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analysis, bipolar, chart, data, graphs, how to, mental health, moods, tools, visualization
Chances are good that if you’ve been diagnosed with bipolar disorder, you’ll have been told that you should keep a mood chart. Remarkably, no one ever told me this. Maybe because I started mood charting when I first started suspecting that I’m bipolar. By now, I have over 450 days of consistent data, and that’s a very powerful tool. Yes, I’m a professional data geek. It has its advantages. 
This is a two-part series on mood charts. Today’s lesson focuses on a couple of mood chart tools, graphing values as time series with Excel, and visually interpreting them. Tomorrow, I’ll discuss a few basic statistics that help you get additional insight out of that mood data. Both of these posts are illustrated with examples from my mood chart data, so hopefully that will make it easier to understand. Feel free to ask questions – data analysis is one of the things I’m pretty good at, and I’m excited to share it with others.
A mood chart is exactly what it sounds like: a tracking tool to help you stay aware and on top of mood changes. There are tons of different mood charts out there. I found many of them too complicated or clunky. I now wish I’d chosen one of the slightly more dimensional ones, but maybe I’ll switch someday. These are all pretty decent, depending on how detail-oriented you are and what other information you want to track:
- www.cqaimh.org/pdf/tool_edu_moodchart.pdf
- www.psycheducation.org/PCP/handouts/Mood_Chart.doc
- www.manicdepressive.org/images/moodchart.pdf
- www.blackdoginstitute.org.au/docs/dailymoodgraphforbipolardisorder.pdf
- www.psychiatry24x7.com/content/backgrounders/psychiatry24x7-nd.emea_com/blank_chart.pdf
In addition to being consistent about recording mood scores, an important aspect of mood charting is tracking covariates. Most mood charts have a space for this, but if you’re bipolar you should always include hours of sleep. Alcohol/drug use is another good one, and med dosages is wise. For the ladies, keeping track of your period will help you figure out how much your cycle is messing with your moods. I use a separate iPhone app for this because it predicts the start of the next cycle pretty accurately, but I also record it on my mood chart.
I ended up using a mood chart that has a simple 9-point scale with spaces for tracking meds, hours of sleep, and periods. I can tuck it into my relatively small mood journal, where it serves as a placeholder and a reminder to jot down a few details about what’s been going on with side effects and so on. Tracking numbers isn’t the whole story, after all.
But wait, there’s more! There are tons of mobile phone apps for mood tracking. I even have a couple of them, but I never got into the swing of using them. I do use a web-based mood tracker, Moodscope, which is getting a lot of recognition for good reason. It’s awesome and free! It uses a 20-item questionnaire with flip cards that have 4 choices on them, and automatically scores them on a 100-point scale. It often surprises me, but I like the way it works – I can’t rig the results because I don’t know what it will return, so there’s no faking it.
Newly introduced Moodscope features include the “affectogram” and “triggergram” which are useful for better understanding your overall mood trends on a per-item basis and the things that set you off. Another cool thing about Moodscope is that it lets you share your mood scores with a buddy by email, so if there’s someone you need to keep posted, this is an easy way to do it. I use this feature to keep my hubby tuned into how I’m feeling, since I don’t always express my moods very well. The main feedback you get from Moodscope is your mood graph; my graph from the last year shows a lot of instability, which at this point surprises no one.
12-month mood graph from Moodscope
What else can you do with mood charts? If you’re a data geek, or even if not, then there’s a lot more you can do with this data. Fire up a spreadsheet program (like Excel) and enter the data by date. Yes, this is time consuming, but rewarding in the end! As mentioned, I track a whole lot of stuff. What I discovered in pretty short order from tracking all those details was that only two of them really matter for me: my mood scores and the number of hours of sleep that I get. How did I figure that out? Two things – making a chart and running a couple of statistical tests. I’ll talk more about statistical tests tomorrow.
I’m including several graphs here, but the first one is just my two sets of mood scores – from the paper sheet with a simple 9-point scale and from Moodscope – with the values adjusted so that you can look at them in the same numeric range (divided Moodscope scores by 10, added 5 to paper chart scores). This graph covers 11 months, pre-diagnosis to post-diagnosis and into treatment.
Two different mood charting scores graphed together.
