on Stress Symptoms: Anxiety
on the Lifetrack Graphic Program
on Further Information
on Stress Symptoms: Anxiety [Top]
What is stress?
Stress can manifest itself in the form of distressing and preoccupying
signals, such as anxiety, anger, physical symptoms, depression,
and even psychosis. These signals arise when our capacity to cope
is exceeded. Our existing personality-the way we think, feel,
and act-is being overwhelmed by the challenges we face in life.
What is anxiety, and why do we become anxious?
Anxiety can be experienced as thoughts, feelings, and actions
that signal nervousness, tension, worry, and fear. It is the first
line of defense (or warning signal) when our past experience and
current ability to cope (our personality) is exceeded by the challenges
we face in our sense of self, a close relationship, or our work.
Q: Why do I get anxious and irritable
in situations where others might not?
A: Getting nervous, anxious,
and irritable is a normal and necessary warning signal to alert
us that we are facing challenges exceeding our past experience
and current ability to cope. It is not objective, external events
alone that create stress, but one's subjective response to those
events. Work on your subjective response to life's circumstances.
Q: I just got the promotion I have
wanted for years. Instead of feeling elated, I'm stressed out
of my mind. Why don't I feel good when I should?
A: Although negative emotions
commonly cause an increase in stress, positive experiences can
also push us to our psychological limits. Getting a long-desired
promotion, being accepted to the school of one's choice, landing
a new job, or persuading the woman or man of your dreams to finally
take notice can provoke anxiety, anger, physical symptoms, depression,
and sometimes even psychosis. The reason one may react negatively
to positive experiences is fear. You are afraid of the very things
you most desire. Instead of being able to enjoy well-deserved
success while it lasts, perhaps you are expecting and preparing
to lose it.
Questions on Personality [Top]
Q: What is personality?
A: Personality is the way
we think, feel, and act in the three key spheres of life: self,
intimacy, and achievement.
What is the self sphere?
Self is the way we think and feel about and act toward ourselves.
What is the intimacy sphere?
Intimacy is how close we are to our partners in our most important,
close, one-on-one relationship, such as that with a spouse or
significant other. For children, parents represent an important
relationship that is critical to their growth and development.
What is the achievement sphere?
Achievement involves our activities that are productive and creative,
those that make us feel connected to the world at large-studies,
work, career, sport, hobbies, and so forth. Achievement gives
us a sense of satisfaction and a sense of meaning in our lives.
Should I try to build my sense of self, intimacy, and achievement
simultaneously? This seems like a rather tall order. My work schedule
requires long hours. During vacations, I try to make up my time
away from home to my family. Occasionally, I find time for myself,
but it's rare.
Short-term tradeoffs among aspirations for self, intimacy, and
achievement are not only natural, but often necessary to maintain
and balance internal health and success. Although such short-term
flexibility is essential to well-being, a consistent denial of
human aspirations over long periods of time can result in great
vulnerability to stress, imbalance, and even insanity. Conversely,
a steady attention to each of the three spheres over one's life
span can result in an increased ability to live life fully, with
resilience to overcome inevitable setbacks and maintain psychological
I have heard of the work of Carl Rogers on personality and have
admired it considerably. How is your approach similar or different?
Like the humanist Carl Rogers, the positive mental health Lifetrack
model was inspired, developed, and tested in daily clinical practice
with demanding patients. It evolved from the need to help demanding
patients with hectic lives improve their overall psychological
adjustment. Patients inspired the model of positive mental health,
put it to the test, and challenged it daily. Much like Rogers
approach, Lifetrack therapy recognizes that the relationship with
the therapist is an essential means to engage someone in change.
Lifetrack, however, goes beyond this recognition to state that
a close interdependent relationship, such as that with a partner,
is even more critical to fundamental change and long-term well-being.
Hence, rather than make the therapist the object of the close
relationship in therapy, the Lifetrack approach helps the patient
to become significantly closer to a person who can stay in his
or her life long after therapy has ended.
I know of Maslow's hierarchy of needs. Are the three spheres an
explanation of psychological needs? What is the difference between
your work and that of Maslow?
