DBT diary card

Not medical advice. This is a research summary to help design journal pages. It is not therapy. The diary card was built to be used with a DBT therapist and a skills group, and this doc does not replace either.

If you are in crisis right now: in the US, call or text 988 (24/7, or chat at chat.988lifeline.org). If you are in immediate danger, call 911. Trans Lifeline (peer support from trans people; they won't call emergency services without your explicit request) is (877) 565-8860 in the US and (877) 330-6366 in Canada, weekdays 10 am–6 pm Pacific. Outside the US and Canada, check your local services. You don't have to read the rest of this.

Checked 2026-09-28. Where a point is uncertain it is marked (uncertain). Self-harm and suicide come up because the card tracks them; this doc keeps those parts factual and non-graphic on purpose. See also the sibling doc safety-planning.

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1. At a glance

2. Summary

The DBT diary card is a one-page weekly grid that a person fills in every day during Dialectical Behavior Therapy. It records, in numbers and ticks, how strong a handful of emotions were (usually 0–5), how strong the urges were for the behaviours they are working on (0–5), whether they acted on those urges (yes/no or a count), what they took (medication, alcohol, drugs), and whether and how well they used DBT skills (a 0–7 scale), with a back page for ticking which skills they practised each day. Its job is to give the person and their therapist an honest, quick record of the week so the session can start from facts, and so any self-harm or suicidal behaviour gets addressed first. It's short by design, private, and non-judgemental: a missed day or a hard day is data, not failure. The card works best inside DBT; used alone it can still be a calm daily check-in and skills reminder, but it isn't a treatment by itself.

3. History and origin

Who created it

Marsha M. Linehan, an American psychologist, created DBT and its diary card. Her memoir, Building a Life Worth Living (Random House, 2020), describes a severe crisis at age 18 that led to years in a psychiatric hospital, and how that experience later shaped DBT, which "combines self-acceptance with actionable change strategies". She earned her PhD, joined the UW Department of Psychology, and ran the Behavioral Research and Therapy Clinics (BRTC) there for over four decades. She said publicly that she had kept her own history private for years and chose to share it after a patient asked whether she was "one of us" (reported in coverage of the memoir; uncertain on exact wording).

Timeline

Cultural context

DBT arrived when BPD was widely seen as untreatable and people who self-harmed were often turned away. It brought behaviourism (track the behaviour, analyse it, change the contingencies) together with Zen-influenced acceptance and mindfulness, which Linehan practised. The diary card is the behavioural half made visible: count what happens, don't guess. The phrase "a life worth living" became DBT's stated goal and the title of her memoir.

Key quotes

• DBT's aim, in Linehan's framing: building "a life worth living" (memoir title and a standard DBT phrase).
• From the 1999 card itself, the skills scale is written in plain words, from "0 = Not thought about or used" to "7 = Didn't try, used them, helped". The card's own language is the clearest statement of its non-judgemental tone: thinking about a skill and not using it still counts as a 1 or 2.

4. Philosophy and principles

• Dialectics: acceptance and change together. You accept what you felt and did today, exactly as it was, and you also work to change it. The card asks for honest numbers without commentary.
• Behaviour is tracked, not guessed. Memory of a week is shaped by the worst day. A daily card corrects that.
• The target hierarchy. In DBT, life-threatening behaviour comes first, then behaviour that gets in the way of therapy, then problems that damage quality of life, then building skills. The card is laid out so the therapist can see at a glance whether anything in the first tier happened, and put it first on the agenda.
• Skills replace problem behaviour. DBT assumes many problem behaviours are attempts to cope that work in the short term. The skills column shows whether new coping is being tried and whether it helped.
• No moral scoring. Urges are rated separately from actions. A high urge with no action is a success, and the card makes that visible.
• Filling it in is itself a behaviour. Not completing the card is treated in DBT as something to understand and solve (was it shame? forgetting? no time?), not punished.
• Problem it solves: sessions that drift into the latest crisis without data; patients and therapists who can't see progress; skills that are learned in group but never practised.

5. Core components

Header

The 1999 BRTC card asks "Filled out in session? Y N" and "How often did you fill out this side? Daily / 2–3x / Once". That's a built-in honesty check: a card completed from memory in the waiting room is less reliable, and the question makes that easy to say without shame.