In case you can’t see the legend (click on the image for a larger one), the blue line is my paper chart score, and the red line is my Moodscope score. I haven’t been 100% reliable on the Moodscope score the whole time, but it is much more useful for statistics. As you can see, the two scores parallel each other pretty well. This is called convergent validity. It basically verifies that both ways of charting my moods are yielding very similar results, and are measuring the same thing (obviously, right?)
To better understand all of these graphs, you need to know the way I’m tracking my moods. Measurement methods matter! I record both scores at the same time of day, first thing in the morning about a half hour after waking, while I have my espresso and bask in the blue glow of my light box. I record the Moodscope score for how I feel right now, and I record the paper chart score for how yesterday went overall. One is in-the-moment, the other is retrospective, but never recorded more than a day late due to memory biases. That’s why some Moodscope scores are missing; the measures are too sensitive to memory errors, and occasionally I’m off the grid (yes, really!) Having these two methods of keeping records for each day lets me track how my mood might have changed during the day. For example, I might wake up in a great mood, and then have everything fall apart on me around lunchtime, ending the day in a pit of despair. In that case, the two scores would be different. Obviously from the chart above, that doesn’t happen all that often.
There are two charts in the next set, and these show the comparison of hours of sleep (in green) with mood scores. In both graphs, the raw numbers are manipulated (scaled) to make a graph that lets me see what I need to. Basically I just multiply each set of values by a constant or add/subtract a constant value, so that the values end up having approximately the same middle point. The Moodscope chart uses a red line and covers 11 months; the paper chart uses a blue line and covers the entire 15 months since I started tracking my moods. Yes, I record a score every single day. I told you I’m a data geek.
Moodscope scores and hours of sleep over 11 months.
Mood scores and hours of sleep over 15 months.
Since we already know that the two sets of mood scores are similar, we’re going to see similar things in both graphs; one just covers a bit more time. Whenever I can, I like to look at the information in multiple ways because sometimes it shows me something new. So what can we see in these charts?
- Sleep mirrors mood. The more sleep I get, the worse my mood is. The less sleep I get, the better my mood is. Causality is not shown here (which came first, sleep or mood?) but the relationship is undeniable. This is actually “normal” to a point, but the patterns here are extreme. The regularity is pretty striking too.
- December 2010 through March 2011 were pretty volatile, but things calmed down a little in April, and June was fairly stable.
- July 2011 was pretty rough with constant, severe rapid cycling featuring rather deep depression. Yes, I can confirm that. It was brutal.
- Something interesting happens in November of 2011. Can you guess what it is? Well, I’m going to tell you anyway: bipolar dx, started Lamictal, started managing sleep better.
Pretty cool, right? Well, that’s not all you can do with mood chart data! Tomorrow, Part 2 will go into some easy statistics for getting more out of your mood charts.
Really fascinated with your findings D.C., and hats off to you for doing such a brilliant job over a long period. The mirroring of mood and sleep is a great finding. My hunch would be that more time asleep is a result of the lower mood. But as you say, we have to be really careful about cause/effect conclusions.
Wondering about the way you track sleep. Presuming that it’s from when you (think?) you dropped off until the time you woke up (properly?). Guess this won’t account for the quality of sleep itself? Forgive me, I’m just thinking aloud really.
Most of all, well done for conducting such a detailed analysis and – especially – for sharing it.
I’ll be all ears for Part 2.
Thanks, Jon! I’m tickled this came to your attention, as I’m a big fan of Moodscope. The affectogram in particular is brilliant and provided a lot of new insight for me.
You’re right on that more sleep is generally a result of lower mood, particularly for atypical depression that features hypersomnia more than insomnia. A psychiatrist once told me that the link between sleep and mood is well-known and affects everyone. Apparently back in the day, psych hospitals used to force depressed patients (the hypersomniacs, I presume) to stay awake because it would elevate their mood. So if the link is well established, then the more interesting questions are around extremes and variability.
As you might guess, I’m fairly rigorous about tracking sleep too…
I track sleep in two ways. One is with the Sleep Cycle iPhone app ($1) which uses the phone’s accelerometer. I like it because it provides a reactive alarm and gives me very interesting, detailed graphs of sleep patterns.
