A Guide To Self-Monitoring

Self-Monitoring

Self-monitoring is a key feature of cognitive behavioural therapy (CBT) for the treatment of eating disorders. It involves keeping a daily record of food and fluid intake, thoughts, emotions, and behaviours.

This practice raises your awareness of your thoughts, emotions, and patterns of behaviours in the moment, and allows you and your clinician to step back together and take a ‘helicopter view’ of your eating disorder and the things that keep it going. Self-monitoring will form a crucial part of your eating disorder treatment, it will begin following your first session of therapy, and be reviewed with your clinician during each session.

Challenges to Self-Monitoring

The idea of self-monitoring every day in real-time might feel overwhelming and confronting. It will take time to get into the habit of recording and may feel uncomfortable at first- this is normal. Self- monitoring is a very important part of your treatment towards recovery, and without it, you may find it difficult to overcome the eating disorder.

It is too much work

It will take time and effort to complete the records after each meal/ snack and will require some planning on your part. But, making records in the moment will draw your attention to your thoughts and behaviours as they are happening, rather than after the event. One of the reasons self-monitoring is so helpful is that it can be difficult to recall thoughts, feelings, or behaviours after some time has passed. As you practice completing self-monitoring, it will become less effortful.

It will make my eating disorder worse

It is not unusual to fear that by recording all of your food and eating patterns that you will then become more focused on food, and this could make your eating disorder worse. People can experience a short-term increase in anxiety and preoccupation when they start, as it can be confronting seeing it written down for the first time, but these feelings are not long-lasting and will reduce as you begin to make changes.

You will become more aware of your food and eating patterns as a result of self-monitoring, but you likely are already spending a lot of time thinking about food and eating even without formally monitoring it. Self-monitoring will make it more guided toward an intention of better understanding the problem to then be able to move out of it.

If you actively avoid thinking about or knowing what your intake or eating patterns are, then self-monitoring will help move you toward recovery by helping you face the problem rather than experiencing fear and avoiding it. Although it initially may be confronting, this knowledge and awareness will be your ally in gaining understanding to change your eating habits.

I have done this before

You may have had previous experience with self-monitoring, but this could have been for very different reasons, and not in the way that is in alignment with this eating disorder treatment. It is not unreasonable to be apprehensive about this, especially if you have not had positive experiences with self-monitoring in the past. However, rather than focusing only on what you eat, this particular self-monitoring is also designed to identify triggers, thought patterns and emotions and think about how certain eating disorder behaviours are maintaining issues over the longer-term.

I feel too ashamed or guilty writing it down

For this treatment, the rationale is to gather data around food, thoughts, emotions and behaviours in daily life to provide insight into your eating disorder and for your clinician to provide you the best treatment. You may be tempted to omit some aspects of your eating behaviour due to feeling ashamed or guilty. Whilst it might feel easier to do this, leaving out information may limit your progress with the therapy. You do not need to be concerned about feeling ashamed or guilty sharing the record with your clinician. They will not judge you and can help you best when they have complete, accurate information.

Helpful Tips for Self-Monitoring

• If you’re using a physical form, take your monitoring forms with you wherever you go. If you would find it easier not completing your forms around others, then you could record your eating on your phone and transfer the information into your form when you get home.

• Set alarm reminders for every meal and snack you eat until you get into the routine of self-monitoring.

• Remind yourself that this is an integral part of your recovery and is not a practice you will have to do forever!

https://www.cci.health.wa.gov.au/~/media/CCI/Mental-Health-Professionals/Eating-Disorders/Eating-Disorders---Information-Sheets/Eating-Disorders-Information-Sheet---01---A-Guide-to-Self-Monitoring.pdf

Targowski, K., Bank, S., Carter, O., Campbell, B. & Raykos, B. (2022). Break Free from ED. Perth, Western Australia: Centre for Clinical Interventions.

Barakat, S., Maguire, S., Surgenor, L., Donnelly, B., Miceska, B., Fromholtz, K., Russell, J., Hay, P., &Touyz, S. (2017). The Role of Regular Eating and Self-Monitoring in the Treatment of Bulimia Nervosa: A Pilot Study of an Online Guided Self-Help CBT Program. Behavioural Sciences, 7 (3), 39