5 Steps To Changing Any Behavior by Alex Lickerman

From quitting smoking to eating healthier to exercising regularly to getting more organized, most of us have a list of behaviors we’d like to begin (or end) that resist our attempts to do so.  As a physician, I find myself giving advice about changing habits on a daily basis.  Even though many of my patients are able to succeed in making desired changes in the short term, most of them revert to their original behaviors in the long term.  What, then, are effective ways to alter behavior on a permanent basis?

The psychology that underlies the changing of behaviors is complex.  Two researchers named Prochaska and DiClemente developed a way of describing it they called theStages of Change Model.  Though originally developed in the context of smoking cessation, it’s five stages actually describe the process by which all behaviors change.

  1. Precontemplation.  In this stage, we’ve either literally never thought about needing to change a particular behavior or we’ve never thought about itseriously.  Often we receive ideas about things we might need to change from others—family, friends, doctors—but react negatively by reflex.  After all, we’re usually quite happy with our current stable of habits (if we weren’t, we wouldn’t have them in the first place).  However, if we can find our way to react more openly to these messages, we might find some value in them.  Remember, they aren’t sent with the intent to harm.
  2. Contemplation.  Here we’ve begun to actively think about the need to change a behavior, to fully wrap our minds around the idea.  This stage can last anywhere from a moment—to an entire lifetime.  What exactly causes us to move from this stage to the next is always, in my view, the change of an idea (“exercise is important”) into a deeply held belief (“I need to exercise”), as I discussed in an earlier post, Cigarette Smoking Is Caused By A Delusion.  What exactly causes this change, however, is different for everyone and largely unpredictable.  What we think will produce this change isn’t often what does.  For example, it may not be the high cholesterol that gets the overweight man to begin exercising but rather his inability to keep up with his wife when they go shopping.  This is the stage in which obstacles to change tend to rear their ugly heads.  If you get stuck here, as many often do, seek another way to think about the value of the change you’re contemplating.  Remember, it’s all about finding and activating a motivating belief.
  3. Determination.  In this stage, we begin preparing ourselves mentally and often physically for action.  The smoker may throw out all her cigarettes.  The couch potato may join a gym.  We pick quit days.  We schedule start days.  This mustering of a determination is the culmination of the decision to change and fuels the engine that drives you to your goal.  I firmly believe that human beings possess the ability to manifest an unlimited amount of determination when properly motivated by a deeply held belief.
  4. Action.  And then we start.  We wake up and take a power walk.  Or go to the gym.  Or stop smoking.  Wisdom—in the form of behavior—finally manifests.
  5. Maintenance.  This is continuing abstinence from smoking.  Continuing to get to the gym every day.  Continuing to control your intake of calories.  Because initiating a new behavior usually seems like the hardest part of the process of change, we often fail to adequately prepare for the final phase of Maintenance.  Yet without a doubt, maintaining a new behavior is the most challenging part of any behavior change.  One of the reasons we so often fail at Maintenance is because we mistakenly believe the strategies we used to initiate the change will be equally as effective in helping us continue the change.  But they won’t.  Where changing a strongly entrenched habit requires changing our belief about that habit that penetrates deeply into our lives, continually manifesting that wisdom (and therefore that habit) requires that we maintain a high life-condition.  If our mood is low, the wisdom to behave differently seems to disappear and we go back to eating more and exercising less (this isn’t, of course, equally true for all behaviors, especially for addictive behaviors we’ve long ago abandoned).  In a high life-condition, however, that changed belief will continue to manifest as action.  When you’re feeling good, getting yourself to exercise, for example, is easier because the belief that you should exercise remains powerfully stirred up and therefore motivating.  The key, then, to maintaining new behaviors…is to be happy!  Which is why it’s so hard to maintain new behaviors.

The true power of this model really becomes apparent when we recognize these stages are sequential and conditional.  In my medical practice, I first identify the stage in which a patient sits with respect to the behavior I want them to change.  A smoker who’s never seriously considered giving up tobacco would be in the stage of Precontemplation—and if I expected them to jump from that stage over Contemplation and Determination directly to Action, they’d almost certainly fail to change and frustrate us both.  If, however, I focus on ways to move them from one stage to thenext, I can “ripen” them at a pace with which they’re comfortable:  from Contemplation to Determination to Action to Maintenance.  As an example, I often give patients in the stage of Precontemplation a simple assignment:  I ask them to think about how the change I want them to make would improve their lives.  That doesn’t seem like such a difficult step, but if they do it, I’ve just moved them into Contemplation!  That may seem like insignificant progress, but it’s actually 1/5 of the work that needs to be done.  Most people (though certainly not all) seem to be more comfortable embracing change in a step-wise fashion.