Urges (0–5)

Urges are rated separately from actions. On the BRTC card the front starts with "Use", "Suicide" and "S-H" (self-harm), each 0–5. Clinics add others, such as urge to binge, to quit therapy, or to isolate. 0 means none; 5 means the strongest. Rating an urge doesn't mean acting on it.

Emotions (0–5)

The BRTC card lists Pain, Sad, Shame, Anger and Fear, plus Joy near the end. "Pain" here means emotional misery. Joy is there on purpose; a 2025 study of 95 adults in DBT found daily joy ratings rose during treatment, fastest in the first months, and rises in joy predicted later drops in BPD severity (Bitran et al.). Some clinics use 0–10 or 0–100 instead of 0–5 (common variation).

Target behaviours

The BRTC card has number-and-specify columns for illicit drugs, alcohol ("ETOH"), prescription meds and over-the-counter meds, a Y/N for self-harm, and a count for lying. "Prescription" here means how much was taken, so that misuse and missed doses are both visible. Many modern cards add "Took meds as prescribed Y/N".

Skills used (0–7)

This is the column people remember. Verbatim from the 1999 BRTC card:

"Didn't try, used them" means the skill happened automatically, which is the goal. A German inpatient study grouped these as no use (0–3), unsuccessful use (4–5) and successful use (6–7) (Probst et al., 2018). Note this grouping puts 5 ("tried, could use them, helped") with unsuccessful use; that's the study's choice, not Linehan's wording.

Before/after session ratings

Bottom of the front: urge to use, urge to quit therapy and urge to harm, rated before and after the session, and "belief in control of" emotions, behaviours and thoughts. These show whether the session itself helped.

Skills checklist (back side)

A list of every skill with Mon–Sun beside each; circle the days you practised it. The shared 1999 sample lists 23 lines: wise mind; observe; describe; participate; nonjudgmental stance; one-mindfully; effectiveness; DEAR MAN; GIVE; FAST; PLEASE; build mastery; build positive experiences; opposite action; distract; self-soothe; improve the moment; pros and cons; radical acceptance; and four "building structure" lines (work, love, time, place). That sample also adds "urge surfing", "alternate rebellion" and "adaptive denial" from the substance-use adaptation. Cards built on the 2014 manual list more skills (see below).

The four skills modules (2014 manual)

Acronym expansions (DEAR MAN = Describe, Express, Assert, Reinforce, stay Mindful, Appear confident, Negotiate; GIVE = Gentle, Interested, Validate, Easy manner; FAST = Fair, no Apologies, Stick to values, Truthful; PLEASE = treat PhysicaL illness, balanced Eating, avoid mood-Altering substances, balanced Sleep, get Exercise; TIPP = Temperature, Intense exercise, Paced breathing, Paired muscle relaxation; STOP = Stop, Take a step back, Observe, Proceed mindfully) are the standard ones taught in DBT groups (uncertain in exact wording between editions).

DBT's four treatment modes

The 2015 JAMA Psychiatry trial describes standard DBT as four parts: weekly individual therapy, weekly group skills training, as-needed phone coaching between sessions, and a therapist consultation team. The card links them: filled in daily (between sessions), reviewed in individual therapy, and its skills column comes from group.

Review in session

In DBT, the individual session usually starts with the therapist reading the card. The order follows the target hierarchy: any self-harm or suicidal behaviour or high urges first, then therapy-interfering behaviour (including a missing card), then quality-of-life targets. A marked behaviour usually leads to a chain analysis: a step-by-step reconstruction of vulnerability, prompting event, links (thoughts, feelings, body sensations, actions), the behaviour and its consequences, followed by "where could a skill have fit?" Therapists are also taught to validate and reinforce the effort of filling it in. (A Wiley DBT book has a whole chapter titled "Self-Monitoring with the Diary Card"; its publisher page blocked automated reading, so details here come from the card itself and the studies below (uncertain in detail).)

6. Setting it up

Inside DBT

1. Your therapist gives you their clinic's card, or you agree on one together.
2. Together you choose targets: the behaviours you want less of (the "actions" columns) and the urges linked to them.
3. You pick emotions to rate (the standard five plus joy is common).
4. You get the skills list, often in the order your group will teach them.
5. You agree when you'll fill it in (e.g. before bed) and where it lives (bag, bedside, phone).
6. You bring it to every session. If it isn't filled in, you fill it in together at the start.

