10 - The Use of Self-Monitoring as a Treatment Intervention

Abstract

This chapter distinguishes the concept of self-monitoring from other activities that describe behaviors in addition to the act of self-monitoring. The term “self-monitoring” is used to describe the systematic recording by the client of his or her own behavior. Self-monitoring is appropriate for having a client report engagement in overt behaviors such as the number of alcoholic drinks consumed per day or acts of self-injurious behavior. It can also be used in having the client monitor internal emotional states such as levels of depression, anxiety, suicidal ideation, and urges to consume alcohol or engage in some other ineffective strategy. Additionally, clients can also self-monitor homework compliance and/or self-management behavior. For example, one of the essential treatment strategies of cognitive-behavioral therapy (CBT) for panic disorder is the use of exposure. Clients are exposed to anxiety-provoking stimuli (imaginal and/or in vivo) during therapy sessions. They are also requested to engage in exposure outside of sessions (i.e., homework). Clients may be asked to report the amount (duration and frequency) of out-of-session exposures. Alternatively, in the treatment Dialectical Behavior Therapy (DBT), clients are asked to keep track of the use of effective and ineffective clinical behaviors. They are asked to report suicidal urges and their behavioral responses to those urges. In other words, the client will give an account of attempts to cope with distressing emotions through skillful behavior such as mindfulness meditation or attempts to self-soothe.