Revision 7T · Full Tutorial Edition · Updated 1 September 2026
PWR-166 · SUPERVISED full tutorial
Keep a clinician-reviewed pattern log and act on early warning signs
This lesson teaches the learner’s part of a clinician-led mood-stability plan: record mood with sleep, activity, function, medication adherence and warning signs; keep routines within the agreed range; use the written response ladder; and review patterns without changing treatment alone. It does not teach self-diagnosis or self-medication.
What you will produceFor fourteen days, the learner completes the agreed daily pattern log and follows the clinician-approved response ladder for any warning sign without changing medication or sleep intentionally.
Method8 numbered Power-specific steps
Practice authorityFull method with qualified supervision where stated
Full step-by-step individual tutorial · TLU-PWR-166
For fourteen days, the learner completes the agreed daily pattern log and follows the clinician-approved response ladder for any warning sign without changing medication or sleep intentionally.
Complete the clinician-reviewed daily sleep, routine, mood, activation, function and warning-sign log.
Use the green–amber–red response ladder on the day its observable threshold appears.
Mark missing data honestly and keep prescribed treatment unchanged unless the responsible clinician directs otherwise.
Qualified help is required for
The clinician defines warning signs, ladder thresholds, contact timing, review dates and urgent routes.
Interpretation of a changing pattern and every medication or treatment decision remain with the clinical team.
Never do this from the page alone
Start, stop or change medication, supplements or sleep based on the log without the prescriber.
Use sleep deprivation, excessive exercise, spending, substances or stimulation to alter mood.
Treat an app score as diagnosis or delay urgent help while collecting more data.
2 · Get ready
Gather what you need and check the starting conditions
What you need
a clinician-reviewed mood and function pattern log.
The clinician’s care plan, personalised early-warning list, crisis contacts and medication instructions.
A daily log with mood range, sleep start/end, activity, function, medication taken as prescribed, substance changes and significant events.
Before you start
Prepare a clinician-reviewed two-week mood, sleep, activity, function and warning-sign log tied to an individual care plan
Before the first mood stabilisation attempt, write the exact result you will score: Clinically assessed episode course, function and harms within an individualized care system.
The clinician confirms diagnosis, current episode status, medication plan, privacy, monitoring burden and who reviews data.
Write thresholds for routine contact, same-day contact and emergency action before logging starts.
3 · The method
Follow these steps in order
Write the response ladder
With the clinician, list green routine signs, amber early warnings, red urgent signs and the exact person/action for each level.
Why: A pre-agreed ladder turns monitoring into timely action rather than passive data collection.
Check: Every level names observable signs, contact and timing.
Set one daily check time
Choose a regular time that does not disrupt sleep. Keep the check under five minutes.
Why: Consistent brief sampling improves comparability and limits rumination.
Check: The log is completed once daily at the declared time.
Record sleep and routine first
Enter sleep start, wake time, awakenings, meals, medication as prescribed and major routine changes before rating mood.
Why: Sleep and routine changes can be important warning context and should not be reconstructed from mood alone.
Check: Objective routine fields are complete before the mood field.
Rate mood and activation separately
Use the clinician’s scales for low mood and activation/energy; add irritability or anxiety only if the plan includes them.
Why: High activation and low mood can coexist and require separate visibility.
Check: Each planned dimension has its own value and no average “mood score.”
Add function and observable signs
Record one concrete function result and any personalised warning sign, such as missed work, rapid speech or unusual spending urge.
Why: Observable function and behaviour make a rating more interpretable.
Check: Every day includes one function item and explicit yes/no warning signs.
Apply the ladder that day
Compare the entry with the thresholds. Follow the contact or emergency action immediately; do not wait for a trend when a red sign appears.
Why: Some signs require action before a pattern is statistically clear.
Check: The log records what action was taken and when.
Keep treatment unchanged unless directed
Continue medication, sleep and routine exactly as prescribed while awaiting advice. Record deviations honestly.
Why: Independent changes can worsen risk and make the pattern uninterpretable.
Check: No treatment change occurs without attributable clinical direction.
Review patterns with the clinician
At the agreed review, look for sequences across sleep, activation, function and events. Keep contradictory days and missing data visible.
Why: A clinician interprets the pattern in context; selective charts can mislead.
Check: The review produces a documented keep, adapt or urgent-care decision.