For example, I can tell that recent medication changes have seriously disrupted my sleep because the smooth up-and-down sleep cycles that you would normally expect to see have been replaced by sawtoothed deep sleep with no shifts between sleep states, which isn’t particularly healthy. I don’t get the same information from my other tracking tool, which is why I use two of them. Triangulating the two, I’ve learned that the deep sleep is being combined with more frequent “waking” which has a strong negative effect on sleep quality – again, not so good!
The second sleep tracker is Fitbit ($99). I love both the device and the site. The sleep tracking is both more and less detailed than the Sleep Cycle app. Its visualization shows only sleep/wake variations, but registers the data somewhat differently from the iPhone app and does more sophisticated things with it. Fitbit counts up waking incidents overnight and shows their duration and times. It also gives me a “sleep efficiency” rating – I’m apparently quite efficient at sleeping!
Better yet, Fitbit does subtractive calculations for sleep time. It gives me a total based on how much elapsed time there was with too little movement for it to be considered wakefulness, so that’s the number I use for my analyses (rounded to easily recorded increments because base 60 is not friendly for recordkeeping.) The Sleep Cycle app’s time calculation is based on when you started the app and the first time the alarm went off, which is much less accurate. If it took me 15 minutes to fall asleep, Sleep Cycle doesn’t care but Fitbit does, and so do I.
Mood charting is something that has constantly been encouraged by our respective therapists. We have used one made by NAMI, inconsistently too. But Moodscope seems so much more helpful.
Do you find it challenging to be consistent when it comes to charting your moods daily? From your writing, you seem to reek great benefits from it.
I’m a really data-driven person, so it helps me a lot. It was extremely valuable for pinning down some triggers for mood swings, verifying their existence based on something more than a “feeling” so to speak, and helping me accept that I have this condition. After 4 independent diagnoses, that is. Now it also helps me identify and predict mood swings so I can intervene as well as possible.
I don’t find it that hard to be consistent (ADD-related forgetfulness aside) because I’ve made it part of my daily routine. I keep my mood journal in plain sight on my desk (under my phone) so there’s also physical reminder. Plus Moodscope sends me a daily email from Jon C, which I like in itself, and also prompts action. I’ve also been tracking stuff more generally for a long time – I’ve worn a pedometer for 6 years to stay aware of and moderate my physical activity.
I have learned not to trust my recall or perceptions of the past, so mood charting prevents me from painting a rosier picture than reality merits. I no longer keep convincing myself over and over (as I did for many years) that things are really OK when they’re really not, so it ended that denial. It also helps me get geared up for therapy sessions too – a quick review reminds me of things I want to discuss.
Of course, that’s just my experience. Some people might be better at accepting, figuring out triggers, and predicting oncoming mood shifts without these tools. I just know that I can’t do these things reliably enough without some help.
I have to tell you, that was basically the ax hanging over my head when I went for my first psychiatrist appointment. I knew that I was bipolar, I knew that he would diagnose me as bipolar, I wasn’t afraid of meds or therapy, but. . . I didn’t wanna keep a mood chart!
Well, of course he told me to and of course I did – for a few months. That was half a decade ago. I find that I need a much more comprehensive picture of the days, in order for it to be of any use to me, personally. I can’t get as much from the data as you. But that’s where journaling and blogging are so very helpful to me.
This is a wonderful post. I think that more people with bipolar disorder should keep mood charts, they (and their treatment teams) would find it to be very beneficial.
Tracking stuff definitely isn’t everyone’s thing! I think to some degree, how much you get out of it is based on how much you already know about yourself. I think the ability to benefit from daily mood charting would probably also be different based on whether you’re rapid cycling – they never diagnosed me as such, but it’s so obvious – or ultradian, versus the prototypical “slow” cycling with less than four mood episodes per year.
For comparison…
Here’s a very different graph from Kari Sullivan, who also found benefit in using Moodscope. Her graph looks happier than I can imagine, sad as that may sound.
Alexandra Carmichael’s graph looks a bit more like mine, which is rather comforting to me.
Seth Roberts has also done some reflecting on Moodscope on his blog about self-experimentation. My comments are among the quotes he included.
