Daily Archives: March 20, 2012

Creating A Personalized Rating System & Scale for Mood Charting

Once you’ve decided to start keeping track of your moods via a mood charting system there are a number of routes you can go. There are a number of types of technology that can be incorporated (I’m going to be talking about that more specifically a little later on this week), as well as a number of different things you can co-chart (like amount of sleep or anxiety level) and add information to your chart about (which I also plan on covering more in-depth tomorrow).

You can choose to log your information in several different ways. You can keep this information in a chart of numbers (used periodically, if at all, to create visual ways of interpreting your information like graphs) or you can translate your immediate data into a visual, skipping the number-charting process.

Confused yet? Don’t worry. This method will be largely decided by whether or not you intend to incorporate technology with your charting techniques (which, again, I will cover later on). To illustrate my ideas here I’ll show you how to create a simple mood chart (we’ll deck it out tomorrow with more types of information) using pen and paper.

I know this might sound a little medieval, but I spent the last year collecting data on charts with just pen and paper, and didn’t begin imputing it into my computer until about a month ago. I enjoy that paper is something that I can rely on without the use of electricity or a functioning device, and as I can spend periods of up to two weeks at a time away from home in isolated regions, I can’t rely on electricity or technology to be present wherever I am.

A paper method also feels more personal to me, something like a private journal almost, so there is an intimacy coupled with this technique. That, and I get to use colored pens, which is something I am a total sucker for.

Ok, so you may have an idea of how you want to chart, but the very first, most important part of charting is discerning what scale and rating system is right for you. At this point having at least a loose familiarity of your symptoms will be extremely helpful.

I’ve had people who have jumped right into mood chart apps ask me how they know what moods are a 1 on the scale and what moods are a 5. What severity are they asking for here? How do I know if what I’m experiencing is a 1 or a 5?

The answer here is that there is no right answer. The lack of a definition between what a 1 is or a 5 means it is entirely up to you. I am generally surprised when people find that to be stressful, because we can personalize the rating scale to fit whatever our needs are.

What would happen if the scale was pre-determined, but you never experienced any of the symptoms past a 2? The rating system wouldn’t be utilizing your full range of symptoms or moods, and the interpretation (what you get out of it) would probably be significantly diminished by this fact. Instead, let’s take the opportunity to create a rating system that is personalized to our own symptoms and experiences.

Zero works great as a normal, baseline, stable mood. What I enjoy most about using zero as the baseline here is that we can give elevated mood positive values (above zero) and our depressive moods negative values (all below zero). Creating a rating system in this format means all of our graphs will have a connected line for our mood that fluctuates either above or below zero, with no breaks, and it is easy just by looking at it to know whether the mood is “elevated” or “depressed”.

Next up is deciding how many steps you want your rating system to have.

Some suggest a 0-3 scale, with a slight (1), moderate (2), and severe rating (3).

I already worked out a 0-3 scale in reference to my depressive episodes to help clue my medical team in to how I’m doing. That scale looks something like this:

0 – no depression, stable mood
1 – depressive symptoms, no suicidal thoughts are present
2 – depressive symptoms with suicidal thoughts or ideation
3 – depressive symptoms with threat of suicide, immediate action required

Now, that scale has worked well for me outside of charting, especially when discerning what kind of threat my depression is putting me in. But, for my mood chart I really want to be as specific as I can. Personally I find breaking depression into 3 parts is somewhat limiting in that sense, so here I’ve expanded that into a model that could work for me for a mood chart.

0 – no depression, stable mood
-1 – fleeting depressive symptoms, feeling generally negative
-2 – constant depressive symptoms with no suicidal thoughts
-3 – constant depressive symptoms with periodic suicidal thoughts
-4 – constant depressive symptoms with suicidal thoughts occurring frequently
-5 – constant depressive symptoms with immediate action needed (the danger zone)

Now, my descriptions here of what each value represents is a little vague, but it can help to think of the worst depression you’ve ever felt (sounds wonderful, doesn’t it?). Were you suicidal? Did you attempt suicide? Or has the worst depression you’ve ever felt included just some suicidal thinking? How about no suicidal thinking at all? The point is that it is different for each of us, so the rating system we all use should be individualized.