Maslow's hierarchy of human needs does not allow for tradeoffs.
It mixes physical and psychological needs. According to Lifetrack,
the need for self, intimacy, and achievement can be creatively
met in myriad ways. In the short run, tradeoffs among these psychological
needs are a sign of flexibility and health. The ability to make
tradeoffs, however, does not imply that these needs are merely
desires, not critical elements of a healthy life. Over time, consistent
frustration in any one of these needs can result in distress and
Another important difference from Maslow is that the model of
positive mental health provides a means to understand the same
individual at different points in the life cycle, whether in dire
distress or optimal health. This differs with Maslow's studies
of self-actualization, which focus on historical figures such
as Lincoln, Jefferson, Thoreau, Einstein, and others as ideal
candidates. Although Maslow contributed much to the field by balancing
the darker side of the human psyche with an understanding of love,
well-being, and exuberance, some say he fell short of integrating
the two halves; the positive and the negative. In this sense,
the positive mental health approach represents a middle ground,
integrating the mind (or personality) both in distress and in
Are you a psychoanalyst? How does your approach differ from psychoanalysis?
The positive mental health approach differs significantly from
psychoanalytic theory in that its focus is not on the diseased
mind, but on the healthy mind. Successful therapy is defined not
in the absence of disease or neurosis, but in the presence of
Although my training in psychiatry taught me how to reduce or
contain symptoms diagnosed as diseases or mental disorders, it
has not helped me understand health to the same degree. When I
realized that "successful psychological adjustment" was not necessarily
much better understood or practiced by traditional mental health
experts than by ordinary people who have never heard of sophisticated
psychological theories, I stopped being a passive observer of
patients divulging problem after problem. Instead, speaking more
than 80 percent of the time in dynamic therapy sessions, I challenged
what I was taught and sought new insights; I put each idea to
a daily test. I spent most sessions analyzing, interpreting, explaining,
and finally persuading patients as to how they must think, feel,
and act for them to break out of the confines of their existing
personalities. The process includes application of visual models
of Lifetrack concepts, as well as daily graphic tracking of patients'
I quickly found that people kick, scream, and yell all the way
to well-being! It is only through persuasion, humor, perseverance,
and a concerted effort that some individuals, according to their
own self-rating and account, achieve and surpass a previous best
level of adjustment. This active approach to therapy differs both
in substance and style to the classical psychoanalytic approach,
which focuses on neurosis and bringing the unconscious to the
fore through the method of free association.
Careful listening to patients' difficult pasts is effectively
finished during the first hour of the first session; during the
second hour, the patients are presented with the therapists' analysis
of their problem. I lay out the goal, method, and process of therapy;
the expected course of therapy; and the required time and cost
of therapy, which typically lasts from 3 to 6 months.
I have heard of preventive mental health, but not of positive
mental health. Why the new term?
Positive mental health is different from preventive mental health,
which entails attending to risk factors, in that it does not suggest
that all disorders are preventable or curable by early intervention.
Rather, a positive mental health approach uses crisis as an opportunity
for fundamental change. The objective is not to directly decrease
the symptoms of disease, but to actively increase the positive
factors in an individual's life beyond a previous best level of
adjustment. When this is achieved, symptoms often disappear, and
a new pattern of coping emerges.
What do you think of the Oedipus complex and other Freudian concepts?
Although the Lifetrack positive mental health approach eschews
the Oedipus complex and the emphasis on sexuality found in psychoanalysis
(intimacy is only one of the three spheres, not the only sphere
in mental health), it does recognize the existence of the conscious,
preconscious, and unconscious. The central goal of therapy, however,
is not to bring the unconscious to the conscious, but to change
the way an individual thinks, feels, and acts about areas in his
or her life that can contribute to positive health.
This is not a passive process. Nowhere is it assumed that understanding
conflicts in oneself can free the individual and create health.
Naturally, understanding the self is part of the process, but
the individual must go farther. Rather than dwelling on a difficult
past, the emphasis in Lifetrack is on helping the individual accept
the past and to think, feel, and act in ways that can improve
the ability to fulfill core human psychological needs in the present.
