DBT DIARY CARD 
                                                                                                         Targets                                                                                                                                          Emotions 
                                                                                                                                                                                                                             nc                                                                            
                                                                                                                                                                                                                             a    e    t            er                         me            d            r
                                                           Suicidal                                                                                                                                                     Self ept       Guil         Ang           Joy          a             Sa           Fea
                                 Self-Harm                 Ideation  Misery                                                                                                                                                  Acc                                               Sh
                Date 
                              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 
                                                                                                                                                                                                                                                                                                        
                                                                                                                                                                                                                                                                                                        
                                                                                                                                                                                                                                                                                                        
                                                                                                                                                                                                                                                                                                        
                                                                                                                                                                                                                                                                                                        
                                                                                                                                                                                                                                                                                                        
                
                                                                                                                                                                                                                                                                                                        
               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