you for engaging in these materials over the last 4 weeks. We hope you continue to 
practice being kind and compassionate with yourself even if you are still finding returning to 
sex difficult. That’s okay. You took a big step to continue to engage in these materials and that 
is enough.  
 
 
 
 
 
 

 
 
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Appendix 
 
 

 
 
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Appendix A 
 
Signposting and Support Handout  
 
Mental Health Support Lines: 
 
Samaritans – Offers free 24/7 support.  
 
 Call 116 123 or email jo@samaritans.org (24 hours, every day) 
 
SHOUT –  Offers free 24/7 mental health support text service if you prefer not to talk. 
 
Text SHOUT to 85258 (24 hours, every day)  
 
Campaign Against Living Miserably (CALM) – Offers our of hours support (5pm – 
midnight, everyday) 
 
Call 0800 58 58 58 or their webchat service through the website 
 
SANEline – Offers out of hours mental health support (4pm to 10pm everyday)  
 
0300 304 7000 
 
Support related to sexual violence and abuse:  
 
Rape Crisis England & Wales - Provides information and support to survivors of sexual 
violence, sexual assault and sexual abuse across England and Wales.  
 
Freephone 0808 802 9999 (12 to 2.30pm, then 7 to 9.30pm, every day) 
 www.rapecrisis.org.uk  
 
Rape Crisis Scotland - Provides information and support to survivors of sexual violence, 
sexual assault and sexual abuse across Scotland.  
 
Freephone 0808 801 0302 (6pm to 12am, every day) www.rapecrisisscotland.org.uk  
 
Nexus NI - Offers free counselling for people who have experienced sexual violence, sexual 
assault and sexual abuse across Northern Ireland. http://nexusni.org/  
 
Galop - Galop gives advice and support to people who have experienced biphobia, 
homophobia, transphobia, sexual violence or domestic abuse. They also support lesbian, gay, 
bi, trans and queer people who have had problems with the police or have questions about the 
criminal justice system.  
 
Helpline: 020 7704 2040  http://www.galop.org.uk  
 
National Association for People Abused in Childhood (NAPAC) - Offers support to adult 
survivors of childhood abuse.  
 

 
 
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Support line 0808 801 0331 (10am to 9pm, Monday to Thursday, and 10am to 6pm on Friday) 
https://napac.org.uk/  
 
Southall Black Sisters - Campaigning, information and advice for women affected by gender-
based violence. 
 
 Helpline: 0208 571 0800 http://www.southallblacksisters.org.uk/ 
 
FORWARD - Advice, support and specialist health care for girls and women affected by 
FGM. FORWARD is staffed by sensitive and approachable African women who as well as 
English speak Arabic and several other African languages.  
 
Helpline: +44 (0)20 8960 4000 http://www.forwarduk.org.uk/resources/support 
 
 
Guided meditations for self-compassion:  
• http://self-compassion.org/category/exercises/#guided-meditations 
 
Mindfulness apps 
• Headspace 
•  The Mindfulness App 
• Mindfulness Daily 
• ACT Coach 
• Calm 
 
Sexual pain: http://www.scarleteen.com/node/85 
 
A website dedicated to exploring the many ways that women can experience sexual pleasure. 
Includes videos and tutorials: www.omgyes.com  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
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Appendix B 
 
Communicating with a partner about level of comfort with sex after trauma 
 
Ground Rules & Boundaries:  
 
Ground rules should be established before the discussion to create an environment that allows 
partners to share their feelings in a safe way. It may be helpful to write these down to refer 
back to if needed. You may not agree on everything and that’s okay, having ground rules 
ensures each view is expressed and respected.  
 
Listening: Listening actively, trying to understand your partners point of view. Being emphatic 
and listening with your full heart. Understanding their difficulties, desire, feelings and action.  
 
