{"id":97430,"date":"2021-10-06T21:09:43","date_gmt":"2021-10-07T02:09:43","guid":{"rendered":"https:\/\/news.medill.northwestern.edu\/chicago\/?p=97430"},"modified":"2021-10-06T21:09:43","modified_gmt":"2021-10-07T02:09:43","slug":"on-a-scale-of-1-to-10-how-helpful-are-self-monitoring-tools-for-mental-health","status":"publish","type":"post","link":"https:\/\/news.medill.northwestern.edu\/chicago\/on-a-scale-of-1-to-10-how-helpful-are-self-monitoring-tools-for-mental-health\/","title":{"rendered":"On a scale of 1 to 10, how helpful are self-monitoring tools for mental health?"},"content":{"rendered":"
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By Sarah Anderson<\/strong>
\n<\/b>Medill Reports\u00a0<\/em><\/p>\n<\/div>\n

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You settle into your seat on the bus and open the app with the virus icon.<\/p>\n<\/div>\n

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\u201cAre you experiencing any of the following symptoms of COVID-19?\u201d\u00a0 You scan the list, click \u201cno\u201d and screenshot the green pass that appears to flash at your office front desk. \u00a0Next, you open the app with the cartoon brain.\u00a0 \u201cAre you experiencing any of the following symptoms of depression?\u201d \u00a0You think about it\u2026<\/p>\n<\/div>\n

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Self-monitoring tools are becoming a part of our daily lives.\u00a0 While those for COVID-19 prompt us to consider our physical health, the less familiar territory of mental health tools helps people tune into and track their moods, behaviors and other symptoms.\u00a0 These include pen-and-paper tools, from journaling about what you did and how you felt that day, to coloring in hand-drawn charts.\u00a0 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.<\/p>\n<\/div>\n

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\u201cWhat 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,\u201d said 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.\u00a0 \u201cWhat are the circumstances when I feel well and what are the circumstances when I don\u2019t?\u201d<\/p>\n<\/div>\n

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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?\u00a0 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, experts advise.<\/p>\n<\/div>\n

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\u201cI 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,\u201d said Paul Pendler, a clinical assistant professor of psychiatry and behavioral sciences at Northwestern University.<\/p>\n<\/div>\n

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However, people with mild or temporary symptoms related to a life change, for instance, can safely explore using self-monitoring tools independently, experts say. \u00a0When self-monitoring on your own, though, it\u2019s important to make sure some resource is filling the role of the professional in helping you use the information you gather productively, explained Sheehan Fisher, an assistant professor of psychiatry and behavioral sciences at Northwestern University.\u00a0 He recommends pairing documentation tools with a self-help book that is supported by scientific evidence, such as those\u00a0<\/span>recommended by the American Psychological Association.<\/a><\/p>\n<\/div>\n

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Some mental health mobile apps serve both purposes, proposing action items based on the data they record. \u201cFor people that have more mild issues, smartphone applications could ultimately be a perfectly adequate substitute for a real live person,\u201d said Stewart Shankman, the chief of psychology in the Department of Psychiatry and Behavioral Sciences at Northwestern University.<\/p>\n<\/div>\n

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When self-monitoring with an app, it\u2019s critical to select one that\u2019s backed by sound research, according to Shankman.\u00a0 It\u2019s also important to ensure that the app is responsive to the moods and behaviors you think it is, Razzano explained.\u00a0 \u201cWe might think, \u2018I feel X, I\u2019m going to pick this app,\u2019 and the app actually works on Y versus X,\u201d she said.\u00a0 Razzano recommends using the American Psychiatric Association\u2019s\u00a0<\/span>App Evaluation Model<\/a>\u00a0<\/span>to find a credible app that\u2019s a good fit for you.<\/p>\n

