Winter Early Warning and Action Plan: A Free Seasonal Relapse Prevention Worksheet
Relapse Prevention · CBT · Practice-informed
A relapse-prevention sheet that turns early warning signs into a traffic-light plan the client and their support people can use. It draws on the relapse-prevention content of CBT for seasonal affective disorder and on the finding that fewer people had a recurrence two winters after CBT than after light therapy. The plan format itself has not been trialled.
Underlying mechanism: Early-Warning Signs and Traffic-Light Action Plan for Seasonal Relapse Prevention (CBT-SAD)
What it helps with
- Agreeing personal early-warning signs and the point at which the client will act.
- Making amber and red responses concrete, including contacting the GP and asking for an earlier session.
- Naming support people and what to ask of them, so help is easier to request.
- Marking key dates in the winter and recording safety information in one place.
How clinicians use it
- Choose three to five signs with the client and agree the threshold in the room.
- Fill in each light with the client's own words and include floor-version anchors at amber.
- Review the plan against the lived winter at the January booster, and use the Winter Watch micro-tool to keep a weekly record.
Clinical Implementation Guide
- Agree the threshold in the client's words and write it on the sheet.
- Make sure the red column names a real person and a real action.
- Book the January booster and give the client the safety information.
What the worksheet looks like
| Light | What it looks like | What the client does |
|---|---|---|
| Green: steady | Mood and energy are workable and most routines are in place | Keep the usual anchors and light |
| Amber: slipping | Two or more early signs for a week | More morning light, anchors (floor versions count), daily slow breathing, talk to a support person, book a session |
| Red: needs help | Signs for two weeks or more. Work, sleep or relationships affected. Feeling hopeless | Contact the GP, tell the support person and ask for an earlier session |
Clinical cautions
This sheet includes safety information but is not a safety plan, so use your usual risk protocol at every session. Low winter mood can include suicidal thoughts. The traffic-light format has not been trialled, although it draws on the relapse-prevention content of CBT for seasonal affective disorder and on recurrence data. If the client already meets criteria for a current episode, use the usual depression pathway. This tool is not a substitute for individual face-to-face therapy or for emergency crisis support.
References
- Rohan, K. J., Meyerhoff, J., Ho, S.-Y., Evans, M., Postolache, T. T., & Vacek, P. M. (2016). Outcomes one and two winters following cognitive-behavioral therapy or light therapy for seasonal affective disorder. American Journal of Psychiatry, 173(3), 244-251. https://doi.org/10.1176/appi.ajp.2015.15060773
- Rohan, K. J., Burt, K. B., Norton, R. J., Perez, J., Iyiewuare, P., & Terman, J. M. (2023). Change in seasonal beliefs mediates the durability advantage of cognitive-behavioral therapy over light therapy for winter depression. Behavior Therapy, 54(4), 682-695. https://doi.org/10.1016/j.beth.2022.11.002
- National Health Service. (2025). Seasonal affective disorder (SAD) [Web page, last reviewed 17 December 2025]. https://www.nhs.uk/mental-health/conditions/seasonal-affective-disorder-sad/
Part of
Wintering Well
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