Psychologist’s Guide to Self-Monitoring & Early Warning Signs
A lot of people only think about seeing a psychologist once stress, anxiety, low mood, or anger becomes so overwhelming that it gets in the way of other things. Poor performance at work, increased frequency of arguments in relationships, and feeling constantly overwhelmed are signs people might notice which could hint that something isn’t going quite right. Sometimes this is the first time mental health starts to be taken more seriously. But, did you know that taking proactive action to manage mental health and seeking professional support early on when changes are first noticed, could help reduce symptom intensity, duration, and frequency? On top of this, proactive management and early intervention can also help restore functioning more rapidly, develop greater resilience, improve overall wellbeing, and prevent a ‘rough patch’ from potentially deteriorating into a mood episode (Morriss et al., 2007; Goossens et al., 2010; Lobban et al., 2011; Chen et al., 2025).
You don’t need to hold out until things are at a crisis level to be able to benefit from psychological tools or therapy, but how do you know when it’s time to try something different? To provide some guidance, this article will introduce how you can use the concept of self-monitoring to determine this and also share some of the common early warning signs of deteriorating mental health to look out for. As with all articles on this website, this is not personalised advice and does not replace receiving guidance from your own individual mental health professional. Instead, this article is for educational purposes to increase awareness of some of the psychological tools and skills available for better respecting and managing mental health.
Self-Monitoring🔎
Changes in mood, patterns of thoughts, and behavioural functioning can be slow and subtle. Often gradually occurring over weeks or months, such that sometimes negative changes aren’t noticed until things are much worse. One psychological tool that can be used to document changes and determine if there is something taking us away from our goals is self-monitoring. Self-monitoring is where attention is regularly given towards observing and recording different aspects of functioning to gain a clearer understanding of our experiences over time. Additionally, because monitoring data is typically recorded each day, this helps to minimise potential hindsight errors or selective attention/recall biases (Shiffman et al., 2008), where we misremember or only pay attention to certain things, which could be misleading. Reviewing self-monitoring increases chances of identifying insidious changes in mood, activity levels, and thought patterns, including awareness of how these might link to everyday situations or ‘triggers’. By regularly evaluating changes and the antecedents and consequences associated with reduced wellbeing, we can boost understanding, ability to self-regulate, and achievement of personal goals (Chen et al., 2017). It has even been suggested that self-monitoring is often the first stage in supporting self-regulation, as it can temporarily disengage automatic behaviours and transition us from a state of mindlessness to mindfulness (Karoly, 1993). This provides a cue to step back and mentally observe unhelpful, in-the-moment thoughts and behavioural urges, and instead gives us space to consider more adaptive responses.
When engaged in self-monitoring we can observe overall changes and patterns in day to day behaviours, as well as check for some of the different signs and symptoms that people commonly experience before a mood episode, known as ‘early warning signs’. This self-observation can facilitate more timely clinical interventions, as well as guiding modification of treatment strategies, including by reducing environmental stressors, providing additional supports, or even by increasing pharmacological protection which can disrupt or prevent further deterioration (Chen et al., 2025). This can be particularly beneficial during times of higher stress, such as following a death or divorce, or if there is a history or risk of conditions including depression, Bipolar Disorder, psychosis, or Eating Disorders (Jørgensen, 1998; Birchwood et al., 2000; Morriss et al., 2007; Goossens et al., 2010; Lobban et al., 2011; Pennesi et al., 2025).
Self-monitoring for early warning signs enables proactive responses that can reduce or limit the frequency, intensity, and duration of symptoms, as well as the social and functional impairments that they can cause, such as extended time off work. This helps reduce the chances of getting stuck in a negative reactive cycle. Where, to continue the example, extended time off work increases financial stress, which further negatively impacts mood and makes symptoms worse. Self-monitoring can be simple and focus on changes in emotional states, known as mood monitoring, or broadened to include additional details such as hours of sleep or medication changes. In this way self-monitoring is modified as a better understanding of an individual’s needs is determined over time. This could be guided by past experiences, diagnoses, or things like family mental health history. For example, if someone has one night of insomnia that might not raise too much concern, but if they start excitedly saying that’s ok because they don’t feel the need to sleep for days at a time this could be a big red flag, especially if there is a family history of Bipolar Disorder.
To make self-monitoring easy to do while still providing useful information, I encourage monitoring at least a few basics and combining this with tracking specific early warning signs if present.
I always start with a rating for daily average mood on a scale of 1-10, worst to best, and find indicating this visually is more readily interpretable than a number across days.
Next, I usually prefer recording sleep and wake times, but will sometimes simplify this to the number of hours of sleep each night.
After this, engagement in exercise, whether time has been spent with friends, and what the work/study schedule looks like can give further indicators of a standard routine.
Brief additional comments recorded for each day and indicating presence of any early warning signs can also add key information to the interpretation of data.