What is the difference between your therapeutic approach and that
of behaviorists who emphasize personality change by focusing on
Unlike Skinner, Watson, and other behaviorists who emphasize behavioral
elements that bring about desired change, the Lifetrack approach
puts equal weight on cognition, emotion, and action. Individuals,
when rating themselves on the Lifetrack scale, are encouraged
to consciously improve how they think, feel, and act about critical
areas in their lives that contribute to psychological health,
often overcoming their emotional resistance.
How is your approach different from Henry A. Murray's large list
of more than 20 motives or needs?
Because the three-sphere model seeks to determine the essence
of, rather than great detail about, human personality, it is more
succinct than Murray's 1938 lengthy list of more than 20 motives
or needs. The three spheres are helpful to patients and lay people
precisely because they remain conceptually broad enough to encompass
all critical psychological events, yet simple enough to be remembered.
At the same time, the tripod model has been further broken down
into three dimensions or nine elements for each sphere (see Definitions
of Terms). This allows the three spheres to be better understood
by individuals who wish to improve in each sphere and provides
a conceptual means to cluster essential elements of each sphere
to show how individual elements and spheres overlap and interact.
What are the similarities between Lifetrack theory and organismic
or systems theory that views personality as an open system of
Unlike strands of organismic theory, which assumes a constant
equilibrium among parts, the parts of personality in the Lifetrack
model influence and are influenced by the environment. A sense
of self is not created in a vacuum. There is no assumption that
human beings are good and are perverted by the environment. A
balanced personality organization is not the natural state of
the organism, nor is disorganization always a sign of pathology.
Crisis and disorganization can be painful but are sometimes necessary
to help the individual challenge and change the way he or she
thinks, feels, and acts in key areas of life. In this sense disequilibrium,
however painful, can become an opportunity.
What do you think of medications such as Prozac or of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) classifications?
Although pharmacological research has given the medical field
increasingly effective and safer medications such as Prozac, the
disease model has failed to prove that specific chemical changes
in the brain are the sole cause or the cure for all mental illnesses.
Experts in psychopharmacological therapy admit that only 8 to
15% of the depressed population actually receives treatment, and
only 30% of those who received pharmacological therapy under proper
professional supervision actually achieve remission. It is also
reported that some 30 to 60% of the general population receiving
care from general physicians receives antidepressants such as
Prozac. If these two statistics are accurate, it means that a
great majority of the general population should or may receive
antidepressants, and only 30% of them could expect remission,
leaving 70% to continue to take ineffective, and potentially dangerous,
medications at great expense under inadequate pharmacological
supervision or follow-up.
The DSM is a classification for diseases and disorders that is
helpful for describing patients' symptom presentations, for the
disbursement of medication, and for insurance claim and reimbursement
purposes. Today, this science based on the disease concept is
outliving its usefulness-not because it is wrong, but because
it is too narrow a worldview. Mental maladjustments and suffering
by so many is indeed a serious problem deserving great sympathy
and care comparable to all other physical illnesses. However,
the disease concept has its limitations and inhibits advance in
our understanding of the problem we face and constrains our effort
to provide potentially more effective ways of helping the suffering
population. Most of all, the disease concept does not attempt
to do what all natural sciences must:
effectively explain, predict, and measure experiences.
Natural science has already gone through such a change in paradigm
over the last century, having been liberated from the Newtonian
worldview that had dominated science for 350 years. Relativity,
quantum mechanics, and Bell's theorem have provided the world
with a far more inclusive and useful paradigm that made possible
rapid advancement of science. Psychiatric science must undergo
a similar transition after 150 years of domination by the "disease
The Lifetrack model is one such attempt. Naturally, all models
are to be continuously challenged, tested, and replaced by more
useful models. In case of psychiatric problem, the most, if not
the only, qualified observer must do such testing, and that is
the patient who is suffering.
Questions on Intimacy [Top]
Why do we end up fighting after having had wonderful time together?