Self-guided (no therapist)

1. Read the limits in section 18 first. If self-harm or suicide urges are frequent, find a clinician; this is not a substitute.
2. Use a free card (UW BRTC or DBT Self-Help) or rule your own: 7 rows, 8–12 columns.
3. Choose 3–5 emotions, 1–3 urges and 1–3 actions. Fewer columns means you'll keep doing it.
4. Choose 6–10 skills you're actually learning. Put them on the back.
5. Pick one time and one cue (brushing teeth, the X4 sleep screen, the last bus home).
6. Write a one-line safety note on the card: "If an urge is 4–5: my plan is on p. __" (see safety-planning).

First day

Fill in one row in two minutes. Don't try to be accurate to the decimal. Rate each item by the highest it got today, unless you agreed with your therapist on "average" (both conventions exist; decide once).

First week

Keep going even with gaps. At the end of the week, look at the whole card for five minutes: which day was hardest, and was there a skill that day? Write one sentence. That's the review.

7. Daily practice

Order of operations (2–5 minutes, evening):

1. Date and a quick breath. Look at the row, not the whole week.
2. Urges first (0–5 each). Highest point today.
3. Actions (Y/N or number). Just the facts.
4. Emotions (0–5 each), including joy.
5. Meds and substances (what and how much).
6. Skills used (0–7), then circle today on the back for each skill you practised.
7. Optional one line: what helped, or what set things off.
8. Check: if any urge is 4–5, or you acted on a harmful urge, follow your safety plan or contact your therapist's coaching line if you have one. If you're in danger, call your local emergency number (in the US, call or text 988, or call 911).

Prompts for the optional line:

• What was the prompting event for the highest number today?
• Which skill did I think about but not use? What got in the way?
• One thing I did that I'm glad about.

8. Rhythms

9. Page anatomy

9.1 Classic weekly card, front (letter, landscape)

+-----------------------------------------------------------------------------------------------+
| DBT DIARY CARD   Initials __  Week of ____   Filled in session? Y N   How often? Daily 2-3x 1x  |
+-----+-------------+-------------------------------+---------------------+------+-----+--------+
| Day |  URGES 0-5  |        EMOTIONS 0-5            |  ACTIONS             | Meds | Joy | Skills |
|     | Use Sui S-H | Pain Sad Shame Anger Fear      | S-H Drugs Alc Lying  | # /  | 0-5 |  0-7   |
|     |             |                                | Y/N  #/what # /what #| what |     |        |
+-----+-------------+-------------------------------+---------------------+------+-----+--------+
| Mon |             |                                |                      |      |     |        |
| Tue |             |                                |                      |      |     |        |
| Wed |             |                                |                      |      |     |        |
| Thu |             |                                |                      |      |     |        |
| Fri |             |                                |                      |      |     |        |
| Sat |             |                                |                      |      |     |        |
| Sun |             |                                |                      |      |     |        |
+-----+-------------+-------------------------------+---------------------+------+-----+--------+
| Skills 0-7 key: 0 not thought about ... 7 didn't try, used them, helped                        |
| Before/after session: urge to use __/__  quit therapy __/__  harm __/__                        |
| Belief in control of: emotions __/__  behaviours __/__  thoughts __/__                          |
+-----------------------------------------------------------------------------------------------+

Proportions: day column about 6% of width; each rating cell 5–6%; skills column wider (8%) because it's the one people discuss. Rows are tall enough to write a two-digit number (about 8–10 mm).

9.2 Classic card, back (skills checklist)

+-----------------------------------------------------------------------------+
| Circle the days you worked on each skill                                    |
+---------------------------------------+-------------------------------------+
| MINDFULNESS                           |                                     |
|  1 Wise mind                          | Mon Tue Wed Thu Fri Sat Sun         |
|  2 Observe                            | Mon Tue Wed Thu Fri Sat Sun         |
|  3 Describe                           | Mon Tue Wed Thu Fri Sat Sun         |
|  ...                                  |                                     |
| INTERPERSONAL  DEAR MAN / GIVE / FAST | Mon Tue Wed Thu Fri Sat Sun         |
| EMOTION REG.   Check facts / Opposite | Mon Tue Wed Thu Fri Sat Sun         |
|                action / PLEASE / ...  |                                     |
| DISTRESS TOL.  STOP / TIPP / Self-    | Mon Tue Wed Thu Fri Sat Sun         |
|                soothe / Radical acc.  |                                     |
+---------------------------------------+-------------------------------------+

