Eating Disorders Treatment Self-Monitoring in the Treatment of Eating Disorders By Elisha Carcieri, Ph.D. Elisha Carcieri, Ph.D. Elisha Carcieri is a clinical psychologist who treats eating disorders, depression, and more. She has written and edited for mirror-mirror.org, an eating disorders help site. Learn about our editorial process Updated on February 26, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Rachel Goldman, PhD, FTOS Medically reviewed by Rachel Goldman, PhD, FTOS Facebook LinkedIn Twitter Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change. Learn about our Medical Review Board Print Yellow Dog Productions / Getty Images In the treatment of eating disorders, logs or diaries are also known as self-monitoring records. Self-monitoring involves keeping track of behaviors, symptoms, or experiences over time. Self-monitoring is an important part of cognitive behavioral therapy (CBT) for many mental health disorders. For depression or anxiety, for example, therapy often involves keeping track of thoughts and associated emotions and behaviors. For insomnia, patients are usually asked to keep sleep logs. Keeping track of eating habits with a food log or diary can help you to better understand your current unhealthy patterns in order to promote change. Why Self-Monitoring is Helpful One of the reasons self-monitoring is so helpful is that it can be very difficult to recall thoughts, feelings, or behaviors after some time has passed. In the moment self-monitoring makes it possible to get an accurate picture of what is really going on with your eating behavior. This can be an important tool whether you are working to change a behavior or problem on your own (self-help), or while working with a therapist. Self-monitoring is a key part of enhanced CBT for eating disorders (CBT-E) and begins following the first session of therapy. Self-monitoring records are reviewed with your therapist during each CBT-E session. Challenges to Self-Monitoring There are challenges associated with self-monitoring. It takes time and effort to complete the records after each meal or snack and may require some planning on your part. However, you can remind yourself that self-monitoring is an integral part of recovery and it is not a practice you will have to maintain forever. Many people have also experienced recording their food intake for weight loss programs and were made to feel bad whenever their records revealed that they did not successfully stick to the diet. As a result, they may have felt embarrassed or ashamed of seeing their eating patterns recorded on paper. Your therapist, on the other hand, takes a very different approach to your records and will not judge you or ridicule you. Instead, your therapist will work with you to use self-monitoring as a tool to provide insight into your eating disorder and inform your treatment. Self-monitoring can help provide your therapist with data and information that is needed to provide the best treatment. How to Keep a Food Record It is recommended that you jot down the following as part of your self-monitoring record: Everything you eat and drink over the course of the day and night Any thoughts or feelings that went along with consuming that meal or snack Whether that particular episode of eating is considered a binge (according to you) Whether you did anything to try to shed the calories, such as vomiting, using laxatives, or exercising Location (for example, “at the dinner table,” or “in front of the television) Any relevant contextual factors, thoughts, or feelings (for example, “at family get together,” or “I ate too much,” or anxious, depressed, happy) You should initially keep your self-monitoring logs without making any changes to your eating patterns for at least a week to begin to identify patterns and themes. However, you may notice making changes without consciously trying to make these decisions. See if you can identify any problematic behaviors or associations. For example, you may notice that you are much more likely to binge eat after fasting for many hours during the day. After this period of time, you can move on to making some changes in your eating patterns. The next step is to make changes to any problematic patterns and to establish a regular pattern of eating. Paper or App Formats are Both Okay for Self-Monitoring Self-monitoring is traditionally done using paper and pencil. But technology has allowed for the use of the computer or smartphone apps that are geared toward recovery. Many find that the convenience of electronic records is motivating and a better fit for a busy lifestyle. Recovery Record and Rise Up + Recover are both free apps for appropriate self-monitoring that can be used independently or while working with a therapist as part of eating disorder treatment. In fact, a 2018 study found that some eating disorder patients found Recovery Record to be supportive and helpful in their recovery period, though others found it to be obstructive. Some applications also incorporate feedback and encourage the use of adaptive coping skills. There are many apps that may appear to fit the bill for self-monitoring, but focus almost exclusively on calorie counting. However, self-monitoring and calorie counting are not the same. Self-monitoring calls for recording information on emotions, context, and patterns of behavior that simple calorie counting does not. It is this additional information that is so powerful in promoting recovery. In fact, exact measurements and calorie counting are discouraged for people with eating disorders and are not a focus in CBT-E. Many sufferers of eating disorders are very rigid about their food intake and spend a lot of time thinking about what they have eaten and efforts to “make up” for calories they have consumed. Calorie counting is not recommended because it can serve to promote this obsessive behavior. Resources Self-monitoring is one of the first steps toward recovery from eating disorders and can be a rich source of information for anyone struggling with their relationship with food. If you are interested in self-help, the Centre for Clinical Interventions offers a workbook called Overcoming Disordered Eating that includes self-monitoring. Many people may find that they need support from a therapist. The National Eating Disorder Association provides a directory of eating disorder therapists. A Word From Verywell While self-monitoring can prove to be a helpful part of eating disorder recovery, it should never completely replace care from your recovery team and doctors. Be sure to always keep them in a loop about your recovery, including the records you are keeping. If you may be veering toward an unhealthy behavior, they can help you correct it and stay on the road to recovery. Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Fursland A, Byrne S, Nathan P. Overcoming disordered eating Part A, Module 4: Self-monitoring CCI self help module. In Overcoming Disordered Eating. Perth, Western Australia: Centre for Clinical Interventions; 2007. Lindgreen P, Lomborg K, Clausen L. Patient experiences esing a self-monitoring app in eating disorder treatment: qualitative study. JMIR Mhealth Uhealth. 2018;6(6):e10253. doi:10.2196/10253 By Elisha Carcieri, Ph.D. Elisha Carcieri is a clinical psychologist who treats eating disorders, depression, and more. She has written and edited for mirror-mirror.org, an eating disorders help site. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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