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As a psychiatrist and novelist concerned with people’s inner conflicts, I’m often asked whether people can truly change.

The answer is: yes, and no.

Most mental health professionals agree that our deeply embedded traits and tendencies are ingrained by the time we’re adolescents. Yes, there can be some minor modifications after that, but our basic way of interacting with others is pretty much set by the time we’re 17 or 18. We interact with others in a fairly inflexible and deep-rooted manner. It’s our “way of being.”

So what about someone seeking psychotherapy because of unhappiness with relationships and how life is going? What about the person who repeats endlessly the same maladaptive patterns of behavior leading to frustration, failure, unhappiness, and even depression? Or the person whose relationships are tainted by neediness, or dependency, or the wish to dominate others; or any other traits that make for problems interacting with people?

You’ll notice these aren’t symptoms such as a phobia, or panic episodes, or an onset of a symptom causing psychic distress. Rather, these are enduring personality traits, not temporary states of being.

The goal of any psychotherapy is to help a person develop a better understanding of one’s self. It’s called insight. Hopefully, by developing an awareness of personality flaws, a person can recognize them, and nip them in the bud before they exert themselves and ruin relationships. If this can be accomplished, the person may experience less conflict or tension with other people, and lead a more fulfilling life.

For example, a man comes for counseling because he’s been fired from three different jobs. During sessions (to which he always arrives late), he realizes that as far back as elementary school, he undermined his own success by tardiness and by not completing tasks on time. In high school, he received Cs instead of As because he never submitted his work by the stated deadline. In business, he repeated the same pattern.

He also learns in the psychotherapy sessions that as a child, being late or dawdling was a way to get much-coveted attention from his parents. Without realizing it, throughout his adult life, he’s been repeating this pattern with every authority figure. This has been the source of conflict, failure, firings and general unhappiness throughout his adult life.

With awareness of this tendency, he can begin working to change this maladaptive and self-destructive behavioral pattern — this deeply ingrained trait. He may not always be successful in this effort, but some positive and adaptive changes in his behavior can occur.

While his trait may not have been eradicated, his behavior and interactions with others can begin to change for the better.

I like to think of it in this simple way: Imagine personality style as a 90-degree angle. If a person can move that angle a mere three degrees, then a significant change in how one interacts with other people is surely possible. This can lead to positive changes.

So once again, can people change their basic personality patterns?

Yes, and no. While they don’t alter their basic personalities, through insight, they can change their behavior and become more skillful in their interactions.

© Mark Rubinstein, M.D.

Awhile back I listed some symptoms of panic and a few techniques that have helped me cope (as well as these exercises for managing anxiety).

These techniques work for me whether I am in the midst of a full-blown panic attack or experiencing some fleeting anxiety. Here are five more ways I deal with my worrying brain.

1. Unravel the worry web.

Panic and anxiety are successful at raising our heart rate because, while we are in that state, a small kernel of a worry is miraculously transformed into a massive web of worries. That takes a bit of sweat and energy. So we have to work equally as hard at unraveling the web of worries back into the kernel or kernels we started with.

Some webs:  “This is the end of the world.” “This is the end of my career.” “This is the end of me.” Try to unravel those webs into three sub-worries, such as “My boss hates me.” “The company is tanking.” “I’m going to get fired.” Then break down each of those into three more, such as: “I’m not performing at work,” “blah blah frightening blah.” Finally, you might arrive at some kernels (based on “This is the end of my career”) such as, “My last press release stunk and my boss was disappointed,” and “My resume is not updated.” Even if your kernel is substantial, like “I need a new job, but I’m scared to get one,” that’s still better that sweating over a generalized statement like, “My career is over.” Even if it is.

 2. Don’t engage.

When one of my kids is throwing a tantrum, the worst thing I can do, which I consistently do, is yell at them. Why? I give him the attention he is seeking. What really drives him crazy? When I don’t engage at all. Or (this is the worst) walk out of the room.

Our worrying brain in the midst of a panic attack is like a kid throwing a colossal tantrum. Give in to it, and the brain wins. Blow it off, the old noggin might forget about what it’s so upset about. This theory is grounded in neuroscience. A study published in Journal of Neuroscience showed that there is a breakdown in normal patterns of emotional processing that can prevent anxious people from suppressing negative emotions. In fact, the more they tried, the more they activated the fear center of their brain, the amygdala, which fed them more negative messages.

3. Rewrite the formula.

“You are equipped to handle this! You go, girl!”

According to Tamar Chansky, Ph.D., founder and director of the Children’s and Adult Center for OCD and Anxiety, the anxiety formula goes like this: Overestimation of threat + underestimation of ability to cope = anxious response.

