Dialectical Behavior Therapy
Skills Diary Card	Initials	Filled out in Session?
     Y        N    (Circle)	How often did you fill out this side?
___ Daily  ____ 2-3x
____ 4-6x ____Once	Started:

Date______/_______/_____	
	ID #				
Circle 
Start Day	Highest Urge To:	Highest Rating for Each Day	Drugs/Medications	Actions		
Day
Of
Week	Avoid	Give
Up	Isolate	Emotion Misery	Depress	Sadness	Shame	Energy	Joy		Alcohol	PRN/Over the Counter	Avoid	Give Up	Isolate	Rein-
force	# hrs
out	Skills	
	0-5	0-5	0-5	0-5	0-5	0-5	0-5	0-5	0-5	#	What?	#	What?	Y/N	Y/N	Y/N	√		0-7	

																				

																				

																				

Notes about what happened

 	 * USED
0 = Not thought about or used
1 = Thought about, not used
2 = Not used, but wanted to
3 = Tried but couldn’t use them 	 SKILLS:
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	
	  Urge to: 	Before Session
(0-5)	 After Session (0-5)	
	Quit Therapy			
Med Changes/Other:	SU			

DBT Skills Diary Card		Filled out this side?  ___ Daily  ____ 2-3x  ____ 4-6x  ____Once ____ In session	
   Homework:						 	Check Skill (if more than one) and Circle days skill was practiced	
1.  Wise mind	MON	TUE	WED	THUR	FRI	SAT	SUN	
2.  Observe: just notice 	MON	TUE	WED	THUR	FRI	SAT	SUN	
3.  Describe: put words on, just the facts 	MON	TUE	WED	THUR	FRI	SAT	SUN	
4.  Participate: enter into the experience	MON	TUE	WED	THUR	FRI	SAT	SUN	
5.  Non-judgmental stance	MON	TUE	WED	THUR	FRI	SAT	SUN	
6.  One-mindfully: present moment	MON	TUE	WED	THUR	FRI	SAT	SUN	
7.  Effectiveness:  focus on what works	MON	TUE	WED	THUR	FRI	SAT	SUN	
8.  Self-Validation	MON	TUE	WED	THUR	FRI	SAT	SUN	
9.  Describe___, Express___, Assert___, Reinforce___  (check)                    	DEAR	MON	TUE	WED	THUR	FRI	SAT	SUN	
10. Broken record___, Ignore attacks___, Appear confident___, Negotiate__ 	MAN	MON	TUE	WED	THUR	FRI	SAT	SUN	
11. Gentle___, Interested___, Validate___, Easy manner___                      	GIVE	MON	TUE	WED	THUR	FRI	SAT	SUN	
12. Fair___, no-Apologies___, Stick to values___, Truthful___                   	FAST	MON	TUE	WED	THUR	FRI	SAT	SUN	
13.  Attend to relationships 	MON	TUE	WED	THUR	FRI	SAT	SUN	
14.  Figure out interpersonal goals and priorities	MON	TUE	WED	THUR	FRI	SAT	SUN	
15. Opposite-to-emotion action (Stop avoiding)	MON	TUE	WED	THUR	FRI	SAT	SUN	
	Opposite-to-depression action		MON	TUE	WED	THUR	FRI	SAT	SUN	
	16. Pros and Cons of acting depressed vs. acting opposite		MON	TUE	WED	THUR	FRI	SAT	SUN	
	17. Mindfulness of Current Emotion/urge	MON	TUE	WED	THUR	FRI	SAT	SUN	
	18. Break overwhelming tasks into small pieces and do first step	MON	TUE	WED	THUR	FRI	SAT	SUN	
	19. Problem solve	MON	TUE	WED	THUR	FRI	SAT	SUN	
	20. Accumulate positives	MON	TUE	WED	THUR	FRI	SAT	SUN	
	21. Build mastery	MON	TUE	WED	THUR	FRI	SAT	SUN	
	22. Exercise (number of minutes)								
    Opposite-to-overwhelm-action (you need to get a new behavior)		MON	TUE	WED	THUR	FRI	SAT	SUN	
	23. Mindfulness of Current Emotion/urge		MON	TUE	WED	THUR	FRI	SAT	SUN	
	25. Break overwhelming tasks into small pieces and do first step		MON	TUE	WED	THUR	FRI	SAT	SUN	
	26. Problem solve; Build mastery		MON	TUE	WED	THUR	FRI	SAT	SUN	
	27. Acceptance with Mind:  Radical acceptance, Willingness		MON	TUE	WED	THUR	FRI	SAT	SUN	
	28. Acceptance with Body:  Relax muscles, Breathe fully and slowly		MON	TUE	WED	THUR	FRI	SAT	SUN	
									
