DBT DIARY CARD

Date started: .

How often did you fill out this section? ___ Daily _ __ 2-3x ___ Once ___ Filled out in session
How often did you use phone consult? ____

Did you attend individual therapy this week? _ _ Y _ _ N _ _ Not Scheduled

SELF- SUICIDAL ALCOHOL DRUGS ** ** MEDS SLEEP

HARM
Day Actions/ Type/ Type/ As OTC In
Out
Urge Actions Urge Urge Urge Asleep Awake of
Planning Amount Amount Directed (specify) bed
bed
0-5 Y/N 0-5 Y/N 0-5 0-5 Y/N Y/N
Mon

Tues

Wed

Thur

Fri

Sat

Sun
 EMOTIONS SKILL USE
Shame Interpersonal Emotional
Day Anger Happy Sad Anxiety Pride Lonely
** **
Mindfulness
Distress
/Guilt Effectiveness Regulation Tolerance
0-5 0-5 0-5 0-5 0-5 0-5 0-5 0-7 0-7 0-7 0-7
Mon

Tues

Wed

Thur

Fri

Sat

Sun

Rating Scale for Emotions and Urges: Skills Used

0 = Not at all 1 = A bit 2 = Somewhat 0=Not thought about or used
3 = Rather Strong 4 = Very Strong 5 = Extremely Strong 1=Thought about, not used, didn’t want to
2=Thought about, not used, wanted to
3=Tried but couldn’t use them
4=Tried, could do them but they didn’t help
5=Tried, could use them, helped
6=Didn’t try, used them, didn’t help
7=Didn’t try, used them, helped
 NOTES
(Events, thoughts, reactions, crisis behaviors, skill use, conversations, homework…etc./anything important)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday
SKILLS USED DURING WEEK OF: .

M T W T F S S
Wise Mind:
* honor your emotions and the facts; make decisions consistent with long-term goals
What Skills Observe:
Core Mindfulness

* Look at the situation without emotion or judgment, just notice what is happening without
trying to change it
Describe:
* Put Words on The Experience (without judgment or emotion)
Participate:
* enter into the experience
How Skills Stay Focused:
* One-mindfully, in the moment
Non-judgmental Stance:
* just the facts, don’t judge judging, separate facts from interpretations/assumptions, avoid
labeling something as good/bad
Effectiveness:
* do/focus on what works, keep in mind my objectives
Saying "no" & observing limits
3 goals of *getting what I want/need*
Interpersonal

interpersonal Objective effectiveness: DEAR MAN

effectiveness (Describe, Express, Assert, Reinforce, Mindfully, Acting confident, Negotiating)
*improving relationships & keeping them steady*
Relationship Effectiveness: GIVE
(Gentle, Interested, Validating, Easy manner)
*feeling effective & maintaining my self-respect*
Self-Respect Effectiveness: FAST
(be Fair, no Apologies, Stick to my values, be Truthful)
PLEASE Treat/take care of Physical iLlness
(reduce emotional Balanced Eating
vulnerability) Avoid alcohol / mood altering drugs
Balanced Sleeping
Exercise
Build MASTERy Mindful to emotion
* Identify & Label emotions, thoughts, and urges
Act Opposite-to-Emotion
* Fear=approach, guilt=apologize/ignore, sad=get active, anger=avoid, gentleness & empathy
Self-Validation
* Respect my emotions, why does it make sense for me to feel this way? What would I say to a
friend if they were me?
Turn the mind
*turn my mind toward the acceptance road and away from the 'rejecting reality' road…
*Accepting painful psychological realities requires mental effort and commitment. Turning the
Emotion Regulation

mind is the decision to not give up and turn to comfort or give in and turn to denial.
Experience positives
* Increase positive emotions/events: engage in pleasant activities, participate mindfulness with
intention and planning
Radical Acceptance
*means completely and totally accepting something from the depths of your soul, with your heart and your
mind
*stop fighting reality, stop responding with impulsive or destructive behaviors when things aren't going the
way you want them to, and let go of bitterness that may be keeping you trapped in a cycle of suffering
Pros / cons: think long-term vs. short-term effects
Experience my emotion as a wave
(Let it come & go, just observe, don’t amplify or suppress)
Check the Facts (of emotion responses)
Practice loving my emotions (step back, experience, accept, don’t judge)
Validate Someone Else (find the kernel of truth in another’s perspective)
Positive Reinforcement (reward yourself or others for positive behaviors)
Action Steps Toward Long-Term Goals: clarify my values and priorities,
generate steps towards my long-term goals
Cope ahead for emotional events
Think Dialectically
* practice non black-and-white thinking, maintain openness to contradictory points of view
Act Dialectically
* walk the middle path
SCREW Solve the problem, Change my relationship to it, Radically accept, Entertain misery,
Worsen the problem
 ACCEPTS Distract myself with Activities

Contribute
Compare/ Count blessing
Different Emotions
Push away thoughts
Substitute Thoughts (thing about something more pleasant)
Sensations
Distress Tolerance

STOP Stop what you are doing

Take some deep breaths / take a step back
Observe the situation/self
Proceed mindfully & effectively
TIPP Tip your Temperature
Intense exercise
Paced breathing
Progressive muscle relaxation
Self-soothe with 5 senses
IMPROVE Imagery
the Moment Meaning
Prayer
Relaxation
One thing in the moment
Mini-Vacation
Encouragement