My exercise of unraveling the worry web aims to break down the threat into pieces that can be addressed and managed. Underestimating the ability to cope is another animal altogether. I have never been able to say confidently, “Self, you are equipped to handle this! You go, girl!” I need to pretend I am talking to a friend.

Psychiatrist and bestselling author David Burns, M.D., calls this “the double standard technique:” you address yourself with the same compassion as you would someone you like and respect. With those two pieces in place, you can begin to build a more realistic response to the panic.

4. Indulge the anxiety.

You’ve tried to break it down. You’ve tried your best not to engage. You’ve tried to rewrite the formula. You’re still stuck. Go ahead and obsess, then.

That’s right. Throw away the self-help books and give the power back to your anxiety. Invite all those bad stress hormones back into your bloodstream and indulge in panic for five or 10 minutes before trying all the other exercises again.

In a famous psychological study from the 1980s, a group of people were told to think about anything but a white bear. Guess what they all thought about? A white bear. So sometimes by trying so hard not to panic, we panic more. Give your brain a break now and then.

 5. Get used to it.

Chansky describes the process of graduated exposure and systematic desensitization, a cognitive-behavioral therapy term, as this: “get used to it” (GUDI). That’s the response a number of kids gave her when she asked how they got over their fears. They said they “got used to it.”

Sometimes panic is just about doing something over and over until it gets easier. When I began writing full-time, I became paralyzed every time I sat down at my computer. I spent about 80 percent of my working hours in panic, sometimes shaking and crying at my keyboard. A month later, having forced myself to churn out material practically every day, I am much less anxious. I simply have had to get used to it.

Originally posted on Sanity Break at Everyday Health.

Since I was younger, I knew that I thought in a different way than most children. As I grew older, I became consumed with death and its aftermath. I couldn’t understand why my biggest worry wasn’t which dress I would wear to prom. I felt like a fish out of water, and no one would understand.

After seeking help, I grew to realize that living with anxiety is not so abnormal. Some people have low cholesterol, some are allergic to peanuts, and some, like me, have an anxious mind. Honestly, I would pick anxiety over a peanut allergy any day.

In the beginning of my treatment, I felt alone and misunderstood. I refused to talk to my parents about what I was going through because I was convinced that they would not understand. While I was learning to cope with my anxiety and irrational fears, I thought about how many other teenagers shared the same thoughts as me. I felt like I wanted to let others know that they are not alone in what they are going through.

I’m not a therapist, a doctor, a social worker, or anything of the sort. I am, however, a daughter, sister, and a friend. Some may even call me an analyst. I take things in and let it marinate until I can understand the world. I learned enough from my experiences, and I continue to learn every day. And maybe I’ve even suffered a little. But mostly, I am a self-motivator. And since I’ve learned so much, from myself, and those around me, including family and friends, I feel inclined to share my knowledge with the world. After everything that I went through, I wanted to help others learn what I have learned, and show people how to look inside themselves without fear. I wanted to show people how to figure out who they are, and understand how to come to terms with it.

I grew up in a nice Jewish home with my family. I have great parents, and both a younger brother and sister. I went to private schools, summer camps, family vacations, I had food on my plate, and my room was painted in my favorite color. How could I complain? I was always a happy child. I had an amazing childhood. On the outside I looked like any other normal American girl. I had playdates, I did well in school, I had a loving family, and I had the ultimate collection of Barbie dolls. And just like a Barbie, I knew how to show my plastered smile and dress to impress. Nobody ever knew what was actually going on inside of me, and how my thoughts and fears ate me up alive. I knew how to hide my emotions, at least the ones I didn’t want anyone to see.

I still lived my life like any other ordinary child. I grew up with fears, but every child did too, so I didn’t think it was anything abnormal per se. But every year, kids grow up a little more. They become more mature. I grew up in a different way. Yes, I got taller, I went through puberty, and I even matured. But most kids’ fear of having a monster under the bed eventually goes away, and they even stop sleeping with a nightlight. My childhood fears followed me into young adulthood, but instead of a monster, my fears became more intensified and more about me. By the time I was 5, I stopped sleeping with a nightlight. I slept through the night and I didn’t worry about the monsters under my bed.

When I was 16, I studied abroad. I lived with three other roommates and everything was great. When I returned home, I started sleeping with the light on. Every night I slept with the light on until I was 19. It was embarrassing, and a secret I’ve kept until now. Before I sought treatment for my anxiety, I didn’t think there was anything wrong with me. Even though I slept with the light on, I didn’t think that I needed to see a therapist or seek any type of help. It wasn’t until my first panicattack that I realized that I have major anxiety.

I was drowning in the most irrational fears and obsessions that made me feel like I could never have a normal future. Because of all of my anxieties, I was convinced that I was mentally ill, and that I needed to be institutionalized. I was afraid of death, and a loss of control, but at the same time, I also struggled to find a purpose for my life. My anxiety took over my life for a long time, until I stopped letting it.

