Self-monitoring tools are becoming a part of our daily lives. The ones we’ve used for COVID-19 symptoms prompt us to consider our physical health, but the less familiar territory of mental health tools helps people tune into and track their moods, behaviors and other symptoms. These include pen-and-paper tools, from journaling about what you did and how you felt that day, to coloring in hand-drawn charts. They also include smartphone apps and other digital tools where you can input observations about your mental health, such as rating your mood on a scale of one to 10.
“What self-monitoring really is, in the end, is the ability for us to think about our mental health and where we are in a moment,” says Lisa Razzano, an associate professor of psychiatry at the University of Illinois Chicago and the vice president of research at the mental health service provider Thresholds. “What are the circumstances when I feel well and what are the circumstances when I don’t?”
There’s An App for That
At a time when many people are looking to take stock of their mental health, a natural question arises: Should these tools be used without the guidance of a mental health professional? For those with more severe mental health conditions such as bipolar disorder, self-monitoring should serve as a complement to rather than a substitute for professional help.
“I think the danger, from my perspective, is that it can be seen as replacing the interaction that has to happen between the patient and the professional,” says Paul Pendler, a clinical assistant professor of psychiatry and behavioral sciences at Northwestern University.
However, people with mild or temporary symptoms related to a life change, for instance, can safely explore using self-monitoring tools independently, experts say. Even then, it’s important to make sure some resource is filling the role of the professional in helping you use the information you gather, explains Sheehan Fisher, an assistant professor of psychiatry and behavioral sciences at Northwestern. He recommends pairing documentation tools with a self-help book that is supported by scientific evidence, such as those recommended by the American Psychological Association (APA). Some mental-health apps serve both purposes, proposing action items based on the data they record.
If you try self-monitoring with an app, make sure that it’s responsive to the moods and behaviors you think it is, Razzano explains. “We might think, ‘I feel X, I’m going to pick this app,’ and the app actually works on Y versus X,” she says. Razzano recommends using the APA’s App Evaluation Model to find a credible app that’s a good fit for you.
Professional and Personalized
Even then, it’s important to evaluate whether self-monitoring independently is meeting your needs. Yesenia Castaneda, a business analyst from Detroit, Michigan, used the app Ginger to help her cope with seasonal affective disorder and isolation during the pandemic. While she recognized the value of reflecting on how she was feeling, she realized that she needed more personalized feedback and started seeing a therapist.
“The app was picking up on keywords… it was much more formulaic,” Castaneda says. “I find that the therapist is able to unpack things on a deeper level than just, ‘Oh, you’re feeling sad. Go for a walk.’”
Like Castaneda, many people need two-way conversation to understand how to translate awareness of their mental health into changes to improve it. “I think working with a psychologist or psychiatrist to help process and figure out what that [insight] means in terms of treatment is useful,” says Christina Boisseau, an associate professor of psychiatry and behavioral sciences at Northwestern.
Self-monitoring records can allow mental health professionals to obtain a clearer picture of someone’s condition. “It can help you discuss what’s going on in your day-to-day life with your psychiatrist or psychologist,” Boisseau says. “Our recollection is often different than what actually happened at the moment or how we felt at the moment.”
Additionally, a professional can help analyze self-monitoring data to identify any patterns or trends in the symptoms. “One of the things we look at is: Are there particular situations or events in your life that trigger an anxious or depressed or other mood?” Boisseau says.
Victoria Watters, a college student from Westwood, Massachusetts, journals regularly about her anxiety in addition to meeting with a therapist. “It was a really helpful tool during therapy because I would have space to process by myself and then a counselor to talk through things,” she says. While it has yielded valuable insight into her condition, being so attuned to her emotions has been difficult for Watters at times. “Journaling does feel like a very pointed opportunity to know how I’m feeling,” she says. “I think the self-awareness can be kind of intense.”
One concern surrounding self-monitoring is the risk that heightened self-awareness could ultimately reinforce negative symptoms. A study of people with bipolar disorder found that those who engaged in daily mood tracking using an app displayed worse depressive symptoms than those who did not. Another study of people with bipolar disorder found that 43 percent of participants who engaged in daily mood tracking reported that the tool served as an unpleasant reminder of their condition.
“It’s hard to get away from the idea that you have a chronic illness when you’re engaging in this kind of daily self-reflection about your mental health,” says Emma Morton, a postdoctoral fellow at the University of British Columbia who studies digital tools for mental health.
Negative symptoms can also be reinforced if someone is not satisfied by the degree of improvement reflected in their self-monitoring data. “Sometimes, change takes a little while,” Pendler says. “If you’re not aware that it may take a little while and you don’t see your numbers coming down, you may wind up getting more anxious.”
Mental health professionals are cognizant of the potential pitfalls of being hyper-attuned to symptoms and can offer support as people adapt to self-monitoring. “Being more aware of those things could create emotional distress, and it might be useful for them to have someone to talk to,” Fisher says.
Path to Progress
Additionally, a professional can assess an individual’s needs to determine which specific self-monitoring tools are right for them. “The type of self-monitoring we ask patients to do really depends on what they’re presenting with,” Boisseau says. “It needs to be… tailored to the person, their goals, their values and what they’re dealing with.”
For example, people who tend to fixate on negative experiences may require strategies to prevent self-monitoring from becoming all-consuming. “You will have to give them some tools to be able to document, but then redirect their attention back to the present moment, rather than that being a trigger for them to spiral out,” Fisher says.
Some clinicians may advise against self-monitoring altogether for people with these tendencies. “When I work with people like that, I basically just want them to go with the flow and documenting and using an app is the antithesis of going with the flow,” Pendler says.
Another approach that a professional may recommend is monitoring a broader range of areas of life. In one qualitative study, Morton asked participants with bipolar disorder to use a “quality of life” tool to reflect on 14 different life areas ranging from money to leisure to self-esteem to relationships. Many reported that the tool helped combat the sense of discouragement they encountered using other forms of self-monitoring. “It was quite validating to reflect on a broad range of life experiences, not just their symptoms,” Morton says. “It picks up areas of strength as well as areas that people might be struggling with.”
Mental health professionals also play a critical role in highlighting growth in an often gradual and non-linear path of progress. They can point out that even if someone is not yet where they want to be, they have come a long way from where they were. Similarly, a professional can help contextualize bad days within a big-picture perspective, Razzano explains. For example, rather than focusing on the fact that you felt depressed on Friday, a professional can emphasize that Friday was the only day this week you felt depressed at all, she says.
Watters’s therapist provided specific journaling prompts such as, “What has your anxiety taught you?” that helped her find meaning in her journey, even if it wasn’t one of constant progress toward treating her condition. “Even just the reframing of ‘What has my anxiety taught me?’ versus ‘How do I overcome my anxiety?’ was really helpful,” she says.
