If you're looking for a window of tolerance PDF to give a client, this page is built to be one. The worksheet below is written to your client in plain words: the signs that they're above, inside or below their window, what brings them back, and the people and places that help. Print this page or save it as a PDF from your browser, and fill it in together before the end of a session.
After the worksheet comes the part for you: where the idea comes from, how trauma clinicians use it, the signs of hyperarousal and hypoarousal you may see in session, how to teach it, how to pair it with grounding, how to adapt it for children, teens and telehealth, where the model stops being useful, and how to note it in a progress note.
Every client in this article is invented. Any resemblance to a real person is a coincidence.
How to print this page or save it as a PDF
- On a computer: press Ctrl+P on Windows or Cmd+P on a Mac.
- On a phone: open your browser's share menu and choose Print.
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- To print only the worksheet: in the print preview, find the pages from "Window of tolerance worksheet" to "End of the worksheet", and enter just those pages as the page range.
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The lines are for a pen. A client who would rather type can copy the bold headings into a note on their phone.
Window of tolerance worksheet
My window of tolerance
Everyone has a range where feelings can be strong but still manageable. Inside it, you can think, feel, talk and choose what to do. Therapists call this range your window of tolerance.
Stress, reminders of hard times, poor sleep, pain or illness can push you out of your window in two directions:
- Above your window:too much. Revved up, on alert, overwhelmed.
- Below your window:too little. Numb, shut down, far away.
Leaving your window is not a failure or a weakness. It's your body trying to protect you. Your window can be wider on some days and narrower on others. This worksheet helps you notice where you are and what brings you back. Fill it in with your therapist or on your own, and bring it to your next session.
Signs I'm above my window
Circle the ones that fit you, then add your own.
- My heart pounds or races
- I breathe fast, or I can't catch my breath
- I feel hot, sweaty or shaky
- My jaw, fists or shoulders get tight
- My thoughts race or jump around
- I feel panicky, angry, irritable or on edge
- Small sounds make me jump
- I want to run, shout or fight
- I can't sit still, or I can't sleep
- My own signs: ________________________
- ________________________________
- ________________________________
Signs I'm inside my window
- My feelings can be strong, but I can still think
- I can listen and talk with people
- I can feel my feet on the floor and my body in the chair
- I can make a choice and follow through
- I can be curious, even about something hard
- I can rest when I'm tired
- My own signs: ________________________
- ________________________________
Signs I'm below my window
- I feel numb, flat or empty
- I feel foggy, spacey, unreal or far away
- My body feels heavy and slow
- My voice gets quiet, or I can't find words
- I lose track of time
- I want to hide, stay in bed or give up
- I don't notice pain, hunger or feelings
- My own signs: ________________________
- ________________________________
- ________________________________
My first warning signs
The earliest small sign that I'm starting to leave my window. Catching it early makes coming back easier.
- Going up: ____________________________
- Going down: __________________________
What helps me come back down (when I'm above)
Circle what you'd like to try, and add what already works for you.
- Breathe out slowly, longer than I breathe in
- Press my feet into the floor
- Slow down my voice and my movements
- Step away from what set me off, if I can
- Hold something soft or heavy
- Wrap up in a blanket, or sip a warm drink
- Do 5-4-3-2-1 grounding, slowly
- What works for me: ____________________
- ________________________________
What helps me come back up (when I'm below)
- Stand up, stretch or walk around
- Push my palms together, or push against a wall
- Sit up straight and look around the room
- Name what I see, out loud
- Touch something with a strong texture, like a rough stone
- Taste something strong, like a mint
- Put on music with a beat
- Text or call someone
- What works for me: ____________________
- ________________________________
People who help widen my window
Who helps me feel steady? Who can I call, text or sit with when things are hard? A pet counts.
- ________________________________
- ________________________________
- ________________________________
Places that help widen my window
Where do I feel calm or settled? A room, somewhere outdoors, or a place I can picture in my mind.
- ________________________________
- ________________________________
- ________________________________
What makes my window smaller
- Not enough sleep
- Skipping meals
- Pain or being sick
- Alcohol or drugs
- Too much noise, or too many people
- Reminders of hard times
- Other things: _________________________
Check-in log
Once a day for a week, circle where you are and write one thing you noticed.
- Day 1: above / inside / below. I noticed: __________
- Day 2: above / inside / below. I noticed: __________
- Day 3: above / inside / below. I noticed: __________
- Day 4: above / inside / below. I noticed: __________
- Day 5: above / inside / below. I noticed: __________
- Day 6: above / inside / below. I noticed: __________
- Day 7: above / inside / below. I noticed: __________
If I'm not safe
If you might hurt yourself or someone else, or you're in danger, call or text 988 (the Suicide & Crisis Lifeline in the US) or call 911.
