We describe an approach to anxiety, depressive, trauma-related, and other disorders, which we conceptualize as “emotional disorders” because of shared underlying dimensions uncovered by the study of traits or temperaments. We then explicate a functional model of emotional disorders based largely, but not exclusively, on the temperament of neuroticism and describe common factors that account for the development and maintenance of these conditions. We conclude by describing, and presenting supporting data for, a unified transdiagnostic approach to the treatment of emotional disorders that directly targets the underlying temperament of neuroticism and associated temperamental characteristics.
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.).
3.
BarlowD. H. (1982). The death of neurosis [Review of the book Cure and care of neuroses: Theory and practice of behavioral psychotherapy, by I. Marks]. Contemporary Psychology, 27(7), 512–514. https://doi.org/10.1037/021288
4.
BarlowD. H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford Press.
5.
BarlowD. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). Guilford Press.
6.
BarlowD. H. (2016). The neurotic paradox: Progress in understanding and treating anxiety and related disorders. Routledge.
BarlowD. H.EllardK. K.Sauer-ZavalaS.BullisJ. R.CarlJ. R. (2014). The origins of neuroticism. Perspectives on Psychological Science, 9(5), 481–496. https://doi.org/10.1177/1745691614544528
9.
BarlowD. H.FarchioneT. J.BullisJ. R.GallagherM. W.Murray-LatinH.Sauer-ZavalaS.BentleyK. H.Thompson-HollandsJ.ConklinL. R.BoswellJ. F.AmetajA.CarlJ. R.BoettcherH. T.Cassiello-RobbinsC. (2017). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74(9), 875–884. https://doi.org/10.1001/jamapsychiatry.2017.2164
10.
BarlowD. H.FarchioneT. J.FairholmeC. P.EllardK. K.BoisseauC. L.AllenL. B.Ehrenreich-MayJ. (2011). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist guide. Oxford University Press.
11.
BarlowD. H.FarchioneT. J.Sauer-ZavalaS.Murray LatinH.EllardK. K.BullisJ. R.BentleyK. H.BoettcherH. T.Cassiello-RobbinsC. (2017). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist guide (2nd ed.). Oxford University Press. https://doi.org/10.1093/med-psych/9780190685973.001.0001
12.
BrownT. A.BarlowD. H. (2009). A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment. Psychological Assessment, 21(3), 256–271. https://doi.org/10.1037/a0016608
13.
BullisJ. R.BoettcherH.Sauer-ZavalaS.FarchioneT. J.BarlowD. H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. Clinical Psychology Science and Practice, 26(2), Article e12278. https://doi.org/10.1111/cpsp.12278
14.
Cassiello-RobbinsC.SouthwardM. W.TirpakJ. W.Sauer-ZavalaS. (2020). A systematic review of Unified Protocol applications with adult populations: Facilitating widespread dissemination via adaptability. Clinical Psychology Review, 78, Article 101852. https://doi.org/10.1016/j.cpr.2020.101852
15.
ClarkL. A.WatsonD. (2008). Temperament: An organizing paradigm for trait psychology. In JohnO. P.RobinsR. W.PervinL. A. (Eds.), Handbook of personality: Theory and research (pp. 265–286). Guilford Press.
16.
CraskeM. G.BarlowD. H. (in press). Mastery of your anxiety and panic: Therapist guide (5th ed.). Oxford University Press.
17.
CuijpersP.SmitF.PenninxB. W.de GraafR.ten HaveM.BeekmanA. T. (2010). Economic costs of neuroticism: A population-based study. Archives of General Psychiatry, 67(10), 1086–1093. https://doi.org/10.1001/archgenpsychiatry.2010.130
18.
DugasM. J.GagnonF.LadouceurR.FreestonM. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215–226. https://doi.org/10.1016/s0005-7967(97)00070-3
19.
EhringT.WatkinsE. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205. https://doi.org/10.1680/ijct.2008.1.3.192
20.