    Stopping problem behaviors		MON	TUE	WED	THUR	FRI	SAT	SUN	
	30. Physically block the behavior (stimulus control)	MON	TUE	WED	THUR	FRI	SAT	SUN	
	31. Mindfulness of Current Emotion/urge “Urge Surfing”	MON	TUE	WED	THUR	FRI	SAT	SUN	
	32. Postpone behavior for a specific small amount of time (fully commit)	MON	TUE	WED	THUR	FRI	SAT	SUN	
		32b. Distract, relax, or self-soothe	MON	TUE	WED	THUR	FRI	SAT	SUN	
		32c. Postpone behavior again (even if just for a few more moments)	MON	TUE	WED	THUR	FRI	SAT	SUN	
	33. Do the behavior in slow motion	MON	TUE	WED	THUR	FRI	SAT	SUN	
	34. Do the behavior in a very different way	MON	TUE	WED	THUR	FRI	SAT	SUN	
	35. Add a negative consequence for the behavior	MON	TUE	WED	THUR	FRI	SAT	SUN	
36. Cold Face 	MON	TUE	WED	THUR	FRI	SAT	SUN	
37. Slow Breathing (write in pace and total minutes or points)			      1	|	|	|	|	|	|	|	
Stress Eraser?    Yes    No						2.	|	|	|	|	|	|	|	
38. Relaxation what type?				(total number of minutes)								
40. Self Care: Exercise 				(total number of minutes)								
41. Self Care: Balance Sleep (consistent times, long enough)	MON	TUE	WED	THUR	FRI	SAT	SUN	
42. Self Care: Balance Eating	MON	TUE	WED	THUR	FRI	SAT	SUN	
43. Challenge Thinking___, Check the Facts___, Decatastrophize___	MON	TUE	WED	THUR	FRI	SAT	SUN	
44. Mindful of Current Thoughts___	MON	TUE	WED	THUR	FRI	SAT	SUN	
45. Mindfulness of Current Emotion	MON	TUE	WED	THUR	FRI	SAT	SUN	
46.  Problem solve	MON	TUE	WED	THUR	FRI	SAT	SUN	
47.  Accumulate positives___, Build mastery___	ABC	MON	TUE	WED	THUR	FRI	SAT	SUN	
48.  Cope ahead___	ABC	MON	TUE	WED	THUR	FRI	SAT	SUN	
50.  Distract		MON	TUE	WED	THUR	FRI	SAT	SUN	
51.  Self-Soothe	CRISIS	MON	TUE	WED	THUR	FRI	SAT	SUN	
52.  Improve the moment	SURVIVAL	MON	TUE	WED	THUR	FRI	SAT	SUN	
53.  Pros and Cons		MON	TUE	WED	THUR	FRI	SAT	SUN	
54.  Radical acceptance, Turn the mind, Willingness	MON	TUE	WED	THUR	FRI	SAT	SUN	
This card is located at www.dbtsandiego.com/current_clients.html						Diarycard-dep.rtf

Things to Do Before Next Session							Completed?
_____________________________________________________________	Yes	No
_____________________________________________________________	Yes	No
_____________________________________________________________	Yes	No
_____________________________________________________________	Yes	No
Fill out worksheet: __________________________________________		Yes	No
Fill out worksheet: __________________________________________		Yes	No

Things to Bring to Next Session							Brought It?
_____________________________________________________________	Yes	No
_____________________________________________________________	Yes	No

Medication Changes	Yes	No
_____________________________________________________________
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