DBT Adolescent Diary Card

Day
&
Date

Initials____ Date Started ____to ____ Date Completed. Please check each behavior for each day on a scale (0-5 See Below)
Parent
Substance
Aggressive
School
Aggressive
SelfSuicidal
Risky
Avoid
Initial
Abuse
Behavior
problems
Behavior
Harm
Thoughts
Sexual
optional
cravings
(verbal)
Yes/No
(physical)
Thoughts (0-5)
urges
(0-5)
(0-5)
(0-5)
(0-5)
Actions
Actions
Use Yes/No
Actions Yes/No
Actions
Actions
Yes/No
Yes/No
Yes/No
Yes/No

Mon
Tues
Wed
Thu
r
Fri
Sat
Sun
Joy

Fear

Anger

Sadness

Loneliness

Pain

Shame

Other

Other:

Mon
Tues
Wed
Thu
r
Fri
Sat
Sun
DBT-SKILLS DIARY DATE:
Place a check mark every time you try to use skill(s)
1. Wise Mind
2. Observe (watch; no words)
3. Describe (use words)
4. Participate (throw yourself in)
5. Dont Judge
6. Stay Focused
7. Do What Works
8. Distract; ACCEPTS
9. IMPROVE the moment
10. Self-soothe: five senses
11. Pros and Cons
12. Radical Acceptance
13. Cheerleading Statements
14. Improving the Relationship: GIVE
15. Getting What You Want: DEAR MAN
16. Feeling Effective & Keeping your Self-Respect: FAST
17. SACRED SELF
18. Reduce Your Vulnerability: HEAR ME , STRONG
19. Build Mastery
20. Build Positive Experiences
21. Letting go of negative emotions
22 Act Opposite-to-Emotion
23. Thinking dialectically
24. Validate self
25. Validate others
26. Reinforce a positive behavior for yourself
27. Reinforce a positive behaviors of others
28. Walk the middle path

Mon

Tues

Wed

Thurs

Fri

Sat

Sun