The utility of the Stages of Change Model isn’t restricted to the medical arena but in fact extends to almost every area of life.  As an example, my wife used it on me to get me to try sushi (which I now love!).  It could be used in business perhaps on employees to yield changes like improved productivity or cooperation, or even on potential clients to get them to hire you!  The potential applications are limited only by your imagination.

Finally, and most importantly, you can use this model on yourself.  By recognizing which of the five stages of change you find yourself in at any one time with respect to any one behavior you’re trying to change, you can maintain realistic expectations and minimize your frustration.  Focus on reaching the next stage rather than on the end goal, which may seem too far away and therefore discourage you from even starting on the path towards it.


The final stage of any process leading to behavior change is one extremely difficult to avoid:  relapse.  Though it may sometimes be inevitable, if you train yourself to view relapse as only one more stage in the process of change rather than as a failure, you’re much more likely to be able to quickly return to your desired behavior.  Alternatively, when you allow yourself to view relapse as a complete failure, that assessment typically becomes self-fulfilling.  Just because you fell off the diet wagon during a holiday doesn’t mean you’re doomed to return permanently to poor eating habits—unless you think you are and allow yourself to become discouraged, in which case you will.  Long term weight gain or loss, it turns out, isn’t correlated to calorie intake on any one day but rather to calorie intake over a period of time, which essentially means if you overeat here or there on a few days only, it won’t actually affect your long-term ability to lose weight.

The same is true, in fact, with any behavior you want to change.  Never let a few days, or even weeks, of falling back into bad habits discourage you from fighting to reestablish the good habits you want.  Always remember:  none of us was born with any habits at all.  They were all learned, and can all, therefore, be unlearned.  The question is:  how badly do you really want to change?


Why Are You Here? by Robert M. Sherfield, Ph.D.

Do you sit around thinking of an answer to this question on a daily basis? Probably not. It is not a question that many people ponder on a daily or even yearly basis, but it is a question that needs to be examined when searching for purpose.

Earlier, the ancient Sanskrit word dharma was mentioned. Dharma means purpose in life. According to this word, you have a rare gift, a unique talent, and an uncommon way of bringing that gift to life.

Have you discovered your dharma? Have you given thought to why you are here? Discovering your gifts can very well lead you to your purpose, which in turn can lead you to healthier self-esteem.

Ask yourself a few questions. What are your unique talents? What are your unique abilities? What do you do that you don’t see anyone else doing? What can you do that you see others doing but not as well as you do? What aptitudes and powers do you have that you simply don’t see exercised every day? Answering these questions can help you find your purpose.

Let’s turn this around for a moment and look at it from the negative side. Sometimes, finding your purpose, and indeed your esteem, comes from looking at what you do not do well, and then changing your actions accordingly.


“Everyone has a purpose in life … a unique gift or special talent to give others. And when we blend this unique talent with service to others, we experience the ecstasy and exultation of our own spirit, which is the ultimate goal of all goals.”

— Deepak Chopra

So, what is it that you do on a daily basis that you do not do very well? What do you do on a daily basis that you do not enjoy doing? What do you do that does not bring you joy? What do you do that does not serve humanity and make the world a better place?

Answering those questions can help you better identify the things that you do well, enjoy doing, and the things that bring goodness into the world.

Overcoming The Fear Of Death

In January of 2007, I developed a mild stomach ache and general feeling of being unwell while at a Sunday brunch.  Initially, the pain sat in the center of my abdomen just above my belly button, but gradually over the course of the day inched its way down into my right lower quadrant, causing me to wonder briefly if I’d developed acute appendicitis.  However, by evening the pain had actually begun to improve so I dismissed the possibility; I’d never heard of a case of appendicitis resolving on its own without surgery.  But mindful of the adage that the physician who treats himself has a fool for a patient, the next day I asked one of my physician friends to examine me.  When he did, he found a fullness he didn’t like in my right lower quadrant and ordered a CT scan.  To our mutual surprise, it showed that I had, in fact, developed acute appendicitis.

