DBT Reflection Form
Reflect on your use of DBT skills with this brief self-check-in. Your responses help you track your progress and insights.
Date of Reflection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Which DBT skill(s) did you use?
*
Mindfulness
Distress Tolerance
Emotion Regulation
Interpersonal Effectiveness
Other
What prompted you to use this skill?
*
How effective was the skill for you?
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1
2
3
4
5
What emotions did you notice before using the skill?
What emotions did you notice after using the skill?
Describe any challenges you faced while using the skill.
What did you learn from this experience?
What might you do differently next time?
Submit Reflection
Should be Empty: