When in doubt, write it out.

 I suggest writing as homework frequently. There are different types of writing exercises that are likely to be helpful for different types of suffering. Here’s a working list. We can add to it when we talk more about it. 

Writing for OCD and anxious doubt

Self-monitoring for daily anxiety and OCD. This writing has a really specific format because I want you to orient yourself towards observing your experience rather than get caught in your content in the anxious moment. Focus on what is happening, rather than figuring out why it’s happening. See this infographicfor questions to answer in your anxious episode or on a daily basis when you are tracking your anxious experiences. 

Scheduled worry time for habitual worry and insomnia due to worry. If you chronically worry about all kinds of different things, try scheduled worry time for 14 days. Try this also if you have trouble falling asleep, staying asleep, or waking up too early. You might not be worried all day long, but if worry is interrupting your sleep, you should work on it during the day. 

Modified self-monitoring for mental compulsions. In the groups that we discuss Harm OCD, many members have already done effective exposures to their feared content. You don’t avoid anymore, but your mental complusions are so persistent. 

Your best option is to redirect your attention to the present moment (that is, whatever you’re currently doing) while bringing your OCD along. You don’t have to make it go away, but you also don’t have to engage with it. If it seems like you can’t redirect your attention, self-monitoring is a good option. This time, rather than answering “do I have the urge to avoid?,” modify it with the question, “what cognitive mechanism might be keeping me stuck?” It’s probably inflated responsibility. It might be anticipatory anxiety, emotional perfectionism, intolerance of uncertainty or fear of evaluation. Write it down and we’ll make you a plan for the next time you get stuck there. 

Modified self-monitoring for depression. As we’ve discussed, Hopeless, Helpless, Worthless is to Depression what Second Fear is to Anxiety.Depression isn’t lots and lots of sadness. Rather, depression is sadness or some other uncomfortable feeling plus the interpretation of that feeling as an indication that you are hopeless, helpless, or worthless. The other symptoms of depression are the consequence of that interpretation. When you self-monitor for depression, describe what’s happening per usual. When you get to “what am I feeling?,” look for hopeless, helpless, worthless. Ask yourself what other feeling might be triggering that interpretation. I can help you with this once you have an example for me to work with. 

Writing for life doubt

Write a list when you have indecision about major life choices. Try not to spin in worry about this. Write out your options, the values these choices represent, and your feared consequences in either direction. If you have OCD related to decision-making, especially small decisions, do not do this. On the contrary, if you have lots of pros and cons lists, you’ve written everything out, and you’ve talked to everyone you know, this is a cue that you have an uncertainty problem, not a values and prioritization problem. Perhaps all options are good ones. Perhaps all options have potential problematic consequences. Sounds like a great opportunity for surrender. I can’t wait to hear what you learn about yourself. Let’s talk more about values and prioritization. 

Values conflicts with self or others. 
Feeling lost or confused could be a cue that you have a values conflict. You may be distant from your values. You might be having trouble reconciling different priorities that seem connected to your values. 

Write a letter to yourself when you have distance from values. One way to think about psychological health is when your thoughts and feelings are aligned with your behavior and your behaviors are aligned with your beliefs and values. If you avoid what you care about in order to manage uncomfortable thoughts and feelings, you will feel distant from your values. Anxiety, OCD, and depression are painful in and of themselves. Your secondary suffering is that living according to what anxiety, OCD, and depression tell you makes you disconnected from yourself. This is more likely to feel vaguely like being lost, confused, and demoralized than an acute physiological experience, but you might have both. Rather than interpreting the sense of being lost as permanent truth about you, try getting curious about it. 

It makes sense that avoidance over time would impact your relationship with yourself, just like avoidance from a friend or partner would impact your relationship with them. Try writing to yourself the way you would write to a romantic partner you lost and you want back. What are you sorry about? What needs to happen to have a good relationship with yourself again? What do you want to commit to and what might be hard about attempting to do it? 

Write a letter to yourself or your partner to align your priorities with your values.Sometimes the confusion is because you are thinking rigidly about how to express a certain value when, in fact, you have all kinds of options, always. Sometimes this happens with yourself. For instance, you might think, “In order to be successful, I need to get into this school or get this job.” That’s not true. What do you mean by successful and how else could you achieve that priority? Success is not a value. It’s a label, and a meaningless one at that. Meaningful descriptions of what you mean be “success” include these types of statements: “A good job is one where I use my skills,” “A good job is one where I fit in with the company culture,”  “A good job is one that is intellectually stimulating for me,” “A good job is one where what I am paid enables me to live out my other values.” You might think that you value money, status, or appearance for its own sake, but all of those labels have other values under them. Common values include influence, respect, and connection. If you get specific about what you mean by success and then flexible about how you live that out on any given day, you are less likely to feel stressed or lost. 

Values conflicts are common within people and between people. You and your romantic partner may feel stuck by a certain decision upon which you seem to disagree. Rather than blaming each other or withdrawing from each other, try going towards the problem with curiosity. You likely have or had shared values at some point. Your task now is to figure out what each of your values are and how they are playing out in the current decision you are struggling with. Once you are clear on your values, your decision may seem a lot clearer. It can be challenging to figure out your values if the conversations have become tense and you both feel defensive and have the urge to avoid. This is another good time to write a letter. You should both write them. What does the decision mean to you? What values are under the decision? What are some other ways that you could potentially live out that same value? Read each other’s letter before you talk about it again.