DBT Diary Cards

Hey guys, it's Dr. May, how are you?

Today we're going to talk about not a coping skill necessarily, but an important tool that is often used in individual therapy as part of DBT. And if you're in DBT, individual therapy, most likely, you've been asked to fill out a diary cards. S

I want to tell you all about what they're used for, and how they help so that you can understand this process a little bit better. O

There's a lot of different diary cards out there different versions of them, they have some in the manual, if you have the manual, but if you look on the internet, and you look up diary cards, all different kinds of stuff come out if you do like a Google image search, and they have specialized ones for things like substance abuse, eating disorders, PTSD, all kinds of stuff.

The important thing is that you find a diary card that feels right for you, so that you feel like it's relevant to you and your issues. And it makes sense that you're doing that particular one. And if you're, if you're not comfortable with it, I'm going to show you how to personalize a diary card, and to make it your own. All right. So um, let's go to this part.

Sometimes people, I've heard mixed reviews about the fact that they are asked to do a diary card and in therapy, and some people really struggle with it, it's not really their thing. They're not used to having to fill one out. And it really feels like an obligation. It feels like this thing that my therapist is making me do, but I don't really feel like doing it.

Some people resist it. And you know, they don't do it during the week, and they have to fill it out in the waiting room before the session. And they're trying to piece it together. Because they just don't particularly like it.

So if you're one of those people that feel that way, that's okay, you're allowed to have your, your feelings about it. Alright, but what I wanted to show you is how it also could be a helpful tool. And my hope is that if you understand, you know exactly how it's used, and why we're asking you to do it, you'll feel more inspired to put effort into it, and to really, you know, own up to how it could help you and put the end, you know, really try to use it in a way that feels more therapeutic for you.

So what are diary cards for? So if we look at the left, it's what are they called, like a self monitoring tool. So how do I monitor myself, and then log that stuff on a chart.

So instead of writing a diary entry, like a journal, like writing paragraphs and stuff, all I'm going to do is to go down and check off certain things about my behavior, my urges my emotions, and some events for the day, my skills, things like that. And it shouldn't really take too long. It's just a matter of sitting down and doing it.

The goal is that after you do that, and you bring it to session, it can help you understand the links between all those factors, and kind of give you some insight and self-awareness. Like, why do I do what I do and what I do it. So your target behaviors will feel like they don't just come out of nowhere, like, you'll see what's related to them, and how, you know, let's say your feelings are influencing the situation, or certain events are influencing the situation.

It makes it like you become more aware of these things. And what people sometimes find is that if you fill out the diary card every day, and then even during the day, when you don't have the card with you, you start to be a little bit more aware, and maybe start to think like, you know what, I don't want to write down my diary card that I did this target behavior, maybe I should not do it. Or you know what, I feel like, I'm really angry, I'm probably gonna have to put that in my diary card later.

So it gets you to think more and be more mindful during the day, instead of being as, you know, automatic in your habits. And that's a really important thing.

It kind of trains your mind to, you know, to look around during the day for what's actually happening.

It's really important to for communicating with your therapist, especially, you know, it puts things into words that you normally may not put into words automatically, but because you had to fill it out on the diary card, you know, you might end up talking about things you wouldn't have even thought to say, and it helps us because if you're doing it day by day, you're being more accurate about each day of the week, and it'll help you communicate better about what happened, like a week ago, than what you could remember, just spontaneously right now, right? Like sometimes I barely remember what happened two days ago, you know, how am I gonna remember exactly what I was feeling and what went on a week ago, right?

So if it's done the diary card, it's much easier for us to figure out what happened that day if there was something special about the day. All right, and also, it could show evidence of your progress. So if you look at your diary cards, For time, you might see, like evidence that things are changing. Right? Like, wow, I, I think I see that if there's fewer target behaviors that I used to have, or my emotions are rated a little lower now. So I guess that's an improvement. Right?

