Can neuroticism (and Tony Soprano) change?
There are seven episodes of the Sopranos I haven’t watched yet. I’ve savored the series over the course of several years, and I’m not ready to know how it ends. Having only started my real clinical training, I’ve seen more of Tony Soprano’s therapy sessions than anyone else’s. I’ve watched his relationship with Dr. Melfi grow and tear and repair. I’ve seen his panic attacks wane. I’ve seen him deal with the stigma of being in therapy, especially in an organized social group for whom secrets are life and death. One of the questions the show keeps asking is: can people change? Can Carmela leave Tony? Can Meadow and AJ lead lives separate from how they grew up? Really, can Tony be anyone other than who he is? Given the way that the characters act time and again, I would say the show answers them with a big no — the characters know what it would mean to change, and part of them wants to change, but they keep doing the same stuff because it is comfortable, and it works on some level.
Similarly, this week’s readings about neuroticism rest on the important question of whether your personality can change. The Barlow et al. (2014) article argues that the differences between emotional disorders are trivial relative to the overwhelming contribution of neuroticism to all of them. They claim that high neuroticism (basically negative affect and stress reactivity) and low extraversion (basically positive affect and social activity) underlie most emotional disorders, so we should work to prevent and treat neuroticism to see large, transdiagnostic effects. Pages 349–351, a section on the “Malleability of Neuroticism,” though, notes that the evidence for the changeability of neuroticism is mixed. Several studies have found that it changes very little over the lifespan, even as individuals develop emotional disorders and remit. Indeed, it seems to me that the weight of the evidence they reported pointed to neuroticism not changing too much in response to treatment, even if neuroticism may sensitize individuals to developing emotional disorders. They did report on one study from their group, however, that neuroticism was the dimension of temperament that changed most over the course of treatment and two-year follow-up, and was associated with the largest treatment effect. This finding is at odds with other research, so should be read with caution, but would support their point well. I guess my main issue with this article is not the idea of trying to prevent and treat transdiagnostic risk factors for depression and anxiety — I’m totally behind this idea 100%. It just seems to me that neuroticism might not be the right target, or the right name for the target, as it seems like neuroticism might not to be too malleable. Perhaps focusing on some of the related, more specific transdiagnostic constructs they mentioned, like emotion suppression, avoidance, and rumination might produce more trackable changes.
The Kendler, Kuhn, and Prescott (2004) article examined the interactions between sex, adversity (which here meant life stressors), and neuroticism in predicting major depression. Their results were very interesting:
· neuroticism sensitized people to adverse events (high neuroticism meant even greater effects of adversity at high levels of adversity), and
· women were much more likely than men to be depressed at low levels of stress, but this sex effect was more or less washed out at high levels of adversity.
The first result wasn’t surprising, but the second got me thinking. Relative to men, are women exposed to more day-to-day stressors that didn’t make the list of “adverse events,” much in the way that micro-aggressions can accumulate for people in minority groups? Do women respond to less stressful events in a more depression-like way than men, who may respond more with something like anger? Or do men maybe have a more acceptable outlet for reacting to adverse events than do women? I think the answer to all of these questions is probably yes, which might suggest that systemic change is necessary, and which also might suggest other opportunities to intervene.