Window of tolerance PDF

Are you a therapist seeking a window of tolerance worksheet to explain the concept to your clients? You’re in the right place.

This article provides an overview of the window of tolerance and suggests various activities to help clients regulate their nervous system.

We’ve included a free downloadable window of tolerance PDF that you can save to your electronic health record (EHR) and use in your practice.

What is the window of tolerance?

The window of tolerance is a model conceptualized by psychiatrist Dan Siegel, MD, to describe the optimal state of arousal within the autonomic nervous system. When clients leave the window of tolerance, the body becomes stressed, and they either become hyperaroused or shut down.

We’ve illustrated these three states of arousal in the window of tolerance graph in the downloadable window of tolerance PDF.

• Window of tolerance: This is the optimal zone for the nervous system, where clients function most effectively. In this state, a client feels calm, alert, emotionally regulated, and safe. They can think clearly, feel empathy, stay present, adapt, and have insight and awareness.

• Hyperarousal: This refers to the fight-or-flight response. In this state, clients may feel activated, anxious, panicked, fearful, hypervigilant, aggressive, or defensive. They may also have racing thoughts, feel unable to sit still, and react strongly to their emotions.

• Hypoarousal: When emotions become too overwhelming, a client’s nervous system may collapse. They might feel numb, dissociated from their feelings, disconnected from themselves, withdrawn, or low. They may also have little energy, feel fatigued, and have trouble thinking.

What are some window of tolerance PDF exercises?

The following exercises can help clients regulate their nervous system and bring them back into their window of tolerance:

Activities for hyperarousal

• Square breathing by inhaling for a count of four, holding for a count of four, exhaling for a count of four, and holding again for a count of four, repeating for up to four minutes

• Shaking the body to discharge excess energy

• Grounding exercises like meditation, progressive muscle relaxation, the 5-4-3-2-1 exercise (name five things they can see, four things they can touch, three things they can hear, two things they can smell, and one thing they can taste)

• Gentle stretching or yoga to reconnect with the body

• Self-soothing by hugging themselves or using a weighted blanket to create a sense of safety if they feel fearful or panicked

Activities for hypoarousal

• Gentle movement, like taking a short walk or standing in the grass outside

• Smelling a strong scent, such as an essential oil

• Splashing cold water on the face or placing an ice cube on the forehead or neck

• Gently squeezing body parts, like the hands or forearms

• Connecting with a friend or family member

• Pushing against a wall, leaning in, while keeping feet firmly planted on the ground

• Making a cup of hot tea

Practices to stay in the window of tolerance

• Mindful walking

• Mindfulness meditation

• Body scan exercise

• Gentle breathing exercises, like diaphragmatic breathing

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How can therapists use the window of tolerance worksheet?

You can download and use the window of tolerance PDF in several ways:

• Use the worksheet to provide psychoeducation about the window of tolerance and give the client a copy of the window of tolerance handout to take home.

• Ask the client to reflect on the worksheet and complete the reflection questions between sessions and report their findings at their next therapy appointment.

• Use the window of tolerance graphic in group therapy sessions to encourage clients to share more about themselves with other participants.

• Combine this window of tolerance worksheet with other trauma-related worksheets and articles, including how to deal with triggers from trauma, CBT for PTSD worksheet, prolonged exposure therapy, and how to move through PTSD to post-traumatic growth.

• Share the window of tolerance PDF with coworkers or leave copies in your office.

• Use this worksheet to provide training to interns or supervisees on the concept of the window of tolerance.

Sources

• Corrigan, F. M., Fisher, J. J., & Nutt, D. J. (2011). Autonomic dysregulation and the window of tolerance model of the effects of complex emotional trauma. Journal of Psychopharmacology, 25(1), 17–25.

• Dana, D. (2020). Polyvagal exercises for safety and connection: 50 client-centered practices. W. W. Norton & Company.

• Johns Hopkins University Student Health and Well-Being. (2020). Finding your window of tolerance.

• Kerr, L. K. (2015). Live within your window of tolerance: A quick guide to regulating emotions, calming your body & reducing anxiety. Pandora’s Project.

• Neff, M. A. (2023). The window of tolerance: How to build emotional resilience and regulation. Neurodivergent Insights.

• Siegel, D. J. (2020). The developing mind: How relationships and the brain interact to shape who we are (3rd ed.). Guilford Press.

• Wise, S. J. (2019). The neurodivergent friendly workbook of DBT skills: A workbook of dialectical behaviour therapy skills reframed [Digital workbook]. Lived Experience Educator.

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