Can Assessing Mood Make It Worse?

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In medical settings, people seeking mental health support are frequently asked to complete depression or anxiety assessments and other questionnaires about function, pain, and other symptoms. Common questions include how often certain symptoms are bothersome, such as lack of interest, feeling down or hopeless, feeling low energy, feeling like a failure, poor concentration, feeling fidgety or slowed down, or thoughts of death or suicide. If you’ve ever spent the day at a medical clinic, you may have answered the same questionnaire several times within a few hours.

Knowing what we know about neuroplasticity and how the brain changes depending upon where we put our attention and focus, could these repeated assessments – questions about feeling bad – actually cause you to feel worse? In other words, rather than uncovering an important issue, might they also cause harm?

Maybe. Ignoring or dismissing negative symptoms can also be harmful. It was once believed that talking about suicide would cause it to increase, especially among teens, but talking about suicide is an important part of preventing it. However, symptom focusing (repeatedly revisiting the topic of one’s physical symptoms) has been found to correlate with increased symptom severity as well as lower functioning for many syndromes. Being overly solicitous of our own or someone else’s symptoms can make symptoms worse. So how do we assess something a person may be struggling with without overdoing it and causing harm?

I believe the answer includes these four steps:

1. Communication and education. Clinicians can communicate with transparency (and compassion) about paying attention to symptoms. But not allowing anxious attention to perseverate on physical symptoms can reduce them. Clients must be informed that what they focus on can amplify the problem.

2. Understand the role the symptom is playing. Physical symptoms may not always be a signal of a disease, but they still may be important signals of distress. Any symptom can be important information, however, their meaning may be misinterpreted.

3. Pay (loving) attention to the symptom, but then think about or do something else. This mindset can be applied to many problems that can worry us.

4. Ask different questions. Assessments can inquire about the circumstances in which people felt engaged, joyful, or peaceful, and there would be a natural movement toward these things.

Different questions invite us to see ourselves wholly – without denial or dismissiveness – including problematic symptoms, behaviors, and experiences. They also allow us to see strengths, and positive moments and see the humanity in ourselves and each other.

Here are 10 questions that can guide our brains toward what is true about us beyond negative symptoms.

1. What have you been interested in lately, and what do you want more of in your life?
2. When do you experience peace, joy, or contentment?
3. Where do you notice that you feel confident about your skills and abilities?
4. Where do you notice mindful attention and good focus during the day?
5. When do you feel calm yet energized?
6. When do you feel engaged in the moment and most alive?
7. What do you feel hopeful about?
8. In what ways do you nourish your mind, body, and spirit daily?
9. What relationships do you find meaningful?
10. What qualities do you possess that support your persistence in times of struggle?

There are many ways to measure well-being: The Adult Hope Scale measures hope, goal-directed behavior, optimism, self-efficacy, and self-esteem (Snyder et al., 1991). The Kindness Scale captures attitudes toward kindness (Comunian, 1998). The Quiet Ego Scale measures detached awareness, inclusive identity, perspective-taking, and growth (Wayment et al., 2015). The Health-Promoting Lifestyle Profile II, commonly used among healthcare workers, includes a scale that measures spiritual growth (Pinar et al., 2009). The Flourishing Scale is a brief questionnaire that assesses exactly what it says. (Diener et al., 2009)

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist, visit the Psychology Today Therapy Directory.