You can't force yourself to fall asleep, but you can create the conditions to make sleep more likely by practicing good sleep hygiene. Similarly, we can't use willpower to prevent psychological suffering, but we can create the conditions to make good mental health more likely.

The conditions for good mental health start with connection both with yourself and others. Compassion is the skill that makes connection possible. Compassion is for mental health what a comfortable bed is for sleeping. We can fall asleep without a comfortable bed, but it will be challenging and uncomfortable. It isn't a long-term solution. Similarly, in any given moment, we can work through an anxious sensation or thought without compassion, but it will be challenging and uncomfortable. It feels better in the moment and will help us feel better long-term to bring along a compassionate attitude while we are learning how to relate effectively to anxiety, unwanted intrusive thoughts or mood symptoms.

Compassion includes mindfulness. It's paying attention, on purpose, to what's happening in our private experience instead of analyzing why it's happening. It's staying present to this experience happening now, rather than ruminating about what happened in the past or anticipating whether it will happen in the future.

Compassion includes kindness. It's treating ourselves in words and actions as we would our close friend. It's noticing the urge to beat ourselves up and choosing to redirect our self-talk to something that is helpful.

Compassion includes common humanity. It's remembering that the suffering we are experiencing happens to other people too. Other people also suffer just like us and other people work through it, just like we can. We might feel alone and hopeless, but that doesn't mean we are.

Shame is the opposite of connection and compassion is the skill that makes connection possible, both with yourself and with others. If in the presence of shame, we can access self-compassion, we will start feeling connected to ourselves and others. Our feelings of connection will reduce your shame. The reduction of shame will increase your self-compassion and make it easier to continue to connect.

As it pertains to creating the conditions to make good mental health more likely, we want to learn to use the momentum of any success you have using the skills. Oftentimes, due to perfectionism, people start expecting too much from themselves as soon as they learn something about mental health.

For instance, as soon as you learn that avoidance creates, maintains, and intensifies anxiety, you might think that you can immediately stop avoiding. I doubt it. Rather, it will take time, patience, and willingness to practice to slowly and gently observe the subtle and not-so-subtle thoughts, feelings, and behaviors that create and maintain your avoidance and then challenge them with courage and humor. It's hard! It's hard to live with it and it's hard to recover from it. It's okay to be frustrated or angry about that. Also, when you start to make progress, don't minimize it. Use it. Any success is worth celebrating and reinforcing. Use what you're doing well to help you take the next step.

The smallest next step to running a marathon is putting your shoes on. The smallest next step to writing a paper is opening the notebook or computer file where you will write. The smallest next step to managing hunger is obtaining food. To achieve a goal, create a habit that sets you up to make the conditions of achieving the goal more likely.

You know that you experience anxiety, unwanted intrusive thoughts, or mood symptoms. Can you accept that this occurs as a portion of your experience, like you accept that hunger is part of your human experience? You plan for hunger. Can you plan for your psychological suffering? A good plan includes both planning for increasing or maintaining your functioning and managing your distress more effectively. For instance, making a commitment to stretching every day regardless of how you feel can increase your functioning. Making a commitment to exposing yourself to an anxiety-provoking situation every day on purpose can help you manage your distress more effectively. In both cases, it's okay to take the smallest next step. Commit to the smallest next step and then always do it again tomorrow.

Whether you're a baby or an adult, falling asleep is made easier when you are exceedingly comfortable. Just like you can't force yourself to have good mental health, you can't force yourself to fall asleep. You can create the conditions that make good mental health more likely and you can also create conditions that make sleep more likely. 

Conditions that make sleep more likely include:

• Go to bed around the same time every night and get out of bed around the same time every morning. 

• If you've been trying to sleep for 20 minutes or more, get out of bed, sit in an uncomfortable chair and stare at the wall until you feel sleepy. Repeat until you fall asleep.

• Make the space you sleep in comfortable, including darkness and blankets that fit the temperature you enjoy. 

• Only use your bed for sleeping. 

• Develop a bedtime ritual. 

• Avoid caffeine and alcohol.

• If you must nap, nap before 3pm and sleep less than 1 hour (preferably 15-20 minutes). 

Falling asleep requires the same surrender as relating well to anxiety. Let your thoughts be there without engaging while feeling the sensations in your body. 