Later that afternoon, I saw a surgeon who began me on antibiotics and scheduled an elective laparscopic appendectomy, which he performed two days later.  The surgery went well and I was back at home that night with a bloated stomach but minimal discomfort.

At 3 a.m., however, I awoke with projectile vomiting, and after a particularly violent episode, briefly lost consciousness.  Panicked, my wife called 911 and an ambulance delivered me back to the hospital where I was found to be anemic.  My surgeon diagnosed an intra-abdominal bleed and began following my red blood cell count every few hours, hoping the bleeding would stop on its own.  By late afternoon, however, it became clear that it wasn’t, so I was taken back to the operating room where the surgeon found and evacuated approximately 1.5 liters of free-flowing blood from inside my abdomen.  All told, I’d bled out half of my blood volume over the course of sixteen hours.  Over the next few days, however, my blood count stabilized and my strength returned, so I was sent home four days after I’d been admitted, slightly less bloated than I’d been after the first surgery but four units more full of a stranger’s blood.

Three weeks later, my wife and I took a four-hour flight to Mexico—a vacation we’d planned to take in Cabo San Lucas prior to my illness—spent three days on the beach, and then flew back home.

Two days later, I developed diarrhea.  Because I’d only had bottled water while in Mexico, I thought I’d contracted a viral gastroenteritis that would resolve on its own within a few days.  While driving home a few days later, however, I developed right-sided chest pain.  I called my physician friend who asked me to return immediately to the hospital to have a chest CT, which in short order showed I’d thrown a largepulmonary embolism.  I was taken immediately to the emergency room and placed on intravenous blood thinners to prevent another clot from traveling to my lung and possibly killing me.  Luckily, this time my hospital stay was uneventful, and I was ultimately discharged on an oral anti-coagulant called coumadin.

A week later, the diarrhea still hadn’t resolved, however, so a stool culture was sent forclostridium difficile.  It came back positive, undoubtedly as a result of the antibiotics I’d been given prior to my first surgery, so I was started on Vancomycin.  Then I developed an allergic reaction to the Vancomycin, so I was switched to Flagyl.  Within a week the diarrhea resolved, but then a week later it returned.  Relapses are common with clostridium difficile colitis, so I tried Flagyl again, this time with a probiotic called Florastor.  The diarrhea resolved and never came back.

A week later, however, the nausea did.  It was absolutely crippling—as was the anxiety that accompanied it.  What could possibly be wrong now?  I longed for the blissful ignorance of a non-medical mind that had no knowledge of all the terrible diseases I now thought I might have.  I called my physician friend who suggested, after listening to my symptoms, that the nausea might be due to anxiety.  I told him that idea hadn’t occurred to me, that I’d supposed the anxiety was present as a result of the nausea, not as its cause, but that I was open to the possibility he was right.  The next day I had a conversation with a psychiatrist who diagnosed me with mild Post-Traumatic Stress Disorder (PTSD).


I’m always surprised by people who say they’re not afraid to die.  Most are usually quick to point out they are afraid to die painfully—but not of  the idea of no longer being alive.  I continue to be mystified not only by this answer but by the number of people who give it.  Though I can imagine there are indeed people who, because of their age, character, or religious beliefs, truly do feel this way, I’ve always wondered if that answer hides a denial so deeply seated it cannot be faced by most.

Certainly, this has been the case with me.  I love being here and don’t want to leave.  I’ve always spoken openly of my fear of death to anyone who’s ever asked (not that many have—I suppose even the question is uncomfortable for most), but I’ve rarely experienced moments where I actually felt afraid.  Whenever I’ve tried wrapping my mind around the concept of my own demise—truly envisioned the world continuing on without me, the essence of what I am utterly gone forever—I’ve unearthed a fear so overwhelming my mind has been turned aside as if my imagination and the idea of my own end were two magnets of identical polarity, unwilling to meet no matter how hard I tried to make them.