These approaches help identify natural mood fluctuations, clarify what influences them, and determine when someone is out of routine versus when changes have become problematic and further support is indicated. For example, it’s normal for mood to dip for a few days sometimes, but if this persists for a week or more, it could suggest that something is off and warrants closer attention for any additional early warning signs. Practising self-monitoring for two to three months can provide these types of valuable insights that are difficult to distinguish without regular observation. The example worksheet below demonstrates how this could look for someone experiencing a gradual decline in mood beyond their normal range. Notable changes include reduced exercise and social contact, initially losing sleep followed by a pattern of behavioural withdrawal and oversleeping, then increasingly unhelpful thought patterns which maintain avoidance of previously positive behaviours.
Common Early Warning Signs🚩
Beyond changes in normal routine, many people report similar early warning signs in the lead up to mental health problems. For depression, the most commonly identified early signs include unhelpful changes in thoughts and mood stability, low motivation and energy, and feeling tired or listless (as seen in the self-monitoring example above). Conversely, feeling energetic and emotionally high, a decreased need for sleep, being very talkative, and having racing thoughts are most commonly reported for experiences of mania (Lam & Wong, 2005; Goossens et al., 2010). However, each person has their own personal early warning signs made up from a unique combination of the signs and symptoms specifically relevant to them. Early warning sign checklists can facilitate identifying these and usually in much greater numbers compared to when spontaneously reported. Checklists can also help by including signs and symptoms that are difficult to articulate or could be socially embarrassing to report (Lobban et al., 2011) and not identified otherwise.
Knowing what some of the common mental health early warning signs are which could forecast significant changes, is like knowing a high fever and starting to sneeze and cough suggests you might have the flu. It’s in this way that the signs and symptoms for both physical and mental health can serve as indicators that we need to take care of ourselves in different ways. A lot of people know how to care for themselves physically, but sometimes don’t have as much familiarity with how to do this mentally or emotionally. This can be important for issues like low mood or anxiety, where if left unattended, can progressively become worse and led to unhelpful patterns of thoughts and behaviours becoming more deeply entrenched over time.
An example of this could be struggling to concentrate after sleeping poorly and starting to think “I must be really stupid if I can’t even do this!”, instead of recognising that it’s hard for anyone to maintain focus when they haven’t slept and taking a break to mentally refresh. This type of self-critical thinking and negative labelling can quickly become an automatic pathway that our minds can go down which only distracts us further and adds an unnecessary emotional burden. Over time this can turn into self-limiting assumptions where we don’t even give things a go, and unhelpful beliefs that “everyone else is smarter than me, I’m always such an idiot”. When this becomes the constant story playing in someone’s mind every day, we can understand why they might struggle with social anxiety and low self-esteem.
To broaden awareness and increase ability to make sense of early warning signs, it can also be useful to break them down into different, yet overlapping domains. This helps acknowledge the role that cultural influences can play on emotional processing and individual challenges in identifying, differentiating, verbalising, and communicating emotions (Chen et al., 2025). For example, some people might report physical restlessness and inability to concentrate due to thoughts about worst-case scenarios, but due to discomfort with emotional expression or lacking vocabulary for this, struggle to recognise or disclose feeling sad and hopeless on most days as important early warning signs. Signs and symptoms may be broadly grouped into the domains of:
Cognitive - the mental processes involved in how we think, interpret, and make sense of ourselves, other people, and the world. This includes our thoughts, thinking patterns, assumptions, beliefs, and the content, quality, and tone of our inner monologue.
Emotional - the range of feelings and mood states that are experienced in response to internal or external events. These can include changes in intensity, duration, frequency, and stability of emotions and moods, as well as capacity for emotional expression or containment.
Behavioural - the observable actions people engage in or avoid in response to stressors, desires, or unmet needs. These can become unhelpful when persistent, rigid, inappropriate, disruptive, or potentially harmful to self or others. I also like to include urges in this domain, whether acted on or not, as these can be strong indicators of underlying psychological tension (e.g., fighting the urge to not do something).
Physical - the bodily sensations, changes, states, or complaints that a person experiences with their body rather than their mind as a result of psychological stress. These often appear before becoming consciously aware of the cause and can be nonspecific or severe, while also lacking obvious medical causes or explanations.
Below is a list of some of the common early warning signs that if you start to notice occurring in increasing frequency, quantity, or duration, could be worth speaking to a mental health professional about. Please note that if you are experiencing thoughts of suicide, self-harm, or are currently in severe mental distress, seek immediate help from local crisis support services. Safety is always the first priority.
Cognitive
Trouble with focus and concentration.
Constant worry, rumination, or second-guessing.
Racing thoughts or impulsive reckless decisions.
Highly negative, critical, or demeaning thoughts.
Feeling mentally ‘foggy’ or detached.
Difficulty remembering or making decisions.
Emotional
Persistent sadness, low mood, or feeling down.
Irritability, anger, or frequent mood swings.
Little or no interest, pleasure, or motivation in doing things.
Feeling anxious, tense, or easily overwhelmed.
Feeling numb, empty, hopeless, or helpless.
Hypersensitivity to stress or perceived criticism.
Behavioural
Withdrawing from friends, work, or study.
Loss of productivity or usual performance.
Neglecting routines, self-care, or responsibilities.
Reliance on alcohol, substances, screens, etc.
