Self-Monitoring in the Treatment of Eating Disorders

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.

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.

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.

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.