Sleep is more challenging when you feel a lot of pressure about it. If you can, try to remember that there have been days in your past that felt too difficult to get through, and you've gotten through them. You've been very tired before. You've let people down before. Whatever you are afraid of -- whether it's not being able to live up to your commitments or being very tired during those commitments -- try your best to commit to the smallest next step and then get through the next day. It won't feel like you're always just getting through the next day if you get yourself some experiential confidence that you can make it through your day. 

Many people seek psychotherapy because they just don’t feel good. They say they feel stuck or that they don’t feel like themselves. They feel tense and keyed up. They can’t stop worrying about work, money, or their relationships. Many say they’ve been sleeping too much or waking up throughout the night. They’ve started drinking or smoking more often. They’ve started eating less healthfully and they never exercise. They have no sense of energy when they wake up in the morning and instead feel dread and fear about what’s coming next. Some people can articulate that they feel lonely, sad, disappointed, confused, anxious. Many others just feel a vague sense of numbness and fatigue. They just don’t feel well.

Sometimes there are external circumstances, like the death of a loved one, a divorce, or a stressful transition, that triggered their change in thoughts, feelings, and behaviors. It is just as likely that there is no external circumstance that explains the change.

In the search for wellbeing, you may have tried all kinds of interventions to help yourself feel better before seeking psychotherapy. You or your friends and family see that you aren’t acting like yourself, that you are sleeping, eating, drinking, and exercising differently. You are tense and irritable or withdrawn and isolating yourself more often. You might try committing to exercise, eating better, drinking and smoking less, sleeping regularly, meditating, putting “boundaries” around work. Sometimes this brings relief and restores your sense of well-being. I am not against any of these healthy lifestyle behaviors.

I want to talk about what’s occurring when healthy lifestyle behavior changes don’t “work.” Let’s discuss what’s happening when no matter how healthy your lifestyle is, you still don’t have a sense of well-being. Or, no matter how much you want to commit to certain behaviors, you can’t seem to commit on a regular basis.

Suffering or wellbeing occurs based on how you relate to your mind and body, not from what you do. It’s not what you do, but how you do it.

People who relate to their thoughts, feelings, and sensations with openness, compassion, and courage do not have the desire to engage in self-destructive behaviors. Self-regulation in the form of balanced sleeping, eating, exercising, working, and socializing occurs naturally, because there’s no fight to be or feel a certain way.

In contrast, people who relate to their thoughts, feelings, and sensations with fear, distrust, anger, guilt, and shame will attempt to avoid themselves. The behaviors they choose in the attempt to avoid themselves often offer immediate relief but in the long-run intensify the feared thoughts, feelings, and sensations. Self-regulation is difficult and feels forced. The constant effort is burdensome and it gets harder and harder to maintain balance. It feels like willpower is required to maintain balance and self-regulation. This becomes a self-fulfilling prophecy, because the more willpower the person uses to maintain equilibrium while avoiding uncomfortable thoughts, feelings, and sensations, the more willpower is required.

Many individuals are so used to using effort to control their thoughts, feelings, and sensations, that they don’t even know that there is another option. Relaxing their effortful control of their thoughts, feelings, and sensations feels terrifying and threatening; they worry that if they embraced this posture, they would “give up,” “lose control,” or something else catastrophic would occur.

Fortunately, relaxing your attempts at control of your internal experience and relating to your thoughts, feelings, and sensations with compassion and courage is a learnable skill. It is not an inherent personality characteristic that some people have and other people do not. Some people have biological and environmental life circumstances that make it easier to relate to themselves with compassion and courage, but overall, it is a learnable skill set.

Work on opening up to your internal experience with compassion rather than criticism. This takes time and practice. Healthy lifestyle changes will likely occur as the result of facing internal or external pain with courage and compassion, not willpower.

There are different types of writing exercises that are likely to be helpful for different types of suffering.

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. You should track:

What triggered you?

What sensations, thoughts, and behavioral urges did you have?

What did you do in response?

Was your response consistent with your values? How could you respond more consistently with your values in the future?

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. 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. 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 as usual. When you get to "what am I feeling?," look for hopeless, helpless, worthless. Ask yourself what other feeling might be triggering that interpretation.

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.

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.