Thought diaries

Before you use these techniques, it's important to point out that they aren't a substitute for treatment by qualified mental health professionals. This technique is used in cognitive therapy but there's more to cognitive therapy than mood and thought monitoring. Also, some people may benefit from a different approach.

If you find that the techniques described here get you so far and then you become stuck - or if they just don't work for you - then it might be better to ask your family doctor to refer you to your local community mental health team.

Using mood and thought monitoring is done using four stages.

• Stage 1 - be clear about what the problem is
• Stage 2 - monitor how bad the problem really is
• Stage 3 - find steps between where you are now and where you want to be
• Stage 4 - work through the steps at your own pace

This isn't as daunting as it all sounds. If you're reading this with more than just passing curiosity, then you've already acknowledged that there's a problem and wish that you could do something about it. It may seem overwhelming now, but things can change - if you take it a step at a time.

A few words of warning:

1. This isn't necessarily a quick fix. It does take working at, and there'll be times when you feel frustrated at your lack of progress.
2. You may feel that things get worse at the beginning. This is because before you can do anything about your symptoms, you may need to concentrate on them and increase your awareness of them. Being more aware may make you feel worse but it also suggests that you're working on the problem and (in the long run) may be successful.

Stage one

Think about your problem. It could be described in general terms - you're feeling depressed or anxious - or it could be you've got a certain phobia or obsessive-compulsion. These labels have their uses, but they say very little about how the problem is affecting you.

To help unpick the problem, it can be useful to split it up into behaviour, feelings and thoughts. You'll usually find that you can link them: certain behaviours will go with certain thoughts and feelings.

It's not important at this stage to try to work out which is causing which - as is so often the case with these problems, it's a vicious circle. Just the same it does help to realise that they feed off each other - as in this illustration.

The behaviours may be things you'd like to do but just can't - or things you want to stop doing, such as a compulsion, a habit, or even an addiction like smoking.

It's important to be absolutely clear that these are very real things that you want to change. These specific definitions are, in part, what will define how successful you've been in changing things.

Many mental health problems are defined by the kind of emotional distress they cause: the depressed person wants to feel happy again, the anxious person relaxed and the phobic person free of fear.

A first step to dealing with your problems is to try to get beyond the sense of distress and be completely clear just what it is that's distressing you so much. To do this you need to look at your thoughts - the third part of the cycle - that come with this distress.

The human mind always has a variety of thoughts going through it - if you're not sure about this try to sit and think of nothing. Not easy, is it?

When you feel distressed, get a blank piece of paper and just note down the thoughts going through your head. This may take some practice. The idea is not to edit them - don't worry about writing in straight lines or about grammar and spelling. You just need to get your thoughts recorded somewhere other than your head.

Another name for these thoughts is 'automatic thoughts' or 'self-talk' - the running commentary or conversation that you may have with yourself as you move from situation to situation. For some people, this will ring a bell and they'll immediately know what this is about. Others will find that it may take them some time to learn to 'tune into' this.

It will also be important (for further work) to rate how bad each part of the problem is. That is:

• How much is the behaviour getting in the way of life?
• How strong are the feelings you're experiencing?
• How strongly do you believe the thoughts?

To help you with identifying - and assessing the strength of - the behaviours, feelings and thoughts that need to change, print out and complete the exercise below. Some points to remember when you're filling it in:

• Sit down to do it at a time when you can be quiet and undisturbed
• Take your time - it's important
• You may not complete it in one session
• It's helpful, having filled it in, to wait a day and then review it
• You don't have to limit yourself to one sheet
• You can spend as much as a week or two to think it through

You should be sure that you've completed this stage before moving on to stage 2.

Stage two

So far you should have developed a clearer idea of definite problem behaviours, feelings and thoughts. We'll call these the internal workings of the problem.

There's also an external element to the problem - all your behaviours, feelings and thoughts are affected by things happening in the world around you. It's essential to get to know how events change the internal working of the problem.

One way to do this is to look for patterns over time. To do this, you need to extend the exercise from stage one. When you're aware of a behaviour, feeling or thought that's distressing - repeat stage one, but note what's going on around you at the time, or what events lead up to the incident.