On the way home from fun weekend trips or after a nice evening
dining out in town, we find ourselves arguing over nothing, spoiling
Increased intimacy provokes defensive reactions, such as anxiety,
anger, physical symptoms, depression, and psychosis in "defensive"
individuals, who are threatened by escalating closeness. To become
closer to another human being requires that you and your partner
overcome these defensive reactions to increased intimacy. Next
time you are riding home and become hostile after a good night,
remind yourself that it is your defenses that are acting up. Take
a moment of silence or laugh at your own defenses. Recognize that
your irritability is your normal reaction to increased intimacy.
It is a good stress! Now act in ways to further enhance your relationship,
rather than sabotaging it.
When I want to become closer to a man, I seem to do everything
wrong. I am difficult, I purposely try to discourage a potential
boyfriend and tell him that I am already with someone else. I
really do want to have a relationship. What is going on?
That people typically fear most what they desperately need to
be happy is neither surprising nor unusual. Behind it lies a mechanism
of defense used by the mind to protect itself from potential harm
and ensure its "self-preservation." When a person experiences
closeness, that person experiences the accompanying "fear" that
it may not last. This fear of eventual loss, rejection, or betrayal
is so powerful that it mobilizes the mind to use its best resources
to prevent or protect itself from such potential disappointment
and loss. Your challenge is not to avoid your fear, but to become
closer in spite of it. To do so, you will need to overcome your
fear of intimacy.
Questions on Self [Top]
Isn't there a safe haven for the "self" that is sheltered from
the ups and downs of achievements and intimate relations? A home
where one can just "be?"
The ability of individuals to keep a sense of peace apart from
what occurs around them does exist. This is a part of the self,
however, that has to be developed and constantly nurtured. Those
who meditate or take time out to reflect during a busy day may
be feeding this part of the self. To create a retreat from a busy
and sometimes even chaotic environment can empower a person to
return to the same environment refreshed, invigorated, and ready
on Achievement [Top]
No matter what I accomplish, I do not seem to satisfy my need
to do more or to be better. I did my job well but quit because
I felt unfulfilled. I went and joined a humanitarian organization
but still feel that I am not amounting to much. I am now thinking
of starting my own firm. What do you think?
The meaning people find in what they do, from the moment they
wake up to the moment they go to sleep, plays a role in how they
feel about themselves. A person may gain more satisfaction from
playing a mean game of tennis than from writing a best-seller.
An unrecognized artisan, who finds what he does meaningful and
rewarding, may reap greater rewards than the recipient of a prize
who is never happy with whatever she accomplishes. To feel good
about yourself depends not only on your objective job or work
environment but on the subjective meaning you attribute to your
work. Rather than continuously changing jobs, I would suggest
that you first understand how achievement is an indirect quest
to be admired, respected, and loved for doing something difficult
and meaningful with your life.
Questions on the Lifetrack Graphic Program
I am confused about the difference between the Lifetrack theory
and the method of tracking. What is the difference?
The contribution of Lifetrack is first to define psychological
spheres that contribute to well-being and distress and second
to develop a means to help patients measure, quantify, track,
and improve the subjective experience of health over time. They
are interrelated, but separate. You can learn about the insights
gained from the model over the years and try to apply them to
your life intuitively. You can also use the tracking method as
a tool to make health part of your daily lifestyle. The tracking
does not provide the totality of the experience, but is a tool
to trigger insights and move beyond a previous best level of experience.
The tool helps you to ask relevant questions of yourself regarding
your capacity and willingness to build your health on a daily
How can I put numbers on how sexually excited I am or on how much
I accept my spouse without wanting to change her?
Patients in Lifetrack therapy do this all the time on a 10-point
scale, where 0 is the minimum and 10 is the initial maximum. Having
people artificially assign a number to their thoughts, feelings,
and actions reinforces the idea that the subjective is controllable.
That a person depends on his or her spouse or significant other
at only a 5 on a 10-point scale means that the individual could
learn to do better.
In Lifetrack sessions, an individual is actively coached on how
to improve in each of the parameters. Although you might presently
depend on your significant other at a level of 3, how might you
strive to make your 3 a 4? How about a 5? Because improvement
is the objective and not the absolute value, the self-rating exercise
is not simply an act of passive accounting. Rather, it is an active
process in which an individual must reflect on how he or she can
think, feel, and act so as to improve daily scores in each of
the positive parameters that help to contribute to positive health.