End of the worksheet. The rest of this page is for therapists.
What is the window of tolerance?
Psychiatrist Daniel (Dan) Siegel is credited with the term "window of tolerance", from his 1999 book The Developing Mind: Toward a Neurobiology of Interpersonal Experience. He described a range of arousal within which, in the words Ogden and Minton quote from page 253, "various intensities of emotional arousal can be processed without disrupting the functioning of the system." Outside that range, Siegel wrote, states of mind are "characterized by either excessive rigidity or randomness" (page 255, as quoted by Ogden & Minton, 2000).
The three-band picture on most handouts, with hyperarousal on top, the window in the middle and hypoarousal below, follows the "modulation model" that Pat Ogden and Kekuni Minton of the Sensorimotor Psychotherapy Institute published in 2000 in the journal Traumatology. Their diagram used the term "optimal arousal zone", which they credit to Wilbarger and Wilbarger (1997), and they called that zone "similar to Siegel's 'window of tolerance'." In their account:
- Inside the zone, a person can "contain and experience (not dissociate from)" feelings, sensations and thoughts, and can process information.
- Above it is hyperarousal: in Siegel's words, "excessive sympathetic branch activity", with a faster heart rate and breathing.
- Below it is hypoarousal: numbing, a dulled sense of the body, slowed movement and less muscle tone. Siegel's phrase is "a sense of 'numbness' and 'shutting down' within the mind."
- Both edges can lead to dissociation, and a person after trauma may stay mostly above, mostly below, or swing between the two.
The window describes a person's range in a given state and situation, not their character. Education Scotland's information note for school staff lists temperament, personality, background (including any trauma), social supports and physiology as things that shape a person's window, and adds that with support it can be expanded.
Signs of hyperarousal and hypoarousal in session
Each client's signs are personal, which is why the worksheet asks for their own. These are the common ones. Most can be seen or heard, which helps when you write the note.
Above the window (hyperarousal): what you may see or hear
- Faster, louder or pressured speech
- Fast or shallow breathing, flushing, sweating or trembling
- Restlessness, fidgeting, scanning the room or the door, startling at sounds
- Jumping between topics, or trouble taking in a question
- Irritability, anger, panicked crying, or an urgent wish to stop or leave
- Reports of a racing heart, "I can't think," or images that won't stop
Below the window (hypoarousal): what you may see or hear
- Slow or quiet speech, long pauses, answers that come late
- A flat face, a fixed gaze, slumped posture, little movement
- "I don't know," "nothing," or losing the thread mid-sentence
- Reports of feeling numb, foggy, far away, heavy or sleepy
- Gaps the client can't account for: "I lost a few minutes there"
- Agreeing to everything, without any feeling behind it
Three things to watch for
- Hypoarousal can pass for calm.A quiet, agreeable client may be shut down rather than settled. When agreement comes in a flat voice, check in.
- Stillness isn't always low arousal.A client who has frozen can look still while feeling intense alarm inside. Ask what is happening in their body instead of reading it from the outside.
- Swings are common.Ogden and Minton describe people after trauma moving between the two extremes, so a client may go from panic to numbness within one session.
The window of tolerance in trauma work
"Poor tolerance for arousal is characteristic of traumatized individuals," Ogden and Minton wrote, citing Bessel van der Kolk. That is why the window turns up so often in trauma treatment. Clinicians use it in three main ways.
- As psychoeducation. It explains symptoms without blame: panic and numbness are two directions of the same protective system, not two separate failings. It is often one of the first handouts in the stabilization phase.
- As a pacing guide. In phase-oriented trauma treatment, clients first learn to notice when they are leaving their window and to come back, before working with traumatic memories. During that work, you watch the edges. In her chapter in Clinical Pearls of Wisdom (2010), Ogden describes keeping arousal high enough to reach difficult material, but not so high that the client can no longer integrate the experience, and borrows psychoanalyst Philip Bromberg's phrase "safe but not too safe." If a client goes past the edge, stop, help them back, and return with a smaller piece.
- As shared language. "I'm going above" or a hand signal lets a client tell you where they are without having to explain. It gives them a say in the pace, which matters in trauma work.
Others have built on the model:
- Ogden, Minton and Pain develop the same model for sensorimotor psychotherapy in their 2006 book Trauma and the Body.