9.3 A day-page version (one day, for a monthly book, 5.5 x 8.5)

The weekly grid doesn't suit a day-per-page book. A day version turns each column into a row of bubbles:

+--------------------------------------------------+
| DATE ______  TITLE ____________  TAGS _________   |  <- fixed scan header
+--------------------------------------------------+
|  URGES            0  1  2  3  4  5               |
|   ~ urge A        o  o  o  o  o  o   acted? [ ]  |
|   ~ urge B        o  o  o  o  o  o   acted? [ ]  |
|  FEELINGS         0  1  2  3  4  5               |
|   sad             o  o  o  o  o  o               |
|   shame           o  o  o  o  o  o               |
|   anger           o  o  o  o  o  o               |
|   fear            o  o  o  o  o  o               |
|   joy             o  o  o  o  o  o               |
|  SKILLS  0 1 2 3 4 5 6 7   key: back of book     |
|           o o o o o o o o                        |
|  Tried today: wise mind  STOP  TIPP  self-soothe  |
|               opposite action  check the facts    |  <- circle words
|  Meds [ ]am [ ]pm   Substances ______             |
|  What helped: ________________________________   |
+--------------------------------------------------+
| SEND TO ...                          [page code] |
+--------------------------------------------------+

The words "urge A/B" are placeholders the person names in the editor (for example "isolate", "skip meals", "self-harm"), so the printed page never says more than they chose.

9.4 Chain analysis page

+--------------------------------------------------+
| CHAIN   date ____   behaviour ________________    |
+--------------------------------------------------+
| Vulnerabilities (sleep, pain, hunger, stress):    |
| ______________________________________________   |
| Prompting event: ______________________________   |
| Links  1 ______  -> 2 ______  -> 3 ______  -> ... |
|        (thought / feeling / body / action)        |
| Behaviour: ____________________________________   |
| After (short term): ________  (long term): ______ |
| Where a skill could fit: link # __  skill ______  |
| Repair / next time: ___________________________   |
+--------------------------------------------------+

9.5 Weekly review strip (week spread)

| WEEK  Highest urge day: __  Days acted: __/7  Avg joy: __  Best skill: ______ |
| One thing I learned: _______________________________________________________   |

10. Worked examples

These are made up, and deliberately mild. Numbers only for urges; no details of any behaviour.

A sample day (Wednesday)

Urges:     isolate 3   skip meals 2   self-harm 1        acted: isolate Y, others N
Feelings:  sad 3  shame 2  anger 1  fear 2  joy 1
Meds:      am yes, pm yes     Substances: none
Skills:    5 (tried, could use them, helped)
Circled:   check the facts, self-soothe, PLEASE (ate lunch)
Line:      Cancelled plans after a hard shift; texted J later and felt a bit better.

A sample week (summary row per day)

Day  Iso Meal S-H | Sad Shame Ang Fear Joy | Acted     | Skills
Mon   1   1   0   |  2   1    1    1    2  | -         | 6
Tue   2   2   0   |  2   2    2    2    1  | -         | 4
Wed   3   2   1   |  3   2    1    2    1  | isolate   | 5
Thu   2   1   0   |  2   1    0    1    2  | -         | 5
Fri   1   0   0   |  1   0    1    1    3  | -         | 7
Sat   4   2   1   |  4   3    2    2    0  | isolate   | 3
Sun   2   1   0   |  2   1    1    1    2  | -         | 5
Review: Saturday after a 10-hour shift was the peak. Skill tried (TIPP) didn't work
while exhausted. Next: PLEASE before long shifts (eat, sleep). Joy best on Friday (walk).

A sample month

Week  Days acted  Highest urge  Avg joy  Most-used skill      Note
 1        2           4          1.6     self-soothe          new job week
 2        1           3          2.0     check the facts
 3        1           3          2.3     PLEASE               started lunch alarm
 4        0           2          2.6     opposite action      first week with no "acted"
Month: urges drifting down; joy up; long-shift days still the risk. Bring to session:
cope-ahead plan for double shifts.