When rating oneself, the person is encouraged to ask the question,
"How can I think, feel, and act to make this score go even higher?"
This concentrated effort accounts for the rapid rate of growth
in a relatively short period of time by those who use the approach.
I am a physicist and see some similarities between the study of
the mind and physics. What I also see is that your method of tracking
is influencing the experience of health itself. Can you comment?
The inner state of mind affects what it is one sees and experiences.
To put it in terms of physics, the observed object is not separate
from the observer. When the mind focuses on one thing, it does
so by selectively ignoring another. When the mind understands
something, it has adopted one perspective exclusive of others.
As you have hinted with your comment, depending on what we decide
to observe and measure, we may be creating what we look for and
find. Hence, if individuals observe and precisely measure diseases
and disorders, they may create them where they might not have
otherwise existed. Conversely, if individuals choose to observe
and measure positive mental health or well-being, they may be
able to create these where it may not have otherwise existed.
Naturally, part of being happy is being conscious of it. In this
sense, it is clear that the observer may well influence the experience
of life by the intention or act of assessing it according to the
Lifetrack model. This is intentional. Daily self-rating attempts
to change not only the objectively measurable life experiences
but the "unconscious measuring rod" or the subjective perception
of experience. The scale should serve to help individuals discern
that they are getting much happier, rather than believing that
their level of happiness is "constant." Taking such a psychological
leap is more than just symbolic. It empowers you through incremental
thinking; In short, the observer may be "creating" what he or
she observes simply by choosing to observe it.
I enjoy the simple self-rating exercise and find that anyone who
can count to 10 can do it. However, I can't fully capture the
richness or complexity of my mind in words, let alone digits!
So why bother?
I agree with you. The subjective experience of happiness, well-being,
depression, and the like cannot be fully described in words or
digits. Health can only be experienced by each individual. This
raises an inevitable question: If the "reality" of psychological
phenomena can only be experienced and not fully described, how
can we track it?
The physicist Finkelstein wrote similarly about how "experience"
in the exact science of physics cannot be fully communicated to
others. Einstein, too, gave us an analogy regarding a physicist
ever wanting to capture reality, but never being able to see under
a watch's face and discover just what it is that makes it tick.
Finkelstein argued that despite the fact that one cannot fully
communicate experience to others, if we can show others how to
make the experience happen and how to measure it, then we can
help others to experience it. This is precisely what has been
done in the Lifetrack self-rating program. Use it as a tool for
building health, and do not confuse the tool with the experience
of health itself.
Why do you allow your patients to rate their health, rather than
administering a personality test or having a panel of doctors
do it? I question the validity of patients' self-rating. They
are not objective in their assessment.
In medicine, the doctor decides if the patient is ill or well.
It is not left up to the patient's subjective opinion. If a patient
is tested and found to have AIDS, that patient is sick even if
in the early stages of the disease he or she is not suffering
from any symptoms. The patient's feeling healthy does not discard
the objective reality of the presence of a potentially fatal disease.
In physical medicine, an objective approach is far more reliable
than a patient's subjective perception of his or her state of
What holds true for the body, however, may not necessarily hold
true for the mind. If someone is miserable, it does not really
matter that a whole panel of psychiatrists "objectively" decides
according to some statistical norm (normality defined as a statistical
average) that the patient has an ideal or well-adjusted life.
If in one's mind life is hell, he or she will continue to feel
miserable unless his or her perception of it changes. The reverse
is equally true. If someone is dying with a terminal illness but
feels at peace, then it doesn't matter that a panel of doctors
"objectively" decides this fellow is really miserable but doesn't
know it. Whatever the "objective" panel concludes will make little
difference to a happy individual.
Naturally, there are limits to using subjective experience as
a yardstick to well-being. A positive mental health approach does
not rely solely on an individual's internal perception of well-being.
In therapy, outside parties-the therapist and the individual's
partner (if there is one)-are constantly following a patient's
subjective response to events. When the patient's perceptions
of events become distorted as in an acute psychotic condition,
his or her own understanding of well-being becomes meaningless.
