The diary card is the road map for your individual therapy session. Recording your moods and urges on your diary card each day (ideally) will help your therapist and you determine your patterns and baseline.
General diary card instructions:
Each night as you are winding down for the day, take a few moments to reflect on what your daily experiences were. We fill out the diary card left to right, one day at a time. The first thing you fill out is the day/date! If your session was on a Tuesday and the date was June 3rd, you would write 6/3 in the Tuesday box. Then move across as you would read a book. There is ample research that shows a strong correlation between tracking and improved outcomes. Whether you want to increase or decrease a behavior, tracking it will help.
The first section asks you to rate your urges for use (drugs/alcohol), self-harm and suicide on an intensity scale from 0-5. This column does not indicate action, you could have an urge for alcohol at a 5 and not actually drink. 5 is very intense; 0 is non-existent.
The second section is for emotions. You are asked to rank the highest intensity of each emotion that day. 5 is very intense; 0 is non-existent. The “P” stands for physical pain (which isn’t an emotion…it just fits there) and the “E” is for emotional pain (which many of my clients like to use as their general stress rating that day. The goal is NOT all zeros…the goal is not all 3s…the goal is that you are honest. Over time in DBT®, what I tend to see is that a person’s negative emotions will go down first, then their positive emotions will raise up (At about the same time that they start using skills). Having this sort of proof to look back on can be very helpful when you start to feel jaded or tired from the treatment. I have also found in this section that people tend to block feeling certain emotions; the diary card allows you and your therapist to find this out faster!
The next big section is about drug/alcohol use (including legal prescriptions). We do need honesty here; your therapist is not going to use this information against you! This section allows us to discover trends much faster. For example, if you have anger outburst every day after a glass of wine…or if you have a depressive slump each time you miss a medication, then we can target that immediately! Some people also find that tracking their medication compliance helps them remember their medications more often.
Next you will find a few blank columns. This is something for you and your therapist to decide on over time. Common things to track are: hours slept, bedtime, whether or not you exercised, eating disordered behaviors, etc.
The last section is your actual actions. This section asks you to indicate (yes or no) whether or not you engaged in self-harm (intentional tissue damage), whether or not you lied (either big lies through the week or lying on the actual diary card) and whether or not you used skills (this is a 0-7 scale indicated on the bottom of the diary card).
The furthest section to the right and smallest section by far is the reward column. In the column we are asking you to remember that humans rarely learn unless someone rewards a behavioral change; we are asking if you rewarded yourself for a job well done. This might mean that you had a 5 in anger and you coped well or that you made a choice to go out with friends resulting in a 4 of enjoyment. A reward could be as simple as positive self-talk/praise or as big as buying yourself a new item (perhaps new workout clothes for going to the gym 3x that week). A reward doesn’t have to cost anything!
Upon entering session, you are supposed to hand your diary card to your therapist for them to review with you and lay the path for that session.
The DBT® individual session is structured in the following way:
1. we address any life-threatening behavior (self-harm, suicide attempts)
2. we address any therapy-interfering behavior (not doing diary card, being late to class or session)
3. we address any quality-of-life interfering behavior (substance use, not rewarding self, lying, etc)
Other helpful diary card hints:
1. Keep it where you will see it. Inside your planner, the front seat of your car, on your nightstand or where you eat breakfast. We don’t care what condition it’s in when we get it back…just that it’s filled out and that you bring it back!
2. Set a reminder alarm on your phone to complete it
3. Use diary card time as a reminder to do your DBT® homework and/or practice mindfulness