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(Sarah Anderson\/MEDILL)<\/figcaption><\/figure>\n<\/div>\n
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Even then, it\u2019s important to evaluate if self-monitoring independently is meeting your needs.\u00a0 Yesenia Castaneda, a 30-year-old business analyst from Detroit, Michigan, used the app Ginger to help her cope with seasonal affective disorder and isolation during the pandemic.\u00a0 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.<\/p>\n<\/div>\n

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\u201cThe app was picking up on keywords\u2026 it was much more formulaic,\u201d Castaneda said. \u201cI find that the therapist is able to unpack things on a deeper level than just, \u2018Oh, you\u2019re feeling sad.\u00a0 Go for a walk.\u2019\u201d<\/p>\n<\/div>\n

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Like Castaneda, many people need two-way conversation to understand how to translate awareness of their mental health into changes to improve it. \u201cI think working with a psychologist or psychiatrist to help process and figure out what that [insight] means in terms of treatment is useful,\u201d said Christina Boisseau, an associate professor of psychiatry and behavioral sciences at Northwestern University.<\/p>\n<\/div>\n

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Self-monitoring records can allow mental health professionals to obtain a clearer picture of someone\u2019s condition by helping the person recall and communicate their symptoms more accurately.\u00a0 \u201cIt can help you discuss what\u2019s going on in your day-to-day life with your psychiatrist or psychologist,\u201d Boisseau said.\u00a0 \u201cOur recollection is often different than what actually happened at the moment or how we felt at the moment.\u201d<\/p>\n<\/div>\n

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Additionally, a professional can help interpret self-monitoring data to identify any patterns or trends in the symptoms.\u00a0 \u201cOne of the things we look at it is: Are there particular situations or events in your life that trigger an anxious or depressed or other mood?\u201d Boisseau said.<\/p>\n<\/div>\n

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Victoria Watters, a 28-year-old student from Westwood, Massachusetts, journaled regularly about her anxiety in addition to meeting with a therapist.\u00a0 \u201cIt was a really helpful tool during therapy because I would have space to process by myself and then a counselor to talk through things,\u201d she said.<\/p>\n<\/div>\n

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Watters said journaling helped her recognize that her anxiety peaks when she is not taking care of her needs\u2014something she had been conditioned to do as a child.\u00a0 \u201cI grew up in a pretty abusive home, and I feel like women in general were kind of expected to take a smaller portion of anything, whether that’s a meal or time or attention or whatever,\u201d she said.\u00a0 \u201cTimes my anxiety has been the most intense is when I’m actively denying myself in times when I should be advocating for myself instead.\u00a0 As I’ve gotten older, my anxiety, in that way, is not as intense because I speak up more.\u201d<\/p>\n<\/div>\n

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While it has yielded valuable insight into her condition, being so attuned to her emotions has been difficult for Watters at times. \u201cJournaling does feel like a very pointed opportunity to know how I’m feeling,\u201d she said.\u00a0 \u201cI think the self-awareness can be kind of intense.\u201d<\/p>\n<\/div>\n

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One concern surrounding self-monitoring is the risk that this heightened self-awareness could ultimately reinforce negative symptoms. A study<\/a>\u00a0<\/span>of people with bipolar disorder found that those who engaged in daily mood tracking using a smartphone app displayed worse depressive symptoms than those who did not.\u00a0 \u201cI think it\u2019s a really fine line between spending too much time on an app almost overemphasizes the problem,\u201d Pendler said.<\/p>\n

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This may be the case if someone perceives self-monitoring practices as a reminder of their symptoms.\u00a0 Another\u00a0<\/span>study<\/a>\u00a0<\/span>of people with bipolar disorder found that 43% of participants who engaged in daily mood tracking reported that the tool served as an unpleasant reminder of their condition. \u00a0\u201cIt\u2019s hard to get away from the idea that you have a chronic illness when you\u2019re engaging in this kind of daily self-reflection about your mental health,\u201d said Emma Morton, a post-doctoral fellow at the University of British Columbia who studies digital tools for mental health.<\/p>\n<\/div>\n