- Corrigan, Fisher and Nutt reviewed it as a model of the long-term effects of the severe emotional trauma of childhood abuse, which they say also applies to adult trauma severe enough to cause PTSD. They suggest that self-harm and substance use can be attempts to regulate a nervous system that reminders of the trauma readily push into extreme states (Corrigan et al., 2011). The brain pathways they discuss are proposals, not findings.
- Couples work: a qualitative study of five bereaved couples described a "relational window of tolerance" for how partners regulate each other in shared grief (Barboza et al., 2025).
Your own window matters too. Long days of trauma work can narrow it, and it is hard to help a client back into their window from outside your own. If you keep noticing your own signs in sessions, our article on therapist burnout and compassion fatigue covers what to look for and what helps.
What "widening the window" means. Clients often ask how to widen their window. In Ogden's account it widens through the work itself: regulation first, then carefully paced work at the edges. Day to day, the things that narrow a window are familiar: poor sleep, skipped meals, pain, alcohol, noise and stress. Widening is a useful way to describe progress with a client, but it is a description, not something anyone has measured (see the limits below).
How to teach the window of tolerance in session
- Choose a calm moment. Teach it while the client is inside their window, not in the middle of a panic. Early in treatment works well.
- Draw it. Three bands on paper or a whiteboard, or your hand held at three heights on video. Let the client name the zones in their own words: "wired," "okay," "checked out."
- Normalize both edges. Going above or below is the body protecting itself. Everyone leaves their window sometimes, and trauma, stress and poor sleep can make it narrower.
- Fill in the signs from a real example. Ask about a recent hard moment: "What did you notice first, in your body, your thoughts, what you did?" Write their words on the worksheet, not yours.
- Find the first warning sign. The earliest cue is the most useful one, because that is when coming back is easiest.
- Match the tool to the direction. Calming tools help from above, and alerting tools help from below. Ogden and Minton note that helping a client regulate "sometimes means stimulating arousal if the client is hypoaroused." A slow, calming breath is a poor first choice for a client who is already shut down. Try one tool of each kind in session and ask what changed.
- Add people, places and habits. Who and what helps them feel steady, and what shrinks their window.
- Set a small practice. A daily check-in on the log: above, inside or below, and one thing they noticed. Review it at the next session.
- Keep using it. Start and end later sessions with a quick check-in, and agree on a signal for "I'm near the edge."
A short explanation you can read aloud and adapt:
Pairing the window of tolerance with grounding
The window tells you and your client where they are. Grounding is one way back. Our 5-4-3-2-1 grounding worksheet is a printable companion to this one, and the two work well handed out together. Adjust the grounding to the direction:
- Check in first.Ask "Where are you on the window right now?" and pick the version that fits.
- From above, slow it down.A low, even voice, a longer out-breath, one object at a time, and plenty of detail: "What color is it, exactly?"
- From below, bring energy up.Eyes open, things named out loud, sitting up or standing, a textured object in the hand, a brisker pace, and small movements: "Point to something blue."
- Check again afterward.If the client is back inside, you can continue or close the session. If not, stay with regulation and leave the topic for another day.
- Agree on its role in exposure work.In exposure-based treatment for panic or anxiety, grounding used to escape feared sensations can work as a safety behavior. Decide with the client in advance when it is for; the grounding article covers this in more detail.
Adapting the window of tolerance for children and teens
Siegel's book is about how relationships shape the developing mind, and the model fits children best when it starts with the adults around them. Young children usually come back into their window with an adult's help long before they can do it alone.
Younger children
- Use simple words and pictures: "too fast, just right, too slow," or an animal, color or weather picture the child chooses.
- Draw the window together and let the child decorate it.
- Use body-based tools: blowing bubbles or a pinwheel for a long out-breath, pushing against a wall, jumping in place, a soft toy to hold.
- Practice in play, when the child is calm.
Caregivers and teachers
- Teach the adults first. A calm voice, a slower pace and staying close help a child come back.
- Help them read the signs. A shut-down child can look defiant or "spacey," and a child above their window can look like they're simply misbehaving. Suggest they respond to the state first, and talk about behavior once the child is back inside.
- Schools use the idea too: Education Scotland's note suggests teaching it to learners directly and using posters as reminders in classrooms.
Teens
- Let them name the zones in their own words, and keep the worksheet as a note on their phone if paper feels like schoolwork.
- Choose discreet tools they can use in class or on the bus.
- With the teen's agreement and the right release of information, share a short plan with a school counselor.
- Ask, without judgment, whether they use substances or self-harm to change how they feel. Corrigan and colleagues describe both as possible attempts to regulate a nervous system that is easily pushed into extreme states.
