How often did you fill out card? daily 2-3 x once. in session URGES ACTIONS EMOTIONS OTHER. Willing- Ness 0-5 M. Anger 0-5. Sad 0-5.
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1 Diary Card Date: How often did you fill out card? daily 2-3 x once Lying on card: (how many) Initials: in session 0 low 5 - high URGE ACTION EMOTION OTHER uicide Drugs /alcohol Hosp. 0 5 How much? hame Anger ad Misery Phys. Pain Willing- Ness M T W Th F Worked on long term goals: (write what you did) Apparently unimportant behaviors: Keeping door to problem behaviors open: Notes to self/comments/questions: In ession Before After Urges to quit therapy: 0-5 Keeping ecrets? Belief in I can stand this (0 5) Core Mindfulness Interpersonal Effectiveness Emotion Regulation Distress Tolerance Access Wise Mind Observe-Describe One-thing-in-the-moment Effectiveness Non-judgment Cued Relaxation Attend to Relationships DEAR MAN GIVE FAT Reduce vulnerability PLEAE Build MATERy Build Positive Experience Act Opposite Avoiding avoiding Distract Wise Mind ACCEPT elf-soothe IMPROVE the moment Pros and Cons Turn the Mind Radical Acceptance
2 Diary Card Date: How often did you fill out card? daily 2-3 x once Lying on card: (how many) Initials: in session 0 low 5 - high URGE ACTION EMOTION OTHER uicide Drugs /alcohol Hosp. 0 5 How much? hame Anger ad Misery Phys. Pain Willing- Ness M T W Th F Worked on long term goals: (write what you did) Apparently unimportant behaviors: Keeping door to problem behaviors open: Notes to self/comments/questions: In ession Before After Urges to quit therapy: 0-5 Keeping ecrets? Belief in I can stand this (0 5) Diary Card Date: How often did you fill out card? daily 2-3 x once Lying on card: (how many) Initials: in session 0 low 5 - high URGE ACTION EMOTION OTHER uicide Drugs /alcohol Hosp. 0 5 How much? hame Anger ad Misery Phys. Pain Willing- Ness M T W Th F Worked on long term goals: (write what you did) Apparently unimportant behaviors: Keeping door to problem behaviors open: Notes to self/comments/questions: In ession Before After Urges to quit therapy: 0-5 Keeping ecrets? Belief in I can stand this (0 5)
3 Core Mindfulness Interpersonal Effectiveness Emotion Regulation Distress Tolerance Access Wise Mind Observe-Describe One-thing-in-the-moment Effectiveness Non-judgment Cued Relaxation Attend to Relationships DEAR MAN GIVE FAT Reduce vulnerability PLEAE Build MATERy Build Positive Experience Act Opposite Avoiding avoiding Distract Wise Mind ACCEPT elf-soothe IMPROVE the moment Pros and Cons Turn the Mind Radical Acceptance Core Mindfulness Interpersonal Effectiveness Emotion Regulation Distress Tolerance Instructions: Circle the days you worked on each skill Access Wise Mind Observe-Describe One-thing-in-the-moment Effectiveness Non-judgment Cued Relaxation Attend to Relationships DEAR MAN GIVE FAT Reduce vulnerability PLEAE Build MATERy Build Positive Experience Act Opposite Avoiding avoiding Distract Wise Mind ACCEPT elf-soothe IMPROVE the moment Pros and Cons Turn the Mind Radical Acceptance
4
5 Week of: MON TUE WED THUR FRI AT UN Isolation Anxiety Frustration Going through the motions uicidal thoughts uicidal Planning Just in case behavior uicidal Action XXXXX s anger Willingness Take on E-mind thinking Belief: My life is worthless TOP skill Implement Crisis plan? Hopeless (0 100) Hopeful Want to die Want to Live Worked on Life Worth Living Goals Emotion Mind hould I call ue?
6 eek of: MON TUE WED THUR FRI AT UN DOs Looked at plan for 15 minutes (2x) Listen to voice memos 4x week Act opposite to shame Do pleasant, soothing things Meds as prescribed (REALLY) daily Mastery task several on the weekend Act opposite to fear In this moment, I am basically OK Mindfulness One Thing In the Moment Yellow Light DON Ts Pros and cons Ask for help and be honest about you need elf-talk tockpiling tuck on a date for suicide Overuse prescribed meds elf-harm ecrets (y/n
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