What Symptoms Are Worth Tracking Between Sessions

A therapy-informed look at symptom tracking, pattern awareness, and how tracking can support the work you’re already doing.

Reframing the Path, by licensed therapist Melissa Rolfes, is your guide to making the most of your therapeutic journey, helping you feel more confident and effective every step of the way. The information provided here is for educational purposes only, and is not a substitute for professional mental health or medical care, nor does it establish a therapist-client relationship. If you're experiencing distress and feel unable to keep yourself safe, please access these resources.

When therapists talk about “symptoms,” we’re not always talking about diagnoses or labels. A symptom is simply a signal, something you notice in your body, mood, thoughts, or behavior that reflects how you’re responding to stress, emotion, or life in general.

Tracking symptoms is a way of noticing patterns and contributing factors over time, as well as gathering helpful information to share with your provider so you’re not relying on memory alone when you come back to your appointment.

When Tracking is Helpful and When It’s Not

Tracking symptoms can be helpful because it allows you to externalize your experience and “collect data” on what’s going on. Stress, anxiety, or mood shifts often blur together, especially over the course of a busy or emotionally charged week. Writing something down gets it out of your head and onto paper, where it can be set aside rather than mentally replayed. For many people, this kind of tracking supports reflection, makes it easier to notice patterns over time, and provides tangible information to share in sessions so your therapist can best support you.

Tracking is most effective when it is done simply and consistently, without trying to capture every detail. A few brief notes are often enough to offer clarity without maintaining a highly detailed log. This can help therapy sessions feel more focused, since you are not relying on memory alone to recall what the week was like.

At the same time, tracking is not helpful for everyone. For some people, especially those with perfectionistic tendencies, tracking can become another thing to monitor or control, and a slippery slope toward obsessing or judging yourself. If you notice that tracking increases rumination, self-criticism, or a sense of pressure to do it “correctly,” it may not be the right approach for you. It is okay to stop. Choosing not to track does not mean you are avoiding the work or doing therapy wrong. There are many ways to heal and grow, and therapy can still be effective without writing this stuff down.

So What Is Actually Worth Tracking?

If tracking feels supportive rather than stressful, the following list can serve as a framework to work with. The goal is not to track everything or do this perfectly. These are options, not requirements. You may find that only a few feel relevant to you, and that is enough. Try approaching them with curiosity rather than judgment, thinking of them as contributing factors rather than problems to solve.

Body-Based and Biological Factors

Many emotional and mental health symptoms are closely tied to what is happening in the body. Tracking a few physical or biological factors can help you and your therapist notice patterns that are easy to miss in the moment.

You might consider tracking:

Menstrual cycle
Tracking where you are in your menstrual cycle can be helpful, as hormonal shifts can affect mood, anxiety, and energy. Day 1 is the first day of your period, and the days leading up to your period are often considered premenstrual. If you are unsure of your cycle, simply noting the days you are on your period is enough.

Sleep
You might note how many hours you slept, whether you had trouble falling or staying asleep, and how rested you felt when you woke up. When noting sleep quality, a general sense of “poor,” “okay,” or “restful” is sufficient.

Pain and physical symptoms
Physical discomfort such as headaches, muscle tension, stomach issues, or chronic pain can influence emotional well-being and stress tolerance. Noting the presence of pain or physical symptoms can help connect physical strain with emotional patterns.

Energy levels
Energy is different from mood. Tracking whether your energy felt low, moderate, or high can provide useful context, especially when motivation, focus, or irritability feel off.

Inputs that Shape Mood and Energy

In addition to what is happening in the body, day-to-day inputs can have a meaningful impact on mood, anxiety, energy, and overall functioning. These are not about doing things “right,” but about noticing what tends to influence how you feel.

You might consider tracking:

Medications
If you are prescribed medication, it can be helpful to note whether you took it as prescribed. This can be especially useful when trying to understand shifts in mood, anxiety, or sleep. If you have an as-needed or PRN medication, it can also be helpful to note if you took it.

Substance use
Alcohol, caffeine, and other substances can influence mood, anxiety, sleep, and emotional regulation. Tracking does not need to be detailed. Simply note whether you used a substance, and roughly how much.

