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DBT DIARY CARD 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? ___________ Targets Emotions Date Self-Harm Suicidal Ideation Misery Self Acceptanc e Guilt Anger Joy Shame Sad Fear Urge Action 0-5 0-5 Urge Action Urge Action Urge Action Urge Action 0-5 0-5 0-5 0-5 0-5 0-5 0-5 Notes for the week Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Sunday:

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Page 1: DBT DIARY CARD - dbtcenterso.comdbtcenterso.com/forms/DBT_Diary_Card_w_SKills_10-2013.pdf · DBT DIARY CARD Targets Suicidal Ideation: 0 = No thoughts.1 = Fleeting Thoughts. 2 = Constant

DBT DIARY CARD

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? ___________

Targets Emotions

Date

Self-Harm

Suicidal

Ideation

Misery

Sel

f

Acc

epta

nc

e

Gu

ilt

An

ger

Jo

y

Sh

am

e

Sa

d

Fea

r

Urge Action 0-5 0-5 Urge Action Urge Action Urge Action Urge Action 0-5 0-5 0-5 0-5 0-5 0-5 0-5

Notes for the week Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Sunday:

Page 2: DBT DIARY CARD - dbtcenterso.comdbtcenterso.com/forms/DBT_Diary_Card_w_SKills_10-2013.pdf · DBT DIARY CARD Targets Suicidal Ideation: 0 = No thoughts.1 = Fleeting Thoughts. 2 = Constant

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