Clinician Training

1The Diary Card — full lifecycle

Build the card, enroll the patient by QR, update it over time, get the data back, and read it well. This is the core workflow; most other tools follow the same shape.

Build the patient's card

Open the Diary Card tool from the Life Lab home page. Configure the card to the patient — this exact configuration is what will appear in their app:

1. Emotions — the specific emotions this patient will rate (0–5).
2. Urges — each urge is rated 0–5 and also asks whether the patient acted on it. The acted/surfed split is a core DBT signal, so track it for any target behavior.
3. Actions and skills — target behaviors to count, and the skills list the patient can log against.
4. Or start from a preset built for common presentations. Loading a preset replaces the current configuration, so load it first and then adjust.

Enroll the patient — one QR, one scan

1. In the Patient Enrollment section, enter the Clinician name (the patient sees it) and an optional Card label.
2. Click Generate Enrollment QR. This is a single static code — everything is encoded in it.
3. The patient points their phone's built-in camera at the screen. One scan opens the app, installs it to their home screen, and sets up their diary card. They choose a PIN and they're done. No app store, no account.

Next to the code: Copy URL (send the link instead of scanning — see section 6) and Download QR (GIF) (an emailable version whose first frame works with the app's Upload code image option).

Updating the card later

Adjust the configuration in the Diary Card tool and generate a new QR. For a patient who already has the app installed, a plain camera scan only opens Safari — the installed app keeps its own storage. Instead, have them open the installed app and tap Update Diary Card (in the DBT course area) or Scan code from clinician (on the home screen), then point the in-app scanner at your new code. The new card loads into the app they already use, with their history intact.

Getting the data back

Two routes out of the patient's app, both under Insights → Export Data for Clinician:

• File export — a JSON file the patient emails or texts you.
• Send securely to clinician — generates an encrypted link the patient pastes into your video visit or a message. The link is end-to-end encrypted, expires in 60 minutes, and works exactly once (burn-on-read). Nothing readable sits on a server.

On your side, open Insights & Goals (the clinician dashboard):

1. Drag the JSON file onto the drop zone — drop multiple files to merge them — or paste the patient's link into Or paste a secure link from the patient and click Load.
2. If you loaded a secure link, use the SAVE PATIENT FILE buttons that appear to download the JSON. Do this every time: secure links only work once, and the saved file is what you re-load next session or open in the Diary Card tool.
3. The Diary Card tool itself can also load an export directly, via Import from Patient (file) or Import from Patient (paste text).

Reading the DBT diary tab

• Regulation profile — the headline is skills logged against high-distress moments, not raw emotion intensity. The bands run from "Skillful under distress" to "Skill-to-distress gap": what predicts outcome is whether a skill gets reached for inside the hard moments.
• Urge outcomes — for urges flagged with the acted question, the surfed-vs-acted rate is the target-behavior signal.
• Emotional spectrum grid — every rated emotion placed on how-it-felt × how-strong. The clinical question is coverage: is the patient experiencing and logging a range of emotion, or living in one corner of the grid?
• Emotion log — every entry in the window with date and time, most recent first.
• Date ranges anchor to the data's end, not the day you're viewing. "Last 30 days" means the last 30 days of the export. An export from three weeks ago shows its own final month, and the tab says so plainly, so you're never reading an empty recent window as deterioration.

2ADHD — course, app, and EF Planner in tandem

The ADHD course is 20 weeks, clinician-led, and designed to run alongside two patient-side pieces: the in-app ADHD Learn chapters and the EF Planner. Run all three together — the course teaches the concept, the chapters install it, the planner is where it lands.

Structure and pacing

1. Week 1: enroll the patient in the app. ADHD Learn is eleven short chapters, completed in order. Chapters 1–6 (the system-setup chapters) are available immediately and pace naturally with the early course weeks; each ends with something configured in the planner, not just something read.
2. Chapters 7 and up unlock as the patient actually uses the system — at most one new chapter per week, so the app cannot be binge-read ahead of the practice.
3. Each course module ends with an "Assign This Week's Homework" panel. Pick the targets, set reminder times, and one QR (or one push — section 5) carries both the goals and the clinician-prescribed reminders. The reminders land in the patient's app as editable entries and stop automatically at the due date.

