The Hardcore Self-Help Podcast with Duff the Psych · Robert Duff, Ph.D.

435: Moving Past infidelity & Coping with Sudden Medication Changes

·28 min·1 clip

Dr. Duff calls the abrupt removal of Xanax and clonazepam 'totally bullshit.'

1. The Hardcore Self-Help Podcast with Duff the Psych answers two listener questions about anxiety, sudden medication changes, and infidelity recovery. 2. Dr. Robert Duff is the host and a psychologist who answers questions about psychiatric care, trauma responses, and relationship repair. 3. The episode asks what to do when anxiety has been lifelong and when a marriage is trying to recover after emotional and physical cheating. 4. A 65-year-old caller describes panic attacks starting at age 17, generalized anxiety disorder, and becoming nearly housebound in a tiny apartment. 5. The caller says Xanax and clonazepam helped him function at work, but a provider replaced them with Valium due to age. 6. Dr. Duff says anxiety can be partly genetic, mentions family patterns, and cites heritability estimates of about 50%. 7. He also says identical twins are more likely than fraternal twins to both have an anxiety disorder, which supports a genetic link. 8. He explains that chronic anxiety and PTSD can change the brain, including increased amygdala reactivity and volume. 9. He tells the caller that avoidance fuels anxiety, because skipping outings and events reinforces the alarm system. 10. He distinguishes Xanax and clonazepam from Valium, saying benzodiazepines are often used for acute panic but carry risks for adults over 65. 11. He names memory problems, confusion, impaired coordination, falls, dependence, and addiction as reasons doctors avoid benzodiazepines in older adults. 12. He says the caller’s abrupt medication change with little discussion was handled badly and should have been explained as a collaborative plan. 13. He suggests a psychiatrist if the current prescriber is not a specialist, and he notes that the caller has agoraphobia and suicidal thoughts. 14. He says hospitalization can be voluntary and does not have to mean a forced 5150 hold. 15. He offers his online course, "kick anxiety's ass," and says it covers panic attacks, agoraphobia, and exposure work. 16. He suggests treatment-resistant anxiety may need approaches like EMDR, TMS, ketamine therapy, or a medical workup for thyroid and other physical drivers. 17. The infidelity question comes from a spouse trying to heal after a wife’s emotional and physical affairs and the lies attached to them. 18. Dr. Duff says the caller’s anger and flooding during arguments are common trauma reactions and recommends couples therapy plus grounding, diaphragmatic breathing, pauses, and journaling. 19. People dealing with panic, agoraphobia, medication changes, or relationship betrayal would get the most from this episode. 20. People wanting light listening or a short topic-specific segment may want to skip it.

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