Behavioral approaches show promise in addressing neuroticism. These approaches focus on understanding how this trait contributes to the risk of developing psychopathology. By identifying the underlying mechanisms through which neuroticism leads to mental health problems, we can develop treatment strategies that target both the symptoms of the disorder and the underlying personality vulnerabilities.
One specific aspect of treatment involves addressing aversive reactions to negative emotions. Many individuals with neuroticism tend to rely on avoidant strategies to regulate their emotions. Paradoxically, these strategies can actually lead to more frequent and intense emotional experiences. Previous research by Wegner et al. (1987) and Rassin et al. (2000a) supports this finding. Therefore, interventions that target aversive reactions to negative emotions can help reduce reliance on avoidant strategies.
Furthermore, when individuals experience fewer negative emotions over time and sustain these changes, it can lead to a decrease in neuroticism. It is important to note that trait change is a complex process (Magidson, Roberts, Collado-Rodriguez, & Lejuez, 2014). However, the treatment elements described in this section, originally designed to alleviate symptoms of DSM disorders, have shown promise in addressing aversive reactivity and potentially impacting neuroticism.
The Cognitive Triad and Neuroticism Treatment
Cognitive Therapy (CT) involves a collaborative process between the therapist and the patient. Its goal is to identify distorted thoughts, analyze them logically, and test them through empirical hypothesis testing. This process helps the patient realign their cognitions with reality (DeRubeis, Webb, Tang, & Beck, 2019).
CT includes various techniques such as thought monitoring, thought challenging, and generating alternative interpretations. These techniques aim to identify unhelpful cognitions and test their validity. By examining evidence from their own experiences, patients have the opportunity to revise their original thoughts.
One advantage of CT is its focus on mental events that are relatively easy for patients to access, namely thoughts. Patients can be trained to report their thoughts, which enables a more thorough examination of their cognitive processes.
The cognitive model of emotional disorders focuses on how individuals think in response to stressors, whether they are real or imagined. This model considers the "cognitive triad," which includes negative views about oneself, the future, and the world (Beck, Kovacs, & Weissman, 1979). These cognitive elements align with our understanding of neuroticism.
Neuroticism is characterized by perceptions of the world as dangerous and unpredictable, as well as a belief that one lacks the necessary skills to cope with challenges (Barlow et al., 2014b). These cognitive aspects are central to the neurotic temperament and may be most amenable to change through cognitive interventions.
This treatment model was first created to help with depression symptoms (Beck, 1963). However, it has also been successfully used for other emotional disorders (Beck & Haigh, 2014). Many studies show that cognitive therapy is effective in reducing symptoms for different diagnoses (Butler, Chapman, Forman, & Beck, 2006; Dobson, 1989; Gaffan, Tsaousis, & Kemp-Wheeler, 1995).
Cognitive Therapy's Influence on Neuroticism
CT may help address beliefs about one's ability to handle difficult situations, which can increase perceived self-efficacy in managing negative emotions. This aspect of therapy could potentially impact how we react to unpleasant emotions. Some research supports this idea. For instance, in a meta-analysis conducted by Smits and colleagues (2008), which included 24 randomized controlled trials with a total of 1,851 patients, CT showed significant reductions in anxiety sensitivity that were of considerable magnitude. Similarly, studies have observed improvements in distress tolerance after undergoing CT (Azizi, Borjali, & Golzari, 2010).
Studies examining cognitive-behavioral interventions have reported decreases in intolerance of uncertainty and experiential avoidance. However, due to the complex nature of these treatments, it is challenging to assess the specific effects of cognitive components (Belloch et al., 2011; Dugas & Ladouceur, 2000; Eustis et al., 2020; Goldman, Dugas, Sexton, & Gervais, 2007; Ladouceur et al., 2000; Overton & Menzies, 2005). Therefore, despite the potential relevance of cognitive therapy in reducing aversive emotional reactions, further research is necessary to gain a better understanding of its unique contributions.