Using the window of tolerance in telehealth sessions
- Plan for emergencies before the first video session. HHS's guide to creating an emergency plan for telebehavioral health lists the client's location, emergency numbers near them, a nearby support person and a plan for a dropped call.
- Check in more often. You see less on a screen. A hand held at three heights works as a quick check-in in both directions.
- A still face may be a frozen video or a frozen client. Ask the client to say something or move before you decide which.
- Ask about privacy. A client who can be overheard at home may stay near the top of their window all session. Headphones, a closed door or a parked car can help.
- Use the client's room. Ask them to name or hold up objects near them for grounding, and to keep a few within reach.
- On audio-only calls, listen for pace, volume and the length of pauses.
- Leave time to come back. Close the session inside the window. There is no walk to the car after a video session, and some clients go straight back to work or family.
- Send the link to this page before or after the session so the client can print the worksheet or save it as a PDF.
Limits of the model: a heuristic, not a measure
The window of tolerance is a heuristic: a simple picture that helps clients and clinicians talk about arousal and pace the work. It is not a diagnostic measure, a scale or a test.
- No cutoffs and no norms.No score says a window is "narrow." The edges are a metaphor, and a client's "I'm below" is a self-report.
- The research is thin.A PubMed search for the exact phrase in October 2026 returned 30 records, several of them about immune tolerance in other fields. A questionnaire built on Ogden and Minton's model, the Arousal Modulation Model Questionnaire, was validated in 2025 in 304 adults who were not in psychiatric care (D'Antoni et al., 2025). That is an early step, not a clinical standard. We found no study testing whether widening the window explains why trauma treatment works.
- Arousal isn't one dial.Freeze can combine stillness with alarm, and a racing heart can come with excitement or with terror. Ask rather than infer.
- The biology is debated.Many handouts explain the window with polyvagal theory, whose basic premises have been strongly challenged (Grossman, 2023). The model works as a teaching tool without that theory, and it is more honest not to present it as settled science.
- Faces mislead.A flat face is not always hypoarousal. Depression, some medications, autism and cultural norms about showing feelings can look similar.
- Rule out medical causes.New or unexplained changes, such as a racing heart, fainting, sudden exhaustion or confusion, can come from a medical problem, a medication, a substance or withdrawal. Encourage a medical evaluation.
- It doesn't replace assessment.Keep using a risk assessment and measures: the PHQ-9, the GAD-7, the PC-PTSD-5, or a dissociation scale such as the DES-II, repeated over time.
- It can be misused."Outside your window" isn't a reason to put off a client's goals indefinitely, or a label for behavior you find difficult.
How to note the window of tolerance in a progress note
Write what you saw and what the client reported, not only the label. "Client was dysregulated" or "outside window of tolerance" on its own tells a reader very little.
- Psychoeducation given:"Introduced the window of tolerance model; client identified her signs for each zone; worksheet given."
- Observable signs:speech rate and volume, breathing, posture, eye contact, response time, affect.
- The client's self-report, labeled as such:"Client rated herself 'below my window.'"
- What moved them:the topic or reminder, with only the detail the record needs.
- Intervention and response:what you did (paused the topic, guided calming or alerting steps, grounding) and how long the signs took to change.
- Pacing decision:continued, paused or changed the plan, and why.
- Risk:what you asked and what the client said, when it applies.
An example in BIRP format. Invented client: a 41-year-old teacher we'll call Dana, in her eighth video session of trauma-focused therapy after a house fire.
In DAP, the observations and the client's self-rating go in Data and your reading of the shift goes in Assessment. In SOAP, the self-rating goes in Subjective and what you saw goes in Objective. For more wording, the progress notes cheat sheet has clinical words for interventions and client response, and you can compare the formats in our BIRP note examples, DAP notes examples and SOAP note examples.
How this works in TranqBay
TranqBay is practice software for therapists in private practice: a practice website, online booking, video sessions and session notes in one place. Here is where this worksheet fits.
- Video sessions are end-to-end encrypted and HIPAA-ready. TranqBay's Business Associate Agreement applies when you accept the Terms, with no separate document to sign, so the telehealth steps above happen inside your practice software.
- Session notes come in BIRP, DAP, SOAP or GIRP format, or as a blank note in your own words. The structured formats are part of the advanced note templates, which some plans include.
- Forms before the session. The form library has ready-made templates you can send a client for a session, including the PHQ-9, GAD-7 and PC-PTSD-5, intake forms, consent to treat and telehealth consent. The client fills them in online and the answers wait with the session. TranqBay doesn't score them; the calculators linked above do the math for the PHQ-9 and GAD-7.