Sometimes we don't recognize we don't give ourselves props for the good stuff that's happening, but it's actually recording the record so we can see for ourselves, right? Okay, so this is the one that I use, okay. And you don't have to use it. Like I said, there's other ones available on the internet.

This is what I look something like this, I have it saved in a Word file. And for each person I work with, I figure out, you know, what their target behaviors are, what their main issues are, and then I personalize it for that person.

And we could also amend it over time, if necessary, but this way, it feels like it addresses exactly what that person needs to address. Alright, and I'm going to explain it more here. So I just took a slice of it. So there's more room. So you could, I could blow it up a little bit.

So the first thing I do is on the top, I put a space for the dates. I didn't used to do this. But sometimes it became a little confusing, you know, which day was which, especially if the sessions in the middle of the week, you know, and sometimes people you know, kind of confused days. So if you write the date in every day, it's it's a lot more clear.

The first part is urges, so urges to do whatever the target behaviors are, that you've identified, and you rate them zero to five, zero being no urge at all, and five being a really, really intense urge. So then the actions, alright, so those are the urges for the behaviors, the actions or the actual behaviors. So the I tried to list them in order of dangerousness or significance. So for example, let's say here, this person self injures, and I might put that as number one, because that's the most physically dangerous thing. Maybe I put aggressive behavior next, because getting into fights is also possibly physically problematic, then maybe substance abuse, and then maybe after that person has eating disorder issues, maybe purging after that. But it really also depends on the person, like for some people purging might be a really significant issue, that would be number two, whereas aggressive behavior might be more verbal aggression, it's not a big deal. Maybe that's number four. Right? It's really a person to person kind of thing.

But you don't have to be too perfectionistic about this part.

Other things you could do is, let's say, the person itself injures in a few different ways. So you might have a few categories for that, right? Maybe taking pills and trying to overdose is one thing. And cutting is another thing. And burning is another thing. All right, we're scratching is another thing, it might, it might have different significance. Or you can leave it as one thing and just say specify. So when you're filling out a certain day, you say what kind of self injury you did. So you can communicate that with your therapist. Same thing with substance abuse, sometimes I've seen subsidies diary cards online, and there's a few different categories, depending on the drug or the alcohol you're using. So you could track exactly what happened.

Otherwise, if it's less of an issue, maybe you could just jot it down for each day. Okay, certain things in actions are a little harder to quantify. So let's say you have an issue with restricting food. So it's harder to say, how many times if it's an absence of something, right? So that might be something you would rate zero to five, for example, or sometimes people have wanted to put things like engaging in bad thoughts or something like that entertaining bad thoughts or obsessive thoughts? And that's hard to quantify. But maybe you could rate that also, like, How bad was it that day, from your point of view? Okay, the emotion section, I generally leave the same for people, because it's pretty much the core emotions that everybody experiences. Although once in a while, if somebody has a different emotion that's very prominent, such as loneliness, we might stick that in also. But it's important to rate negative as well as positive emotions such as joy, because it might mean something if you had more joy in a certain day, right?

I also leave a section for what I call noteworthy events positive or negative. So if you were to reflect back in the day, like what some of the main things that happened that day, that's important based on the other ratings you're filling in. So it was something negative event maybe that impacted the urges or the actions you had or the emotions you had was something positive, that also could have a very big effect. But just a couple of words, it doesn't have to be a big deal. But if you really want to write about it, you certainly could do it on another piece of paper or a journal or whatever. Um, coping skills. Um, sometimes people like to fill out a check sheet with all the DBT skills on it, like the original diary card has something like that.

But what I found is sometimes people either over endorse or under During divorce, so people who haven't learned about most of the skills may not even know what they're filling out, they might leave it blank. And other people might check a whole bunch of things. And then by the time they come to session, they don't remember exactly what that looked like for them. say, Oh, I see you did self soothe. What? What did you do that day? Say, I don't know, I guess I self soothe. I remember what I did. Right.

