DBT DIARY CARD

DBT DIARY CARD
0-5
0-5
Urge
Action
Urge
Action
Urge
Action
Urge
Action
0-5
0-5
Fear
Action
Sad
Urge
Shame
Misery
Date
Joy
Suicidal
Ideation
Anger
Self-Harm
Emotions
Self
Acceptanc
e
Guilt
Targets
0-5
0-5
0-5
0-5
0-5
Suicidal Ideation: 0 = No thoughts. 1 = Fleeting Thoughts. 2 = Constant thoughts. 3 Very Intense Thoughts. 4 = Developing specific plan. 5 = Acting on plan.
Intensity: 0 = Not at all. 1 = A little. 2 = Mild, lukewarm. 3 = Strong, warm. 4 = Very strong, hot. 5 = EXTREMELY STRONG, boiling.
URGE TO QUIT WORKING ON SELF IMPROVEMENT? ___________
Notes for the week
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
DBT DIARY CARD