Keeping the anxiety log will be most useful if you keep a separate sheet
for each assignment, and make an entry on the sheet for each exposure.
Keep the sheets together in a notebook with the dates listed at the top or
on the side. Just doing them can help you see, in a measurable way, that
your peak anxiety goes down with repeated exposure to the same assignment;
that is, your numbers should drop over the course of the week, from the top
to the bottom of the sheet. This will also give you a way to see that your
numbers will also drop over time between assignments, that is, from sheet
to sheet. This is true even though you will be doing harder assignments as
you go. One other benefit of keeping the anxiety logs is that, if you have
a bad day or a bad week, you have something to look back on to see that you
have been making improvements. Remember the spiral of contraction and
expansion that we presented in the first chapter? Well, that basically
said that even though you will be continually improving overall, you might
have a bad day or even a bad week from time to time. When you do, it's
helpful to have something to look back on, something in numbers to show
that it's just a bad week, that overall you're doing better and that your
anxiety is going down and you're accomplishing more. The anxiety log is a
great tool for exactly that.
Assignments, help and "cheating." Let's review how to set up assignments.
Once you know what level of anxiety you're ready to work on, choose
something from that level on your hierarchy. It should seem that you can
do it, experiencing only a little anxiety. Then plan to do that assignment
at least once a day every day of that week. Do it more often than once a
day if you can, because more repetitions help get each of these pieces
anchored in better. Even if you end up not feeling any residual anxiety
after three or four couple of exposures, repeat it anyway, and make sure
that you reinforce it as a completed assignment. We do that in the
behavior therapy group as well. Try to record your anxiety levels as you
do this on the anxiety log. Sometimes you won't have ready access to a
log, or you might not be in a position where you can write immediately, so
record it as soon as you can before you forget what the anxiety felt like.
If you have trouble, first try figuring out why. Often the item was not
written out specifically on the hierarchy, but you don't notice that until
you try it. You might have to improvise and make it more specific on the
spot. Or it might be too difficult for you at the time. If you try it two
or three times and can't get it done, don't worry. That's another
important piece of information (that the assignment was too hard for you
right now) and is never counted as a failure. Bring it up with your group
or therapist and discuss the problem. They'll try to help you figure it
out how to make it more workable and less intimidating.
One last word about "cheating." Cheating is anything you do to reduce the
anxiety you're supposed to be feeling for the sake of the assignment. Some
people refer to this as "using safety maneuvers," and this isn't a bad
choice of words since we don't intend any blame here. It's meant as silly,
grade-school type of reminder that the assignment was too hard the way it
was stated. Anxiety reduction is normally a good thing, but not when you
use it to get through assignments. This especially includes getting
someone else to reassure you (or to do it for you), re-working the
assignment so that it doesn't cause any anxiety and taking anti-anxiety
medication just before an assignment. Remember that each of these
assignments is designed by you with your therapist's help to create only a
manageable amount of anxiety. The brain needs the experience of having the
anxiety dissipate by iteslf, without reassurrance or rituals, in order to
make the chemical changes that you want. If you find you can't do the
assignment any other way, then it was too hard to start with; time to
choose an easier assignment. It won't help your recovery at all to avoid
the anxiety, since your brain needs to know it can handle the challenge.
And if you're in a behavior therapy group, the group will be able to call
you on it, since they too know what it is. So if you have any questions
about what might constitute cheating in any particular situation, please
ask your therapist or group whenever it comes up.
Choices. At this point you've been educated about the problem and the
process of recovery, and you have some choices to make. One of the
possible choices is that you might want to stop here, collect your
education and go on with your lives. That choice is very workable for some
people. Another choice, now that you know what the options are, is to go
back to see your psychiatrist and either start taking, or stick with, a
medication program that's right for you. That alone might be right for
other people. Some of you will want to choose a behavior therapy program,
either instead of or in addition to your medications. In this case, you
have the choice of pursuing that, and you may have the choice of individual
therapy or group therapy. Both have their advantages and disadvantages.
Individual therapy can be faster and more tailored to your individual
needs. However, you may end up paying more money for it than for group,
and will miss out on the benefit of having other people with OCD, the true
experts, assist in your recovery. Finally, you might choose some
combination of group and individual, couples or family therapy if you think
that those other modalities would be helpful.
That's the end of our 6-session psycho-educational course about OCD. Take
the time you need to decide where to go from here, and ask questions of
your prvoviders; be an informed consumer. If you needs any additional
answers to questions, please check out the list of referrals and other
OCD-related resources here.
Figure 14 - The Anxiety Log
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