Title: Dialectical Behavior Therapy
Author: Department of Psychology
Last saved by: Milton
Company: University of Washington

DBT Skills Diary Card | | At the top of each column write in the current date
Write in the Number of Days in the last 7 days | | | | | | | |
Our Behaviors | | | | | | | |
1	We argued | | | | | | | |
2	We had strong observable anger or judgment | | | | | | | |
3	We avoided due to our fear		E = extinction | | | | | | | |
4	We were coerced and then gave in	E = extinction | | | | | | | |
5	Our other emotions got in the way | | | | | | | |
6	Gave single, concise, prompt specifying needed behavior & time frame | | | | | | | |
7	We reinforced desired behaviors with DEaR gratitude | | | | | | | |
8	We reinforced desired behaviors with requested favors or activities | | | | | | | |
9	DEAR MAN (concisely) when different behaviors are needed | | | | | | | |
10	DEAR MAN (thoroughly) addressing a pattern of behavior | | | | | | | |
11	Followed consequences specified on the behavior contract | | | | | | | |
12	Punished by taking something away (not on the contract) | | | | | | | |
13	Natural punishment (“on favor lockdown”) | | | | | | | |
14	Interest – thoroughly asked and summarized what my child said | | | | | | | |
15	Brief validation (“makes sense” or “yes, that’s true” or “of course”) | | | | | | | |
16.	Thorough validation | | | | | | | |
Our Child’s Behaviors | | | | | | | |
Days of arriving late to school | | | | | | | |
Full days of school missed | | | | | | | |
Severe Noncompliance with Requests | | | | | | | |
Physically destructive acts | | | | | | | |
Threats of Physical violence | | | | | | | |
Anger, Yelling, screaming, or Insults | | | | | | | |
Self Harm or Threats | | | | | | | |
Positive drug or alcohol test	(Y or N) | | | | | | | |
Away from home without permission / past curfew | / | / | / | / | / | / | / | /
Extreme isolation or passivity | | | | | | | |
.
DBT Skills Diary Card | |
Write in the Number of Days in the last 7 days | | | | | | | |
Our Behaviors | | | | | | | |
We argued | | | | | | | |
We had strong observable anger or judgment | | | | | | | |
We avoided due to our fear | | | | | | | |
We were coerced and then gave in	E = extinction | | | | | | | |
Our other emotions got in the way		E = extinction | | | | | | | |
Gave single, concise, prompt specifying needed behavior & time frame | | | | | | | |
We reinforced desired behaviors with DEaR gratitude | | | | | | | |
We reinforced desired behaviors with requested favors or activities | | | | | | | |
DEAR MAN (concisely) when different behaviors are needed | | | | | | | |
DEAR MAN (thoroughly) addressing a pattern of behavior | | | | | | | |
Followed consequences specified on the behavior contract | | | | | | | |
Punished by taking something away (not on the contract) | | | | | | | |
Natural punishment (“on favor lockdown”) | | | | | | | |
Interest – thoroughly asked and summarized what my child said | | | | | | | |
Brief validation (“makes sense” or “yes, that’s true” or “of course”) | | | | | | | |
Thorough validation | | | | | | | |
Our Child’s Behaviors | | | | | | | |
Days of arriving late to school | | | | | | | |
Full days of school missed | | | | | | | |
Severe Noncompliance with Requests | | | | | | | |
Physically destructive acts | | | | | | | |
Threats of Physical violence | | | | | | | |
Anger, Yelling, screaming, or Insults | | | | | | | |
Self Harm or Threats | | | | | | | |
Positive drug or alcohol test	(Y or N) | | | | | | | |
Away from home without permission / past curfew | / | / | / | / | / | / | / | /
Extreme isolation or passivity | | | | | | | |

Your Family Name: _________________________

Once per week, write in the boxes for a single column, reporting the number of days each behavior occurred in the last 7 days.

At the top of each column write in the current date (when you are reporting the behaviors).