4 · Worked example
See the whole method used once
Scenario
A person with clinician-managed bipolar disorder uses a two-week plan with amber signs of two nights of reduced sleep or unusual spending urge and red signs of no sleep plus risky behaviour.
Walkthrough
Clinician and learner write the green/amber/red ladder with same-day and emergency contacts.
For six days the learner logs sleep, medication, activation, low mood and work function at 19:00.
On day seven, sleep is four hours for a second night and spending urge is marked yes; mood feels “good,” but amber criteria are met.
The learner contacts the clinic that day and keeps medication and bedtime unchanged while waiting.
The clinician reviews the full pattern and adjusts the care plan; the app or log itself makes no diagnosis.
Result
An early warning triggers the pre-agreed clinical response despite a pleasant mood rating. Timely action—not a stable-looking graph—is the useful outcome.
5 · Right and wrong
Compare correct or safer execution with the common wrong version
Right and wrong comparison
Moment
Right / safer
Wrong / riskier
Why it matters
Write the response ladder
With the clinician, list green routine signs, amber early warnings, red urgent signs and the exact person/action for each level.
Track mood with no written action threshold.
A pre-agreed ladder turns monitoring into timely action rather than passive data collection.
Set one daily check time
Choose a regular time that does not disrupt sleep. Keep the check under five minutes.
Check repeatedly late at night and disrupt sleep.
Consistent brief sampling improves comparability and limits rumination.
Record sleep and routine first
Enter sleep start, wake time, awakenings, meals, medication as prescribed and major routine changes before rating mood.
Rate mood first and guess sleep afterward.
Sleep and routine changes can be important warning context and should not be reconstructed from mood alone.
Rate mood and activation separately
Use the clinician’s scales for low mood and activation/energy; add irritability or anxiety only if the plan includes them.
Average depression and activation into one number.
High activation and low mood can coexist and require separate visibility.
Add function and observable signs
Record one concrete function result and any personalised warning sign, such as missed work, rapid speech or unusual spending urge.
Use only feelings and omit observable function or warning behaviour.
Observable function and behaviour make a rating more interpretable.
6 · Common mistakes
Spot the error and apply the correction
Common mistakes and corrections
Mistake
Fix
Track mood with no written action threshold.
With the clinician, list green routine signs, amber early warnings, red urgent signs and the exact person/action for each level.
Check repeatedly late at night and disrupt sleep.
Choose a regular time that does not disrupt sleep. Keep the check under five minutes.
Rate mood first and guess sleep afterward.
Enter sleep start, wake time, awakenings, meals, medication as prescribed and major routine changes before rating mood.
Average depression and activation into one number.
Use the clinician’s scales for low mood and activation/energy; add irritability or anxiety only if the plan includes them.
Use only feelings and omit observable function or warning behaviour.
Record one concrete function result and any personalised warning sign, such as missed work, rapid speech or unusual spending urge.
7 · Practice
Turn the steps into a usable skill
First session
Clinician & learner build a green–amber–red response ladder using observable warning signs, contact names & response times. Learner rehearses whom to contact at each level; emergency & routine routes are not left as vague instructions to seek help.
Set one sustainable daily check time for fourteen days. Prepare separate fields for sleep timing, routine change, mood direction, activation, function, observable warning signs, support & ladder action; medication dose is a read-only field unless prescriber directs a change.
Complete first entry by recording sleep & routine before mood. Rate low-to-high mood & low-to-high activation separately, because elevated activation, depressed mood & mixed change cannot be represented by a single average number.
Add one observable function & any concrete sign, such as missed meals, unusual spending urge, slowed work or reduced need for sleep. Avoid back-filling personality explanations, diagnoses or a narrative that changes yesterday's raw entry.
Match current signs to clinician-approved ladder that same day. Practise sending amber contact message with date, sleep change, activation & function; do not wait for two-week review if red threshold is met.
Schedule clinician review & inspect completeness, pattern & ladder use, not whether every day looks stable. End tutorial without deliberate sleep restriction, activation experiments or medication changes intended to test log.
Repeat plan
Complete one entry at same daily time for fourteen days & use response ladder whenever its observable threshold appears. Clinician reviews day 7 & day 14 for sleep–activation–function patterns & response timing. Any future monitoring period is clinician-set; missing days are marked missing, never reconstructed from memory.
Progress when
For fourteen days, learner completes agreed daily pattern log & follows clinician-approved response ladder for any warning sign without changing medication or sleep intentionally.
