Notice your patterns and choose a manageable next step
Dr. Katherine Jewett, PsyD, LMFT
Licensed Marriage and Family Therapist #100342
Download your check-in
This two-page PDF offers prompts for noticing your patterns, choosing one manageable response, and planning for support.
What you will need
- For screen use: a phone, tablet, or computer and a PDF viewer that supports fillable fields.
- For paper use: a printer, paper, and a pen or pencil.
How to use it
- Download the PDF and save your own copy.
- Choose a manageable moment. Read the guide, then work through the prompts you want to try.
- Type in the fields in a compatible PDF viewer, or print the pages and write your responses.
- Save your completed copy privately. If you fill it in on screen, check that your answers have saved before closing it.
This webpage does not collect or save your answers. The check-in text is also available below.
Skip any prompt; there is no score. You do not need to revisit a traumatic memory. Keep your completed copy private.
A simple guide to the model
Higher activation
Tense, anxious, irritable, or overwhelmed.
Within your window
Able to feel emotions and consider choices.
Lower activation
Numb, distant, or less able to engage.
Experiences can overlap. These descriptions are prompts, not diagnoses.
1. Notice your current experience
□ Wound up or overwhelmed
□ Present enough to engage
□ Flat or disconnected
□ Mixed or unsure
My early signs in thoughts, feelings, or actions
What was happening just before I noticed this
What feels difficult right now
Examples: listening, making a decision, answering a message, or staying present. You can describe the situation without focusing on sensations in your body.
Choose what would help
One small response and a plan for support
First check whether you are safe enough to pause. If the situation is unsafe, prioritize getting to safety and finding support. Stop an exercise if it makes you feel worse.
2. Choose one manageable response
If you feel wound up, consider reducing noise or pausing a task. If you feel disconnected, try noticing an ordinary object or a familiar sound. You can ask someone supportive to stay with you. Breathing is optional; keep it gentle if you choose it.
□ Reduce noise or demands
□ Notice my surroundings
□ Pause a task or conversation
□ Ask for supportive company
□ Try a few easy breaths
□ Choose another response
The one thing I will try
3. Check the effect
□ More manageable
□ About the same
□ Less manageable
□ Not sure yet
What I noticed and what I might change
4. Decide when to ask for support
A person or professional resource I can contact
A sign that I need more support
Seek professional help for repeated disconnection or distress that disrupts daily life. General education, not a diagnostic tool. Keep your completed copy private.
Sources: NHS Ready to Relate | NHS inform | VA coping guidance