Dialectical Behavioral Therapy Diary
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1DIALECTICAL BEHAVIORAL THERAPY DIARY
NAME:
DATE RANGE:
FREQUENCY: __daily __2-3x __weekly
RATE ON A SCALE FROM 1-5 (SEE KEY BELOW)
S-H
SUICIDAL
OTHER
USED
DAY
DATE
SADNESS
SHAME
ANGER
FEAR
AGITATION
JOY
S-H URGES
NOTES
ACTION
ACTION
TARGET
SKILLS
RATING SCALE FOR EMOTIONS AND SELF-HARM URGES:
Urge to quit individual therapy: ___
0 = none
1 = minimal
2 = mild
3 = moderate
4 = strong
5 = intense
0 = Didn’t think about using
3 = Used skills but didn’t help
USED:
1 = Thought about using but didn’t want to use
4 = Used them, helped
Urge to quit group therapy: ___
2 = Wanted to use but didn’t
5 = Didn’t need them, practiced
Write in your skills and check off the days that you worked on them.
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