The EF Planner — what the patient is working with

• Home Base — instant capture. Anything on the mind goes in as a title, nothing else required. Working memory leaks; Home Base is the external one.
• The 4 D's — each Home Base item gets processed: do it now, defer it onto the calendar, delegate it, or drop it.
• Today tab with Plan Today — a 90-second morning ritual (the ▶ button): sweep yesterday's leftovers, check the day's load, star the Top 3. Finishing it builds a visible streak. This ritual is the single highest-value habit in the system — ask about the streak in session.
• Top 3 — capped at three, deliberately. The app refuses a fourth.
• Capacity bar — scheduled minutes against the waking day, with a marker at 60%. The rule the course teaches: plan to 60% of your time, because the other 40% absorbs what actually happens.
• Stuck filter — tasks rolled over more than three days get an amber Stuck chip. The patient labels the block as one of five: Unclear start, Information gap, Waiting on someone, Too big, Dread — and each label comes with a matched fix (rename to the first physical action, make finding the info step one, move to the waiting list, shrink it).
• Routines — save a day that worked as a reusable routine, drop it onto a bad day. Ready-made structure for the mornings when building structure is the thing that's impossible.
• Waiting on others — delegated items with follow-up dates, resurfaced when the follow-up comes due.
• Physical items — keys, wallet, meds, chargers: tracked homes for the things that get lost.
• Look Back — the weekly review: what got done, what rolled, streaks.

What to watch in Insights & Goals → ADHD · EF Planner

• Usage fingerprint — a fully-checked-off week says little by itself; the timestamps say more. The tab breaks down planned-ahead vs logged-after-the-fact, how long after an event it gets checked off, and whether the app is touched live through the day or in occasional batch sittings. Retro-logging in one evening sitting is the planner version of the batch-filled diary card, and the coaching is the same.
• EF scaffolds — what's switched on — which supports the patient actually uses (ritual, routines, physical items, waiting list). A scaffold that's off is a concrete session topic.
• Engagement over the course — is use holding, building, or fading week to week.

3Values and Body+ — course and app pairing

Both follow the same loop: the course teaches it in session, the app logs it between sessions, the end-of-module panel assigns the week, and the Insights & Goals tab closes the loop.

Values — what to instruct the patient

• In the app's Values area the patient keeps My values and My limits in their own words, and logs values moments (acted on a value) and limits moments (held or crossed a line) as they happen.
• The Values Map rates each life domain on how important it is versus how well the patient is living it right now — the gap between the two is where the work is.
• The values list is manageable from inside the DBT course (My Values & Boundaries) and from the app's Settings, so course exercises and daily logging edit the same list.

Body+ — what to instruct the patient

Body+ is a daily check-in across the wellness pillars you enable for the patient: sleep, movement, exercise, nutrition, stress, social, meaning. Instruct one check-in per day — it takes under a minute — and let the record accumulate; patterns like sleep quality after movement days only show up with consistent daily entries.

Closing the loop

1. Teach the module in session. The Values and Body+ courses each end their modules with an Assign This Week's Homework panel scoped to that module's concepts (values/limits targets, pillar targets).
2. Assign small targets — three values moments this week, five pillar check-ins — via the panel's QR or push. Small targets get met and build the habit; ambitious ones get abandoned by Wednesday.
3. Start the next session by opening the patient's actual data in the Values or Body+ tab of Insights & Goals. Reviewing the real log — not the patient's summary of it — is what makes the assignment matter.
4. Adjust: raise a target that's being met, shrink one that isn't, and connect what the data shows to the next module.

4The Emotions Trace Map — the on-ramp

A starting point for patients who need work on emotion labeling before DBT skills make sense. If a patient can't name what they feel, a diary card full of named emotions to rate is a wall, not a tool.

The trace map asks less of the patient than the diary card. Each entry is: a feeling in the patient's own words (free text, no list to choose from), how it sits — Feels Wrong, Feels Good, Feels Flat, or Feels Mixed — an energy level, and where it lives in the body. That's the whole entry. No emotion vocabulary is required to start; the vocabulary is what the tool builds.

A trainable sequence

1. Weeks of trace-map only. The patient logs feelings as they notice them, in whatever words they have. The habit being built is noticing valence, energy, and body signal throughout the day — the same throughout-the-day timestamp rule from section 1 applies here in full.
2. Review together. In the Emotions tab of Insights & Goals, look at the distinct words the patient has used and their spectrum coverage. A widening vocabulary and entries spreading across the grid are the readiness signals; a patient still using two words for everything isn't ready yet, and that's fine — it's the work.
3. Graduate to the diary card. Build the card (section 1) using the patient's own emerging vocabulary where you can. The diary card now lands on a patient who can already notice and name — which is what makes the skills teachable.

5The push system — how it works, and fixing it

One paragraph of mechanism, then the troubleshooting list.