During this talk you can discuss with your partner  
 The impact of sexual trauma and how it affects the way survivors return to sex – this is 
physiological and biological response that you have no control over and is not your 
fault. (You may choose to share or discuss the brains alarm system from session 1)  
 the level of comfort with sex – are there any dos or don’ts specific to you? Anything 
you would prefer your partner to do/not do? This can start very simple e.g. holding 
hands, dancing, cuddling up in bed with a film. It can then branch into sexual things 
you feel comfortable with. You can compare ideas with your partner and see if anything 
on your ‘safe’ list also appeals to them.  
 Go through the sexual activities list and body map together 
 What sexual terms are off limits?  
 Agree to stay away from shaming each other 
 Be as specific as you can, giving examples of what you mean and offer different options 
for solutions with the understanding that these options can be negotiated and 
compromised on.  
 Tell your partner what they do well, not just what needs to be changed  
 Grounding techniques that you can use together  
 Safe words to use if either of you are feeling uncomfortable at any point and how that 
is not a sign of rejection but a pause to look after yourself. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
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Appendix C 
 
Sexual Activities List and Body Map  
 
Using the sexual activities list and/or body map as guidance to reflect on areas you are happy 
to explore with your partner or the areas you are less happy to explore.  
 
You do not need to share this list with your partner, this list is for you to use. Share only what 
you are comfortable with.  
 
Anal Sex 
Cuddling 
Cunnilingus 
Ejaculation 
Eye Contact 
Face Sitting 
Fellatio 
Foot Play 
Fingering 
Hand Holding  
Handjob 
Hair Pulling  
Kissing (where) 
Lingerie  
Massage  
Masturbation  
Sexting 
Sex Toys  
Slapping (where) 
Phone Sex 
Teasing  
Tickling (where) 
Touching (where)  
Vaginal Pentetration 
Watching  
69  
 
You can include your own 
activities as well  
____________ 
____________ 
____________ 
____________ 
____________ 
____________ 
____________ 
____________ 
____________ 
____________ 
____________
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
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Looking at the images below, reflect on what areas you are happy to explore and which 
areas you are not ready to.  
 
This activity can be done on your own before discussion with a partner if you feel ready to do 
so.. You do not need to share the body map with them if you are not comfortable 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
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Appendix E 
 
Compassionate Letter Writing developed by Paul Gilbert 
 
 
The purpose of compassionate letter writing is to help you refocus your thoughts and feelings 
on being supportive, helpful and caring of yourself. In practicing doing this it can help you 
access an aspect of yourself that can help tone down negative feelings and thoughts.  
 
The key of this exercise is to practice becoming inwardly gentle, kind, compassionate and 
self supportive. It takes time to build this compassionate muscle. You can practice thinking 
about how, each day, you can become more and more as you wish to be. As in all things there 
will be good times and not so good. Spend time imagining your postures and facial expressions, 
thoughts and feelings that go with being compassionate and practice creating these inside you. 
This means being open with our difficulties and distress, rather than just trying to get rid of 
them.  
 
To start your letter, try to feel that part of you that can be kind and understanding of others; 
how you would be if caring for someone you liked. Draw upon the qualities you would like 
your compassionate self to embody. You do not have to feel like is who you are currently to 
draw on being compassionate.  
 
As you write your letter, try to allow yourself to have understanding and acceptance for your 
difficulties and distress. For example, your letter might start with “I am sad you feel distressed; 
your distress is understandable because…….” Note the reasons; realizing your distress makes 
sense. Then perhaps you could continue your letter with… “I would like you to know 
that………..” (e.g., your letter might point out that as we become depressed, our depression 
can come with a powerful set of thoughts and feelings – so how you see things right now may 
be the depression view on things).  
 
You can consider the following when writing your letter but you do not need to cover them all. 
Alternatively, you can write different things in different letters to yourself. As you write these 
letters avoid telling yourself what you should or should not think, feel or do. There is no right 
ot wrong, it is the process of trying to think in a different way that is important  
 
Standing Back: Once you have acknowledged your distress and not blamed yourself for it, it is 
useful if your letter can help you stand back from the distress of your situation for a moment. 
If you could do that, what would be helpful for you to focus on and attend to?  
 