The true significance of my denial wasn’t made clear to me, however, until I was diagnosed with PTSD.  The anxiety that began to envelop me at that point was of an entirely different order than I’d ever experienced before.  It began to interfere with my ability to function, which made plain to me that what my brush with death—twice—had taken from me was my ability to believe I would never die.  Knowing intellectuallythat death awaits us is quite clearly a different thing from believing it, much in the same way knowing intellectually gravity will make you fall is a different experience from actually swooning at the edge of a parapet at the top of a tall building.  Ultimately, being ill brought me to the realization, contrary to what I’d always believed in my heart, that there was nothing special about me at all.  Like everyone else, I was only a piece of meat that would eventually spoil.

From that point forward, whenever I’d feel a minor twinge in my chest or develop a rash on my arms or my hand would shake for no reason I would become paralyzed with anxiety.  Even though I recognized intellectually that my reaction was overblown, every new random symptom I felt caused my doctor’s brain to leap to horrifying conclusions simply because I now knew in a way I hadn’t before that bad things could actually happen to me.  I felt like one of my long-time patients who for as long as I’ve known him has been consumed by an anxiety so great he’d become like a child in his need for constant reassurance that he would be all right.  His anxiety had made him inconsolable and his life a joyless nightmare.

PTSD is often diagnosed in men (and now women) who return from the battlefield, women who’ve been raped, people who witnessed the Twin Towers come down on 9/11—in short, in anyone who either has an intense traumatic experience themselves or witnesses one occurring to someone else.  In my view—completely unsubstantiated by any psychiatric literature, I should point out—PTSD results when a person has their deluded belief that they’re going to live forever stripped away from them.


I’d always considered the shattering of delusion in my life to be a good thing, something that’s always brought me more happiness rather than less.  And yet here seemed to be an example that contradicted that rule, for around the time I was diagnosed with PTSD I was surely suffering to a degree I never had.  Frankly, I was happier before living in denial.

Over time, though, the crippling anxiety of PTSD resolved and I returned to my previous level of functioning.  However, even minor injuries or transient symptoms that I would have ignored before now stir up vague feelings of worry.  I remain acutely aware to this day that my ability to believe in my invulnerability has been irrevocably ruined.

I’ve decided, however, that this is a good thing:  I’ve been given the opportunity to challenge my fear of death without actually having to be actively dying.  Many others aren’t so lucky.  I began practicing Nichiren Buddhism 20 years ago because I was intrigued by the notion that enlightenment might actually be a real thing, attainable if only the correct path was followed.  I’ve continued because I’ve had experiences with the practice that have convinced me it has real power to shatter delusions about life.  But now more than an intellectual curiosity, my desire for enlightenment has become synonymous with my desire to relieve myself of delusions about death.

For me, three things are certain:  First, my experiences with Buddhism so far have inclined me to think that enlightenment is a real thing, and that it might be the solution to my problem with fear of death.  But, second, for me to become convinced that life is eternal (“there is no beginning called birth or ending called death”), I must have an experience that proves it to me beyond a shadow of a doubt.  I need to know it the way I know gravity is real.  I must confess I can’t today even conceive of what that experience could be.  Yet I must remember that every time I’ve gained real wisdom from my Buddhist practice and become genuinely happier, it’s always come as a result of having an experience I could never have predicted.  And lastly, because I hope the establishment of indestructible happiness based on a belief in the eternity of life is possible, I must remain on guard against the seductive tendency to convince myself of it.  Belief that arises from a desire to believe is usually, in my experience, too flimsy to withstand a genuine challenge.  And I can think of no more genuine a challenge to a belief in life after death (whether through reincarnation or an ascension to Heaven or anything else) than the actual imminent approach of death itself.

I fully recognize that my current belief about death—that it is truly the final end of the self—is likely to be correct.  Which makes me wonder if I wouldn’t be better off throwing my energies into re-embracing denial and simply accepting that when it comes my time to die, if I’m given the chance to see it coming, I’ll suffer however many moments, hours, days, or weeks of fear there are to suffer and then be granted a final release.

If only I could.  Once a delusion has been shattered, I’ve found there’s no going back.  And even if there were, at some point I’m certain to be re-confronted with a denial-eradicating sickness or injury.  Everyone will.  Depending on your current life stage this might not seem like a pressing issue.  But shouldn’t it be?  An experience like mine could become yours at any moment.  And even more desirable than being able to die peacefully is being able to live fearlessly.  In fact, one of the supposed benefits of manifesting the life-condition of the Buddha is freedom from all fear.

