Dialectical Behavior Therapy for Binge Eating and Bulimia (22 page)

Skills Practice Record (Reverse Side of Diary Card)

Dialectical Behavior Therapy for Binge Eating and Bulimia

by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen. Copyright 2009 by The Guilford Press.

From

Permission to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for details).

83

APPENDIX 3.10

Instructions for Filling Out a Diary Card

Completing your diary card on a daily basis is an essential component of your treatment.
“Mindful” completion of the diary card (i.e., paying attention without
judging) increases awareness
of what is going on for you. Therefore, completing the diary card is a skillful behavior. You will
derive the greatest beneft if you complete the diary card on a daily basis. We suggest you
complete it at the end of each day, but if another time is more convenient for you, that is fne.
Here’s how you complete the card:

Initials/ID:
Write in your initials (or ID# if participating in a research protocol).

How often did you fll out this side?
Place a check mark to indicate how frequently you flled in
the diary card during the past week.

Day and date:
Write in the calendar date (month/day/year) under each day of the week.

Urge to binge:
Refer to the legend and choose the number from the scale (0–6) that best
represents your highest rating for the day. The key characteristics of the urge to consider when
making your rating are intensity (how strongly you felt the urge) and duration (how long the urge
lasted).

Urge to purge:
Refer to the legend and choose the number from the scale (0–6) that best
represents your highest rating for the day. The key characteristics of the urge to consider when
making your rating are intensity (how strongly you felt the urge) and duration (how long the urge
lasted).

Binge episodes:
Write the number of binge episodes you had each day, if any. A binge refers to
an eating episode in which you felt a loss of control while eating, as if you could not stop. Large
(or “objective”) binge episodes refer to amounts of food that are unquestionably larger than most
people would eat under similar circumstances. Some guidelines include eating two full meals
or more or three or more entrees/main courses. Other examples would include one-half box of
cookies and a quart of ice cream. Small (or “subjective”) binge episodes involve feeling out of
control when eating an amount of food that most people would not consider large or excessive,
even if you would (e.g., candy bar, one-half bag of microwave popcorn).

Purge episodes:
Write the number of episodes in which you used vomiting or other behaviors
(e.g., laxatives, fasting) as a means to compensate for food eaten.

Mindless eating:
Write in the number of “mindless” eating episodes that you had each day.
Mindless eating refers to not paying attention to what you are eating, although you do not feel the
sense of loss of control that you do during binge episodes. A typical example of mindless eating
would be sitting in front of the TV and eating a bag of microwave popcorn or chips without any
awareness of the eating (i.e., somehow, the food was gone, and you were only vaguely aware of
having eaten it). Again, however, you didn’t feel a sense of being out of control during the eating.

(continued)

Adapted from Telch (1997a). Copyright 1997 by Christy F. Telch. Adapted with permission in Dialectical Behavior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen. Permission
to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for
details).

Instructions for Filling out a Diary Card (page 2 of 2)
Apparently irrelevant behaviors (AIBs):
Circle either “yes” or “no” depending on whether you
did or did not have any AIBs that day. If you did, briefy describe the AIB in the place provided or
on another sheet of paper. An AIB refers to behaviors that, on frst glance, do not seem relevant
to binge eating and purging but that actually are important in the behavior chain leading to these
behaviors. You may convince yourself that the behavior doesn’t matter or really won’t affect your
goal to stop bingeing and purging when, in fact, the behavior matters a great deal. A typical AIB
might be buying several boxes of your favorite Girl Scout cookies because you wanted to help out
a neighbor’s daughter (of course, you could buy the cookies and donate them to the neighbor).

Capitulating:
Refer to the legend and choose the number from the scale (0–6) that best
represents your highest rating for the day. The key characteristics to consider when making your
rating are intensity (strength of the capitulating) and duration (how long it lasted). Capitulating
refers to giving up on your goals to stop binge eating and to skillfully cope with emotions. Instead,
you capitulate or surrender to bingeing, acting as if there is no other option or way to cope than
with food.

Preoccupied with food:
Refer to the legend and choose the number from the scale (0–6) that
best represents your highest rating for the day. Food preoccupation refers to your thoughts or
attention being absorbed or focused on food. For example, your thoughts of a dinner party and
the presence of your favorite foods may absorb your attention so much that you have trouble
concentrating at work.

Emotion columns:
Refer to the legend and choose the number from the scale (0–6) that best
represents your highest rating for the day. The key characteristics to consider when making your
rating are intensity (strength of the emotion) and duration (how long it lasted).

Used skills:
Refer to the legend and choose the number from the scale (0–7) that best represents
your attempts to use the skills each day. When making your rating, consider whether or not you
thought about using any of the skills that day, whether or not you actually used any of the skills,
and whether or not the skills helped.

Weight:
Weigh yourself once each week and record your weight in pounds in the space provided.
Please write in the date you weighed yourself. It is best if you choose the same day each week
to weigh yourself. Many clients fnd that arriving a few minutes early to the session and weighing
themselves at the clinic is a good way to remember to do this.

Urge to quit therapy:
Indicate the strength of your urge to quit therapy before the session and
after the session each week. Both of these ratings should be made for the same session as the
one in which you received the diary card. It is best to make both of these ratings as soon as
possible following that day’s session. Use a 0–6 scale of intensity of the urge, with 0 indicating no
urge to quit and a 6 indicating the strongest urge to quit.

Completing the skills side of the diary card:

How often did you fll out this side?
Place a check mark to indicate how frequently you flled out
the skills side of the diary card during the week.

Skills practice:
Go down the column for each day of the week and circle each skill that you
practiced or used that day. If you did not practice or use any of the skills that particular day, then
circle that day on the last line, which states, “Did not practice/use any skills.”

APPENDIx
3.11

Structuring Client’s Report of Skills Practice

1.
Did you have a binge?

2.
Did you practice the skills?

a.
If no, what got in the way?

b.
If yes, what worked?

3.
Did you fll out your diary card and chain analysis?

a.
If not, what got in the way?

b.
If yes,

i.
What was the problem behavior?

ii.
What was the dysfunctional link?

Skills Taught Thus Far

1.
Practicing the commitment

2.
3″
× 5
″
card

3.
Filling out diary card and chain analysis

From Dialectical Behavior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice
Y. Chen. Copyright 2009 by The Guilford Press. Permission to photocopy this appendix is granted to purchasers
of this book for personal use only (see copyright page for details).

APPENDIX 3.12

Sample Chains Focusing on Key Dysfunctional Link(s)

From Dialectical Behavior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice
Y. Chen. Copyright 2009 by The Guilford Press. Permission to photocopy this appendix is granted to purchasers
of this book for personal use only (see copyright page for details).

APPENDIx
3.13

Dialectical Abstinence

Dialectical Abstinence

The dialectical view recognizes that for every force or position there exists an opposing force or position: a
thesis and antithesis; the yin and the yang. A dialectical view searches for a synthesis that is more than the
sum of the opposite parts. For example, the yin and yang symbol is black and white, yet the synthesis of
these is not merely the color gray. A synthesis transcends both.