Changing problem behaviors requires that you understand and investigate what is happening when the behavior occurs. When you discuss problems in therapy, it’s critical to know if you are sad when you have the urge to self-injure or feeling threatened when you take a drink. Information about how you think and feel when you are most vulnerable is essential to the therapy process.
Most often behaviors such as self-destructiveness, aggression, substance use problems and other impulse behaviors happen at times of high stress and intense emotions. And stress and emotion both have a significant impact on memory. They interfere our ability to accurately remember events and skew what we do remember.
Diary cards, in DBT, are central to investigating and understanding problems that are being targeted in individual therapy. They are completed during the course of the week--as emotions, events and problematic behaviors occur—with the intent of improving memory. If targeted behaviors have occurred, they are discussed in therapy. If patterns emerge, they are investigated in therapy.
But diary cards can be difficult to complete. It’s easy to forget to carry them, can be stigmatizing to pull them out and complete them when you’re on the go and they can be complicated.
Now, Sammy Banawan, PhD, a clinical psychologist in private practice who has trained in DBT, has developed an app for diary cards to address some of these problems and enhance the use of diary cards. I had the pleasure of talking to Dr. Banawan about the app he developed.
Christy: Why an app for DBT diary cards?
Dr. Banawan: In my practice, I've found that a couple things really stand out about DBT and diary cards:
- First, they're very helpful to structure sessions and provide a clear idea of treatment targets and where to focus our work. They provide a lot of insight into particular patterns of emotion and behavior and can be extremely informative for both me and my clients.
- Second, they often get forgotten. Either my clients forget to do them in the moment or forget to bring them in. The DBT Diary Card app was designed to help alleviate this problem. It also allows the user to have quick access to descriptions of the items on the diary card and add their own skills and targets for treatment.
Christy: How can this app enhance treatment?
Dr. Banawan: There's a lot of research supporting the idea that self-monitoring can help change behavior. This is just one step closer to keeping people on top of what they're thinking, feeling and doing. It also frees us from having to fit the skills and treatment targets on one sheet of paper which can be extremely problematic and counter-productive.
Christy: Is it possible to personalize targets and preferred skills on the app?
Dr. Banawan: The app was designed to be completely flexible. I always start a diary card with a set of skills and targets and then customize them as appropriate. This app gives the user the ability to do that without a second thought. It's really the app's best feature.
Christy: Can you explain the “coaching” portion of the app?
Dr. Banawan: The Coaching part of the app doesn't get nearly the attention it deserves and many of my users tell me it's the most valuable part of it! In individual DBT treatment, we have "Coaching calls" where a client can call to get some skills coaching on the phone between sessions. This is a part of any comprehensive DBT program and helps get therapy outside of the therapy office. These coaching calls are designed to generalize skillful behavior. The Coaching part of the app is there to put some problem-solving skills at one's finger tips. This part of the app will walk users through their particular situation and give them some suggestions about how to handle it and which DBT skill to use. It's not a replacement for an actual DBT therapist, but it can go a long way towards making problem-solving easier.
Christy: Can you send a diary card created on the app to your therapist?
Dr. Banawan: The app will generate a PDF of your skills and treatment targets to your therapist automatically if you choose, remind you to send it or let you do it manually.
Christy: What other features of the app might compel someone to use it, rather than the paper and pencil version used in most DBT treatment.
Dr. Banawan: Accessibility and availability. Having the diary card with you at all times, in an inconspicuous way, can be extremely helpful. You also have access to essentially every skill you've ever learned right at your fingertips and you can add them as you learn new ones. This, combined with the coaching section can really make a big difference in both tracking your week and generalizing your skills.
How to find the app:
The app can be found on the iTunes store here:
http://itunes.apple.com/us/app/dbt-diary-card/id479013889?mt=8 or you can learn more about it at www.diarycard.net .
More about Sammy Banawan, PhD.
Sammy Banawan completed his Ph.D. in clinical psychology in 2004 from the University of Georgia where he was trained in the use of empirically supported treatments for a variety of psychological conditions. His dissertation examined the effectiveness of a self-paced online intervention for marital discord using a modified version of Behavioral Marital Therapy. He completed his internship and post-doc at the Duke University Medical Center where he focused on Dialectical Behavior Therapy in both clinical and research settings. He worked directly with Dr. Marsha Linehan and her group at the BRTC at the University of Washington to adapt DBT for substance use disorder. As part of this NIH-funded multi-site randomized clinical trial, Dr. Banawan worked with Dr. Thomas Lynch (PI) and other faculty at Duke to deliver DBT in a modified format. He also completed a two-week intensive training in DBT as well as had several training sessions directly with Dr. Linehan herself.
Clinically, Dr. Banawan has been interested in the use of DBT for a variety of conditions including depression, eating disorders and anxiety. After his post-doc, Dr. Banawan began his private practice, Durham DBT, with a focus on delivering comprehensive DBT to the Triangle region of North Carolina. He also worked as the DBT therapist for the Carolina House, a residential facility for women with eating disorders. He has long had an interest in the use of technology to assist in the delivery of empirically supported treatments and to aid in treatment outcomes. DBT Diary Card is the first app to make that interest a clinical reality.