I’ve tried to resolve my fear of death intellectually and come to the conclusion that it can’t be done, at least not by me.  Some kind of practice that actually has the power to awaken me to the truth is required (assuming, of course, the truth ends up being what I hope it to be).

Knowing What You Need by Robert M. Sherfield, Ph.D.

Finding your purpose in life may rest in that one question: What do you need — not what do you want, but what do you need? Your needs are quite powerful and they may hold the key to helping you discover your purpose.

There is a difference between need and want. To need is to require, to want is to desire something greatly. Needs are stronger than wants. Many people confuse the two.

Needs involve things that are required to actually help you live, but they also involve things that are required to help you live well. Psychologist Abraham Maslow identified several levels of needs in every human, including basic needs such as air, water, safety, love, and esteem, higher-level intellectual needs, and finally, the need for self-actualization or self-fulfillment.

So, what do you really need in your life? Do you need happiness? Do you need passion? Do you need love? Do you need caffeine? Do you need to have purpose?


“If you deliberately plan to be less than you are capable of being, then I want to warn you that you’ll be deeply unhappy the rest of your life.”

— Abraham Maslow

Stop reading for a moment and make two lists — one list should be the things you need to actuallysurvive, and the other list should involve things you need to live in true self. Do not include wants. Make your list now.

Survival and True SelfWas that a hard task? Look at your list and see if there are any “wants” listed? Can you tell the difference? If you have listed things like a new car, a luxurious home, a supercomputer, you are listing “wants” instead of needs.

If your needs list for survival includes things like food, shelter, clothing, safety, and some money, you are on the right track. If your needs list for “true self” includes things like family, friends, passion, and intimacy, you are on the right track.

What is the lowest common denominator in the list of “true self” needs? It is people. So, it can be said that a part of your needs for “true self” is an association with people.

Take a moment and think about your list of needs for “true self.” After you review your list, look for the common denominators such as people, power, the need to be outdoors, the need to have creative access, or the need to feel needed. This will help you begin to define and refine your purpose.

The Case of GloriaGloria felt lost, absolutely lost. She felt alone, empty, and unfulfilled in her home life, her career, and in her heart. She knew that her life was not in sync with her purpose, but she did not know what her purpose really was. She had tried to find her purpose while in college. She majored in office administration and had become a very successful executive assistant. While the people she worked with loved how she did her job, she did not love her career.

She sat down one weekend and tried to think about the things in her life that brought her joy. She listed her friends, her two cats, food, music, going to the movies, and reading. But she wondered how her purpose could be found in a hot dog and Gone With the Wind. She began to list the things that she really needed in her life. Her list revealed that she needed to feel loved and give love, she needed to feel safe, both in terms of physical safety and in terms of monetary safety, and she listed that she needed her two pets.

That was a very strange and unexpected thing for her to find on her list. She knew that she loved her pets and cared for them deeply, but she never dreamed that pets would appear on an honest list of basic “true self” needs. But there they were, larger than life.

What does this mean, she thought? So, she began to explore further and realized that she not only loved her pets dearly, but that she had always loved others’ pets as well. She thought back across her life and realized that she had always taken in stray cats and dogs, and on occasion, she had volunteered to pet sit for friends going out of town.


“Happiness is the meaning and the purpose, the whole aim and end of human existence.”

— Aristotle

She made a decision to take a step. She went to the computer, created several flyers and some business cards, and decided that on Monday, she would begin to let people know that she was available to “pet sit” on a limited basis. She wondered if she would enjoy it as much as she had in the past. She knew that she had the skills, knowledge, and desire to do it, but she wondered if this new part-time job would bring her joy.

She booked a few jobs and found that she was in love with being around animals and caring for them in their owner’s absence. She was giving love and feeling love. She began to book more sitting jobs in the early mornings, walks during lunch, and feeding in the evening. She could not believe how much elation this had brought to her life.

Her friends could not believe it either and thought that she had gone overboard with the number of bookings. She knew that she had not. She knew that bigger things were on the horizon. She knew that in one month, she would quit her job and become a professional pet sitter. She had found her passion, her calling, and her joy. There it was written on a strange little list during a weekend of soul-searching. There it was, in the face of her two cats, her purpose.