Appetite and eating patterns
Changes in appetite can be both a cause and a consequence of emotional stress. You might notice days when you ate less than usual, overate, or had little interest in food.

Physical activity and rest
Movement, rest, and recovery all affect mental health. You may choose to note whether you were active, what kind of movement you did, or whether you intentionally rested. Rest days are just as relevant as active ones.

Stress, Triggers, and Context

Symptoms rarely exist in a vacuum. Stressors, situations, and context often shape how symptoms show up and how intense they feel. Tracking these factors can help you connect internal experiences with what is happening around you.

You might consider tracking:

Stress level
You may want to note how stressed you felt overall that day. This can include work, family, financial pressure, health concerns, or other ongoing stressors.

Triggers
Triggers are situations or experiences that tend to activate symptoms. Common triggers include work or school demands, social situations, family interactions, health worries, or financial stress.

Cognitive functioning
Changes in focus, concentration, memory, or mental clarity are common during periods of stress, anxiety, or depression. Noting when it feels harder to stay on task can provide helpful context.

Motivation and follow-through
You might note whether motivation felt low, moderate, or high, or whether starting tasks felt harder or easier than usual.

Internal Experience

Internal experiences often give important clues about how stress, anxiety, or emotional load are being processed, meaning how they show up in your mood, thoughts, and reactions. These experiences can shift quickly and are often influenced by what is happening around you. You do not need to track them in detail for them to be useful.

You might consider tracking:

Overall mood
A general sense of how your mood felt that day can be enough. Some people prefer a simple scale or broad categories such as low, neutral, or positive. I’ve had some clients even use emojis to mark this.

Anxiety level
Noting how anxious you felt overall can help identify patterns related to stressors, triggers, or recovery time. Anxiety can show up as excessive worrying, racing thoughts, restlessness, or feeling on edge. This is another area where scaling can be helpful.

Emotions
You may notice particular emotions that stood out, such as sadness, frustration, worry, irritability, or grief. This is optional, and it is okay to skip this if mood tracking feels sufficient.

Thoughts and self-talk
Tracking themes in your internal dialogue can be useful, especially if thoughts tend to be self-critical, worry-based, or repetitive. Paying attention to what you’re saying to yourself, especially when things get tough, can be helpful information to share with your therapist.

Coping, Regulation, and Response

Tracking is not only about what you felt, but how you responded. Noticing what helped, what did not, and how your system reacted can provide useful information without turning the process into self-evaluation.

You might consider tracking:

Coping strategies
You might note what you did to cope with stress or difficult emotions that day, such as grounding practices, reaching out for support, distraction, rest, or problem-solving. If it feels helpful, you can also note whether it helped, without judging yourself.

Self-care and restorative activities
You might notice whether you engaged in activities that helped you feel more regulated or supported, such as spending time outside, practicing mindfulness, or doing something creative,.

Emotional regulation
Did you experience difficulty managing your emotions today? Track instances of outbursts, irritability, or emotional shutdowns. Difficulty regulating emotions is common in mental health conditions.

*A Note About Scaling

You may find it helpful to use scales when tracking things like mood, anxiety, energy, or stress. Many of the above categories could be tracked with scaling. This can be an easy way to notice changes without needing to describe everything in words.

The specific scale you use does not matter. You might use a 1 to 5 scale, a 1 to 10 scale, or broad categories such as low, moderate, or high. Some people even use symbols or emojis. What matters most is consistency: use the same scale every time. Seeing the number shift from one day to the next is often more meaningful than the number itself.

Choose What’s Supportive for You

Tracking symptoms is a tool, not a requirement. For some people, it helps externalize experiences, notice patterns, and bring useful information into sessions. For others, it can become another source of pressure or self-monitoring.

If tracking starts to feel overwhelming, obsessive, or unhelpful, it is okay to stop. There are many ways to heal and grow, and therapy can still be effective without writing anything down. The most important thing is choosing approaches that feel steady, supportive, and sustainable for you.

Looking for a new therapist?

I work with adults across Virginia through online therapy, helping clients make sense of their symptoms and find a path forward. Whether you’re in Richmond, Northern Virginia, the Tidewater region, or elsewhere in the state, telehealth allows us to work together.

If you’re a Virginia resident considering starting therapy or making a change in your current care, I’d be glad to hear from you.