Objective routine fields are complete before mood field.
Log records what action was taken & when.
Review produces a documented keep, adapt or urgent-care decision.
Do not progress when
Do not interpret or progress log when sleep, activation & mood have been collapsed into one score or repeatedly entered retrospectively.
Use urgent or emergency ladder immediately for its named warning signs rather than waiting to collect a cleaner fourteen-day pattern.
Never alter medication, deliberately reduce sleep or provoke activation to test whether monitoring system detects change.
8 · Check the result
Measure what changed
Clinically assessed episode course, function and harms within an individualized care system
How: For Mood stabilisation, measure Clinically assessed episode course, function and harms within an individualized care system. Keep the mood stabilisation fixture stable. Target: For fourteen days, the learner completes the agreed daily pattern log and follows the clinician-approved response ladder for any warning sign without changing medication or sleep intentionally. Log mood stabilisation errors, prompts, burden and stops.
Good result: Objective routine fields are complete before mood field. Log records what action was taken & when. Review produces a documented keep, adapt or urgent-care decision.
This does not prove: A complete self-report log does not prove that mood is stable or that every warning sign was observed, accurately recalled or clinically interpreted.
Self-check
Starting check — Every level names observable signs, contact and timing.
Can you show this before continuing? The log is completed once daily at the declared time.
If you catch this mistake — Track mood with no written action threshold. — use this correction: With the clinician, list green routine signs, amber early warnings, red urgent signs and the exact person/action for each level.
What this result does not prove: A complete self-report log does not prove that mood is stable or that every warning sign was observed, accurately recalled or clinically interpreted.
9 · Stop, adapt or get help
Keep the safety boundary practical
Stop and get help
Use urgent clinical or emergency help for suicidal intent, psychosis, dangerous impulsivity, severe agitation, inability to sleep with escalating activation, or inability to care for basic needs.
Stop logging if it increases obsession, sleep disruption or distress and contact the clinical team for an alternate monitoring method.
Do not interpret or progress log when sleep, activation & mood have been collapsed into one score or repeatedly entered retrospectively.
Use urgent or emergency ladder immediately for its named warning signs rather than waiting to collect a cleaner fourteen-day pattern.
Never alter medication, deliberately reduce sleep or provoke activation to test whether monitoring system detects change.
Accessibility and adaptations
Keep usual aids for Mood stabilisation; record each support inside the mood stabilisation setup.
Accessible opening check for Mood stabilisation: Every level names observable signs, contact and timing.
Use pictorial scales, voice entry, caregiver-supported logging with consent, reduced fields or paper; keep the clinician-defined warning signs and action ladder intact.
10 · Evidence and limits
Why these instructions are here
primary research
A specialist-care smartphone trial found no effect on mood instability or secondary outcomes, so monitoring alone is not treatment.
Official bipolar guidance supports collaborative care plans, monitoring relapse signs and prompt clinical response, with medication decisions made by qualified clinicians.
J W Yeom; J Jeong; E Moon; Y M Park; M S Lee; H K Yoon; C Shin; Y Yoon; J Y Seo; S Jeon; M Choi; C H Cho; H An; T Lee; J B Lee; H J Lee · 2026 · Primary research
M Faurholt-Jepsen; A Risom; M S Dyreholt; N B Kyster; E M Christensen; B Smidt; U Knorr; K Brøndmark; A Mathiesen; D Cululejevic; R Sjaelland; H Nørbak-Emig; L L Sponsor; D Mardosas; J D Bukh; T V Heller; N Iversen; M Vinberg; E Budtz-Jørgensen; L V Kessing · 2026 · Primary research
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Step-by-step learner mode
Each activity includes its success check, a nearby accessible alternative and an “I’m stuck” correction path. Alternatives preserve the target where possible; when they change the task, Titan labels them as related rather than equivalent.
01
Write the response ladder
With the clinician, list green routine signs, amber early warnings, red urgent signs and the exact person/action for each level.
Why this step exists
A pre-agreed ladder turns monitoring into timely action rather than passive data collection.
Success check
Every level names observable signs, contact and timing.
I’m stuck on this step
Reset: Re-read this authored instruction — “With the clinician, list green routine signs, amber early warnings, red urgent signs and the exact person/action for each level.” — and its success check, then attempt only this step.
Possible snag: Track mood with no written action threshold.
Correction: With the clinician, list green routine signs, amber early warnings, red urgent signs and the exact person/action for each level.