The True Cause Of Depression by Alex Lickerman

About two years ago a patient of mine, Mr. Burndt (not his real name), committed suicide.  When his wife, who was also my patient, told me the news at one of her visits, I was shocked.  Fully aware that 40% of older patients who are suicidal visit their primary care doctors within one week of killing themselves, I found myself wondering over and over how I’d missed recognizing the severity of his distress.  I’d known he’d been suffering from depression but had thought it mild.

But even more shocking than the news of his suicide was the reason his wife gave for it:  six months earlier, he’d been involved in a car accident and had inadvertently killed a pedestrian.  In the end, he simply couldn’t live with the guilt.


The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies depression into the following types (there are even more, but these cover the basics):

  1. Dysthymia.  In essence, having a depressed mood on most days for at least two years.
  2. Major Depressive Disorder.  In addition to feeling “down” as in dysthymia, other characteristics may include excessive feelings of guilt and suicidal ideation, as well as various physical symptoms like loss of hunger and fatigue.  It can be mild, moderate, or severe.
  3. Adjustment Disorder with Depressed Mood.  This is grief due to a loss of some kind (which itself can be classified as normal or complicated).
  4. Depression NOS (not otherwise specified).  Includes things like premenstrual depression and seasonal depression (SAD).
  5. Secondary depression.  Depression due to an underlying medical disorder like Cushing’s disease or hypothyroidism.

Though not in DSM-IV, some practitioners further classify depression into two broad types:

  • Endogenous (or chemical) depression to denote depression that arises without an obvious identifiable cause, thought to reflect some kind of “chemical imbalance” in the brain.
  • Exogenous (or external) depression which is thought to arise from a specific, identifiable external cause.

Given this confusing and non-parallel classification scheme it’s astonishing doctors don’t become depressed themselves as they try to figure out into which bucket their patient’s depression fits!

How can we make sense of all this and, more importantly, understand the real cause of depression in order to augment the effectiveness of currently available therapies?


First, we need to recognize the distinction between chemical and external depression is becoming outdated.  Many neuroscientists have suggested that the mind arises from, and is actually caused by, the physical brain, meaning chemical and electrical reactions somehow give rise to thoughts and emotions.  Evidence in support of this theory can be found in numerous studies that show altering brain chemistry with anti-depressant drugs (chemicals) can make depressed people feel better emotionally.  The same is true for anxiolytics (like Valium) and their effect on anxiety.

But recently, with the advent of functional MRI scans (fMRI), we now have proof the opposite is equally true, that changes in thinking cause significant, measurable changes in brain chemistry and functioning.  In one study, patients suffering from spider phobia underwent fMRI scanning before and after receiving cognitive behavioral therapy aimed at eliminating their fear of spiders.  Scans were then compared to normal subjects without spider phobia.  Results showed that brain function in patients with spider phobia before receiving cognitive behavioral therapy were abnormal compared to subjects without spider phobia but then changed to match normal brain patterns after cognitive behavioral therapy.  This may represent the best evidence to date that changes made at the mind level are able to functionally “rewire” the brain, and that the brain and the mind are more mutually influential than we’d previously thought.  It certainly supports the Buddhist view that brain and mind are in fact only two sides of the same coin, or different ways of viewing the same single thing.


Where, then, does the true cause of depression lie?  I would argue that depression arises at its core from a belief that we’re powerless to solve our problems.

This is clearly true with people who know why they’re depressed:  invariably, once they figure out how to solve their particular problem, their depression lifts.  But I would also argue this holds true for people who are depressed for no reason they know.  Why?  Because thoughts can trigger feelings that remain stirred up long after the thoughts themselves have been forgotten.  Some studies have suggested people think upwards of 12,000 thoughts per day.  How could we ever remember them all?  Yet a fleeting thought we might have had this morning about the possibility of losing our job can and often does leave an emotional residue that lasts hours, days, weeks, or even longer.  I would argue, therefore, any depression that appears to be “chemical” is more likely caused by a thought that simply isn’t remembered—a thought about a problem we don’t believe we can solve.

