Part of my job as a cardiovascular nurse was to educate and motivate heart patients to change many of their life long unhealthy habits. You see many of those habits were what got them into trouble and now they needed to change. This can be very challenging, to say the least.

Think about it. Why do you eat that piece of cake when you know that your slacks are tight and you want to lose a few pounds? Or why do you keep smoking when you've heard all the warnings about the danger to your health?

To gain pleasure!

How about avoiding pain? You have a deadline for a project and you procrastinate about completing it. The night before it's due you stay up late to finish it. Why? Because the pain of being unreliable or losing a job is more painful than the pleasure of a good night's sleep.

For real change to take place, we often have to get to the point of threshold. What's threshold? It's when you finally get to the point where not changing is more painful than the pain associated with changing.

You catch a glimpse of yourself in the mirror and can't believe it. How did this happen? Did you really buy those slacks last month when they fit like a glove? How can they now be so tight? Something's got to change.

Welcome to your threshold! It's actually a good place to be. To continue the same way is finally too painful.

I remember a patient once said to me that he wished he could have a tape of how painful it was after his heart bypass surgery. He would pull it out and watch it every time he was tempted to return to his old habits. The painful reminder of what he went through would be so painful and a reminder to keep up with the new changes.

Where are you at this point? Have you finally reached your threshold? Or are you still at the point of enjoying the pleasure your unhealthy habits bring? I'd love to hear from you.

• The way you were raised
• Your role models, whether good or bad
• Subliminal messages from TV, movies
• Our culture
• Deliberate choices we make

How many times have you found yourself saying "that's just how I am" or "I can't change" or "I'm just not a disciplined person"?

This morning as I was exercising on the treadmill (a habit I've established by choice), I was watching the Today Show. Dr. Phil was being interviewed and he said "Biology is not destiny. It just means they're predisposed." I had to jump off the treadmill and write that one down. Now, Dr. Phil wasn't necessarily talking about establishing habits but I thought it could be applicable. After all, we may have a tendency to accumulate those extra pounds around the waist or thighs, depending on our genetic predisposition, but it doesn't have to be our destiny to have heavy thighs or bellies.

I remember reading a book by Dr. Maxwell Maltz and he said that it takes 21 days to form a habit and 100 days for it to be automatic. So, if that's true, I need to commit to a particular habit I wish to establish for at least 3 weeks. On the days when I find myself making excuses it's wise to remember this.

William James wrote the following:

Who Am I?

"I am your constant companion. I am your greatest helper or your heaviest burden. I will push you onward or drag you down to failure. I am at your command. Half of the tasks that you do you might just as well turn over to me and I will do them quickly and correctly. I am easily managed; you must merely be firm with me. Show me exactly how you want something done. After a few lessons, I will do it automatically. I am the servant of all great people, and alas, of all failures as well. Those who are great, I have made great. And those who are failures, I have made failures. I am not a machine, but I work with all the precision of a machine plus the intelligence of a person. You may run me for profit or run me for ruin; it makes no difference to me. Take me, train me, be firm with me and I will lay the work at your feet. Be easy with me and I will destroy you. Who am I? I am called habit. Habit is my name."

So, what can you learn from this?

• Take a moment to really think about the things you do automatically; things that you probably don't even think about before doing. Do you constantly taste food as you're cooking it? Do you always drink a jumbo size soft drink? Do you eat in bed watching TV?


• Write down a few habits you would like to add to your life. If you want to lose weight, exercise is a must. If you want to read more, spending less time watching TV might be in order. Become more aware of your daily habits so you can decide if they are helping or hurting your long term goals.