They're, naturally, reserving their energy by remaining calm. Plus, when you're always relaxed, you're a more likable and approachable person. You're more trustworthy. You're the one people seek out when they need something important done because they know you're not going to freak out and mess it up. Regularly practice relaxing and eliminating extreme emotions when they come up. I learned that he had had two orthopedic surgeries, in rather short order, a couple of years earlier for sports-related shoulder and knee injuries. He had been prescribed Percodan postoperatively for his knee procedure and OxyContin after the shoulder surgery, appropriate for short-term pain relief but generally not for ongoing, nonterminal treatment. He was given a month's supply of medication each time, and he subsequently requested and received refills for the pain that enervated him and interfered with travel and everyday activities at home and work. He said he had no time for physical rehab and that the pills were his way of keeping going. But soon he was on that substance-induced merry-go-round of relief and intoxication followed by withdrawal. His performance began to suffer and he became short with colleagues and at home. After his orthopedic doctors stopped his supply of opioids, he purchased them on the black market--an addiction he hid from his firm, but that did not escape notice by his wife. I stressed that while what he valued was not yet lost, it was surely in peril, and asked what if anything he wanted to do about it. The first session ended and he agreed to return for another. My job was to enable him to own his problem, not blame others, and to see that he could be helped if he worked at it, had the support of his family, and received good treatment. After a number of meetings, he became ready to quit drugs and recover the life he wanted. My therapeutic opponent had become a partner. At last, he could begin to walk the road of both physical and substance-use recovery. Samuel Gold's is a success story, especially in that he came early to treatment, recognized that he had a lot to lose, had important supports at home and work, and had the resources to support an effective treatment. Not everyone is so blessed, but treatment works--just sometimes not right away.

The first important insight I gleaned was one we have already discussed above, in treating the methods of cognitive behavioral therapy. I realized, in short, that I did not have to start by tackling the one thing I dreaded most. I didn't have to just "suck it up" and get on board an airplane. Instead, in the months leading up to the Iceland trip, I could work my way up to this challenge through stages I found less intimidating. I was mildly uncomfortable with taking the train on my own, for instance, but I did not find this "impossible," so I experimented for a few days with simply taking the subway long distances. I visited the art museum. I went to the tallest building in the city and rode on an elevator to the highest floor. I realized as I did so, that I actually felt empowered by allowing myself to do something I had been afraid of before. This was surprising to me because all that time, I had been afraid of losing power, afraid of losing control. I was worried that if I put myself in a situation, I found "scary," then I would panic and lose control of my emotions. What I found instead, however, was that as soon as I started putting myself into situations that I found mildly scary, I felt more empowered, and more in control, than I had in years. I had proved to myself that I could still choose to do things, even though I found them frightening. My panic was not in control of my actions and my life. I was in control. If you began a weight-lifting program and continued your new regimen over time, would you be surprised if you noticed increased muscle mass and strength? Of course you wouldn't. This is merely a common example of the positive relationship that exists between exercise and fitness. In much the same way that exercise strengthens muscles, every time we delay taking action, we are simultaneously developing a mental muscle of sorts, we could think of it as our "procrastination muscle." Imagine for a moment, a person visiting his doctor and complaining about feeling listless, or lacking the energy to deal with his chores. He then goes on to mention that procrastination has become an annoying part of the lackluster period that he finds himself in. Generally speaking, the medical community often sees procrastination as one of a number of symptoms that relate to the condition of mental depression, and rightly so because procrastination is a symptom of depression.