The patient turns on notifications in their app under Settings → Reminders. Their device registers under their display name — the name in their app. From then on, every Send to Patient's App button on your side (the end-of-module assign panels, the Assign Goals tab in Insights & Goals) delivers the goals or homework straight to their phone as a notification; tapping it loads the package exactly as a QR scan would, and any reminder schedule you set rides inside the same payload. No QR needed after the first enrollment.

The registry manager

At the bottom of the Assign Goals tool is Patient apps registered for notifications — every registered patient, under the exact name push matches against, with device count and last check-in. Use Send test to confirm a patient is reachable before you rely on push, and Remove when a patient leaves your care or changes their name (their app re-registers automatically next time they open it with notifications on).

When a send fails

1. Name mismatch is the usual cause. The name you type must match the patient's display name exactly. Check the spelling against the registry list — the registry is the truth.
2. The patient must have opened the app at least once with notifications turned on. Until then, they don't exist in the registry.
3. On iPhone, the app must be added to the home screen and opened from there. Notifications don't work from a Safari tab.
4. "No device is registered under…" means exactly that — the patient hasn't registered yet. Use the QR or Copy URL for this assignment and have them enable notifications for next time.
5. Notifications blocked at the phone level — the fix is in the phone's own Settings for the app, not inside Life Lab.
6. When in doubt, Send test. A test that arrives proves the whole path is live, in seconds.

6Phone-only patients (telehealth)

The patient is on their phone in the video call — the same device that would scan the QR — so they can't point the camera at your shared screen. Three ways through, in order of preference.

1. The screenshot trick. Share the QR on screen and have the patient screenshot it. On iPhone: open the screenshot in Photos, long-press the code (Live Text), tap the link. On Android: open it in Google Lens and tap the link. Same result as a scan.
2. Copy URL. Every QR in the platform has a Copy URL button beside it — the link and the code carry the same payload. Send the link through your clinic's approved messaging channel and the patient taps it.
3. Stop using QRs entirely. Once the first enrollment is done and notifications are on, push everything with Send to Patient's App (section 5). For ongoing telehealth patients this is the steady state: no codes, no links, homework just arrives.

7No phone at all — the analog diary card

The diary card predates smartphones; the method works on paper. What you lose is automation, not the clinical core.

1. Print a paper card matching the patient's configured card: the same emotions rated 0–5, the same urges rated 0–5 with an acted yes/no column, and the skills list to check off. Keeping the paper card identical to the digital configuration means a later switch to the app is seamless.
2. The patient fills it daily — and writes the time next to each entry. The timestamp coaching from section 1 applies with full force on paper, where batch-filling in the waiting room is even easier.
3. Weekly, either transcribe or review on paper. Transcribing the week's entries into the Diary Card tool takes a few minutes and buys you the longitudinal tracking; a paper-only review in session is also legitimate if transcription isn't practical.

8Attune — clinical use

Attune gets people out of their head and into their body, and trains them to regulate on purpose — to move their physiology toward the state they want or need, through breath work, body scans, and heart-rate feedback.

The regulation training is the visible half. The clinically crucial half is what comes up during practice. Slowing the body strips away distraction, and distraction is most people's primary avoidance strategy — so a quiet body exposes the patient to exactly the material they push away the rest of the day. Attune practice is, structurally, exposure.

The post-exercise reflection — coach this hard

After each exercise the app asks what came up. The reflection has three parts: free text ("What thoughts or feelings came up during the session?"), what-kind-of-thing tags — a worry, a memory, self-criticism, a person or situation, a body sensation, sadness or grief, urge to stop or escape, mind stayed quiet — and three skill lenses: was there judgement in it, was the patient fused with it or watching it, and was it about the past, present, or future.

Tell every Attune patient explicitly to fill in the reflection, every time. It takes thirty seconds and it is where the clinical material is. A patient who does the breathing but skips the reflection is getting relaxation; a patient who does both is producing a running record of their avoided content.

Reading it in Insights & Goals → Attune

• "What comes up when we get out of our head, and into our body?" aggregates the reflection tags across the record. A theme that recurs — self-criticism week after week, one person or situation again and again — is avoided material announcing itself. Recurring themes are your exposure targets and, directly, the session agenda.
• Felt vs. measured compares the patient's felt rating of their state against the measured heart-rate band. A patient who consistently under-reads arousal (feels calm while the body measures activated) is showing avoidance or alexithymia; over-reading is leverage for anxiety work. Either way, working the gap trains interoception, and the tab tracks whether it narrows.
• The pulse read is always optional. Every exercise can be started without it (Skip the read) — nothing is ever blocked behind the camera. Tell camera-shy patients this on day one so it never becomes the reason practice stops.