Excessively seeking reassurance from others.
Increased arguments or aggressive outbursts.
Physical
Difficulty sleeping or constant fatigue despite rest.
Noticeable unintentional appetite or weight changes.
Muscle tension, shakiness, or gut issues linked to stress.
Restlessness or inability to relax during downtime.
Hypersensitivity to normal sensory input.
Frequent tears or feeling like crying.
Summing Up
Self-monitoring is an approachable psychological skill and therapeutic tool that can be used to build awareness and insight of our internal states and behaviours, identify patterns in these, and guide future changes. This article discusses how to recognise when psychological functioning could be starting to shift from normal baseline levels, what some of the early warning signs of more serious changes can look like, and why noticing these changes could be important. Learning how to use the psychological skills discussed here to recognise when to seek help can allow for problems to be addressed earlier and form a proactive step towards improving management of mental health and quality of life. Remember, the majority of challenges in mental health don’t just show up overnight, and many people benefit from seeking out therapy for stress, relationship issues, or adjustment difficulties before they become overwhelming. There are even a growing range of mental health focused apps, including those specifically targeting self-monitoring and practising self-observation, such as How We Feel, Daylio, and eMoods, which provide free or low-cost options to make developing this type of self-insight easier. Improving your awareness through self-monitoring and learning more about mental health can be powerful tools to manage wellbeing.
If you or someone you know is struggling, it could be important to consider reaching out for professional support. Talking to a psychologist or therapist can be a great first step and help you learn additional coping strategies to prevent stress from turning into distress. Whether you are located in Brisbane or accessing telehealth sessions, Kelly Brooks Psychology offers professional, compassionate support. If you feel like you could benefit from learning new psychological skills, I invite you to reach out today to book an appointment.
Key Points:
🔎 Consider self-monitoring for 2-3 months to develop greater self-awareness of your normal psychological functioning and ability to self-regulate.
🚩 Learning to recognise common early warning signs can build your mental health literacy and reduce lag time before support is accessed when needed.
References
Birchwood, M., Spencer, E., & McGovern, D. (2000). Schizophrenia: early warning signs. Advances in Psychiatric Treatment, 6(2), 93-101. https://doi.org/10.1192/apt.6.2.93
Chen, J. A., Fearey, E., & Smith, R. E. (2017). “That Which is Measured Improves”: A theoretical and empirical review of self-monitoring in self-management and adaptive behavior change. Journal of Behavior Therapy and Mental Health, 1(4), 19-38. https://doi.org/10.14302/issn.2474-9273.jbtm-16-1180
Chen, P.-F., Lung, H., Tsai, Y.-L., & Lung, F.-W. (2025). Psychometric evaluation of a patient- and caregiver-rated early warning signs scale for acute exacerbations in schizophrenia. BMC Psychiatry, 25(1). http://dx.doi.org/10.1186/s12888-025-07364-4
Goossens, P. J. J., Kupka, R. W., Beentjes, T. A. A., & van Achterberg, T. (2010). Recognising prodromes of manic or depressive recurrence in outpatients with bipolar disorder: A cross-sectional study. International Journal of Nursing Studies, 47(10), 1201-1207. https://doi.org/10.1016/j.ijnurstu.2010.01.010
Jørgensen, P. (1998). Early signs of psychotic relapse in schizophrenia. British Journal of Psychiatry, 172(4), 327–330. https://doi.org/10.1192/bjp.172.4.327
Karoly, P. (1993). Mechanisms of self-regulation: a view. Annual Review of Psychology, 44(1), 23-52. https://doi.org/10.1146/annurev.ps.44.020193.000323
Lam, D., & Wong, G. (2005). Prodromes, coping strategies and psychological interventions in bipolar disorders. Clinical Psychology Review, 25(8), 1028-1042. https://doi.org/10.1016/j.cpr.2005.06.005
Lobban, F., Solis-Trapala, I., Symes, W., Morriss, R., & ERP Group. (2011). Early warning signs checklists for relapse in bipolar depression and mania: utility, reliability and validity. Journal of affective disorders, 133(3), 413-422. https://doi.org/10.1016/j.jad.2011.04.026
Morriss, R., Faizal, M. A., Jones, A. P., Williamson, P. R., Bolton, C. A., & McCarthy, J. P. (2007). Interventions for helping people recognise early signs of recurrence in bipolar disorder. Cochrane Database of Systematic Reviews, (1). https://doi.org//10.1002/14651858.CD004854.pub2
Pennesi, J. L., Jabs, M., Baillie, S., Hart, L., Hay, P., Mitchison, D., ... & Wade, T. D. (2025). Early Warning Signs for Eating Disorders in Children: A Realist Synthesis of Websites Summarizing Caregiver and Consumer Perspectives. International Journal of Eating Disorders, 58(3), 583-597. https://doi.org/10.1002/eat.24359
Shiffman, S., Stone, A. A., & Hufford, M. R. (2008). Ecological momentary assessment. Annual Review of Clinical Psychology, 4(1), 1-32. https://doi.org/10.1146/annurev.clinpsy.3.022806.091415