11. Variations and offshoots

12. Community practice

• What people do: peer sites (DBT Self-Help, subreddits on DBT and BPD) share modified cards: fewer columns, bigger boxes, colour-coded modules, joy and gratitude columns, sleep and pain columns. People often talk about the card feeling like homework at first, then becoming a way to "see" a week.
• Common customisations: swapping "self-harm" for other targets; adding "dissociation", "sleep hours", "pain", "therapy-interfering"; 0–10 scales; a notes column; putting the skills list on a bookmark.
• Aesthetic vs minimalist: some keep it in a decorated bullet journal with a weekly spread; others use a bare spreadsheet or app. DBT itself doesn't care about looks, only that it's done daily and honestly.
• Honesty and shame: a common theme is fear of writing a high number. Clinicians teach that the card is for noticing, and high numbers get help, not blame.
• Caution: community forms vary in quality and some drop the safety parts. Stick to a card your therapist agrees with.

13. Official products and formats

Release cycle: none; editions every decade or two.

14. Tools and supplies

• Paper: letter or A4, landscape; or a half-letter card folded into a wallet. 90–100 gsm stops pen show-through if printed double-sided.
• Pen: anything. A pencil lets you fill in during the day and ink at night.
• Holder: a clipboard or plastic sleeve so it survives a bag; a bookmark-sized skills list.
• Optional: a small timer or phone alarm for the nightly fill-in.
• No stickers, stamps or colour needed. Colour coding of modules is optional; black-and-white works.

15. Digital and hybrid versions

• Apps: many DBT diary card apps offer reminders, charts and PDF export for a therapist. Check privacy: this is sensitive health data; prefer apps that store locally and don't sell or share data.
• Spreadsheets: easy trend charts; DBT Self-Help offers a spreadsheet-style card.
• E-ink: a PDF card on a reMarkable, Kindle Scribe or Boox works well; handwriting stays private and offline.
• Scanning: a photo each week for the therapist; don't upload to general cloud folders without thinking about who can see it.
• Gained digitally: reminders, charts, no lost cards. Lost: the calm of paper, the "hand it over" ritual, and privacy if the app syncs to servers.

16. Evidence and research

Claimed vs supported:

• Supported: DBT (with the card) reduces self-harm and suicidal behaviour in BPD; skills use is a mechanism; diary-card data track skill use and daily states well enough for research.
• Partly supported: the card as a self-help tool (only one small clinician-supported trial).
• Claimed, not isolated in trials: that the card by itself improves outcomes, strengthens alliance, or reduces shame. These are clinical rationale (uncertain).
• Completion is a known issue: in McCool et al. about 28% of possible urge ratings were missing.

17. Benefits

• Fewer self-harm and suicidal behaviours when used within DBT: evidenced (for DBT as a package).
• Makes skills use visible and trackable: evidenced (used as a research measure).
• Links skill use to lower same-day distress: evidenced (observational).
• Supported diary-card self-monitoring helps binge eating: evidenced (one small trial).
• Joy ratings show progress that distress numbers miss: evidenced (one study).
• Faster, more focused therapy sessions: claimed.
• Notices patterns (shifts, sleep, pain) that trigger urges: claimed, widely reported.
• Separating urges from actions reduces shame: claimed.
• A 3-minute, low-writing habit that works on bad days: claimed.

18. Pitfalls

19. Accessibility and adaptations

• ADHD: fewest possible columns; same time daily tied to an existing habit; bubbles instead of writing; a visible place (X4 sleep screen). See adhd-journaling.
• Autism and sensory needs: explicit written anchors for each number; allow "can't tell" as a valid mark; add a sensory load column; emotion words can be hard, so use body cues ("tight chest") too. See autistic-sensory-journaling.
• Chronic illness and low spoons: mark spoons and pain; a minimum version (one urge, one feeling, skills 0–7) for bad days; pain here is physical, distinct from the card's emotional "pain" column (label clearly).
• Depression and anxiety: keep joy and "what helped"; don't reread the week on a low night; review with someone.
• Trauma: don't write details; use code words; chain analysis should be done with a therapist when it involves trauma triggers.
• Dyslexia and dysgraphia: bubbles and circle-the-word lists, no required writing; large print skills list.
• Low vision: large-print card, 14 pt+, thick lines, high contrast; or voice notes; one item per row.
• Motor or hand pain: bubbles or ticks only; a bigger card; digital with large buttons (the X4 buttons).
• Trans and gender-diverse people: add dysphoria as an emotion if useful; misgendering and minority stress can be prompting events, and the card should allow naming them without judgement; find a DBT therapist who is affirming; Trans Lifeline is peer-run and does not call emergency services without explicit request.
• Shift workers: rate by "waking day" not calendar day; mark the shift type; fill in after the last sleep of the day rather than at midnight.
• Low income: cards are free from UW BRTC and peer sites; handwritten grids work; many community mental health centres offer DBT skills groups on sliding scales (varies by area).

