Waverider

Finding patterns and other benefits of tracking

Symptom and behavior tracking is a key part of Dialectical Behavior Therapy (DBT). Using the dairy cards that support symptom and behavior tracking provides a host of benefits and improved outcomes for many in the mental health community. Yet there are challenges for both the clients and providers. So how do we overcome both?

Let’s start with the basics: What is a DBT Diary Card?

Marsha Linehan, the brilliant mind behind Dialectical Behavior Therapy (DBT), created DBT diary cards. She designed them with the purpose of tracking clients’ symptoms and behaviors because of their complexity with the Borderline population she was working with.  

Diary Cards are a key component of DBT. These mood, behavior, and skills trackers, which are meant to be filled out daily, help demonstrate patterns and keep skills top of mind. A diary card is a paper – or app – where clients record what skills are used, rate different emotions, and track behaviors.

A DBT Diary Card includes symptoms such as depression, anxiety, anger, mood changes, impulsive behaviors such as substance use, sexual experiences, self-injury, and other important indicators such as sleep and appetite. Additionally, tracking can include reflecting on gratitude, positive experiences, and skills practice which helps clients think about the good stuff every day.

How can DBT Diary Cards help clients?

One of the major reasons we want clients to track symptoms and behaviors daily is for them to find insight into the changes they experience and how these changes relate to their mental health. For instance, if a client with bipolar charts daily and notices a change in their sleep patterns, they might also see this as a change in their mood episodes.

How can DBT Diary Cards help clinicians?

Many clinicians aren’t even aware of what symptom and behavioral tracking is and the benefits they bring to the therapeutic process.  As clinicians, how do we keep our clients motivated to maintain their daily tracking habits?

Clinicians also want to see the client’s symptoms and behaviors to understand the challenges they faced over the week. When we are able to see our client’s tracking we already know if they self injured, have had conflicts, or suicidal thoughts over that week and can target these things in our next session with them. Over time, we can also see trends: we can see cycles in mood episodes, trends of symptoms, and behaviors escalating or getting better over periods of time. These clinical insights can help us see whether our interventions are helpful and effective or if we might need to change strategies.

What are some challenges of DBT tracking?

Getting our clients to see these benefits and stay motivated in tracking their symptoms and behaviors is an obstacle, especially since Covid-19 hit. Key challenges include:

• Time-consuming for clients
• Giving handouts or sharing digital copies of diary sheets
• Figuring out ways to keep the diary cards confidential and neat
• Reminding clients, session after session, why tracking is important if they aren’t seeing much improvement
• Some get frustrated due to poor time management, forgetfulness, or inconvenience
• Can be a painful process to look over their day and remember what happened, especially if it was a rough day. 

Two solutions for more effective tracking:

1. Create your own digital diary card: Add all of the information you want to track and share this virtually with your clients utilizing whatever HIPAA-compliant software you already use to keep your client’s information confidential. You can ask clients to set reminders on their phones to complete daily tracking in the evenings. This solution may not be very efficient or dependable in the long run.
   
2. Use a tracker specially designed to help: There is a solution designed for clinicians to gather all the information they feel will benefit their client’s treatment and save time and energy spent motivating and reminding clients to log daily. Waverider allows clinicians to see tracking in real-time, as clients save tracking daily, and allows us to modify and tailor each diary card to each specific client’s needs easily. 

Whatever the situation, all clinicians and clients can benefit from tracking symptoms and behaviors that they want to treat in therapy. There are now many different options in how to approach this kind of tracking: print outs, digital sharing, or utilizing Waverider. Try out symptom and behavior tracking with your clients and see how it can benefit your practice and improve your session time with clients.

About the author: 

Alexandra Mejia is a licensed mental health counselor specializing in trauma, personality, mood, and anxiety disorders. She utilizes evidence-based treatment modalities such as CBT, DBT, Mindfulness and Exposure therapy. Alexandra joined Waverider as a Clinical Advisor and has been instrumental representing the providers perspective. Her passion and commitment to helping clients work towards behavioral development goals has informed our thinking behind our behavioral tracker.