Further, sometimes what appears to be a “chemical” depression is caused by a thought that isn’t directly or consciously recognized.  These thoughts are often about problems that seem so unbearably awful and unsolvable we literally don’t want (and often refuse) to think about them (such as our becoming jobless or the prospect of our own death).

Finally, I believe the commonly accepted idea that some forms of depression like depression NOS and secondary depression (#4 and #5 above) are caused by chemical or hormonal abnormalities overstates the case.  I’d suggest an alternative explanation, that these forms of depression have a chemical or hormonal influence—reducing our ability to believe we can solve our problems but not entirely eliminating it.  At first glance this might not appear to be a significant distinction given how incredibly difficult it is to believe in our ability to solve problems, for example, when experiencing premenstrual syndrome.  But knowing intellectually we can win even if we’re having a hard time believing it can help to sustain the most valuable thing depression tends to reduce:  hope.


None of this is by any means to say we can simply decide to believe we can solve a particular problem when no solution is obvious or forthcoming.  Changing any belief, whether consciously recognized or not, is one of the hardest things to do.  But armed with a clearer understanding of the true cause of depression we can consider the following steps to help ourselves:

  1. Find a way to raise your life-condition.  Your inner life state has more to do with your ability to believe you can solve your problems than anything that may be actually going on in your life.  If your thoughts are swirling in despair, take action to break free of them and attain a fresh perspective.  Become immersed in a great book that moves you or watch a movie that transports you.  Exercise.  Go where it’s warm.  Chant Nam-myoho-renge-kyo.  In short, do what you know from experience bounces your thinking to a more optimistic place.
  2. Identify the problem or problems you don’t think you can solve.  It’s amazing how often you don’t know why you’re depressed and how helpful it can be to figure it out.  Making a list of everything that’s bothering you—a sort of stream-of-consciousness rant on paper—can be a fantastically helpful exercise.  Or if you do know why you’re depressed, recognizing the cause isn’t that you have a problem per se but rather that you have a problem you don’t believe you can solve can be remarkably empowering.  Also, sometimes we become depressed not because we have one problem we believe we can’t solve but because we have multiple problems we believe we can’t solve.  Handling challenges can be likened to balancing a “plate” of a certain size:  if we pile too many problems onto it, not only do we risk having it topple over, we often find ourselves wanting to pitch the whole thing on purpose.  When this is the case, allow yourself to only worry about and focus on solving one problem at a time.
  3. Identify the reason a problem seems unsolvable.  As I pointed out in a previous post, Changing Poison Into Medicine, many things erroneously cause us to conclude we’re deadlocked, chief among them our inability to identify a solution to our problem right now.
  4. Recognize that your thoughts are profoundly influenced by your mood.  Once depression has established itself, it takes on an insidious life of it’s own, further diminishing your belief in your ability to solve problems, your ability to plan, and your ability to have hope for the future.  In this way the cause of any depression always reinforces itself.
  5. Remember that your depressed self is not your true self.  Whatever life-condition you find yourself in at any one moment always feels like the only life-condition you’ve ever had or will have.  But your life-condition can and often does change literally from moment to moment.
  6. Understand that anti-depressants only treat the symptoms of depression.  None of the foregoing has been intended as a denial that anti-depressant medication plays a critical role in the treatment of depression.  In the right patient, anti-depressants reduce the symptoms of suffering exceptionally well and can be literally life-saving.  But they can’t make anyone actually happybecause happiness isn’t merely the absence of suffering.  The best approach, in my view, is to treat the symptoms of depression with anti-depressants (or cognitive therapy or even electroconvulsive therapy) when symptoms are severe enough to warrant it while at the same time attempting to address the underlying cause of the depression itself.

I fully recognize that as a means to battle depression—especially a deep, all-consuming depression—these suggestions are inadequate.  My point in making them, however, is to emphasize that the single most effective means to resolve a depression is to find a way to tap into our immense power to solve problems.

In a sense, we’re all on a journey to find just such a way.  For me, the practice of Buddhism has been a consistently effective means by which to win over obstacles I didn’t believe I could, a tool that has enabled me to manifest wisdom, courage, and most importantly concrete solutions I don’t believe I would have stumbled upon had I not been practicing.  If you have a different means that your experience has demonstrated works, stick with it.  If not, spur yourself on to explore other paths until you find one that proves it has real power.