Stop / get help: Use urgent clinical or emergency help for suicidal intent, psychosis, dangerous impulsivity, severe agitation, inability to sleep with escalating activation, or inability to care for basic needs.
02
Set one daily check time
Choose a regular time that does not disrupt sleep. Keep the check under five minutes.
Why this step exists
Consistent brief sampling improves comparability and limits rumination.
Success check
The log is completed once daily at the declared time.
I’m stuck on this step
Reset: Re-read this authored instruction — “Choose a regular time that does not disrupt sleep. Keep the check under five minutes.” — and its success check, then attempt only this step.
Possible snag: Check repeatedly late at night and disrupt sleep.
Correction: Choose a regular time that does not disrupt sleep. Keep the check under five minutes.
Stop / get help: Use urgent clinical or emergency help for suicidal intent, psychosis, dangerous impulsivity, severe agitation, inability to sleep with escalating activation, or inability to care for basic needs.
03
Record sleep and routine first
Enter sleep start, wake time, awakenings, meals, medication as prescribed and major routine changes before rating mood.
Why this step exists
Sleep and routine changes can be important warning context and should not be reconstructed from mood alone.
Success check
Objective routine fields are complete before the mood field.
I’m stuck on this step
Reset: Re-read this authored instruction — “Enter sleep start, wake time, awakenings, meals, medication as prescribed and major routine changes before rating mood.” — and its success check, then attempt only this step.
Possible snag: Rate mood first and guess sleep afterward.
Correction: Enter sleep start, wake time, awakenings, meals, medication as prescribed and major routine changes before rating mood.
Stop / get help: Use urgent clinical or emergency help for suicidal intent, psychosis, dangerous impulsivity, severe agitation, inability to sleep with escalating activation, or inability to care for basic needs.
04
Rate mood and activation separately
Use the clinician’s scales for low mood and activation/energy; add irritability or anxiety only if the plan includes them.
Why this step exists
High activation and low mood can coexist and require separate visibility.
Success check
Each planned dimension has its own value and no average “mood score.”
I’m stuck on this step
Reset: Re-read this authored instruction — “Use the clinician’s scales for low mood and activation/energy; add irritability or anxiety only if the plan includes them.” — and its success check, then attempt only this step.
Possible snag: Average depression and activation into one number.
Correction: Use the clinician’s scales for low mood and activation/energy; add irritability or anxiety only if the plan includes them.
Stop / get help: Use urgent clinical or emergency help for suicidal intent, psychosis, dangerous impulsivity, severe agitation, inability to sleep with escalating activation, or inability to care for basic needs.
05
Add function and observable signs
Record one concrete function result and any personalised warning sign, such as missed work, rapid speech or unusual spending urge.
Why this step exists
Observable function and behaviour make a rating more interpretable.
Success check
Every day includes one function item and explicit yes/no warning signs.
I’m stuck on this step
Reset: Re-read this authored instruction — “Record one concrete function result and any personalised warning sign, such as missed work, rapid speech or unusual spending urge.” — and its success check, then attempt only this step.
Possible snag: Use only feelings and omit observable function or warning behaviour.
Correction: Record one concrete function result and any personalised warning sign, such as missed work, rapid speech or unusual spending urge.
Stop / get help: Use urgent clinical or emergency help for suicidal intent, psychosis, dangerous impulsivity, severe agitation, inability to sleep with escalating activation, or inability to care for basic needs.
06
Apply the ladder that day
Compare the entry with the thresholds. Follow the contact or emergency action immediately; do not wait for a trend when a red sign appears.
Why this step exists
Some signs require action before a pattern is statistically clear.
Success check
The log records what action was taken and when.
I’m stuck on this step
Reset: Re-read this authored instruction — “Compare the entry with the thresholds. Follow the contact or emergency action immediately; do not wait for a trend when a red sign appears.” — and its success check, then attempt only this step.
Possible snag: The result from “Compare the entry with the thresholds. Follow the contact or emergency action immediately; do not wait for a trend when a red sign appears.” does not yet meet this declared check: The log records what action was taken and when.
Correction: Return to the start of “Apply the ladder that day”, reduce complexity or pace, and repeat only the part needed to satisfy: “The log records what action was taken and when.”
Stop / get help: Use urgent clinical or emergency help for suicidal intent, psychosis, dangerous impulsivity, severe agitation, inability to sleep with escalating activation, or inability to care for basic needs.