My battle against my anxiety isn’t over yet, but I’ve come a long way already. Seeking help saved my life, and I am grateful for all of the support I received. Things got easier over time, but it was the will to make my life better that got me through my toughest moments. Anxiety disorder does not mean you’re crazy. It’s perfectly fine to need extra support. You’re not alone.

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“I don’t have trauma.”“What happened to me isn’t trauma.”

“Trauma is something horrific.”

“I should have been able to cope with it.”

“It’s not sad.”

“I’m not upset.”

Accepting you are suffering from trauma is by far one of the most difficult aspects of recovery. I thought that admitting I was suffering from trauma suggested I couldn’t cope with the events in my life or I didn’t have the strength to deal with and process those events. I thought (and sometimes in my dark moments still think) that suffering from the effects of trauma made me weak, broken and a failure. I have met many other people who share this sentiment. They are stuck in a cycle of denial which keeps them prisoner in a cage of negative behavior patterns and harmful symptoms.

Admitting you are suffering is not only difficult for you, but has an impact on everyone in your life, in particular your family. Others around you may not want you to be suffering from trauma as it makes some difficult truths real.

Admitting trauma means other people have to look at themselves. The denial of trauma absolves everyone of their own feelings. Having the strength to say, actually, you know what, this happened and this has contributed to where I am today, is the hardest thing many sufferers will have to do in their lives. Having the strength to say this trauma is mine and I am owning my feelings will mean others have to step back and own their own feelings. Refusing to hold other people’s reactions as my own has been, and still is, nearly impossible. Often you will go against the opinion of nearly everyone closest to you.

Admitting you are suffering does not mean you are blaming anyone. Trauma’s reality does not mean someone must be responsible. The nature of getting better is to look internally and to accept that trauma is a subjective experience as opposed to objective facts of what happened.

So what is trauma? Why are some events considered traumatic to some and not others? Why did this event affect one person and yet have no impact on another? Why do people find trauma so hard to accept? I believe it’s because it is an unspoken topic. There is no narrative for trauma.

The psychological definition of trauma is “damage to the psyche that occurs as a result of a distressing event or an overwhelming amount of stress that exceeds the ability of the individual to cope and integrate the emotions involved.” This definition often gets simplified into the dictionary definition of “a deeply disturbing or distressing event,” which is where we all get a little lost. It’s very easy to understand trauma as something horrific, like war, or mass violence, or a natural disaster. It’s the “exceeding ability to cope and integrate emotions” section that gets lost on us.

We need to get rid of the view that trauma is an action (an event). The more psychology tells us about trauma, the more it becomes clear that trauma is a reaction. Most importantly, it is an individual reaction.

My therapist is always telling me that some children are born more sensitive than others. The word “sensitive” always irritates me, so we have decided to agree that some children are born more emotionally intelligent than others. They are more in tune to others’ emotions and more able to connect and empathize with others’ feelings.

These children are the ones most susceptible to trauma. Combined with the lack of protective factors such as the ability or willingness to ask for help and inbuilt resilience characteristics, the possibility of trauma already seems higher. Trauma can happen to anyone. It does not discriminate.

The view through trauma-tinted lenses is one of constant fear. It makes the world seem a frightening and dangerous place where no one can be trusted. Trauma leaves people feeling confused and insecure. Many children carry these tinted lenses into adulthood and this is when signs of post-traumatic stress disorder become apparent.

These normal reactions to abnormal events in childhood provided a function while the world was inherently dangerous. However, in adulthood these reactions become abnormal and become a hindrance to the ability to live, love and be loved.

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Four years ago, a good friend of mine put her 10-year-old son on Prozac (fluoxetine). He had always suffered from anxiety and anger outbursts, but at age 9, his behavior turned violent, and his ruminations were keeping him up at night. My friend and her husband went to a variety of child psychologists, but the cognitive behavioral therapy wasn’t enough. Finally, they got a referral to a psychiatrist, who diagnosed the boy with attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and generalized anxiety disorder (GAD). The doctor prescribed both Ritalin (methylphenidate) and Prozac.

The boy’s behavior was much better initially, but the drugs presented other problems: His weight dropped, and he stopped growing. Once a kid who was born with a healthy appetite and would try any food, such as chicken curry at age 1, his parents now couldn’t get him to eat anything. He went from being in the back row of his basketball photos, where the tall kids line up, to the front line, where the short kids kneel. And after six months, his old behavior returned.

The parents weaned him off the Ritalin, and the boy’s appetite returned. They tried to get him to eliminate gluten and sugar as much as possible, and have him load up on protein. They began giving him fish oil supplements, a multivitamin, and a probiotic. The dietary changes had a substantial impact on his behavior.