It is at these times that subjective rating does not make sense.
Individuals who have difficulty in introspection may also do less
well in Lifetrack therapy.
Is happiness or distress measured in the same way by everyone?
Experiences of psychological distress or well-being (such as "anxiety,"
peace," "depression," or "happiness") are essentially subjective
and can only be observed and reported by the person who is experiencing
them. What makes one person happy might make another miserable
and vice-versa. Furthermore, happiness to one person may not be
exactly the same thing as happiness to another. It may even be
different for the same person at a different time. Nevertheless,
because the experience of well-being or distress is a subjective
internal phenomena, the best expert to measure it is still oneself.
I am an up-and-down type of person. The mood you catch me in when
I start to rate myself makes me doubt the validity of my self-rating.
Should I rate myself anyway? Who am I trying to fool?
Psychological experience occurs in spikes of thoughts, feelings,
and actions. As you have experienced yourself, happiness and depression
are not steady states but can change from one moment to the next.
For this reason, the Lifetrack total adjustment sheet (each self-rating
exercise) is really a snapshot of moments. Even with a simple
10-point scale, assessments may be different if you perform the
exercise only a few minutes later (depending on what happened
in the meantime) or what you might have happened to think about
when you were self-rating yourself.
Despite this fundamentally subjective and changeable nature of
self-assessment, in the experience of Lifetrack therapy, repetitive
self-rating according to the same fixed model yields highly valuable
information. Although memory is short, one can reliably observe
if one is happier or more depressed than the day before.
To use an analogy, you can imagine that each of your individual
self-ratings is much like a droplet in your psychological experience.
These droplets, when viewed individually or in isolation, may
not tell us much. They are really a collection of "snapshots"
that are arbitrarily pulled together. Nevertheless, for lack of
a better way to capture the dynamically changing states of the
mind, this may be a good beginning. Most important, my patients
have discovered that when you use the same model consistently
over time, the droplets accumulate, creating patterns that take
the shape of a fountain. Although we can individually see the
droplets and patients can attempt to describe their experience
at one given point in time, it is only when we see the fountain
that we capture personality. In this sense, you can think of your
overall psychological state as a fountain, which keeps a certain
shape, but consists of constantly changing and discontinuous droplets.
You say the scale is from 0 to 10, but then later you correct
yourself and say you can go beyond 10. Why doesn't one's best
stay constant at a 10?
In modern physics, the speed of light in a vacuum is known to
be constant at approximately 186,282 miles per second, regardless
of the direction and speed of movement of the observer measuring
it. The reason for this is that the tool used to measure the speed
of light changes its length depending on the observer's relative
speed of motion. When the observer is in motion a high rate of
speed, the tool shrinks according to the observer's speed, thereby
explaining the reading on the scale as always exactly the same:
186,283 miles per second. In a similar way, the tool used to measure
one's subjective psychological experience seems to change its
length in such a way that the reading is always the same for most
individuals. "One's best" is always one's highest limit. The term,
much like the speed of light, is thought of as a constant, the
highest attainable limit at any given point in time.
When one translates the term best into a number on a 0- to 10-point
scale, a problem arises. A brilliant scientist who became my patient
pointed out the predicament to me many years ago. As the patient
exceeded in certain elements his previous best adjustment, he
consistently rated himself at a 10 (the maximum score). Insisting
that his 10 today was much higher than the 10 of last week, he
felt that his scores were no longer representative of his true
It was at this time that I realized that internal psychological
adjustment has no limits. The scale would have to be open-ended
to reflect that reality. The 0- to 10-scale expands as one's experience
surpasses a previous best. When an individual exceeded a past
optimal experience, the measuring tool grows to enable the measurement
of higher levels of adjustment that were previously thought unimaginable
(the patient could rate an 11, 15, and so on). Past maximums could
in this way be challenged and replaced by a new maximum.
Questions on Further Information [Top]
Q: Where can I find more information
on your approach?
The Download section of this site lists articles, books, and other
material for download as they become available.