Self-monitoring tools are becoming 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 in and track their moods, behaviors, and other symptoms. These include pencil and paper tools, from journaling what he did and how he felt that day, to coloring in hand-drawn charts. They also include smartphone apps and other digital tools where you can enter observations about your mental health, such as rating your mood on a scale of one to 10.
“What self-control really is, in the end, is the ability we have to think about our mental health and where we are at any given moment,” says Lisa Razzano, associate professor of psychiatry at the University of Illinois Chicago and vice president. Research chair of mental health services provider Thresholds. “What are the circumstances in which I feel good and what are the circumstances in which I don’t?”
There’s an application 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-management should serve as a complement to, and not a substitute for, professional help.
“I think the danger, from my perspective, is that it can be seen as a replacement for 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 example, can safely explore using self-management tools independently, experts say. Even then, it’s important to make sure some resource plays the role of the professional to help you use the information you collect, explains Sheehan Fisher, an assistant professor of psychiatry and behavioral sciences at Northwestern. He recommends combining documentation tools with a self-help book backed by scientific evidence, such as the 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 it responds to the moods and behaviors you think it is, Razzano explains. “We might think, ‘I feel X, I’m going to choose this app,’ and the app actually works Y versus X,” she says. Razzano recommends using APA Application evaluation model to find a credible app that is right for you.
Professional and Personalized
Even then, it is important to assess whether independent self-monitoring meets your needs. Yesenia Castaneda, a business analyst from Detroit, Michigan, used the Ginger app 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 began seeing a therapist.
“The app was picking up keywords…it was much more formulaic,” says Castaneda. “I find that the therapist is able to unpack things on a deeper level than just, ‘Oh, you feel sad. Go for a walk.'”
Like Castaneda, many people need a two-way conversation to understand how to translate awareness of their mental health into changes for the better. “I think working with a psychologist or psychiatrist to help process and figure out what that is [insight] medium in terms of treatment is helpful,” says Christina Boisseau, an associate professor of psychiatry and behavioral sciences at Northwestern.
Self-monitoring records can allow mental health professionals to get a clearer picture of a person’s status. “It can help you discuss what’s going on in your day-to-day life with your psychiatrist or psychologist,” says Boisseau. “Our memory is often different from what actually happened at the time or how we felt at the time.”
Additionally, a professional can help analyze self-monitoring data to identify any patterns or trends in 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, writes regularly about her anxiety in addition to meeting with a therapist. “It was a really helpful tool during therapy because I had room to process by myself and then a counselor to talk things through,” she says. While she has provided valuable insight into her condition, being so in tune with her emotions has been difficult for Watters at times. “Writing in a journal feels like a great opportunity to find out how I feel,” she says. “I think self-awareness can be a little intense.”
One concern around self-monitoring is the risk that increased self-awareness may ultimately reinforce negative symptoms. TO study of people with bipolar disorder found that those who tracked their mood daily using an app had worse depressive symptoms than those who didn’t. Other study of people with bipolar disorder found that 43 percent of participants who participated 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 engage 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 with the degree of improvement reflected in their self-monitoring data. “Sometimes change takes a little while,” says Pendler. “If you’re not aware that it may take a little while and you don’t see your numbers go down, you may end up feeling more anxious.”
Mental health professionals are aware of the potential dangers of being hypertuned to symptoms and can offer support as people adjust to self-management. “Being more aware of those things could create emotional distress and it could be helpful for them to have someone to talk to,” says Fisher.
road to progress
Additionally, a professional can assess an individual’s needs to determine which specific self-management tools are right for them. “The kind of self-monitoring we ask patients to do really depends on what they present with,” says Boisseau. “It has to be … tailored to the person, their goals, their values and what they’re dealing with.”
For example, people who tend to dwell on negative experiences may need strategies to prevent self-control from becoming overwhelming. “You’ll have to give them some tools to be able to document, but then redirect their attention to the present moment, instead of that being a trigger for them to drift,” says Fisher.
Some doctors may advise against self-monitoring altogether for people with these tendencies. “When I work with people like that, I basically want them to go with the flow, and documenting and using an app is the antithesis of going with the flow,” says Pendler.
Another approach that a professional may recommend is to monitor a broader range of life areas. in a qualitative study, Morton asked participants with bipolar disorder to use a “quality of life” tool to reflect on 14 different areas of life ranging from money to leisure, self-esteem and relationships. Many reported that the tool helped combat the feelings of discouragement they encountered when using other forms of self-monitoring. “It was very empowering to reflect on a wide range of life experiences, not just their symptoms,” says Morton. “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 he wants to be, he has come a long way from where he was. Similarly, a professional can help put bad days into a bigger picture, Razzano explains. For example, instead of focusing on the fact that you felt down on Friday, a professional can emphasize that Friday was the only day this week that you felt down, she says.
Watters’ therapist provided specific prompts for journaling, such as “What has your anxiety taught you?” that helped her find meaning in her journey, even if it wasn’t one of steady progress toward treating her condition. “Even the rephrasing of ‘What has my anxiety taught me?’ versus ‘How do I get over my anxiety?’ it was really helpful,” she says.
