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Name: Diary Card for the week of:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday


SELF CARE

Sleep (0-5 / # hrs)


Exercise (Y/N)
Relaxation (Y/N)
Social/Supports (Y/N)

Suicidal Ideations
Self-Harm Urges
U
R Self-Harm Actions (Y/N)
G Risk-taking / Impulsivity
E
S Medication Abuse
Verbal Agression
$ Overspending $
Substance Abuse
5
0-

Food (Binge/Purge/Restrict)

Irritable
Anxious
E
Afraid/Fear
M
O Insecure
T
I Angry
O
Ashamed
N
S Guilty
Sad
Unfocused
Peaceful
Accepting
5
0-

Strong

Reluctance
S Regretful
O
C Fearful
I
A Masking
L Confused
Wise
Forgiving
5
0-

Willing

Avoiding
Negative Self-talk
Signs of Downward Spiralling

Physical pain
Taking things personally
Nightmares
Changes in eating patterns
Crying easily
Sleeping too much/too little
Dissociation
School/Work Conflict
5
0-

Flashbacks/Memories
Tally how many tmes you use each skill each day. M T W Th F Sa Su
Core Mindfulness Skills
Wise Mind (blend reason and emotion)
Observe (surf the urge, just notice)
Describe (just the facts; label accurately)
Participate (become one with the moment)
Non-judgmentally (accept, dont judge)
One Mindfully (focus on one thing at a time)
Effectively (be appropriate to the situation)
Interpersonal Effectiveness Skills
DEAR MAN (describe situation, express emotions, assert, reinforce others,
mindfully, appear confident, negotiate)
GIVE (be gentle, show interest, validate, use an easy manner)
FAST (be fair, dont apologize for your opinion, stick to your values, be
truthful)
Emotion Regulation Skills
PLEASE (treat physical illness, balanced eating, avoid mood-altering drugs,
balanced sleep, get exercise)

MASTERy (do things that make you feel competent and in control)

Building Positive Experiences (increase positive emotions)


Opposite-to-Emotion Action (act contrary to how you feel)
Distress Tolerance Skills
Distract with Wise Mind ACCEPTS (activities, contributing,
comparisons, generate opposite emotions, pushing away thoughts, make other
thoughts, sensations)
Self-Soothe (seeing, hearing, smelling, tasting, touching)
IMPROVE the moment (imagery, meaning, prayer, relaxation, focus
on one thing, vacation, encourage yourself)
Pros and Cons (consequences of coping and of not coping)
Radical Acceptance (let go of fighting reality)
Turning the Mind (choose to accept)

Willingness (be willing to do what is needed)


Tally how many tmes you use each skill each day.