A few months later, they decided to try to taper him off the Prozac. He did fine initially, and the parents thought they were home free. But two months after he was off the Prozac, their son’s worrisome behavior returned — and it was worse than ever. My friend thought that they should take him back to the psychiatrist, but her husband disagreed. He had researched the half-life of Prozac and other withdrawal stories, and told her that many people go through a delayed withdrawal two to three months after taking the last pill. Unfortunately, he said, they would have to tolerate the bad behavior for a few months until the synapses in his brain made the adjustments.

The husband was right. The boy had two-and-a-half rough months, but he pulled through. Today he is eating, growing, and thriving — managing his anxiety some days better than others.

I remembered her story because I recently tapered off of one of my antidepressants. A month off, I was doing fine when all of a sudden I was hit with some acute anxiety. I wondered, “could it be a delayed withdrawal symptom?” I brought this up to my fellow depression warriors on Group Beyond Blue and ProjectBeyondBlue.com, and received confirmation: When you have tapered off an antidepressant, it is incredibly difficult to know whether you are relapsing into a depression, or if you are merely experiencing withdrawal symptoms that will go away in a few weeks or months.

My friend Margarita Tartakovsy interviewed Ross Baldessarini, MD, professor of psychiatry and neuroscience at Harvard Medical School, and director of the psychopharmacology program at McLean Hospital, for an article on Psych Centraldistinguishing withdrawal symptoms from depression. Dr. Baldessarini believes that when the depression re-emerges quickly, it’s easier to identify as withdrawal. If it happens weeks to months after discontinuation, then he thinks there is much more risk of its being a relapse.

But after weighing in with several of the members on both forums, I’m not so sure I agree with Baldessarini.

For example, one woman went off her antidepressant in March, and got really depressed and anxious in July. Her doctor said this is to be expected and is not unusual at all — that it’s a natural part of the brain’s readjusting process. According to her doctor, it takes a few months for the brain to realize something is missing, and to start the readjusting. The whole process can last six months to a year.

That makes a lot of sense to me. There are so many organic changes going on in the gray matter of your brain when you stop taking an antidepressant. For people like me who have a significant response to a teaspoon of sugar or three bites of pumpkin pie, think about the mayhem that’s going on inside the limbic system of my brain as it tries to reorganize all the synapses after it’s no longer getting a hefty dose of a powerful psychotropic drug. Although I don’t believe most classifications of antidepressants to be addictive — unlike benzodiazepines — I do believe your brain becomes dependent on them, so that it needs to relearn how to ride the bike again without training wheels when you go off them. Lots of skinned knees…

Of course, the withdrawal process is different for everyone. Much has to do with how long a person has been taking the medication, and at what dose. Obviously, someone who was taking 60 milligrams (mg) of Prozac for 20 years might need to wean much more slowly and endure many more withdrawal symptoms (and for much longer) than a person who was taking 10 mgs for a few months.

For some, the withdrawal symptoms are very distinct from the symptoms that they were experiencing before. They might resemble that of the flu: headaches, dizziness, nausea, or fatigue. In fact, Baldessarini discusses the “SSRI Discontinuation Syndrome” in his interview with Margarita that occurs in 20 percent of people who withdraw from antidepressants. A person may become agitated and angry more than depressed (if he or she was depressed before), or sad and lethargic more than anxious (if he or she was primarily anxious before). If a person is suddenly having crying spells after going off a medication that treated her anxiety and insomnia, chances are she is experiencing withdrawal symptoms rather than a relapse of her condition.

After reading dozens of articles on typical withdrawal times, and corresponding with dozens of folks, it seems as though three months is the average recommended time (and this begins once you start having symptoms, which could be two months after you’ve weaned off your drug) to wait to see if the symptoms clear up.

Jim Kelly, a member of my forum and a mental health advocate and speaker living in Westchester, Illinois, never agrees to a medication change without a transition plan.

“Changing medications, either starting or ending, cannot be fully assessed until two or three months in; that’s for me,” Kelly says. “And I always request some transitional medication in a small dose to ease side effects.”

Kelly has learned to be patient with the ugly process.

‪”I’m undergoing a change right now, and two weeks in I feel terrible,” he explains. “It feels like withdrawal from the old, rather than anything to do with the new…yet. I wish the two or three months would go faster, but it is what it is.”

Ultimately, I think you know yourself better than anyone and can tease apart the difference between withdrawal or relapse more easily than you think you can. After comparing my symptoms this week to the symptoms of depression I’ve had for so much of my life (for this reason, it’s important to keep a mood journal!), and assessing other things going on in my life (different diet, changes in schedule, etc.), I could recognize it was my brain just readjusting to a different chemistry, and that I’m on the right track.

Much like my friend’s son.