Description
“Please just start again if you’re going to be like this.” Someone at home usually says it before the client does. By the time it reaches your room, the anger has already cost something.
For clinicians, coaches and quit advisors
Plenty of worksheets let you print and use them with clients. This one does too. Here is what it adds.
- You may give a client their own blank copy to keep, by email or through a secure patient portal.
- You may use it in groups you run yourself.
- You may print without limit, for as long as you practice.
- And a written license page comes as a separate sheet in the download, so your practice has something to file.
One practitioner. Not transferable to a colleague, and not for resale.
Written for smoking cessation
Not adapted from general therapy material. The 8+ rule, the discharge list and the hour grid do not exist on a general anger sheet, because they are built around withdrawal that peaks and passes rather than around a temper — by a nurse with twenty-five years in pulmonary care who is also a certified quit coach.
Why anger, and not willpower
Withdrawal anger is the part clients apologize for afterward. It is also the part that ends quit attempts — not through craving, but through the argument, the message sent, the drive home taken angry.
A client who knows the anger is coming, and has a page that tells them what to do with it in the next ten minutes, does not need more resolve. They need somewhere for it to go. These four pages give it that, and give you something to read back at the next appointment.
What you get
Four pages — US Letter and A4 both included — 134 fillable fields.
Plus the license page, in both sizes.
1 — The 72-Hour Survival Grid
One box for every completed smoke-free hour, and an anger level from 1 to 10 beside it. At 8 or higher the page sends the client to page 2.
2 — The 8+ Emergency Button
Freeze the scene, discharge without damage, meet the body need, make contact. An anger rating before and after ten minutes, so the client brings you a number.
3 — The Anger Dump
Written down and not sent. Then a needs-mapping block: what withdrawal is blaming, and what the client actually needs.
4 — After the Wave
A cognitive behavioral thought record, filled in once anger is 5 or lower. The moment, the thought with a belief rating, the evidence in two columns, the answer chosen, the belief rated again, and one line to keep.
How it sits in a session
Page 1 runs across the first three days and comes back to you filled: seventy-two hours of anger levels on one sheet, with the hours that went over 8 visible at a glance.
Page 2 is the in-the-moment page. It ends with two blank lines: the client’s practitioner, and a crisis line they can call. You fill those in once and print. There is no crisis number printed on page 2, because a number that only works in one country is worse than no number at all.
Page 3 is written alone, when the wave is still high, and not sent.
Page 4 is filled in afterwards, once anger is 5 or lower. It is a full thought record, and the second belief rating is the point: it turns a page of writing into something you can compare across appointments.
Nothing on these pages asks for a diagnosis, and nothing is scored.
Three ways to use it
- Hand a client one page, or all four.
- They type straight into it on a phone or tablet — page 2 is needed where the anger is, not at a printer.
- Or print it and use a pen.
Two sizes, both fillable
US Letter, 8.5 x 11 in — United States and Canada
A4, 210 x 297 mm — the standard size everywhere else
Both are in the download at no extra cost, and both work the same way: type on screen, or print. The fields do not show on paper.
Before you start
Open the file in Adobe Acrobat Reader — it’s free, on iPhone, Android, Mac and Windows. A browser preview will show the pages, but it won’t reliably keep what a client types.
Keep the blank original blank. Save filled copies under a new name.
The practice license
One practitioner, unlimited clients, worldwide. Print for your own clients, use one-to-one and in groups you run yourself, send a blank copy to an individual client, and keep a filled copy in a client file where your recordkeeping rules require it. Not for resale, and not transferable to a colleague — each practitioner needs their own. The full terms come as a separate page in the download.
Personalized license copy, on request
The license page carries the name of this set and has fields for your name, your practice, and the date of purchase, so you can complete it yourself and keep it with your records. If you would rather have those details typeset into the page instead of typed into a form field, write to hello@cessationworksheets.com after your purchase and I will send one back. No charge — it is part of the license.
How buying works
Checkout runs through Gumroad, a payment platform used by independent creators worldwide. You pay on their secure checkout page, and your card details never reach me.
The price shown here is $7.99 before tax. VAT or sales tax is added at checkout, based on where you live, so the total can differ from country to country. You see the full amount before you pay.
Charges are processed in US dollars. Outside the United States, your bank converts the amount and may add a small fee of its own.
Straight after payment you get a download link on screen and by email, with both files — A4 and US Letter — and a receipt.
Who wrote this
I am a pulmonary nurse, trained in asthma and COPD. I work in a respiratory outpatient clinic, where I see people with asthma and COPD and run the smoking cessation consultations. I am listed in KABIZ, the Dutch quality register for healthcare professionals, which means I work to the national care standard for tobacco and nicotine dependence.
Evidence-informed and developed with reference to current tobacco-dependence and smoking-cessation guidelines, using CBT-informed behavioral tools to support structured cessation conversations.
Every page is built on national standards for tobacco dependence and on published evidence, and checked against the guidance in each. See the seven guidelines.
No lectures. No scare tactics.
Instant digital download. Nothing is shipped. No refunds once the download has been opened. If the file does not work as described, write to me and I will sort it out.
Support tool only — not medical advice, and not a substitute for the clinical judgment of the practitioner using it.