I’ve been tracking my moods since I was diagnosed. It was extremely helpful for my therapist and pdoc to know where I was and what I was experiencing. I keep track hours of sleep and menstrual cycle as well. I’m not as detailed as you Dee Dee but I know when I’m getting off track. I made up a key as to what my 1 to 10 numbering system means for me to help my husband and my therapist see where I’m at too. I get a reminder on my phone at noon each day. If I have a significant change from that point, I’ll not that in my calendar.
You know, it worries me a little that no one ever asked for mine. The Bad Psychiatrist looked them over once, fixated on one particular detail (alchohol consumption) and ignored the rest.
Maybe my next psychiatrist will be more data-driven. That would please me quite a bit.
I understand that fact, one of my first pschiatrists was fixated on my alcohol habits and spending habits, he wasn’t even concerned about my medication…….I’m sensible, so I went for a second opinion and it was explained my escitalpram was too high and causing a manic episode….
In my case, alcohol had more to do with self-medicating, and once I was on mood stabilizers the drinking stopped entirely. The doctor who fixated on alcohol as causal rather than symptomatic was not willing to diagnose nor prescribe the medications that were appropriate for bipolar, so I never got any better under her care.
It’s extremely frustrating when doctors won’t listen.
Thank you DeeDee and Jon C – I have ebnn using Moodcsope since I discovered it and as I really can’t be bothered with paper and pen when I susethe computer(s) for just about everything. One of my psychiatrtists opening questions every time I see hime is “where’s yor mood on a acale of 1 to 10 where 1 is catatonic and 10 is as high as a kite only higher. Nowadays I shoe him my Moodscopereadins and history. I know other regular Moodies to whom I introduced the site. Also, the email notification facilityprovides a very simple mechaism for aleting others.
You’re welcome!
I also find the tool very useful, but I started recording scores for quite awhile and then deleted my account (I do things like that when I’m feeling low) before starting up again. There are a couple months when I was inactive due to massive depression, but at least I left the account in place, and have been quite careful to keep up with it since.
ditto and when I miss two or three I receive a what’s up e-mail. of course I am now concerned or rather my pdoc is anxious that I might tip into a manic state. having a weekend of indolence i.e. not doing anything more exciting than taking the dog out and doing stuff around this flat. sharing the process with you and others is always helpful David x
p.s. please tell me if I appear to be posting manic stuff
I agree that having a peer group, even if “virtual”, is really helpful. It’s one of the things that I really enjoy about blogging and the exchanges with other bloggers.
My therapist told me that for those of us in the Northern Hemisphere, hospitalizations for mania peak in March because it’s the month when the days lengthen most quickly. Interesting, eh?
yes, thence the expression “as mad as a March hare”
Thanks for doing this post. I’ve signed up to moodscope now so I’ll be interested in seeing what comes from that. My score today was lower than I would have expected.
Have to say my scores were definitely lower than I expected at first – but it took awhile to get a “baseline” set and also really stop to think about each of the cards.
Keep at it – over time it becomes pretty interesting!
Here is mine http://i.imgur.com/ITgji.jpg
The happiest time was after breaking up with my ex and meeting another girl. Then she had to go back to her country and everything is a bit unstable since then.
Thanks for sharing your graph! I find the comparison really interesting.
My worst time was a morning when I launched a research survey and everything went wrong with it – the emails did not send properly, passwords were left out so people couldn’t respond if they wanted to, etc. It was terribly upsetting, in addition to already being rather depressed.
My happiest time was a beautiful summer day when I was traveling to an event that I was really excited to attend, and many friends were there. I was also quite manic, though!
Thank you very much for this, and for Jon for sharing the link on my Moodscope reminder e-mail. I have been meaning to do the same tracking using my Excel skills for some while but I must admit to always putting other people and tasks before myself. However reading your blog has given the swift kick up the jacksy I really needed….I’m off to start work on a new spreadsheet (woo hoo, mostly for getting to use Excel for something other than Payroll today. Geek chic rocks!!) Much love & respect, Bex x
You’re welcome! I became an Excel “power user” as part of my professional work, and have always been pleased to find new uses for it. Most of what I do with mood chart data in Excel is quite simplistic by comparison to what I would do for work, but my personal data aren’t nearly as complicated as the analysis I used to do for clients. The interpretation, however, is quite a bit more complex!
