The Surge Map: A Free CBT Formulation and Goals Worksheet for Adults with ADHD

ADHD · CBT · Practice-informed

A page to fill in together at Session 1. It sets out the six steps of a surge with a made-up example, maps one recent medium-sized surge in the client's own words, finds the earliest step that can be caught, records three goals rated 0 to 10 and holds the clinician-completed measures at the start, at Session 8 and at the booster.

Underlying mechanism: CBT-Informed Shared Formulation, Goals and Baseline Measures for Adult ADHD and Emotional Surges

What it helps with

  • Showing a surge as a chain of steps, so that the earliest step, often a body signal, becomes visible.
  • Building a formulation in plain words, without blame and without treating strong feelings as a flaw.
  • Agreeing two or three goals that matter to the client and rating them at the start and the end.
  • Seeing whether the work is helping across several measures and not one symptom total.

How clinicians use it

  • Use it in the first session after confirming the ADHD assessment, and repeat the ratings and measures at Session 8.
  • Pick a medium-sized recent surge and keep the client's own words.
  • Complete the numbers box yourself with licensed measures, and say that the numbers are not a test.
  • If reading or writing is hard, complete the sheet together and keep the sitting short.

Clinical Implementation Guide

  1. Confirm the assessment, screen for risk and explain that the map is about steps, not blame.
  2. Work down one recent medium-sized surge and find the earliest step the client can catch.
  3. Agree goals, rate them, and repeat the ratings and measures at Session 8.

What the worksheet looks like

The Surge Map — worked example
StepA made-up example
1. TriggerA short, blunt reply to a message
2. BodyHot face, tight chest, heart racing
3. Thought"They are annoyed with me. I always get it wrong."
4. UrgeFire back a reply or go silent
5. ActionSent a sharp message
6. AftermathHours of shame, a row, a day lost

Clinical cautions

The measures box is for the clinician to complete with licensed instruments and is not a diagnostic or risk-assessment tool. Check licensing before using any of the named measures (WSAS, CORE-10, PHQ-9, GAD-7, DERS-16). The client does not need to share their past to use the map. Do not use the map to suggest the client is to blame. Where the formulation shows hopelessness, screen for suicidal thoughts and follow local risk procedures.

References

  1. López-Pinar, C., Selaskowski, B., Schulze, M., Oscarsson, M., Fenollar-Cortés, J., Sibley, M. H., Philipsen, A., & Hirvikoski, T. (2026). Cognitive behavioral therapy effects on global functioning, domain-specific functioning, and quality of life in adult ADHD: A comprehensive meta-analysis. Behaviour Research and Therapy, 201, 105026. https://doi.org/10.1016/j.brat.2026.105026
  2. Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., Groves, M., & Otto, M. W. (2010). Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: A randomized controlled trial. JAMA, 304(8), 875-880. https://doi.org/10.1001/jama.2010.1192
  3. Solanto, M. V., Marks, D. J., Wasserstein, J., Mitchell, K., Abikoff, H., Alvir, J. M. J., & Kofman, M. D. (2010). Efficacy of meta-cognitive therapy for adult ADHD. American Journal of Psychiatry, 167(8), 958-968. https://doi.org/10.1176/appi.ajp.2009.09081123
  4. Champ, R. E., Meneses, R. W., Adamou, M., Gillibrand, W., Arrey, S., & Tolchard, B. (2025). A neuroaffirmative, self-determination theory-based psychosocial intervention for adults with attention-deficit/hyperactivity disorder: Randomized feasibility study. JMIR Formative Research, 9, e69943. https://doi.org/10.2196/69943

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/

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Steady the Surge

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