Directions: Choose one anxiety or OCD theme at a time. Write what your mind is afraid might happen, what tends to set the fear off, what you do to feel safer or reduce anxiety, and the outcome you are ultimately trying to prevent. There are no “right” answers. Use your own words.
Tip: For general anxiety, “compulsions” may look more like avoidance, reassurance-seeking, overplanning, checking, distraction, or other safety behaviors.
2. Triggers
What this means: Triggers are situations, thoughts, feelings, memories, sensations, people, places, images, or uncertainty that make the fear show up or make anxiety increase.
Example: Driving on the highway; hearing about a car accident; feeling my heart race; being alone; seeing a knife; getting an unclear text.
Things that trigger or increase this fear (list as many as you notice):
3. Compulsions / Safety Behaviors
What this means: Write down what you do (out loud, in your mind, or through avoidance) to make the anxiety go away, feel certain, feel safe, or prevent the feared event. These behaviors often help temporarily but can keep the anxiety/OCD cycle going.
Example: Checking the route repeatedly; asking someone for reassurance; Googling symptoms; replaying a conversation; praying until it feels “right”; avoiding driving; distracting myself immediately.
What I do to reduce anxiety or feel safer (list as many as you notice):
4. Feared Outcome
What this means: The feared outcome is the deeper result your mind believes could happen if the fear came true or if you did not use your usual safety behavior. Ask yourself: “What am I ultimately afraid this would mean or lead to?”
Example: If my fear is “What if I die while driving?”, the feared outcome may be “I lose control, crash, and die,” or “My family is left without me.” If my fear is “What if I make a mistake?”, the feared outcome may be “I get fired and people think I am incompetent.”
5. Put the Cycle Together
Example: Here is what one completed anxiety cycle might look like:
| Example | Driving anxiety |
|---|
| What if…? | What if I lose control of my car and crash? |
|---|
| Trigger(s) | Driving on the highway, merging into traffic, hearing about a car accident, or noticing my heart race while driving. |
|---|
| Anxiety / discomfort | 8/10 |
|---|
| Compulsion / safety behavior | Avoid highways, repeatedly check mirrors or the route, drive much slower than needed, or ask a passenger to reassure me that I am safe. |
|---|
| Feared outcome | I could crash, die or seriously hurt someone, and my family could be left without me. |
|---|
Now complete your own cycle below:
Fills any empty boxes below with what you wrote in Sections 1 to 4.
Prefer pen and paper? Click “Print / Save as PDF” without typing anything, and you'll get a blank worksheet with lines to write on by hand.
Prefer an editable file? Click “Save as Word Doc” instead of printing if you would rather edit your answers later before uploading them.
Step 1: When you're finished, click “Print / Save as PDF.” A print window will open on your device. Nothing is sent anywhere automatically at this point.
- On a Mac: click the “PDF” button in the bottom-left corner of the print window, then choose “Save as PDF…” from the menu.
- On Windows: choose “Save as PDF” (or “Microsoft Print to PDF”) from the printer or destination list, then click Save.
- On an iPhone or iPad: tap the share icon on the print preview screen, then choose “Save to Files.”
Save the file somewhere you can find it again, like your Desktop or Downloads folder. Your typing is not saved on this page, so please save the PDF before closing or refreshing.
Step 2: Log into the Client Portal, go to the Documents tab, and scroll to My Uploads. Upload the PDF you just saved (drag and drop it, or click Upload Files), then click Submit or Finish to share it with Mary.
This page is not continuously monitored and is not an emergency communication method.
If you are in immediate danger or experiencing a mental health emergency, call 911, go to the nearest emergency department, or call or text 988.