Diary Cards

Diary cards are a key element of DBT. They can be really helpful in gathering data to track student’s urges, moods and what skills were or were not helpful. They can also be useful to structure your individual sessions with students. Here are some examples of DBT Diary Cards – there are many more freely available just by doing a quick search on Google.

Adolescent Diary Card – Rathus and Miller (2015)

Generally speaking the Diary Cards are completed for a week (just noting the date of each day you record on your sheet)

Top half of the page:

This examines target behaviours which can be adjusted for the individual. So “Behaviour 1” might be verbal aggression, “Behaviour 2” might be leaving the classroom. I really like that in this aspect of the Diary Card, you can incorporate the student’s therapy goals. Students are then asked to rate the urge they had that day to do their target behaviour and whether or not they engaged in that behaviour (yes/no). It’s great that this practice not highlights the difference between urges and actions but also reinforces observation of the urges and time when we don’t act upon such urges.

Students are then asked to very briefly consider other relevant factors to them eg. self harming behaviour, medication compliance, school performance as well as which emotions they experienced that day and what skills they used.

Bottom half of the page:

Focuses on the specific DBT skills that the student has engaged in on what day – student can simply circle or highlight the skills.

DBT Diary Card – More simplified version (Rathus and Miller, 2014)

Diary Card tips:

• It’s really important to adjust the diary card to suit the individual eg. if the student has a trauma history, maybe it is not helpful to focus on shame each day so that emotion could be removed. Also adjusting the behaviours to incorporate student therapy goals can assist in compliance.
• Despite the diary cards literally taking around a minute to complete (when practiced), almost every DBT clinician I have spoken to, particularly in the USA, has had GREAT DIFFICULTY in getting their students to actually complete their Diary Cards. Indeed, it’s been one of the most talked about stressors in the DBT consultation meetings that I have attended. This has actually made me feel really relieved as aI have had this experience with my own students and I was really struggling to support them in completing the Diary Cards regularly. Some strategies that clinicians have come up with to combat this are:
  • Have students complete it with you in their individual sessions. Some clinicians I have spoken to have been quite firm with their students to elicit compliance, whereby focusing on the diary card before starting their session together
  • Complete the Diary Cards together and time how long it takes to complete each time – to demonstrate that it really doesn’t take that long
  • At the beginning of the DBT therapy, folding the page in half (separating the top and bottom) to just focus on the rating of behaviours as opposed to focusing on the skill. It can be a little overwhelming to look at the whole page initially and sometimes the students haven’t covered all of the stills yet so it’s a good idea to either adjust the page to suit where they’re at or fold it over initially.

Resources

• Rathus, J. H. & Miller, A.L. (2015) DBT Skills Manual for Adolescents Guilford Publications, New York (NY)
• DBT Diary Card Examples
  • http://www.cbm-dbt.com/images/Diary_Card.pdf
  • https://www.dbtselfhelp.com/html/diary_card_4.html
  • http://www.mydailydbt.com/2012/12/printable-dbt-diary-card.html
• App DBT version
  • https://itunes.apple.com/us/app/simple-free-dbt-skills-diary/id666921665?mt=8

 

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