How to Use DBT Diary Cards

What is a diary card?

A diary card is a unique tool that is used in the Dialectical Behavior Therapy, or DBT, system. It is a grid-like form that helps a person to track when their target symptom occurs and if, and which, skill they use to cope with it. The card can be tailored to address the specific targets that a therapist and client have agreed on.

DBT in a nutshell

DBT is an approach that is based on cognitive-behavioral principles to improve psychological distress, including self-harm behavior and imbalanced moods. These state that thoughts, feelings, and behavior are intricately linked and influence each other. Also, that positive behavior can be deliberately practiced, which contributes to improved thoughts and feelings. In DBT, four core techniques were added to make the change process more efficient, namely dialectics, mindfulness, emotion regulation, and interpersonal effectiveness.

• Dialectics: There is an apparent contradiction between acceptance and change. A dialectical mind is able to balance the two needs by accepting the past but striving for an improved future.
• Mindfulness: With a mindful attitude intentional focus is placed on the present moment to experience all thoughts, feelings, and sensations with acceptance and nonjudgment.
• Emotion Regulation: The ability to initiate, inhibit, or modulate one’s emotions at any time is a skill linked to mood improvement, increased compassion, and better relationships.
• Interpersonal Effectiveness: Getting on better with others means to attend to relationships, balance priorities and demands, and offset the “wants” and “shoulds” by applying mastery and respect for ourselves and others.

More about diary cards

In a DBT program, diary cards are filled out daily and brought to weekly sessions. They are designed to record instances of target behaviors such as self-injurious acts, thoughts and urges about suicide, feelings of misery, and the use of substances, as well as the use of behavioral skills. There is a blank area on the card where other targeted behaviors can be recorded. These may include episodes of binge eating, purging, flashbacks, panic attacks, and others. Daily productive activities are noted too.

The therapist reviews the diary cards at the beginning of each session, and issues highlighted discussed. As such, the risk of suicide and patterns of substance abuse are identified and viewed as life-threatening or quality-of-life-interfering behaviors that must be managed.

According to Alec Miller and his co-authors of the title “Dialectical Behavior Therapy for Adolescents,” diary cards are typically introduced at the end of the first session or during the second session. The two-page card is photocopied to fit on the front and back of an 8 ½ x 11 page (see an example here). It's importance and rationale as a crucial tool of DBT is then explained.

Goals of diary cards

The completion of diary cards fulfills various useful objectives. First, filling it out requires a person to self-monitor their target behaviors, thoughts, and skills. Such awareness is recognized as the first step to self-improvement. Secondly, the cards provide an organized overview of the client’s week to the therapist and serves as a basis for discussion and further work. Third, the cards function as a diary that a person can review to remember past experiences and identify areas of progress and where it may still lack. Finally, it enables the client and therapist to explore possible links between situations, emotions, and behavior. Therefore, diary cards help to focus effort on what is important in a person’s daily life.

There’s an App for that!

Yes, that’s right! Diary cards can be quite intimidating and daunting to the newbie. Fortunately, there is now an app available in the Apple store that is straightforward and free to use. In addition to a diary log for each day with the 28 DBT skills to choose from, it features full descriptions and explanations. Information is collated to give a view based on a week, a month, or any other date range. The are space for additional notes too, a notification that can be set to remind you to fill it in each day, and the ability to share it on social media or email. Check out more about the app here, download the user manual, or view a video review.

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