20. Comparison

21. Combining

• Safety plan: the card notices urges; the plan says what to do when they're high. Put a pointer to the plan on the card. See safety-planning.
• CBT thought record: use a thought record for the one moment behind the day's highest number. See cbt-thought-record.
• Mood tracking: a year-in-pixels colour for the day can be derived from the card's feelings. See mood-tracking-year-in-pixels.
• Habit tracking: PLEASE skills (eat, sleep, move, meds) are habits; habit dots cover them. See habit-tracking.
• Symptom tracking: pain, sleep and medication overlap; keep one place for each number. See symptom-tracking.
• Stoic journaling: evening review has a similar "what did I do, what next" shape, without the scales. See stoic-journaling.
• Expressive writing: avoid pairing long trauma writing with a high-urge day; see expressive-writing for its own cautions.
• ADHD and sensory journaling: see adhd-journaling and autistic-sensory-journaling.

22. Ready-to-use bank

Columns and trackers

1. Urge (your word) 0–5 + acted? Y/N
2. Emotions 0–5: sad, shame, anger, fear, joy
3. Skills used 0–7 (with the key on the back page)
4. Circle-the-skill list: wise mind, STOP, TIPP, self-soothe, check the facts, opposite action, PLEASE, radical acceptance, DEAR MAN
5. PLEASE dots: ate, slept, moved, meds, no mood-altering substances
6. Meds am / pm / as needed
7. "Belief I can control my emotions today" 0–5
8. Urge to quit therapy 0–5 (weekly)
9. Sleep hours
10. Physical pain 0–5 (label it "body pain")
11. Dysphoria 0–5 (optional)
12. Build mastery: one hard-but-doable thing done? Y/N
13. Pleasant event today? Y/N and what
14. Therapy-interfering: skipped homework / late / didn't bring card (weekly)

Prompts

1. What was the prompting event for my highest number?
2. Which link in the chain could a skill have changed?
3. What did wise mind say today?
4. Cope ahead: what's hard tomorrow, and which skill will I use?
5. Check the facts: what actually happened, and does my emotion fit the facts?
6. Opposite action: what does this emotion want me to do, and what's the opposite?
7. One pleasant thing I can do tomorrow (accumulate positives).
8. What am I willing to accept today that I can't change?
9. What worked this week that I want to keep?
10. Who could I ask for help, and how (DEAR MAN)?

Headings

1. "Today in numbers"
2. "Urges ≠ actions"
3. "Skills I reached for"
4. "What helped"

23. Glossary

24. FAQ

Do I need a therapist to use a diary card? It was designed for DBT with a therapist, and the evidence is for that. Using it alone as a check-in is reasonable, but if urges to self-harm or suicide are part of your life, pair it with professional help and a safety plan.

Is 0–5 or 0–10 better? Neither is proven better. 0–5 is the classic BRTC card and quicker to circle. Pick one and keep it.

Highest of the day or average? Both are used. Most people find "highest" easier to remember. Decide once and note it on the card.

What if I didn't use any skills? That's a 0, 1 or 2. Those are useful: 2 ("wanted to") tells you what got in the way.

What if I don't want to write down that I self-harmed? Talk to your therapist about that fear; it's common and it's workable. You can use a code word or a symbol you both understand. If you're not in therapy, a doctor or 988 can help you find care.

Isn't writing about urges going to make them worse? There's no good evidence that rating urges increases them, but some people find it makes them dwell. Keep it fast, include joy, and stop after the row (uncertain: not directly studied).

Can I use it for things other than BPD? Yes. DBT skills are taught widely for emotion dysregulation, substance use, eating problems and more. The card adapts: change the targets.

