Mood monitoring in bipolar disorder: Is it always helpful?

Abstract

Mood monitoring is widely used in the treatment and self-management of bipolar mood swings. Typically, service-users record their affective states in a paper or electronic diary over an extended period (e.g. weeks, months). The aim is to help people to achieve greater awareness and understanding of their affective states, which then enables them to better prepare and account for problematic changes in their mood, preventing escalation to mood episodes and relapse. A possible strength of mood monitoring is that ambulatory monitoring allows for insights that might not normally be identified through retrospective assessment, facilitating intervention before a deterioration in mood state occurs. Mood monitoring is therefore a form of high-intensity early warning sign detection and planning intended to keep people well. Clinicians have employed mood monitoring within psychological interventions, including cognitive behavioural therapy (CBT), psychoeducation modules, and as a standalone intervention. It is also promoted widely outside of clinical services through self-help books, websites and resources. There are now multitudes of freely available mood monitoring diaries on the internet, some endorsed by leading bipolar disorder charities. Additionally, there are burgeoning numbers of smartphone mood monitoring software applications, with varying levels of supporting evidence and validation (1). This Clinical Care Article considers the question: Is mood monitoring always helpful in people with a diagnosis of bipolar disorder? The authors propose that, although potentially helpful for some individuals, the use of mood monitoring in bipolar disorder can at times be inappropriate or even detrimental. We advocate the need for careful and sensitive deployment of mood monitoring, with consideration of an individual formulation and clear personalised goals, rather than one size fits all adoption. We explore for who, when and how mood monitoring might be most helpful.