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Dialectal Behavior Therapy

Diary Card
1. Wise mind

Instructions: Circle the days you worked on each skill Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Mon Before therapy session: ______________ Before therapy session: ______________

Filled out in session? Y N Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Tues Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed Wed

How often did you fill out this side? _______ Daily _______ 2-3x ______ Once Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Thurs Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Fri Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sat Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun Sun

2. Observe: just notice (Urge Surfing) 3. Describe: put words on 4. Participate: enter into the experience 5. Nonjudgmental stance 6. One-mindfully: in-the-moment 7. Effectiveness: focus on what works 8. Objective effectiveness: DEAR MAN 9. Relationship effectiveness: GIVE 10. Self-respect effectiveness: FAST 11. Reduce vulnerability: PLEASE 12. Build MASTERY 13. Build positive experiences 14. Opposite-to-emotion action (Alt. Rebellion) 15. Distract (Adaptive Denial) 16. Self-soothe 17. Improve the moment 18. Pros and cons 19. Radical Acceptance 20. Building Structure// Work 21. Building Structure// Love 22. Building Structure// Time 23. Building Structure// Place Urge to use (0-5): Urge to quit therapy (0-5):

After therapy session: _______________ After therapy session: _______________

BRTC Diary Card Copyright 1999 Marsha M. Linehan, Ph.D.

Download and modify this card for yourself at http://www.dbtselfhelp.com/html/extras.html

Dialectal Behavior Therapy

Initials

ID#

Diary Card
Day & Date Mon Tues Wed Thur Fri Sat Sun Use
0-5

Filled out in session? Y N Anger


0-5

How often did you fill out this side? _____ Daily _____ 2-3x ______ Once ETOH
# Specify #

Date Started

Suicide
0-5

S-H 0-5

Pain
0-5

Sad
0-5

Shame
0-5

Fear
0-5 #

Illicit
Specify

Prescrip
Specify #

OTC
Specify

S-H
Y/N

Lying
#

Joy
0-5

Skills
0-7

Before Urge to use (0-5): Urge to quit therapy (0-5): Urge to harm (0-5):

After

*USED SKILLS 0 = Not thought about or used 1 = Thought about, not used, didnt want to 2 = Thought about, not used, wanted to 3 = Tried but couldnt use them Belief in control of . . . Before After Emotions: Behaviors: Thoughts:

4 = Tried, could do them but they didnt help 5 = Tried, could use them, helped 6 = Didnt try, used them, didnt help 7 = Didnt try, used them, helped

BRTC Diary Card Copyright 1999 Marsha M. Linehan, Ph.D.