Keeping your mood 'on the record'

Howdy...
Self-monitoring is a vital tool to help get your head around a problem you are tackling. Self-monitoring simply involves keeping track of key pieces of information over a given period of time to improve our understanding of a psychological issue such as anger, anxiety, low mood, and even physical/medical issues such as fatigue and pain. This improved understanding usually comes in the form of improved awareness of 'things' that make your problem worse or better. For instance, panic attacks are often associated with specific 'triggers', such as feeling your heart racing, stepping onto a train (where an attack has previously occurred), or having an anxiety-provoking thought (e.g., 'what if I am about to have a heart attack?'). With an increased awareness of such triggers, you are in a better position to manage them in a way that reduces the frequency of attacks. Sometimes this may mean avoiding triggers or risky situations (although not normally done for anxiety problems) or changing anxiety-provoking thoughts to more accurate (less anxiety-provoking) ones. 

To keep things as simple as possible, we will focus on low mood for the rest of this discussion. Self-monitoring can provide more benefits that just trigger recognition. This activity can be used to gain an accurate picture of your difficulties. Many psychological problems result in distortions in reality, often due to their adverse effects on thinking. For example, depressed people are prone to thinking 'errors' or 'biases' which means negative events stick-out more readily than neutral or positive events. So, when asking a depressed person how their week was, the reply is often "terrible" or "awful" because they tend to remember only the bad things that happened. Collecting some basic information on paper can help overcome such biases.

Self-monitoring can also help us look at low mood from a 'big-picture' perspective. I often ask depressed people to keep a record of their activities over 1-2 weeks as a treatment starting point. This can provide insights into unhelpful behaviours and lifestyle practices. For instance, a person may be spending 8 hours a day lying on their beds (to cope with fatigue associated with their depression). When a person sees this activity dominating an entire week, they can more easily see the significance of this for their on-going low mood. 

Self-monitoring is also very important in evaluating the effectiveness of strategies used to tackle a problem. For instance, we might evaluate the effect of an exercise program on mood. Again, we need to minimise the extent to which reality is distorted though thinking biases. Instead of saying guessing what effect a strategy had on our mood (e.g., 'I think exercise has made me feel better, but its hard to say for sure') we can use concrete evidence (through a mood rating scale, for instance) to be more certain about what effect our intervention had. 

Right. Now you've got a number of good reasons to give self-monitoring a go... I would say that you tend to get far more out of self-monitoring with help from a psychologist. But, you can still get some useful insights nonetheless. I have attached two forms for you to use:

A basic ABC form

This form can be used to track the role played by your beliefs in low mood. The form has three main components:

  • A = 'antecedent' or trigger for experiencing your problem. Experiencing a strong negative emotion is usually triggered by something you can identify (e.g., being told you are softer than a piece of sponge cake (triggering anger), feeling rejected by a friend (triggering low mood), standing up in front of a crowded room of people (triggering anxiety)). Noting down these triggers is an important first step in identifying patterns that play a role in your low mood.
  • B = 'belief' or what ran though your mind immediately after this triggering event.
  • C = 'consequence' or the classic psychologist question 'how did that make you feel' (I promise I use this only when absolutely essential). In this case, the response of interest is our mood, but people often experience other unpleasant emotions at the same time such as guilt, helplessness or anger.

When you experience a dip in your mood, record the situation on this form. You start by recording what was happening just before your mood changed (in the A column). Note what activity you were doing, where you were, who you were with (if anyone) and what time of the day the change occurred. Next you record what you said to yourself. For instance, if a co-worker walks past without acknowledging you, some possible thoughts might be 'He/she doesn't want anything to do with me' or 'He/she obviously thinks I am rubbish at my job' (ahhh...the joys of making assumptions based on no evidence!). Finally, note the consequence of these thoughts in terms of your emotional response and rate the intensity of each emotion on a 10-point scale (0= experienced none of that emotion, 10= experienced that emotion with extreme intensity).

Once you have collected information on several instances of mood change (the more the better, but at least 15 recordings is a good start), ask yourself the following questions:

  1. Are there common triggers for mood changes (e.g., more likely at work, or at a certain time of the day, or towards the end of the week)?
  2. Are there specific thoughts that tend to come up frequently (e.g., you may repeatedly experience the fear that people think negatively of you)?
  3. In what situations did I experience the strongest emotional response?

These questions are designed to get you using the information you collected to learn more about your mood changes. Your answers to these questions can help you identify effective strategies to manage low mood. For instance, if dips in mood happen most frequently at night when home alone, then it may be a good idea to plan a productive activity outside the house rather than staying in. If a particular negative thought comes up repeatedly, you could look to challenge the accuracy of this thought with questions such as 'Do I have hard evidence that this is true' or 'What's another way to think about this?'

Activity Monitoring Form

This form can be used to record your activities over a 1-week period. It is broken up into hourly slots. Fill this out for 2 weeks, recording how you spend each hour in the day. Just enter a single word or phrase such as 'work', 'TV', 'Dr appointment' or 'movies' into each box. For each activity, also record your mood score (on a scale of 0-10 as above) immediately before and after the activity. This helps you remember what effect a particular activity had on your mood. After a couple of weeks, take a look at the forms and think about some of the following points:

  • People who are low in mood sometimes have little variety in their activities- how much variety is there in your week (variety is very important)? Make sure pleasant events, social activities, 'goal' activities (doing something that gives you a sense of achievement) and physical exercise are a regular part of your weekly routine.
  • Look out for long periods of inactivity lasting more than a couple of hours. For example, spending several hours in front of the activity is usually not helpful for your mood. Think about shorter periods of TV-watching time and do something active with the remaining time.
  • Look for activities that seem to make your mood worse (based on before and after mood scores). If these are non-essential tasks, think about replacing them with something that has a more positive effect on your mood.
  • What activities seem to make your mood better. If they are positive over the long-run (e.g., don't involve substance use, robbing banks, etc), then do more of it. Just make sure you don't do it all the time. This is because variety is important and an activity can lose some of its positive punch if repeated constantly.

OK, this is a very basic starter for you, but hopefully gives you some ideas to work with. On its own, self-monitoring can be an effective tool for people who experience dips in their mood. I will say again that it can be hard to do this self-monitoring on your own, so think about seeking professional help if you are stuck.

One little side-note: Low mood is actually a normal part of life. So, don't get too worried with the occasional dip that lasts a few hours. Self-monitoring can be used if low mood is getting in the way of living life they way you want. You really need to seek help though if you have been experiencing low mood for more than a couple of weeks and you are finding it very hard to complete your normal day-to-day activities. Thoughts of self-harm represent an emergency situation that requires immediate professional help.

Jason.

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