Does the unified protocol really change neuroticism? Results from a randomized trial
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BACKGROUND: Neuroticism is associated with the onset and maintenance of a number of mental health conditions, as well as a number of deleterious outcomes (e.g. physical health problems, higher divorce rates, lost productivity, and increased treatment seeking); thus, the consideration of whether this trait can be addressed in treatment is warranted. To date, outcome research has yielded mixed results regarding neuroticism's responsiveness to treatment, perhaps due to the fact that study interventions are typically designed to target disorder symptoms rather than neuroticism itself. The purpose of the current study was to explore whether a course of treatment with the unified protocol (UP), a transdiagnostic intervention that was explicitly developed to target neuroticism, results in greater reductions in neuroticism compared to gold-standard, symptom focused cognitive behavioral therapy (CBT) protocols and a waitlist (WL) control condition. METHOD: Patients with principal anxiety disorders (N = 223) were included in this study. They completed a validated self-report measure of neuroticism, as well as clinician-rated measures of psychological symptoms. RESULTS: At week 16, participants in the UP condition exhibited significantly lower levels of neuroticism than participants in the symptom-focused CBT (t(218) = -2.17, p = 0.03, d = -0.32) and WL conditions(t(207) = -2.33, p = 0.02, d = -0.43), and these group differences remained after controlling for simultaneous fluctuations in depression and anxiety symptoms. CONCLUSIONS: Treatment effects on neuroticism may be most robust when this trait is explicitly targeted.
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The UP was designed to reduce mental health symptoms by targeting negative emotions, including by teaching skills for more effectively responding to and regulating negative emotions.
“the UP was designed to reduce mental health symptoms by targeting negative emotions, including by teaching skills for more effectively responding to and regulating negative emotions (41, 42).”
From Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the unified protocol for transdiagnostic treatment of emotional disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders (2025) · cites this paper as [41]
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Sexual Minority Mental HealthPreprint
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- Authors
- Sauer-Zavala, S., Fournier, J. C., Jarvi Steele, S., Woods, B. K., Wang, M., Farchione, T. J., & Barlow, D. H.
- Affiliations
- University of Kentucky (US)
- University of Pittsburgh (US)
- Boston University (US)
- Corresponding author
- Sauer-Zavala, Shannon
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2020-04-21
- Volume
- 51
- Issue
- 14
- Pages
- 2378-2387
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC7678331
- OpenAlex
- W3016695856
- Cited by
- 133
- References
- 63
- Citations by year
- 2026: 13 · 2025: 21 · 2024: 24 · 2023: 31 · 2022: 25 · 2021: 15 · 2020: 4
- FWCI
- 18.13
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Smith ScholarWorks (Smith College) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH090053)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- neuroticism, Unified Protocol, transdiagnostic treatment, anxiety disorders, cognitive behavioral therapy, trait change, treatment response, waitlist control, depression, anxiety symptoms
- MeSH terms
- Neuroticism, Adult, Anxiety Disorders, Female, Humans, Male, Brief Psychiatric Rating Scale, Phenotype, Waiting Lists, Cognitive Behavioral Therapy, Treatment Outcome, Self Report
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