In retrospect, I wish I’d suggested to Mr. Burdnt that he think about his guilt over the death of the pedestrian he caused as a problem to be solved—and more importantly as a problem that could be solved.  Perhaps had I also begun him on an anti-depressant medication to stave off what were obviously strong suicidal thoughts, he might have had time to work through his guilt.  Perhaps he could have shaken loose from its grip in time to forgive himself, and his depression might have lifted.  But I’ll never know.  And that’s a problem I have to solve for myself.

Murray’s Theory of Psychogenic Needs

Henry Murray and Psychogenic Needs

American psychologist Henry Murray (1893-1988) developed a theory of personality that was organized in terms of motives, presses, and needs. Murray described a needs as a, “potentiality or readiness to respond in a certain way under certain given circumstances” (1938).

Theories of personality based upon needs and motives suggest that our personalities are a reflection of behaviors controlled by needs. While some needs are temporary and changing, other needs are more deeply seated in our nature. According to Murray, these psychogenic needs function mostly on the unconscious level, but play a major role in our personality.

Murray’s Types of Needs

Murray identified needs as one of two types:

    1. Primary Needs
      Primary needs are based upon biological demands, such as the need for oxygen, food, and water.
  1. Secondary Needs
    Secondary needs are generally psychological, such as the need for nurturing, independence, and achievement.

List of Psychogenic Needs

The following is a partial list of 24 needs identified by Murray and his colleagues. According to Murray, all people have these needs, but each individual tends to have a certain level of each need.

1. Ambition Needs

    • Achievement: Success, accomplishment, and overcoming obstacles.
    • Exhibition: Shocking or thrilling other people.
  • Recognition: Displaying achievements and gaining social status.

2. Materialistic Needs

  • Acquisition: Obtaining things.
  • Construction: Creating things.
  • Order: Making things neat and organized.
  • Retention: Keeping things.

3. Power Needs

  • Abasement: Confessing and apologizing.
  • Autonomy: Independence and resistance.
  • Aggression: Attacking or ridiculing others.
  • Blame Avoidance: Following the rules and avoiding blame.
  • Deference: Obeying and cooperating with others.
  • Dominance: Controlling others.

4. Affection Needs

  • Affiliation: Spending time with other people.
  • Nurturance: Taking care of another person.
  • Play: Having fun with others.
  • Rejection: Rejecting other people.
  • Succorance: Being helped or protected by others.

5. Information Needs

  • Cognizance: Seeking knowledge and asking questions.
  • Exposition: Education others.

Influences on Psychogenic Needs

Each need is important in and of itself, but Murray also believed that needs can be interrelated, can support other needs, and can conflict with other needs. For example, the need for dominance may conflict with the need for affiliation when overly controlling behavior drives away friends, family, and romantic partners. Murray also believed that environmental factors play a role in how these psychogenic needs are displayed in behavior. Murray called these environmental forces “presses.”

Research on Psychogenic Needs

Other psychologists have subjected Murray’s psychogenic needs to considerable research. For example, research on the need for achievement has revealed that people with a high need for achievement tend to select more challenging tasks. Studies on the need for affiliation have found that people who rate high on affiliation needs tend to have larger social groups, spend more time in social interaction, and more likely to suffer loneliness when faced with little social contact.

10 Most Common Dangers That Can Lead to a Alcohol or Drug Relapse

here are many factors that can lead to a drug relapse. Here are the most common alcohol and drug relapse risk factors.

  1. Being in the presence of drugs or alcohol, drug or alcohol users, or places where you used or bought chemicals.
  2. Feelings we perceive as negative, particularly anger; also sadness, loneliness, guilt, fear, and anxiety.
  3. Positive feelings that make you want to celebrate.
  4. Boredom.
  5. Getting high on any drug.
  6. Physical pain.
  7. Listening to war stories and just dwelling on getting high.
  8. Suddenly having a lot of cash.
  9. Using prescription drugs that can get you high even if you use them properly.
  10. Believing that you no longer have to worry (complacent). That is, that you are no longer stimulated to crave drugs/alcohol by any of the above situations, or by anything else – and therefore maybe it’s safe for you to use occasionally.

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