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Negative symptoms can also be reinforced if someone is not satisfied by the degree of improvement reflected in their self-monitoring data.\u00a0 \u201cSometimes, change takes a little while,\u201d Pendler said.\u00a0 \u201cIf you\u2019re not aware that it may take a little while and you don\u2019t see your numbers coming down, you may wind up getting more anxious.\u201d<\/p>\n<\/div>\n

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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.\u00a0 \u201cBeing more aware of those things could create emotional distress, and it might be useful for them to have someone to talk to,\u201d Fisher said.<\/p>\n<\/div>\n

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Additionally, a professional can assess an individual\u2019s needs to determine which specific self-monitoring tools are right for them.\u00a0 \u201cThe type of self-monitoring we ask patients to do really depends on what they\u2019re presenting with,\u201d Boisseau said.\u00a0 \u201cIt needs to be\u2026 tailored to the person, their goals, their values and what they\u2019re dealing with.\u201d<\/p>\n<\/div>\n

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For example, people who tend to fixate or ruminate on negative experiences may require strategies to prevent self-monitoring from becoming all-consuming.\u00a0 \u201cYou 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,\u201d Fisher said.<\/p>\n<\/div>\n

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Some clinicians may advise against self-monitoring altogether for people with these tendencies. \u201cWhen 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,\u201d Pendler said.<\/p>\n<\/div>\n

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Alternately, the timing and rigor of self-monitoring regiments can be adjusted as a person\u2019s needs evolve. \u00a0\u201cOver time, maybe you don\u2019t need to be constantly checking in with yourself.\u00a0 And even being reminded of some of these things, it\u2019s not beneficial anymore,\u201d said Elizabeth Murnane, a professor of engineering at Dartmouth University who studies technology for human wellbeing.\u00a0 A mental health professional can help implement these \u201cmoments of tighter or looser monitoring,\u201d as Murnane said, to maximize its value for an individual.<\/p>\n<\/div>\n

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Another approach that a professional may recommend is monitoring a broader range of areas of life.\u00a0 In one qualitative\u00a0<\/span>study<\/a>, Morton asked participants with bipolar disorder to use a \u201cquality of life\u201d tool to reflect on 14 different life areas ranging from money to leisure to self-esteem to relationships.\u00a0 Many reported that the tool helped combat the sense of discouragement they encountered using other forms of self-monitoring. \u00a0\u201cIt was quite validating to reflect on a broad range of life experiences, not just their symptoms,\u201d Morton said. \u201cIt picks up areas of strength as well as areas that people might be struggling with.\u201d<\/p>\n<\/div>\n

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Mental health professionals also play a critical role in highlighting growth in an often gradual and non-linear path of progress.\u00a0 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.\u00a0 \u201cIt can be helpful to show people that this situation that used to make you very anxious is only making you moderately anxious now,\u201d Boisseau said.<\/p>\n<\/div>\n

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Similarly, a professional can help contextualize bad days within a big-picture perspective, Razzano explained.\u00a0 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 said.<\/p>\n<\/div>\n

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Watters\u2019s therapist provided specific journaling prompts such as, \u201cWhat has your anxiety taught you?\u201d that helped her find meaning in her journey, even if it wasn\u2019t one of constant progress toward treating her condition.\u00a0 \u201cEven just the reframing of \u2018What has my anxiety taught me?\u2019 versus \u2018How do I overcome my anxiety?\u2019 was really helpful,\u201d she said.<\/p>\n<\/div>\n

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As we ventured into another sensitive and personal topic, I asked Watters if she wanted to take a break.\u00a0 \u201cThat\u2019s okay,\u201d she replied.\u00a0 \u201cI\u2019ll just journal about it later.\u201d<\/p>\n<\/div>\n

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Sarah Anderson is a health, environment and science reporter at Medill and a Ph.D. chemist. \u00a0Follow her on Twitter @seanderson63.<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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