Should the X4 or my journal warn anyone if I rate high? No. Journalwright Studio never sends alerts. Your plan and your people are the response; you choose when to reach out.

How long do people keep cards? Through DBT (often a year) and sometimes long after in a lighter form.

Can I share it with my doctor or psychiatrist? Yes; a week's card is a good summary of meds taken and hard days.

25. For Journalwright Studio

a. Printed book

Pages that hold these therapy blocks print a short note: "Use with a therapist", with the 988 line and Trans Lifeline.

b. E-ink companion (X4)

c. Editor blocks (built and proposed)

Bridge note: the scale block now has a "Number from 0" option, exported to the X4 as 0..steps-1, and Words to circle can export as a choice item. Earlier drafts of this table listed both as gaps. The therapy blocks below were built as their own block types rather than as presets.

A full DBT set (2 urges + 2 acted + 5 feelings + skills) is 10 X4 items, inside the 16-item limit.

d. Proposed method layout: "Diary card"

Planned: not in the editor's "Start from a method" list yet, but the core blocks exist today.

1. Moon/sun/season
2. Care check-in (meds, meals, mood, anxiety)
3. Urge + acted (two urges, 0–5)
4. Feelings 0–5 (sad, shame, anger, fear, joy)
5. Skills used 0–7
6. Words to circle: Skills I tried (preset list)
7. Habit dots: PLEASE
8. Lined notes: What helped (1 line)
9. Safety plan pointer (one line)
10. Writing space (lines), small

On pages printed from this layout, the skills key and chain analysis sheets go in back matter once per month.

e. Don't adopt

• Printing "suicide" or "self-harm" as default labels. Let the person name urges; the page may be seen by others.
• Alerts, scores, streaks or colours for "good" and "bad" days. Out of scope and shaming.
• Risk ratings or "danger levels". That's clinical assessment, not a journal's job.
• Copying the BRTC card verbatim as a product page. It's free for clinical use but not commercial; KDP books are commercial. Use original layout and wording, and point to UW BRTC for the original.
• Scan uploads of urge and action data by default. Route to a private destination only.
• Generative AI "coaching" on the e-ink companion. Out of scope.
• Detailed behaviour fields (method, amount of harm). Not needed and not safe to prompt for.

26. Open questions

• Does the diary card itself, apart from DBT, improve outcomes? Only one small supported trial (binge eating) tests it.
• Is 0–5 or 0–10 more reliable for daily emotion ratings? No head-to-head data found.
• "Highest" versus "average" daily ratings: which predicts outcomes better? Not settled.
• Exact date the diary card first appeared in DBT: not confirmed.
• Whether the 2025 revised handouts change the diary card layout: not confirmed (publisher page doesn't say).
• Behavioral Tech's founding year and evidence page could not be opened (blocked); marked uncertain.
• Whether rating urges daily raises distress for some people: not directly studied.
• Best way to show a 0–7 scale with meanings on a 1-bit screen without clutter: design question for the X4.

27. Further reading

• Linehan, Cognitive-Behavioral Treatment of Borderline Personality Disorder (Guilford, 1993): the treatment manual.
• Linehan, DBT Skills Training Manual (2nd ed. 2014; revised 2025): how the skills are taught.
• Linehan, DBT Skills Training Handouts and Worksheets (2014; revised 2025): the handouts people use daily.
• Linehan, Building a Life Worth Living (Random House, 2020): her own story.
• UW BRTC assessment instruments: free diary cards and measures for clinical use.
• Marsha M. Linehan DBT Clinic (UW): services, skills groups and family resources.
• DBT Self-Help (dbtselfhelp.com): peer-run explanations and editable cards.
• Neacsiu, Rizvi and Linehan (2010): why skills use matters.
• Storebø et al. (2020), Cochrane: the careful, sober view of the evidence.
• "Self-Monitoring with the Diary Card", a chapter in a Wiley DBT volume (DOI 10.1002/9781118957882.ch13): the clinician's view of reviewing cards (not opened: the publisher page blocked automated reading).

28. Sources

All checked 2026-09-28. PubMed article pages showed a captcha, so journal abstracts were read through PMC or the Europe PMC REST service.

