The Pause Card: A Free STOP, Check the Facts and Urge Surfing Worksheet for Adults with ADHD

ADHD · DBT · Emerging

Four short skills for the gap between a trigger and what comes next: STOP, check the facts, opposite action and urge surfing. The client writes their earliest body signal, three cue words and a first move on a card that fits on a phone. The DBT skills are rated Emerging for adults with ADHD because the trial results are not consistent.

Underlying mechanism: DBT-Informed Pause Skills for Adult ADHD: STOP, Check the Facts, Opposite Action and Urge Surfing

What it helps with

  • Putting a small gap between a trigger and a reply, even a two-second one.
  • Checking the story against the facts before acting on it.
  • Choosing a small opposite action when an urge does not fit the facts.
  • Riding an urge as a wave that rises, peaks and falls, without acting on it or fighting it.

How clinicians use it

  • Teach STOP first at Session 4 and role-play a recent mild surge.
  • At Session 5 add check the facts, opposite action and urge surfing.
  • Keep the card to three cue words and one first move, and photograph it for a lock screen.
  • Say honestly that the DBT skills are Emerging for adults with ADHD and measure what changes.

Clinical Implementation Guide

  1. Teach STOP and role-play a mild recent surge.
  2. Add check the facts, opposite action and urge surfing.
  3. Fill in the card and photograph it for the client's phone.

What the worksheet looks like

The Pause Card — worked example
SkillWhat to do
S: StopFreeze for a moment. Hands off the keyboard or phone.
T: Take a step backOne slow breath. Put space between you and the trigger.
O: ObserveWhat am I feeling in my body? What is the story? What do I want to do?
P: Proceed mindfullyChoose the next small step on purpose, even if it is wait ten minutes.

Clinical cautions

The DBT skills are rated Emerging for adults with ADHD. This is not a comprehensive DBT programme: for frequent self-harm or suicidal behaviour use a risk plan and consider a full DBT pathway. Opposite action should only be used where the urge does not fit the facts and should be small and kind. Do not use it to push a client to stay in a situation that is unsafe. Start with a mild surge and not the worst one.

References

  1. Zhang, L.-Q., Pan, M.-R., Dong, M., Kong, X., Yu, Z.-Y., Zhang, S.-Y., Li, H.-M., Liu, L., Wang, Y.-F., & Qian, Q.-J. (2026). Group dialectical behavior therapy skills training versus group cognitive behavioral therapy for adults with ADHD: A randomized controlled trial. BMC Psychiatry, 26(1), 512. https://doi.org/10.1186/s12888-026-08130-w
  2. Kang, M. Y., Cheung, Y. C. H., & Wong, D. F. K. (2026). Mindfulness intervention reduced executive dysfunction, delay aversion, and ADHD symptoms: A randomized controlled trial based on the dual pathway model. Behavior Therapy, 57(4), 654-666. https://doi.org/10.1016/j.beth.2026.01.002
  3. Philipsen, A., Jans, T., Graf, E., Matthies, S., Borel, P., Colla, M., Gentschow, L., Langner, D., Jacob, C., Groß-Lesch, S., Sobanski, E., Alm, B., Schumacher-Stien, M., Roesler, M., Retz, W., Retz-Junginger, P., Kis, B., Abdel-Hamid, M., Heinrich, V., … Tebartz van Elst, L. (2015). Effects of group psychotherapy, individual counseling, methylphenidate, and placebo in the treatment of adult attention-deficit/hyperactivity disorder: A randomized clinical trial. JAMA Psychiatry, 72(12), 1199-1210. https://doi.org/10.1001/jamapsychiatry.2015.2146
  4. 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 10 October 2026, revised as the evidence develops.

Suggested citation (APA 7th edition): Pomfret, R. (2026). Steady the Surge: A skills-first, neuroaffirmative protocol for adults with ADHD and emotional surges (Version 1.0) [Therapist guide and worksheets]. Third Wave Therapy Tools. https://thirdwavetherapytools.com/

Part of

Steady the Surge

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.