However, if a person procrastinated for a very long time, what levels of happiness and self-satisfaction would you expect to see in that person? Do you think you would see such a person as having high self-esteem or low self-esteem? Although I am not a health professional, as someone who has suffered first-hand with procrastination as a long-term debilitating condition, I believe procrastination is not merely a symptom of depression, but it can also be a direct cause of depression in some individuals. For a person like myself, whose last name is not followed by "M.D.," the most scientific name that I can come up with for the kind of immobilizing procrastination that I and other procrastinators have suffered from, is a "conundrum." Simply put, it is my belief that there is a relationship between the conditions of procrastination and mental depression. In other words, as the habit of procrastination becomes pronounced and grows stronger, the sufferer's self-esteem can weaken to the point where he feels hopeless, helpless, and terribly depressed. Constant mental and emotional chatter robs you of energy. You're drained of the fuel you need to push forward and get things done. No matter what you're doing, practice shutting your brain off. Shut down the thoughts and emotions and get it done. Forget what happened yesterday. Forget what you're doing that day. Forget what's happening tomorrow, next week, and next year. None of it matters in the moment. All that matters is focusing on what needs to happen right then and there and making sure it gets done right and on time. Eben Pagan says 100 watts in a light bulb will light up a room but if you take those same 100 watts and point them all in one direction, it becomes a powerful laser that cuts through steel and shines for miles. When your mind and emotions are running, you're as weak and ineffective as a light bulb. It's good enough to light up a room, but you won't cut through the hard stuff and you won't go the distance. But when you turn your mind off and place all of your focus in one direction and on one thing, you will get things done better, faster, and with less energy. Not only will you get things done, you will get more things done because you will be able to move from one thing to the next with no thought and emotion interrupting and distracting you. Eliminate the thoughts, emotions, people, and things preventing you from focusing for longer periods of time.

Turn off your phone. Put it on silent. Log out of your social media accounts. Work in a quiet room. Go somewhere where people in your environment won't be a distraction. The most important and powerful skill you can possess is to keep your attention focused on one thing and in one direction. You need the ability to think about one single thing for a very long time without internal and external distractions and interruptions. This means you can focus for hours each day and repeat it daily for months and years at a time. Related to the value of an authentic partnership between patient and clinician is attention to patient preferences. We all do what we want to, when possible, and our adherence to treatments and self-care is no different. Some people prefer therapy, others medications, some all that is possible. Some value regular appointments, while others prefer a more ad hoc arrangement. Some like phone calls and emails, others to meet in person. When we ask about and respond to patient preferences, we have someone far more likely to get the hard work of treatment done. An essential corollary is that collaboration extends, whenever possible, to families and friends. No mental health system will ever be able to identify serious behavioral problems as early as a loving family or close friend. They are both the elements of a needed and effective early-warning system as well as the most enduring supports a person can have. They see the trouble, the drift toward relapse, daily. Many times it is they who seek help for their loved one. Families and friends (though, of course, not all of them) are among the strongest allies clinicians will have.

If this weren't bad enough, there is yet another conundrum where procrastination can be observed, and that is through its similarities to the condition known as Obsessive-Compulsive Disorder (OCD). It has only been in the last few decades that OCD was at last recognized as a disabling condition in its own right. Today, it is generally defined as a psychiatric disorder characterized by obsessive thoughts and compulsive actions. For our purposes of defining OCD, we can think of obsessions as recurrent and persistent thoughts, while compulsions are repetitive behaviors and mental acts. Interestingly, procrastination has aspects of both branches of OCD; in other words, one can find both obsessions and compulsions within the procrastinator. For example, a procrastinator might obsess over a past inaction by thinking, "I should have taken care of those bills yesterday; why didn't I do it when I had the chance?" At the same time, his behaviors can also mimic the compulsive component of OCD because before taking action, he backs off, saying to himself, "I know I should sit down and pay the bills right now, but I don't feel like it. I'll do it tomorrow!" So, procrastination can not only take the form of either an obsessive thought or a compulsive behavior, it can also be a complex mix of both components, working together as a disharmonious tag-team helping to propel procrastination to its highest heights. Most of us see all stress as bad. In reality, stress teaches. It points out weaknesses. It helps you grow. It helps you find your limits. It helps you become better. It keeps you humble. Resistance and finding your limit creates stress. While running, you're not stressed when you start. It takes time until you feel the pain. The further you go, the more and more stress you feel in your muscles, joints, body, and mind. The more it sucks. The harder it gets.