Not alone: When we feel distressed we can often feel that we are different in some way. 
However, rather than feeling alone and ashamed remember many others can feel depressed 
with negative thoughts about themselves, the world or their future.  
 

 
 
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Reduce Self criticism: If you are feeling down, disappointed or are being harsh on yourself, 
note in your letter that self criticism is often triggered by disappointment, loss or fear. So we 
need to acknowledge and be understanding and compassionate about the disappointment, loss 
or fear. Allow yourself to be sensitive to those feelings.  
 
 
Compassionate behavior: It is useful to think about what might be the compassionate thing to 
do at this moment or at some time ahead – how might your compassionate part help you do 
those things? So in your letter you may want to think about how you can bring compassion into 
action in your life. If there are things you are avoiding or finding difficult to do, write down 
some small steps to move you forward. Try to write down steps and ideas that encourage you 
and support you to do the things that you might find difficult.  
 
Dilemmas: If you are in a dilemma about something, focus on the gentle compassionate voice 
inside you and write down the different sides of the dilemma. Note that dilemmas are often 
difficult, and at times there are hard choices to be made. Therefore, these may take time to 
work through. Talking through with others might be a helpful thing to do. Acceptance of the 
benefits and losses of a decision can take time.  
 
Compassion for feelings: Your compassionate side will have compassion for your feelings. If 
you are having powerful feelings of frustration, anger or anxiety, then compassionately 
recognize these. Negative emotions are part of being human and can become more powerful 
in depression or when we are distressed but they do not make you a bad person – just a 
human being trying to cope with difficult feelings. Your compassionate mind will remind you 
that we often don’t choose to feel negatively and these feelings can come quite quickly. In 
this sense it is ‘not our fault’, although we can learn how to work with these difficult feelings 
and take responsibility.  
 
What is helpful: Your letter will be a way of practicing how to really focus on things that you 
feel help you. If thoughts come to mind that make you feel worse, then notice them, let them 
go and refocus on what might be helpful – remember there are no ‘I shoulds’.  
 
Warmth: Now try to focus of the feelings of warmth and genuine wish to help in the letter as 
you write it. Spend time breathing gently and really try, as best you can, to let feelings of 
warmth be there for you. When you have written your letter, read it through slowly, with as 
much warmth as you can muster. If you were writing to somebody else would you feel your 
letter is kin. 
 
Remember that this is an exercise that might seem difficult to do at times but with practice you 
are exercising a part of your mind that can be developed to be helpful to you. Some people find 
that they can rework their letters the next day so they can think through things in a different 
way. The key of this exercise is the desire and effort of becoming inwardly gentle, 
compassionate and self-supportive. The benefits of this work may not be immediate but like 
‘exercising to get fit’ can emerge over time with continued practice. Sometimes people find 
that even though they are depressed they would very much like to develop a sense of self that 
can be wise and compassionate to both themselves and others. You can practice thinking about 
how, each day, you can become more and more as you wish to be. As in all things there will 
be good times and not so good. Spend time imagining your postures and facial expressions, 
thoughts and feelings that go with being compassionate and practice creating these inside you. 

 
 
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This means being open with our difficulties and distress, rather than just trying to get rid of 
them. 
 
 
Exercise by Paul Gilbert (2007) 
 
Additional optional activity: building on the sensual self 
 
If you would like to add an additional component to the compassionate letter, it is encouraged 
that you reflect on how you would like to build on your sensual self and also write this down 
in the letter. What kind of activities can you do for yourself that is for no one else. What makes 
you feel good about yourself? How would you like your sensual self to feel? You can 
incorporate aspects of compassion here as well. There is no need to be harsh or critical with 
yourself here but hold yourself with nurturing compassion.