Trigger Identification Worksheet

In this worksheet, you will explore the emotions, situations, thoughts, and sensations that often lead to urges to self-harm. Take your time and answer as honestly as you can.

1. Emotions and Feelings

List the main emotions you experience when you feel an urge to self-harm (for example: sadness, emptiness, anger, guilt). Write at least three.

2. Situations or Events

Describe specific situations, places, or events that often come before an urge to harm yourself (for example: an argument with a friend, feeling alone at home). List at least two.

3. Thoughts and Self-Talk

Write down any recurring thoughts or messages you notice in your mind when you’re feeling the urge (for example: “I don’t deserve help,” “No one cares about me”). List at least two.

4. Physical Sensations

Notice and describe any physical sensations you feel in your body during these moments (for example: tight chest, hollow feeling, numbness). List at least two.

5. Urge Intensity Rating

On a scale from 1 (very mild) to 10 (overwhelming), rate how strong your self-harm urges feel in these situations.

Situation/Event: ____________________ Rating: ___ / 10

6. Initial Coping Ideas

Based on what you’ve written above, list two coping strategies you might try next time you notice these triggers (you’ll explore these more in our next session).

Thank you for your honesty. We will use this information to choose and practice healthier ways to manage these feelings and urges in our next session. If you need to talk or feel unsafe at any point, please reach out to a trusted adult or contact your counselor immediately.

Coping Strategies Handout

When you feel the urge to self-harm, it can help to have a set of safer, go-to strategies. Try one or more of these and see what feels most grounding or soothing. Keep this handout nearby so you can check it when you need it.

1. Breathing and Relaxation

Box Breathing

1. Breathe in slowly for 4 counts.
2. Hold your breath for 4 counts.
3. Exhale slowly for 4 counts.
4. Hold for 4 counts.
5. Repeat until you feel calmer.

4-7-8 Breathing

• Inhale quietly through your nose for 4 counts.
• Hold the breath for 7 counts.
• Exhale completely through your mouth for 8 counts.
• Repeat 3–4 times.

2. Grounding Techniques (5-4-3-2-1)

Use your five senses to bring yourself back to the present moment:

• 5 things you can see (e.g., a poster on the wall)
• 4 things you can touch (e.g., the edge of your desk)
• 3 things you can hear (e.g., a ticking clock)
• 2 things you can smell (e.g., your lotion)
• 1 thing you can taste (e.g., a sip of water)

3. Physical Safe Alternatives

• Draw a red line on your skin with a washable marker instead of cutting.
• Hold or rub ice cubes until your skin feels very cold (then safely discard).
• Squeeze a stress ball or a folded washcloth as hard as you need.

4. Distraction Activities

Choose something simple that shifts your focus:

• Listen to an upbeat song or calming playlist.
• Draw, color or doodle on paper.
• Write a quick journal entry or list five things you’re grateful for.
• Do 10 jumping jacks or stretch your arms and legs.

5. Self-Soothing with the Senses

• Sight: Look at a favorite photo or watch a short funny video.
• Hearing: Put on a comforting song or nature sounds.
• Touch: Run your fingers over a soft blanket or fabric.
• Smell: Inhale a scented lotion or essential oil.
• Taste: Sip a cold drink or chew a piece of gum.

6. Seeking Support

• Call or text a trusted friend or family member and say, “I’m struggling—can we talk?”
• Visit your school counselor or another caring adult.
• Use a 24/7 crisis line if you need more help (e.g., dialing 988 in the U.S.).

7. Create a Personalized Safety Box

Gather items that help you cope and keep them in a small box you can use anytime:

• A stress ball or small toy
• Photos or notes from people who care about you
• Your favorite snack or a small bottle of lotion
• A list of coping steps and phone numbers to call

Remember: practice these strategies even when you feel okay so they’re easier to use when you need them most. You’re not alone—reach out whenever you need extra support.

Coping Reflection Worksheet

In this worksheet, you will reflect on how you used the coping strategy you chose in our last session. Be as honest and detailed as you can. Your thoughts will help shape our next steps.

1. Strategy Details

Name of the coping strategy you used:

Date and time you used it:

Situation or trigger that led you to use it:

2. Effectiveness

On a scale from 1 (not helpful) to 10 (very helpful), how well did this strategy work? __ / 10

Describe what happened when you used it:

3. Emotional Response

How did you feel BEFORE using the strategy?

How did you feel AFTER using the strategy?

4. Reflection on the Strategy

List two things you liked about using this strategy:

List two things that made it hard to use or didn’t feel helpful:

5. Looking Ahead

What would you change or try differently next time?

Choose one or two new ideas (from our handout or your own) to explore in our next session:

6. Additional Support

Who did you (or could you) reach out to when you felt the urge?

Any extra notes or questions for our next meeting?

Thank you for taking the time to reflect. We will use your responses to build a personalized safety plan tailored to what works best for you.

Personal Safety Plan Template

Use this template to create your own plan for staying safe when you have urges to self-harm. Fill in each section with what makes the most sense for you.

1. Warning Signs

What thoughts, feelings, or situations tell you that you might be at risk?

2. Self-Help Strategies

Things I can try on my own when I notice warning signs (from our handout or new ideas):

3. People I Can Contact

Names, relationships, and how to reach them when I need support:

1. Name: ________________________ Relationship: ______________ Phone/Contact: ________________

1. Name: ________________________ Relationship: ______________ Phone/Contact: ________________

1. Name: ________________________ Relationship: ______________ Phone/Contact: ________________

4. Safe Places

Places I can go that help me feel calm and safe:

5. Professional and Emergency Resources

Who to call if I feel like I might hurt myself or am in crisis:

• School Counselor: _________________________ Phone: ___________________

• Crisis Hotline (e.g., 988 in the U.S.): _________________________

• Other Professional: _________________________ Phone: ___________________

6. Encouraging Statements

Reminders, positive messages, or steps I can say to myself when I’m struggling:

Keep this plan where you can find it easily. Review and update it whenever you need to. You are not alone—help is available.