- The worksheet itself lives on this page. Send your client the link, or print it.
practice.tranqbay.health shows a video session and its note on the session's page, so you can see where a window of tolerance check-in and the note that records it would sit.
Frequently asked questions about the window of tolerance
Is there a window of tolerance PDF I can print?
This page works as one. Print it, or choose "Save as PDF" in your browser's print window, and set the page range to the worksheet pages if you only want the client handout.
Who created the window of tolerance?
Psychiatrist Dan Siegel is credited with the term, from The Developing Mind (1999). Pat Ogden and Kekuni Minton published the familiar three-zone diagram in 2000 and linked it to Siegel's window. It has since become a common teaching tool in trauma treatment.
What is the difference between hyperarousal and hypoarousal?
Hyperarousal is too much activation: a racing heart, fast breathing, panic, anger, racing thoughts. Hypoarousal is too little: numbness, fog, heaviness, a flat voice, feeling far away. Both are outside the window, and both can come with dissociation.
How does trauma affect the window of tolerance?
Trauma is often described as narrowing the window, so smaller stresses or reminders push a person above or below it, and some people swing between the two. Trauma treatment often starts by helping the client notice those shifts and come back.
How do you increase or widen a window of tolerance?
In trauma work, through regulation first and then carefully paced work at its edges, with your therapist. Day to day, sleep, regular meals, movement, people you trust and fewer stressors help keep it wider, and practicing your coming-back tools when calm makes them easier to use when you need them.
Is the window of tolerance evidence-based?
It's a widely used clinical model, not a tested intervention or a measure. Research on measuring it is at an early stage, and its link to polyvagal theory is disputed. Use it to explain and pace, and track progress with validated measures.
Is the window of tolerance a DBT skill?
No. It comes from Siegel's work and is used most in trauma and sensorimotor therapy. DBT has its own distress tolerance skills, a different idea with a similar name. Many therapists use both.
Can teens use a window of tolerance worksheet?
Yes. Let them name the zones in their own words, keep the worksheet on their phone if they prefer, and choose tools they can use discreetly at school.
Before your next session
Teach the window on a calm day, fill in the signs in your client's own words, and open and close the next few sessions with a quick check-in. Within a few weeks, "I'm going above" becomes a sentence your client can say before the session gets away from both of you.
If you want booking, video sessions and session notes in one place, see how TranqBay works for private practice: you can browse the practice website designs, including a sample site for a trauma therapist, and see the booking page your clients would use. If you're deciding whether to join, this page explains how joining TranqBay works.
Sources
Books 3Research 5education.gov.scot 1HHS 1988 Lifeline 1
Books and publishers3
- 1Siegel DJ. The Developing Mind: Toward a Neurobiology of Interpersonal Experience. Guilford Press (1999); third edition 2020guilford.comhttps://www.guilford.com/books/The-Developing-Mind/Daniel-Siegel/9781462542758
- 2Ogden P, Minton K, Pain C. Trauma and the Body: A Sensorimotor Approach to Psychotherapy. W. W. Norton (2006)wwnorton.comhttps://wwnorton.com/books/9780393704570
- 3Ogden P. Modulation, Mindfulness, and Movement in the Treatment of Trauma-Related Depression. In Kerman M, ed. Clinical Pearls of Wisdom. W. W. Norton (2010)wwnorton.comhttps://wwnorton.com/books/Clinical-Pearls-of-Wisdom
Research5
- 4Ogden P, Minton K. Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory. Traumatology 6(3):149-173 (2000)doi.orghttps://doi.org/10.1177/153476560000600302
- 5Corrigan FM, Fisher JJ, Nutt DJ. Autonomic dysregulation and the Window of Tolerance model of the effects of complex emotional trauma. Journal of Psychopharmacology (2011)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/20093318/
- 6Barboza J et al. Forming our grief rhythm: The relational window of tolerance for bereaved parents. Family Process (2025)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/39142334/
- 7D'Antoni F, Matiz A, Crescentini C. The Arousal Modulation Model Questionnaire (AMMQ): Development, validation, and transdiagnostic applications. European Journal of Trauma & Dissociation (2025)doi.orghttps://doi.org/10.1016/j.ejtd.2025.100564
- 8Grossman P. Fundamental challenges and likely refutations of the five basic premises of the polyvagal theory. Biological Psychology (2023)pubmed.ncbi.nlm.nih.govhttps://pubmed.ncbi.nlm.nih.gov/37230290/