There is evidence suggesting that cognitive strategies can influence neuroticism. If individuals can develop a habit of changing the content of their thoughts, they may be less likely to experience negative emotions in response to stressors over time. In terms of empirical support for the use of cognitive elements in addressing neuroticism, the Tang et al. (2009) study mentioned earlier found that CT resulted in greater reductions in neuroticism compared to a placebo condition. However, when controlling for changes in depressive symptoms, the effect of treatment condition was not significant. Further research is needed to better understand the unique and specific effects of cognitive interventions on this personality trait.
Modifying Avoidant Behavior in the Neuroticism Treatment
Another technique frequently employed in the treatment of emotional disorders is to encourage patients to modify their emotionally avoidant behavior, which is a crucial aspect of the functional model of emotional disorders. This approach aligns with the basic principles of emotion science, which propose that the most fundamental way to change an emotion is by altering the associated action tendencies (Barlow, 1988, 2002; Barlow et al., 2014b).
One example of a helpful technique is opposite action, which comes from the emotion-regulation module of dialectical behavior therapy. It involves patients reflecting on whether their usual avoidant behaviors might actually contribute to more frequent or intense negative emotions, even though they may provide temporary relief (Selby et al., 2008; Selby et al., 2009). After this reflection, they are encouraged to practice engaging in approach-oriented alternative actions.
Several studies have investigated the specific impact of opposite action. In one laboratory study involving participants, they were instructed to respond to induced negative mood by either acting consistently with their emotion-driven urges or acting in an opposite manner (Sauer-Zavala, Wilner, Cassiello-Robbins, Saraff, & Pagan, 2019). The results indicated that opposite action led to more significant reductions in negative emotions compared to consistent action. In a subsequent multiple-baseline study conducted by Sauer-Zavala and colleagues (2020), a brief treatment module aimed at countering emotional behaviors resulted in reductions in avoidant responding frequency and decreased negative emotions. Furthermore, opposite action has been found to decrease the intensity of a specific negative emotion, namely shame (Rizvi & Linehan, 2005). Collectively, these findings provide preliminary evidence that encouraging patients to approach their emotional experiences may disrupt the cycle of emotional disorders, where avoidant coping inadvertently intensifies the frequency and intensity of negative emotions, thus perpetuating neurotic temperament.
The Role of Exposure Therapy in Behavior Modification
Exposure therapy is another technique used to modify patient behavior. It involves systematically and repeatedly exposing individuals to their feared stimuli, and it is a key component in the treatment of anxiety and related disorders. Exposure can take different forms, such as gradual or intense, brief or prolonged, and can include the use of various cognitive coping strategies. It can also be conducted through imaginal exposure (imagining the feared situation) or in vivo exposure (real-life exposure) (Meuret, Wolitzky-Taylor, Twohig, & Craske, 2012). The process of extinction learning is believed to play a crucial role in long-term reductions of fear experienced by patients (Craske et al., 2014). Extinction occurs when the feared stimulus, such as engaging in small talk, encountering dogs, or touching dirty doorknobs, is presented without the anticipated negative consequences, like feeling awkward, getting bitten, or falling ill.
It is crucial to acknowledge that during extinction, the original association between feared stimuli and undesirable outcomes is not erased. Instead, a new relationship is formed where the stimulus no longer predicts the negative consequence, leading to the inhibition of the fear response (Bouton, 1993).
Meta-analytic studies indicate that exposure therapy, whether used alone or in combination with other techniques like cognitive reappraisal, has significant effects on reducing symptoms of anxiety disorders (Cuijpers, Cristea, Karyotaki, Reijnders, & Huibers, 2016). Since the goal of exposure is to decrease distress in response to emotion-triggering stimuli, it is logical to expect that this therapeutic approach would lead to lasting reductions in negative affect, which are essential components of changes in neuroticism. However, there is limited data specifically focusing on the isolated effects of exposure therapy on temperament or aversive reactivity to emotions. In one study, Brake and colleagues (2016) demonstrated that exposure, both imaginal and in vivo, resulted in decreases in experiential avoidance. Additionally, findings from a trial comparing internet-based cognitive behavioral therapy (CBT) predominantly utilizing exposure practices with a waitlist condition suggest that exposure leads to significantly greater reductions in neuroticism (Hedman et al., 2014). Further research is needed to gain a better understanding of how exposure therapy influences temperament and the underlying mechanisms that sustain it.