Hi Dee Dee
Fascinating and clever work! Well done.
I have a dilemma in that deep sleep seems to trigger a feeling of euphoria the following day; this in itself is not a problem..it’s good and as it happens rarely I know I won’t feel high for days on end. Also I tell myself that were I lucky enough to experience deep refreshing sleep for a few nights in a run, my euphoric feelings would diminish the more I got used to the good nights. (I can’t be sure this would happen as for years now I have not had deep sleep or the feeling of euphoria two nights or two mornings in a row. I can only surmise). Now to my problem..I have had CBT for insomnia and it has been great in that sleep or lack of deep sleep does not now feature so prominently in my daily/nightly thoughts and I do not blame my moods or interaction with people on sleep. At least I am trying not to and it works for the most part. For this reason I am disinclined to chart my sleep and mention it when recording my feelings and reasons for my mood in Moodscope although secretly I know I feel low when I have slept badly. When I have had deep sleep, everything looks shiny and rosy. I can conquer the world. What I am saying is that I miss out recording the main reason I perceive deep down for my moods swings. If I did my affectogram would have the word “sleep” figure prominently
It’s so complex I guess.
You personally correlate lots of sleep with depression. I think I understand this. I tend to stay in bed longer if I feel depressed but wouldn’t say I was sleeping alot/deeply. When I sleep deeply, rarely, I tend to get up earlier, bounce through the day and go to bed later.
Thanks, Julia, and interesting insights! Sleep quality and quantity are definitely different things.
Now that you mention it, if I get only deep sleep (as indicated by Sleep Cycle) I wake up groggy and tired. If I get the “normal” wavy cycles of sleep, I wake up much more refreshed and energetic. I haven’t been tracking sleep quality directly, but that might very well explain even more of the mood patterns that I see in my own data – good idea!
I can understand why you wouldn’t want to track that if you had problems around perceptions of sleep and effects on behavior. Sometimes I think the data can be encouraging, though, because it can show that when you really make an effort there’s an improvement. I guess it all depends on the individual.
Atypical depression often features hypersomnia, while the “usual” depressive features include insomnia for many people. Unfortunately, I don’t know of many heuristics that focus on quality of sleep rather than just quantity, which is much easier to measure overall.
Staying in bed and sleeping are definitely not the same thing! That’s why I measure sleep the way I do, but I also have a personal rule against staying in bed because I feel poorly. I can mope in my chair just as easily.
Many thanks Dee. I am very grateful that you have thought about what I said and given me answers which I can work on. I may record my perceived sleep quality on moodscope from now on. However by not doing this since I joined Moodscope, it has been interesting to see that actually there are other things which influence how I feel.
Hopefully by recording these and sleep from now on, I will be able to see a combination of mood influencing factors.
You make a good point – by ignoring some factors, we can see others that have made a difference. The truth is, the more details you’re looking at, the harder it can be to see the relevant patterns. Sleep was just the jump-out major influence that I could observe for my charts.
Analytically, accounting for multiple factors is much harder than these basics, if you are trying to be “rigorous” about it. But you can also learn a lot just from looking at simple relationships. I’m sure it will be interesting to see how different factors combine to affect mood – just don’t read too much into it!
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Thank you for the great article! Mood charting is very useful, even if you’re not bipolar… One can discover many interesting things about mood triggers and patterns… Personally I prefer iMoodJournal – really nice app with a nice feature to attach self-portraits/pictures of things to each mood… http://itunes.apple.com/app/imoodjournal-mood-journal/id517952128?mt=8
JFYI, being a devoted iPhone user, I found an interesting app to analyze sleep patterns – Sleep Cycle alarm clock, but haven’t tried it yet.
I like Sleep Cycle quite a bit – I’ll check out the iMoodJournal app too. There are so many mobile apps, it’s a challenge to find something with the right functionality (but not too much) and get it set up just right to suit you. And then actually using it regularly – that’s something else entirely!
Cool.
Well done for being such a dedicated mood tracker!
Am glad to have come across your blog today.
I look forward to reading your future posts.
All the best,
The Quiet Borderline
http://quietbpd.wordpress.com/
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Excellent, useful, well-done piece–even better, because it’s a particular interest of mine!