07
Keep treatment unchanged unless directed
Continue medication, sleep and routine exactly as prescribed while awaiting advice. Record deviations honestly.
Why this step exists
Independent changes can worsen risk and make the pattern uninterpretable.
Success check
No treatment change occurs without attributable clinical direction.
I’m stuck on this step
Reset: Re-read this authored instruction — “Continue medication, sleep and routine exactly as prescribed while awaiting advice. Record deviations honestly.” — and its success check, then attempt only this step.
Possible snag: The result from “Continue medication, sleep and routine exactly as prescribed while awaiting advice. Record deviations honestly.” does not yet meet this declared check: No treatment change occurs without attributable clinical direction.
Correction: Return to the start of “Keep treatment unchanged unless directed”, reduce complexity or pace, and repeat only the part needed to satisfy: “No treatment change occurs without attributable clinical direction.”
Stop / get help: Use urgent clinical or emergency help for suicidal intent, psychosis, dangerous impulsivity, severe agitation, inability to sleep with escalating activation, or inability to care for basic needs.
08
Review patterns with the clinician
At the agreed review, look for sequences across sleep, activation, function and events. Keep contradictory days and missing data visible.
Why this step exists
A clinician interprets the pattern in context; selective charts can mislead.
Success check
The review produces a documented keep, adapt or urgent-care decision.
I’m stuck on this step
Reset: Re-read this authored instruction — “At the agreed review, look for sequences across sleep, activation, function and events. Keep contradictory days and missing data visible.” — and its success check, then attempt only this step.
Possible snag: The result from “At the agreed review, look for sequences across sleep, activation, function and events. Keep contradictory days and missing data visible.” does not yet meet this declared check: The review produces a documented keep, adapt or urgent-care decision.
Correction: Return to the start of “Review patterns with the clinician”, reduce complexity or pace, and repeat only the part needed to satisfy: “The review produces a documented keep, adapt or urgent-care decision.”
Stop / get help: Use urgent clinical or emergency help for suicidal intent, psychosis, dangerous impulsivity, severe agitation, inability to sleep with escalating activation, or inability to care for basic needs.
Correct versus incorrect execution
These accessible process diagrams are built from the tutorial’s own right/wrong teaching. They are not anatomical illustrations and do not add technique beyond the canonical tutorial.
Write the response ladder — A pre-agreed ladder turns monitoring into timely action rather than passive data collection.
Correct / safer
With the clinician, list green routine signs, amber early warnings, red urgent signs and the exact person/action for each level.
Wrong / riskier
Track mood with no written action threshold.
Set one daily check time — Consistent brief sampling improves comparability and limits rumination.
Correct / safer
Choose a regular time that does not disrupt sleep. Keep the check under five minutes.
Wrong / riskier
Check repeatedly late at night and disrupt sleep.
Record sleep and routine first — Sleep and routine changes can be important warning context and should not be reconstructed from mood alone.
Correct / safer
Enter sleep start, wake time, awakenings, meals, medication as prescribed and major routine changes before rating mood.
Wrong / riskier
Rate mood first and guess sleep afterward.
Rate mood and activation separately — High activation and low mood can coexist and require separate visibility.
Correct / safer
Use the clinician’s scales for low mood and activation/energy; add irritability or anxiety only if the plan includes them.
Wrong / riskier
Average depression and activation into one number.
Add function and observable signs — Observable function and behaviour make a rating more interpretable.
Correct / safer
Record one concrete function result and any personalised warning sign, such as missed work, rapid speech or unusual spending urge.
Wrong / riskier
Use only feelings and omit observable function or warning behaviour.
Method-structure checklist
10 of 10 structural checks present
✓ Ordered, Power-specific instructions — present
✓ Every activity has a success check — present
✓ Materials or supplied records are declared — present
✓ Measurement or assessment rule is present — present
✓ Tutorial-specific troubleshooting is present — present
✓ Stopping or escalation boundary is present — present
✓ Every activity has an adjacent alternative — present
✓ Correct-versus-incorrect comparison is present — present
✓ Evidence context is bound to the Power record — present
✓ Planning metadata is present — present
The method-readiness band and presence checklist assess tutorial presentation and are separate from evidence quality for the underlying Power. They are automated editorial aids, not human approval.
Manual editorial sign-off: Pending. This tutorial must not display a human-approved state until an identified editor signs the exact content hash.