1. UW Behavioral Research & Therapy Clinics. "Assessment Instruments" (NIMH S-DBT, NIDA and CARES diary cards; terms of use). http://depts.washington.edu/uwbrtc/resources/assessment-instruments/
2. Marsha M. Linehan DBT Clinic, University of Washington. Home page. https://sites.uw.edu/dbtclinic/
3. DBT Self-Help. "Diary Cards." https://dbtselfhelp.com/diary-cards/
4. BRTC Diary Card (Copyright 1999 Marsha M. Linehan), sample copy hosted by DBT Self-Help (column headers and the 0–7 skills key quoted from it). https://dbtselfhelp.weebly.com/uploads/8/2/0/9/82096548/diary_card_sample_01_typical.pdf
5. Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL. "Cognitive-behavioral treatment of chronically parasuicidal borderline patients." Arch Gen Psychiatry 1991;48(12):1060–1064. PMID 1845222. Europe PMC record: https://www.ebi.ac.uk/europepmc/webservices/rest/search?query=EXT_ID:1845222&resultType=core&format=json
6. Linehan MM, Comtois KA, Murray AM, et al. "Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder." Arch Gen Psychiatry 2006;63(7):757–766. PMID 16818865. Europe PMC record: https://www.ebi.ac.uk/europepmc/webservices/rest/search?query=EXT_ID:16818865&resultType=core&format=json
7. Neacsiu AD, Rizvi SL, Linehan MM. "Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder." Behav Res Ther 2010;48(9):832–839. PMID 20579633. Europe PMC record: https://www.ebi.ac.uk/europepmc/webservices/rest/search?query=EXT_ID:20579633&resultType=core&format=json
8. Linehan MM, Korslund KE, Harned MS, et al. "Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis." JAMA Psychiatry 2015. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2205835
9. Storebø OJ, Stoffers-Winterling JM, Völlm BA, et al. "Psychological therapies for people with borderline personality disorder." Cochrane Database Syst Rev 2020, CD012955.pub2 (plain-language summary). https://www.cochrane.org/evidence/CD012955_psychological-therapies-people-borderline-personality-disorder
10. Klein AS, Skinner JB, Hawley KM. "Targeting binge eating through components of dialectical behavior therapy: preliminary outcomes for individually supported diary card self-monitoring versus group-based DBT." Psychotherapy 2013. PMID 24295464. Europe PMC record: https://www.ebi.ac.uk/europepmc/webservices/rest/search?query=EXT_ID:24295464&resultType=core&format=json
11. Probst T, et al. "Suicidal ideation and skill use during in-patient dialectical behavior therapy for borderline personality disorder. A diary card study." Front Psychiatry 2018. https://pmc.ncbi.nlm.nih.gov/articles/PMC5920639/
12. McCool, Mochrie, Lothes, Guendner, St John and Noel. "Dialectical behavior therapy skills and urges to use alcohol and substances: an examination of diary cards." Subst Use Misuse 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC11172370/
13. Bitran A, Hughes C, Bist J, Krall HR, Yin Q, Rizvi SL. "The effects of dialectical behavior therapy on joy: a diary card study." Cogn Ther Res 2025, DOI 10.1007/s10608-025-10704-z (publisher page redirects to a login; details from the Europe PMC preprint record): https://www.ebi.ac.uk/europepmc/webservices/rest/search?query=DOI:10.31234/osf.io/wbm6y_v1&resultType=core&format=json
14. Guilford Press. Cognitive-Behavioral Treatment of Borderline Personality Disorder (Linehan, 1993). https://www.guilford.com/books/Cognitive-Behavioral-Treatment-of-Borderline-Personality-Disorder/Marsha-Linehan/9780898621839
15. Guilford Press. DBT Skills Training Manual (2nd ed. ISBN page, now showing the Revised Edition, 2025). https://www.guilford.com/books/DBT-Skills-Training-Manual/Marsha-Linehan/9781462516995
16. Guilford Press. DBT Skills Training Handouts and Worksheets, Revised Edition (2025). https://www.guilford.com/books/DBT-Skills-Training-Handouts-and-Worksheets/Marsha-Linehan/9781572307810
17. Penguin Random House. Building a Life Worth Living: A Memoir (Linehan, 2020). https://www.penguinrandomhouse.com/books/225252/building-a-life-worth-living-by-marsha-m-linehan/
18. 988 Suicide & Crisis Lifeline. Home page. https://988lifeline.org/
19. Trans Lifeline. "Hotline." https://translifeline.org/hotline/