EustisE. H.GallagherM. W.TirpakJ. W.NauphalM.FarchioneT. J.BarlowD. H. (2020). The Unified Protocol compared with diagnosis-specific protocols for anxiety disorders: 12-month follow-up from a randomized clinical trial. General Hospital Psychiatry, 67, 58–61. https://doi.org/10.1016/j.genhosppsych.2020.08.012
21.
EysenckH. J. (1947). Dimensions of personality. Kegan Paul.
22.
KotovR.KruegerR. F.WatsonD.CiceroD. C.ConwayC. C.DeYoungC. G.EatonN. R.ForbesM. K.HallquistM. N.LatzmanR. D.Mullins-SweattS. N.RuggeroC. J.SimmsL. J.WaldmanI. D.WaszczukM. A.WrightA. G. C. (2021). The Hierarchical Taxonomy of Psychopathology (HiTOP): A quantitative nosology based on consensus of evidence. Annual Review of Clinical Psychology, 17, 83–108. https://doi.org/10.1146/annurev-clinpsy-081219-093304
23.
LaheyB. B. (2009). Public health significance of neuroticism. American Psychologist, 64(4), 241–256. https://doi.org/10.1037/a0015309
24.
LaheyB. B.MooreT. M.KaczkurkinA. N.ZaldD. H. (2021). Hierarchical models of psychopathology: Empirical support, implications, and remaining issues. World Psychiatry, 20(1), 57–63. https://doi.org/10.1002/wps.20824
25.
LilienfeldS. O.TurnerS. M.JacobR. G. (1993). Anxiety sensitivity: An examination of theoretical and methodological issues. Advances in Behaviour Research and Therapy, 15(2), 147–183. https://doi.org/10.1016/0146-6402(93)90019-X
MowrerO. H. (1950). Learning theory and personality dynamics. Ronald Press.
28.
Naragon-GaineyK.McMahonT. P.ParkJ. (2018). The contributions of affective traits and emotion regulation to internalizing disorders: Current state of the literature and measurement challenges. American Psychologist, 73(9), 1175–1186. https://doi.org/10.1037/amp0000371
29.
Naragon-GaineyK.WatsonD. (2018). What lies beyond neuroticism? An examination of the unique contributions of social-cognitive vulnerabilities to internalizing disorders. Assessment, 25(2), 143–158. https://doi.org/10.1177/1073191116659741
ReissS.McNallyR. J. (1985). Expectancy model of fear. In ReissS.BootzinR. R. (Eds.), Theoretical issues in behavior therapy (pp. 107–121). Academic Press.
32.
Sauer-ZavalaS.BarlowD. H. (in press). Neuroticism: A new framework for emotional disorders and their treatment. Guilford Press.
33.
Sauer-ZavalaS.BoswellJ. F.GallagherM. W.BentleyK. H.AmetajA.BarlowD. H. (2012). The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the unified protocol for the transdiagnostic treatment of emotional disorders. Behaviour Research and Therapy, 50(9), 551–557. https://doi.org/10.1016/j.brat.2012.05.005
34.
Sauer-ZavalaS.FournierJ. C.Jarvi SteeleS.WoodsB. K.WangM.FarchioneT. J.BarlowD. H. (2020). Does the unified protocol really change neuroticism? Results from a randomized trial. Psychological Medicine. Advance online publication. https://doi.org/10.1017/S0033291720000975
35.
TyrerP. J. (1989). Classification of neurosis. John Wiley & Sons.
36.
WegnerD. M.SchneiderD. J.CarterS. R.WhiteT. L. (1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology, 53(1), 5–13. https://doi.org/10.1037/0022-3514.53.1.5
37.
WilliamsA. L.CraskeM. G.MinekaS.ZinbargR. E. (2021). Neuroticism and the longitudinal trajectories of anxiety and depressive symptoms in older adolescents. Journal of Abnormal Psychology, 130(2), 126–140. https://doi.org/10.1037/abn0000638