So when you leave a space at the bottom like this, I would want to know, in your own words, what you actually did to cope, you know, so maybe you'll say I took a warm bath. And that's what you meant by self soothe, but because you wrote exactly what it was, you'll remember when we meet for a session. Okay? But that's really important too, because we want to know, if you're trying and what you're trying and what works and what doesn't work. So if you put it day by day, we can help track that as well.

I'm going to show you a sample. Alright, just so you can see how all these pieces move together. And I'll show you three different kinds of days.

What we can gain from a diary card looking at these different days. So let's look at Sunday, which I highlighted. So let's say this person, I made these up, by the way, all right, I had really strong urges, right. So five is the highest of the urges or five, right, suicidal urges for and urge to use an urge to purge a three kind of medium, right, but overall, you know, some strong urges there. So then we look at the action. So a few of those urges translated into an action.

So the person said, Yes, for cutting. Yes, for hitting a wall and cursing. Right. So that's an aggressive action. And yes, for purging times, too. So something big was going on that day. Right?

And I would want to know, in session, well, what what is it that happened? So under noteworthy events, argument with mom on the phone? So I would want to find out from that person? What is it about that argument that really got to you, you know, and emotions too. So joy is really low, it's one, but the other emotions are really intense fear, Misery, sadness, anger, and shame or guilt. So maybe that argument led to all those other reactions, urges and behaviors. And I want to know how this all interacted, and how they, you know, what we need to do differently the next time. So I can see the person attempted to use some skills, listen to music, and maybe it was an attempt. But given the intensity of the situation, it wasn't enough, right? So listening to music wasn't enough to prevent the behaviors. So perhaps we would start discussing about, well, is there maybe some different skills you could try the next time, you know, maybe there's something that could be a little more effective that we could add into the mix, that would change the outcome? All right, so this is an example of maybe a really difficult day.

So let's look at Monday. So Monday, this person has kind of, you know, medium to higher, just so sort of high in the suicidal self injury and fighting urges, a little lower on urge to use an urge to purge kind of low to medium.

But if you look at the actions, the person did say yes, for aggression, put nasty text maybe, you know, got a little angry, send something they shouldn't have sent. But maybe it's not as bad as some other physical aggression the person had. So that's why it's important to specify. So punching somebody isn't as bad is sending a nasty text, although we still would want to work on that. But the good part is that, despite those fairly high urges, is there was no self injury, it was no substance abuse or purging. So something maybe went a little bit better, right?

Let's look at the emotions. Alright, so kind of medium levels, maybe not as intense as the day before, but still, you know, Misery, sadness and anger. Were fours, it's still fairly high. And some of the other ones fear anxiety, shame and guilt are three, which is kind of medium. Right? So despite some of those, you know, intense emotions, the person did pretty well. So noteworthy events, so maybe what triggered all this friends canceled plans last minute, right? So we got to figure out what is it about that, that led to this chain of events.

Another thing that's important here is the person listed for different coping skills. So maybe the friends canceled last minute, they did feel stronger, because they did feel intense emotions, but they tried things such as self soothe, exercise wise mind and coloring, right. And I want to know exactly how those coping skills were implemented. And you know, what was helpful about them because they obviously did something, because the actions were different this time. Right. So that's an important discussion to have on Monday.

Let's look at Tuesday. So Tuesday seems like a pretty good day. The person's urges overall were fairly low, much lower than the other days. There were no target behaviors, which is great. So we definitely want to figure out what what worked right. Joy's rated a four. Wow, that's a lot different from the other days, right. Other emotions were fairly low one to two.

So what was a noteworthy event? Maybe something was inspiring some of this improvement, right? Hung out with cousins walked on the boardwalk. So maybe we could figure that out? Well, maybe the cousins are supportive, they're fun to hang out with maybe the exercise of fresh air was really good. And if that's good, how can we maybe do more of that kind of stuff, maybe that's helping your day go better, right. And also coping skills, the person put exercise in mindfulness. So maybe that had to do with something that was going on while walking on the boardwalk, but I certainly would ask the person, okay, so we want to figure out what happened on the bad days, as well as what happened on the good days. That's how direct cards can help.

