One of the most important cognitive-behavioural techniques is self-monitoring. It helps the therapist (and the client) to get a more objective view of the complaints and to examine possible causes and changes of symptoms in the course of the day or week. More.

Usually a depressed patient will feel low and depressed all day, thinking there are no changes or it might become even worse in the course of the day. However self-monitoring of mood might help to get a different view. One of my clients described it this way:

"Somehow, the act of recording moods gave me a sense of control. I used the mood diary to track my reactions to pharmaceutical drugs and side effects and to record daily thoughts and feelings."

He used an analog scale starting with

• 0 = desperate, feeling extremely low to
• 10 = feeling great, no signs of depression

Obviously, at the beginning of therapy he felt low and depressed, so he mainly used the range of 0-4.

We started with a diary of mood and activities, to get a better understanding of his symptoms during the day:

Here are some notes of the first days of self-monitoring:

• 06:00 1 wake up, ruminating in bed
• 07:00 2 going to the bathroom
• 07:30 2 cup of coffee, low appetite
• 08:00 0 try to read a book, can't concentrate
• 09:00 2 back to bed, feeling low, worrying about the future
• 10:00 3 listening to some birds outside
• 11:00 4 decided to get up, have a walk with the dog
• 12:00 3 lunch, still no appetite
• 13:00 2 need a nap, cannot do my normal work
• 14:00 5 playing cards with my grandson
• 15:00 2 he left, feel lonely and desperate
• 16:00 0 extremely depressed, lay down in bed
• 17:00 0 cannot fall asleep.
• 18:00 2 read the newspaper (sports)
• 19:00 2 dinner with my family
• 20:00 3 watching TV

With this diary of mood and activities we got a better understanding what might influence his depression:

1. There was a change of symptoms during the day! This is typical for depressive disorders, with a low mood in the beginning of the day. Usually there is a slight improvement during the days or in the afternoon.
2. He noticed an influence of activites like walking the dog or playing cards with his grandson. This helped him to overcome worrying and to activate himself. So he deciced to schedule a regular walk to the park at least 4 times a week. Another of his ideas was to start gardening again. This was a hobby he had stopped at the onset of depression. These activities helped to give a better structure in the course of the day.