The DBT Diary Card: What It Tracks and How It Is Used

In crisis or thinking about suicide? Call or text 988 now (in Colorado it reaches the 988 Colorado Mental Health Line). If you are in immediate danger, call 911.

Why your DBT therapist hands you a card

If an urge to hurt yourself is strong right now, put the card down. Call or text 988, or call 911 if you are in danger. You can fill in the card later.

Early in DBT, many people are given a diary card and asked to fill it in every day. It can feel like a lot: one more task in a week that is already hard. It helps to know what the card is for. It gives you and your therapist a clear record of the week, so sessions are based on what actually happened rather than on what you remember in the moment.

A 2021 review of DBT apps puts it plainly: daily tracking of behaviors and skills use on a diary card is integral to delivering DBT. That is why therapists ask about it every week, and why it is worth finding a way to make it work for you.

This guide explains the card itself. For what happens in your first appointment, see your first DBT session.

What a diary card tracks

Cards differ from program to program, and therapists often tailor them to your own goals. In a 2021 Danish trial, people in DBT recorded their emotions, urges and skills used every day, either on paper or in an app. Most cards include some version of these rows:

• Emotions. How strong feelings such as sadness, anger, shame or fear were each day.
• Urges. How strong the pull was toward behaviors you are working on, such as self-harm, substance use or quitting therapy.
• Target behaviors. Whether you acted on an urge that day. These come from the goals you set with your therapist.
• Skills used. Which DBT skills you tried. The four skill areas are covered on our page of DBT techniques.
• Notes. A short space for anything else your therapist asks you to track, such as sleep or a hard event.

How therapists use it in session

A 2021 review describes the diary card as an essential part of treatment that guides individual therapy, tracks progress week to week, helps set the agenda and supports suicide risk assessment. Another clinical paper describes the DBT session as having a "crisp beginning" that involves reviewing the diary card.

The agenda follows DBT's order of priorities. Life-threatening behavior comes first, then anything that gets in the way of therapy, then problems that seriously affect your quality of life. So if the card shows a self-harm urge on Wednesday, that is likely where the session starts. Your therapist may then walk through a chain analysis, a step-by-step look at what led up to the behavior and what followed it.

Over several weeks, the cards can also show patterns that are hard to see day to day. You might notice that urges rise after poor sleep, or that a skill you rarely try works when you do. As your goals change, your therapist may add or drop rows so the card keeps tracking what matters now.

A 2016 review notes that people in skills group can talk about how they used a skill, but the diary card is mainly worked through with the individual therapist. You do not read it out in group. Learn more about how individual DBT and groups fit together on our page about DBT therapy in Denver.

Common worries, and what usually happens

Most people have mixed feelings about the card at first. These worries come up often.

• "I forgot to fill it in." A study of DBT diary cards notes that paper diaries can feel like a burden. Therapists usually treat a missed card as a problem to solve together, such as picking a set time or a simpler format.
• "I'm afraid to write down urges." An urge is not an action, and honest ratings are what let your therapist help. If writing it down feels unsafe, say so in session.
• "My week looks bad on paper." The card is information, not a grade. A hard week tells your therapist where to focus.
• "Someone might read it." That is a fair concern, and the next section covers privacy.

Paper or app, and keeping it private

A few habits make the card easier: fill it in at the same time each day, keep it with something you use daily, and bring it to session even if it is half empty. A partly filled card still gives your therapist more to work with than none.

Some therapists use paper cards, and some use apps. Research does not yet point to one clear winner. In that small Danish trial, people using a diary app tended to stay in treatment longer and log more skills each week, while the paper group did better on two other measures, including depression. Patients found the app easy to use, while therapists worried about its effect on the therapy relationship. The authors concluded the app had both positive and negative consequences and that more research is needed.

If you use an app, check it carefully. A 2021 review of 21 free DBT apps found that only five had a diary card feature, only two let you share the card with a therapist, and about one in three was password protected.

Whatever format you use, keep the card where others cannot easily see it. You can use initials or a code for sensitive items, and agree on the codes with your therapist. Ask your therapist how they store cards after sessions.

When a diary card is not enough

A diary card does not replace getting help in the moment. In comprehensive DBT, that is what phone coaching is for, and in a crisis it is 988 or 911. If your urges are rising day after day, tell your therapist, even if the session agenda is already full.

If you are not in DBT, tracking your moods can still be useful, but a diary card is designed to be used inside treatment, where someone helps you make sense of it. To see what full DBT involves, read what comprehensive DBT asks of you. If you are not sure which format fits, compare comprehensive DBT, DBT-informed therapy and skills groups.

Mountainside offers DBT for teens and adults and a free 15-minute consultation. Start with DBT therapy in Denver.

Frequently asked questions