Another thing I want to bring up is that some people who are not willing or able to do a diary card for whatever the reason. And we still want to monitor behavior, if there's active behaviors going on an option, if you're the therapist is to give the parent if it's a parent of a team, or a staff, if it's a person in inpatient, or maybe someone in a residence, give them a behavior checklist for the person with the main type target behaviors that they can be aware of. Now, this happened to be one that gave to the parent of a girl who I think was in her teens, I don't really remember this person. And I also changed the name for this purpose. But those were actually the behaviors that were on the list.

So an outsider could observe these things. And maybe perhaps some noteworthy events that they are aware of, that may have corresponded with those things that day. And coping skills would be like if they know of coping skills their kid did, but you can always know what the person's thinking. Right. So they may have done something mentally, like think of consequences that the rater isn't aware of, but that at least they could try to report what they observed.

And also note here that I didn't put a section for emotions. While you could kind of guess somebody's emotions, sometimes, you can always get in somebody's head and determine how they're feeling. So I wouldn't necessarily put emotions Unless, you know, a noteworthy event is the person was yelling and screaming, seem really angry or something to that effect. Okay, but that could always be discussed in session. But it's really important to have this tool as you can see earlier, I'm sorry, it's my phone in the background. But anyway, sorry, I'm a little distracted. So um, so this is just an alternative if you need it.

So some tips and suggestions. So if you're the one filling out the diary card, I would try to fill it out every evening at the same time. So this way, it's fresh in your mind, you can reflect on the day, and you don't have to try to piece it together the day of your session, which may be really hard to do, as we talked about earlier. expect that when you do come to session, that the behaviors will be addressed in order of priority for an order dangerousness, because we want to make sure first that you're okay. You know, the most important thing is that you're alive that you're not physically harming yourself or others.

For example, on the sample we did, I would start with Sunday, because that was the hardest day. And then after Sunday's taking care of I would look at some of the other days, you know, and if there's a lot of things that are troublesome during the week, sometimes they interconnect, and sometimes they don't, but I would try to generally address it in order of priority.

If there happens to be no target behaviors during the week, and it was good week, there's much more freedom about what we can talk about, you know, maybe there's other things that come up that are on your mind. And, you know, we can have a little more freedom in discussing that and maybe some other skillful things.

Another thing is, for those of you who are tech savvy, they do have DBT apps and DBT apps with diary cards on them. Now, because I work in patient right now, and I haven't done private practice for about five years. I'm not as familiar with that. But some of you out there might be and I'd love to hear from you about how you've been doing with those apps and how they're helpful to you.

But it might be worth checking out, just download it and see if it works. And maybe there's even some kind of capability where you can kind of communicated to your therapist and had them see what you entered or something like that. But I don't want to guess I know I guess wrong because I you know, I haven't really done it.

Another thing I would say too, is you know, if you're not sure you know if your diary card you have that you're using in therapy as helpful as to see if you can revise it, just communicate your therapist about it. Right or, you know, if you want help changing it, ask for help.

Or if you're forgetting why you need the diary card. Either watch this video again or ask your therapist like how they think it'll help you. Okay, so you could be assertive about it. Use your human skills, right? self respect, like figure out how is this helping me like how can I look out for myself in this therapeutic process.

And also, like I said earlier, feel free to save your diary card so you can look back and really see your progress on paper. You know, sometimes, as a therapist, I would collect the person's diary cards, but you as a client can collect them to, you know, make a copy first before you give it to your therapist so you could see, right, that'll empower you to look at your patterns yourself.

All right. So that's my, my little spiel about diary cards. I hope that helped you understand them better and see how they work. So I hope you give it a try on your own.

Even if you're not in therapy, you know, there's some value to monitoring your own behavior, just personally and it gives you some insight.

Okay, guys, so stay tuned for the next video about behavior chain analysis, which kind of springboards from diary cards. Alright, so thanks for listening and see you in the next video. Bye.

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