Understanding self-harm, and an urge-delay plan
Read a short, plain explanation of self-harm, then make a plan with your therapist for putting off an urge so it has time to pass, and keep a log of what helps. Based on NICE guideline NG225 (2022): the explanation puts its points in our words; the urge-delay plan and urge log are our additions.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Understanding self-harm, and an urge-delay plan
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About this sheet
This sheet has two parts. The first explains self-harm in plain words. The second helps you make a plan for putting off an urge so it has time to pass, and a log of what helps. Use it with your therapist, alongside your safety plan, not instead of it.
You choose how much to write. You can leave any box blank, and you do not need to write about hurting yourself.
If going over this brings back urges to hurt yourself, stop and use your safety plan if you have one, and tell your therapist. If you might act on the urges, call 999 or go to A&E. To talk to someone now, call Samaritans free on 116 123.
Understanding self-harm
Self-harm means hurting or poisoning yourself on purpose, whatever the reason behind it. It can happen at any age.
People self-harm for many different reasons, and the reasons can change from one time to the next. Often it is a way of coping with feelings that seem too much, such as anger, shame, sadness or feeling numb. It can bring short-term relief, and that is one reason the urge can come back.
Self-harm is not a diagnosis, and it is not attention seeking. Some people who self-harm also have thoughts of ending their life, and some do not. Your therapist will ask about this gently, because it matters for keeping you safe.
You should be listened to, treated with compassion and involved in decisions about your care. Talking therapy can help you understand what drives your urges and find other ways to cope. You and your therapist can work on it together, at your pace.
Urges often rise, peak and then fade, even when they feel as if they will last forever. Putting off acting, even for a few minutes, gives the urge time to drop and gives you time to choose something else.
My urge-delay plan
If going over this brings back urges to hurt yourself, stop and use your safety plan if you have one, and tell your therapist. If you might act on the urges, call 999 or go to A&E. To talk to someone now, call Samaritans free on 116 123.
Fill this in with your therapist at a calm time. Keep it where you can find it quickly. This plan is only about urges to hurt yourself. Your warning signs and people stay in your safety plan. The new part is how long you will wait and what you will do while you wait.
| # | Something I can do | Good for when I feel | What I need ready | Actions |
|---|---|---|---|---|
| 1 | ||||
| 2 |
| # | Who | How to reach them | What I might say or ask for | Actions |
|---|---|---|---|---|
| 1 |
After an urge
If going over this brings back urges to hurt yourself, stop and use your safety plan if you have one, and tell your therapist. If you might act on the urges, call 999 or go to A&E. To talk to someone now, call Samaritans free on 116 123.
If you have hurt yourself and the injury needs treatment, or you have taken too much of any medicine or anything else, get medical help straight away, even if you feel well. Go to A&E or call an ambulance.
When an urge has passed and you feel settled, add a row. Rate the urge when you started waiting and again at the end, where 0 means no urge at all and 10 means the strongest urge you have had. Write about the urge and what helped, not about hurting yourself. If you did hurt yourself, that is not a failure, and it is useful to talk about with your therapist.
| # | Date and time | What was happening | Urge at start (0 to 10) | What I did while I waited | How long I waited | Urge at end (0 to 10) | Actions |
|---|---|---|---|---|---|---|---|
| 1 |
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When to use the Understanding self-harm, and an urge-delay plan
The Understanding self-harm, and an urge-delay plan is an interactive cognitive behavioural therapy (CBT) worksheet. As a core CBT skill it is used right across the model, with presentations including depression, anxiety, OCD, trauma and low self-esteem, rather than being tied to a single diagnosis.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 30 minutes. It moves through four short steps:
- About this sheet: This sheet has two parts. The first explains self-harm in plain words. The second helps you make a plan for putting off an urge so it has…
- Understanding self-harm: Self-harm means hurting or poisoning yourself on purpose, whatever the reason behind it. It can happen at any age. People self-harm for…
- My urge-delay plan: If going over this brings back urges to hurt yourself, stop and use your safety plan if you have one, and tell your therapist. If you might…
- After an urge: If going over this brings back urges to hurt yourself, stop and use your safety plan if you have one, and tell your therapist. If you might…
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, the Understanding self-harm, and an urge-delay plan works by noticing the links between situations, thoughts, feelings, physical sensations and behaviour and finding practical ways to change unhelpful patterns. The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- National Institute for Health and Care Excellence (2022). Self-harm: assessment, management and preventing recurrence (NICE guideline NG225). NICE. https://www.nice.org.uk/guidance/ng225.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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