My Surge Plan and Keeping Going: A Free DBT-Informed Worksheet for Menopause and Perimenopause
DBT · DBT · Practice-informed
A one-page surge sequence, body-first options and a hard-weeks plan with early signs, what helps and who to contact, plus a note for very low moments.
Underlying mechanism: DBT-Informed Emotion Regulation Sequence and Relapse-Prevention Plan for Menopausal Emotional Surges
What it helps with
- Meeting a sudden surge of irritability, tears or panic with a short, practised sequence.
- Checking the facts and acting opposite when the urge would hurt something that matters.
- Repairing afterwards so shame does not lead to withdrawal.
- Planning for hard weeks, with early signs and people to contact.
How clinicians use it
- Use it at Session 6 and normalise surges before teaching the sequence.
- Practise the steps on a recent surge and choose body-first options.
- Write the early signs of a hard week and who the client will contact.
- Ask about hopelessness and follow your risk protocol.
Clinical Implementation Guide
- Learn the five-step surge sequence.
- Choose body-first options and write the early signs of a hard week.
- Write what helps and who you will contact and when.
What the worksheet looks like
| Sleep | Body | People | Kindness to myself |
|---|---|---|---|
| Steady wake time | A short walk | A friend who gets it | My kind-voice card |
Clinical cautions
Not a diagnostic or medical tool. Psychological support sits alongside medical care: encourage review by a GP or menopause specialist, especially for heavy or unusual bleeding, new or sudden symptoms or any symptom that worries the client, and never advise on starting, stopping or choosing hormone therapy. Screen for depression, anxiety and suicidal thoughts with your usual risk protocol before and during the work, because mood can worsen in the transition. Avoid pathologising a normal life stage or implying that symptoms are psychological in origin, and use inclusive language. Heat, sweating and breath focus can be activating for clients with trauma or panic, so go slowly, offer choice and let the client keep their eyes open. Breathing is taught to settle the body and the fear response and must not be promised to reduce hot flushes (Huang et al., 2015). Sleep window work needs the checks in the guide: avoid or modify it for bipolar disorder, seizure disorder, safety-critical work and suspected untreated sleep apnoea, and keep time in bed at or above about five and a half hours without specialist guidance. After breast cancer treatment or surgical menopause, coordinate with the oncology or medical team.
References
- Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Copyright and use in research
© 2026 Dr Richard Pomfret and Third Wave Therapy Tools. May be used in research with the author and site cited. Version 1.0, approved 20 October 2026, revised as the evidence develops.
Suggested citation (APA 7th edition): Pomfret, R. (2026). Steady Through the Transition: A third-wave protocol for menopause and perimenopause (Version 1.0) [Therapist guide and worksheets]. Third Wave Therapy Tools. https://thirdwavetherapytools.com/
Part of
Steady Through the Transition
Related worksheets
Next steps
- Browse the full clinical resource library — every worksheet, free and printable.
- Hear about new free resources. Join the clinician email list for occasional notes when there is something useful to share. The sign-up form is at the foot of this page once it has finished loading. This worksheet is free without signing up; unsubscribe anytime.
- Professional and Studio workflows — saved Client Packs, secure delivery and programme publishing when you need more than individual free resources.
