Therapy For Real Life DBT Diary Card Template

	A	B	C	D	E	F	G	H	I	J	K	L	M	N	O	P	Q	R	S	T	U	V	W	X	Y	Z	AA	AB	AC	AD	AE
1	Therapy For Real Life DBT Diary Card Template - Stage 1: Interrupting Life Interfering Behaviors
2		Name:							Date Started:								Guiding Values:			...
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4		My "Life Worth Living" Goal Is:															Stage of Therapy:				Current Target(s):		[ ... ] (eg. Mindfulness, Emotion Regulation, Relationship Skills, Distress Tolerance)
5		Day	LIfe Threatening / Avoidance Behaviors																		Emotions
6			Self-Harm			Suicidal Ideation			Alcohol			Drugs			Meds			Other			Emotions
7			Urges	Actions	Skills Used	Urges	Actions	Skills Used	Urges	Actions	Skills Used	Urges	Actions	Skills Used	Taken as Rx'd?	Risky Sex or Behav?	Skills Used	Urges	Actions	Skills Used	Angry	Fearful	Happy	Anxious	Sad	Ashamed	Guilty	Lonely	Grateful	...	Skills Used
8			0-5	yes/no	0-7	0-5	yes/no	0-7	0-5	yes/no	0-7	0-5	yes/no	0-7	0-5	yes/no	0-7	0-5	yes/no	0-7	0-5	0-5	0-5	0-5	0-5	0-5	0-5	0-5	0-5	0-5	0-7
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10		Monday
11		Tuesday
12		Wednesday
13		Thursday
14		Friday
15		Saturday
16		Sunday
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18		Notes / Skills Used:
19		Monday:																			Skills Used							Rating Scale For Emotions And Urges
20		Tuesday:																				0 - Didn't think about or use any skills							0 - Not at all
21		Wednesday:																				1 - Thought about skill/but didn't use/didn't want to							1 - A bit
22		Thursday:																				2 - Thought about skill/didn't/but did want to							2 - Somewhat
23		Friday:																				3 - Tried, but couldn't use the skill							3 - Strong
24		Saturday:																				4 - Tried to use the skill, but it didn't help							4 - Very strong
25		Sunday:																				5 - Tried the skill and it helped							5 - Extremely strong
26		Therapy Priorities:																				6 - Used the skill without trying/but it didn't help						Urge to quit therapy:
27		Questions:																				7 - Used the skill without trying/and it helped						Misery Index:
28		Win List:																										Other Index:
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30			Current life worth living practice:							________________________________________________________ (Specific, measuarable, achievable, realistic, timely)
31			Current life worth living practice:
32			"I'm living a life worth living..."							(How much do you agree or disagree?)						Say more about your feelings about a life worth living and the number you chose ...								...
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34																										TherapyForRealLife.com
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36		DBT Self-Care Skills
37			Mindfulness Practices																Acceptance Strategies to Surf High Distress
38			Wise mind																Radical Acceptance
39			Observing with the senses (8 mini mindfulness practices)																Urge Surfing
40			Observing dialectics / How To Think and Act Dialectically																Bio-Mood Hacking - TIPP Skills
41			Describe (thoughts, feelings, sensations, urges, values ) nonjudgmentally																Pros and Cons and Motivation Boosters
42			Participate / Loving Kindness Meditation																DISTRACT / Self-Soothe / IMPROVE The Moment
43			Nonjudgmentally as a practice , Nonjudgmental communication phrases , mindful listening																Willingness
44			One-mindfully																Mindfulness to Current Thoughts
45			Doing what works - Mindfulness to what is effective																Willing Hands / Half-Smiling
46			Walking the middle path																Love The Dandelions
47																			Apply The Four Solution Anaylsis
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49			Regulating Mood Skills																Relationship Skills
50			Mindfulness to current emotion DictionaryOfObscureSorrows.com																Define core needs and areas of flexibility
51			Daily Emo-Check (podcast): Describe emotions and their needs																Zen and the Art of Relationships - MultiAmory Podcast
52			Opposite Action for emotional fitness																Define relationship objectives, a healthy relationship, and dignity/self-respect
53			What get's in the way of regulating your mood?																How To Show That You Are Listening (Validation)
54			Check The Facts																How To Ask For What You Want (podcast) (DEAR MAN handout)
55			Problem- Solve																GIVE (be Gentle, act Interested, Validate, use an Easy Manner)
56			Accumulate Positives - Pleasure Activism																FAST (be Fair, don't over-Apologize, Stick to your values, be Truthful)
57			Build mastery / Cope Ahead																THINK
58			PLEASE (Phys needs, Eating, Avoid drugs, Sleep, Exercise)																DIME Game ( How strongly to ask or say 'No' podcast)
59			Self-Validation (see also Validation Variety Pack podcast ep.)																Attend to relationships / Engage in Community
60		Therapy For Real Life Library of Self-Care and Relationship Skills, Worksheets, and Ideas
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63		Therapy For Real Life Podcast - Including DBT and other Therapy Skills Adapted for Self-Care
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70		Original DBT Diary Card from Marsha Linehan's research
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