As I touched on a little bit yesterday though, our symptoms can change over time, and it is an unfortunate but real fact that they can get worse. This part can be a little tricky, and I am sure on my own end that I have experienced the most intense depression has had to offer (as it has led to both hospitalizations and suicide attempts), so I feel confident making it a -5. For anyone who has not experienced this depth of depression, I would suggest equating your worst depressive episode with a -4. I am in no way attempting to minimize your experiences, just allowing some room in case something more intense occurs down the line.

I only make that suggestion, because that is what I’ve had to do for the elevated side of my rating system. Up until recently, I’m not convinced I’ve had a full-on manic episode (outside of having a bad reaction to medication), so my episodes have been landing more in the severe hypomania area, about a 3. Every so often now though I remember why I made that a 3, because I will experience a 4 or 5. It is an unfortunate change, but I am glad I left myself room on my scale for more intense episodes, because they’ve arrived.

My elevated scale looks similar to this:

0 – no mania, stable mood
1 – slight hypomania with increased energy and mood
2 – hypomania with need to expel energy, others beginning to take notice
3 – intense hypomanic symptoms, trouble speaking and maintaining focus
4 – extremely irrational behavior, losing track of time and intent
5 – full-on manic symptoms, potential psychosis

Again, these descriptions are tailored to what I experience, but the idea is to figure out what symptoms are associated with which part of your rating scale. It is ok to have a general idea, because once you begin actually taking down data and have done it for a time, it becomes almost second nature discerning what level mood you are in.

Alright, great! So we have a 0 to 5, and 0 to -5 scale! This is our “y axis” value on the scale.

Next we need to pick how often we are going to evaluate our mood.

Most folks with bipolar disorder tend to take down their mood information once per day. For people who have generally one mood level per day, this is definitely a realistic and useful method.

Charting once per day usually yields graphs on a monthly scale, which would look something like the box above, only with your own, personalized, wiggly mood line moving through it! You’ll have 12 graphs per year.

An example of this graph can be seen up in the “CHART WEEK” graphic at the top of the page. That graphic is based on my moods in the month of October, 2011 (when I started this blog).

For others, who can cycle several times in one day, like me, you may want to consider an hourly chart. It may sound tedious, but for me it has been extremely worthwhile and I’ve reached the point where I just take a mental note of what time it is when I shift into another mood, then copy them down on a slip of paper in my pocket or jot them down when I get home. With the 24 hour method here, you’ll also be keeping track of your sleep patterns by default (as you can only chart your mood while awake).

With hourly charting, you will create one graph per day, which means a total of 365 for the year. So how often you are interested in pinpointing your mood will determine the time portion here, the x-axis on our graph.

As I discussed earlier on in this post, you can also make lists of your values, and then create graphs with them later. This is great if you’re on the go, or know you’re willing to keep up with it and have time to evaluate the results later.

Personally, I like creating the graph as I go because I am a very visual person, but also because of moments like in the graph above. I was experiencing two level 2 mixed episodes, and I could denote this on my graph by having my main mood line going through my dominant mood (the red line in the elevated mood level) with the dashed line going through the associated depressive mood symptoms below.

At this point, I haven’t come up with a great way to denote a mixed episode with its own numerical value rating system, so keeping a list of numbers that are associated with my moods is difficult. Also, the fact that I can cycle so quickly makes that method difficult for me as well. Even in the graph above, you can see I went from dysphoric (mixed) hypomania, to euphoric hypomania, and back again in one day, so when it comes to translating what I experience into a monthly graph (like the one at the top of the page) the information becomes somewhat skewed.

Once you’ve created a personalized rating system and picked a scale that works with your mood swings, creating the actual chart and graph are fairly simple -simple enough that it can be done with a pencil and a piece of paper each day.

Before jumping into a mood tracking app or beginning to chart, I really encourage each of you to consider how you rate your moods, what your symptoms correlate for you in regard to the severity of your mood swings, and what you can do make this process personalized for your needs! The idea is to provide you with something helpful and even intimate, the more time you spend working on it, the easier it becomes until it is effortless!