To help you do this use a new form.

If you feel that the distress is with you all the time it may be better to stop and take a few minutes three or four times a day to note down how you've felt and what's been going on around you.

Whichever way you decide to do stage one, it's also helpful to start tracking your thoughts and feelings over time. This way you may spot a general improvement - or worsening - of things, or realise that certain times of the day or certain regular events improve - or worsen - how you're feeling.

To do this you can use the following chart either to monitor the number of incidents - such as panic attacks, or to rate each day in terms of how low, anxious or how much craving, for example, you felt.

Stage three

By now, you've done a lot of work around your problems. For some people, working at developing this level of insight is therapeutic; for others, becoming this aware of their distress can make things seem worse. You can ask your GP to refer you to your local community mental health team if you need help.

What you should have by now is a clearer idea of:

• Behaviour that needs to change
• Feelings that cause distress
• Thoughts that contribute to the feelings and behaviours
• Situations that set off the whole cycle or make it worse

Using this information it's now time to decide what you want to change first. It's very important not to be too ambitious - this is change by evolution, not revolution. The big changes will come later and by that time they won't seem so big.

Deciding on what to change first will, of course, depend on the problem. Here are some suggested first changes for different problems:

• Phobias - just try thinking about the thing without feeling afraid
• Obsessive-compulsion - try to put off a ritual for one minute, or if it's something you feel you have to do a certain number of times, try doing it one less time
• Smoking - go without a cigarette on one occasion
• Depression or anxiety - identify a negative thought and work on changing it

Obviously, for some problems the focus needs to be on the behaviour, while for others it's the thoughts. It doesn't really matter where you start though as long as it's something that you can envisage being achievable.

Having identified this first step, think about how things would be if the problem had been resolved - not just "I wouldn't smoke anymore" or "I wouldn't be frightened anymore" - but what would your thoughts and feelings be like, and what situations would now be no problem.

This is your final step: write them in the goals sheet. Now we know where the journey starts and where it finishes.

Stage four

Working through the steps at your own pace sounds easy this is where the real work begins. If it were as easy as just setting yourself small goals and achieving them then there wouldn't be a problem.

Certainly, if a step proves too difficult then move back and try something easier, but at each step it's good to have a definite strategy for how to approach it.

This will also allow you to be clear about when it's time to move on. The strategy we'll use here focuses on your behaviours and thoughts.

Think of each step as an experiment in behaviour - are its consequences so terrible? So, if you suffer from a phobia, what was the consequence of thinking about the thing you're afraid of? Obviously you felt some anxiety; use the graphs to rate your anxiety and try the exercise again the next day.

You can supplement this by practising relaxation techniques and trying to use them while you're thinking about the anxiety-causing behaviour.

Similarly, if you've an obsessive-compulsion, think about not completing a ritual - or leave one small ritual out - and practise a simple relaxation exercise.

The other thing to concentrate on is your thoughts - specifically your 'automatic thoughts' or 'self-talk.' These can prompt all sorts of inaccurate assessment of situations, including:

• Split thinking - you may be telling yourself that there can only be two extremes in a situation, one totally satisfactory and one disastrous. For example, "If this happens I'll be ecstatic. If it doesn't, I'll just be destroyed."
• Catastrophe thinking - you may fail to see any satisfactory outcome or be convinced that it could not happen. For example, "All right, it could happen, which would be great, but I just know it won't. This is going to be a disaster."
• Personalisation - an action taken by another person or organisation is taken as a personal attack. For example, "The boss moved the office just to make my journey more difficult."
• Selective recall - the evidence that something is going to go wrong may be drawn from one occasion that something went wrong, when on most occasions everything was fine. For example, "He didn't like my work that time, I just know it's going to happen again."

The list goes on and on. It's important at each step to note your thoughts down and look at just how accurate they are. To do this, you can ask yourself four questions about each thought:

• What evidence is there to show this is accurate?
• Is there another equally believable interpretation of what's going on here?
• What action can I take to have some control of the situation?
• If my best friend were in this situation, what advice would I give to them?

After asking yourself the four questions, re-rate your thoughts and feelings and see if things have improved. Again keep a record so that you can track improvement.