Neuroticism has long been associated with psychopathology and there is increasing evidence that this trait represents a shared vulnerability responsible for the development and maintenance of a range of common mental disorders. Given that neuroticism may be more malleable than previously thought, targeting this trait in treatment, rather than its specific manifestations (e.g., anxiety, mood, and personality disorders), may represent a more efficient and cost-effective approach to psychological treatment. The goals of the current manuscript are to (a) review the role of neuroticism in the development of common mental disorders, (b) describe the evidence of its malleability, and (c) review interventions that have been explicitly developed to target this trait in treatment. Implications for shifting the focus of psychological treatment to underlying vulnerabilities, such as neuroticism, rather than on the manifest symptoms of mental health conditions, are also discussed. (PsycINFO Database Record

Men who have sex with men (MSM) are the group most at risk for HIV and represent the majority of new infections in the United States. Rates of childhood sexual abuse (CSA) among MSM have been estimated as high as 46%. CSA is associated with increased risk of HIV and greater likelihood of HIV sexual risk behavior. The purpose of this study was to identify the relationships between CSA complexity indicators and mental health, substance use, sexually transmitted infections (STIs) and HIV sexual risk among MSM. MSM with CSA histories (n = 162) who were screened for an HIV-prevention efficacy trial completed comprehensive psychosocial assessments. Five indicators of complex CSA experiences were created: CSA by family member, CSA with penetration, CSA with physical injury, CSA with intense fear, and first CSA in adolescence. Adjusted regression models were used to identify relationships between CSA complexity and outcomes. Participants reporting CSA by family member were at 2.6 odds of current alcohol use disorder (OR: 2.64: CI 1.24 – 5.63), 2 times higher odds of substance use disorder (OR 2.1: CI 1.02 – 2.36), and 2.7 times higher odds of reporting an STI in the past year (OR 2.7: CI 1.04 – 7.1). CSA with penetration was associated with increased likelihood of current PTSD (OR 3.17: CI 1.56 – 6.43), recent HIV sexual risk behavior (OR 2.7: CI 1.16 – 6.36) and a greater number of casual sexual partners (p = .02). Both CSA with Physical Injury (OR 4.05: CI 1.9 – 8.7) and CSA with Intense Fear (OR 5.16: CI 2.5 – 10.7) were related to increased odds for current PTSD. First CSA in adolescence was related to increased odds of major depressive disorder. These findings suggest that CSA, with one or more complexities, creates patterns of vulnerabilities for MSM, including PTSD, substance use, and sexual risk taking and suggests the need for detailed assessment of CSA and the development of integrated HIV prevention programs that address mental health and substance use comorbidities.

Borderline personality disorder (BPD) is a severe, difficult-to-treat psychiatric condition that represents a large proportion of treatment-seeking individuals. BPD is characterized by high rates of co-occurrence with depressive and anxiety disorders, and recently articulated conceptualizations of this comorbidity suggest that these disorders may result from common temperamental vulnerabilities and functional maintenance factors. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) was developed to address these shared features relevant across frequently co-occurring disorders. The purpose of the present study was to explore the preliminary efficacy of the UP for treatment of BPD with comorbid depressive and/or anxiety disorders in a clinical replication series consisting of five cases. For the majority of cases, the UP resulted in clinically significantly decreases in BPD, anxiety, and depressive symptoms, as well as increases in emotion regulation skills.

Most patients in community practice attend significantly fewer sessions than are recommended by treatment protocols that have demonstrated efficacy in addressing emotional disorders. Personalized interventions that target the core processes thought to maintain a wide range of disorders may serve to increase treatment efficiency, addressing this gap. This study sought to evaluate the feasibility and acceptability of the personalized delivery of a mechanistically transdiagnostic intervention, the Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders. Using an AB phase change design in accordance with the single-case reporting guideline for behavioral interventions (SCRIBE), 18 individuals with heterogeneous emotional disorders were randomly assigned to receive UP treatment modules ordered according to either their pretreatment strengths or weaknesses. Results support the feasibility of reordering the treatment modules as the majority of patients presented with marked differences in skill levels, as well as the acceptability of this approach as patients in both conditions reported satisfaction with their assigned treatment order. Furthermore, the majority of patients demonstrated symptom improvement consistent with previously reported effects of the standard-order UP. Finally, there is preliminary evidence to suggest that those in the strengths condition displayed improvements in outcomes earlier in treatment than those in the weaknesses condition. Taken together, these findings offer preliminary support for improving treatment efficiency through the utilization of a personalized, strengths-based, transdiagnostic approach.

Objective The purpose of this study is to assess the prospective relationship of neuroticism to frequency of headaches and stomachaches in adolescents. Methods Participants were 3,676 adolescents sampled from Wave 1 (mean age 16) and Wave 2 (mean age 17) of the National Longitudinal Study of Adolescent Health (i.e., Add Health), a comprehensive, nationally representative, longitudinal data set. Binary variables were created to isolate participants who reported high versus low/medium frequency of pain. Subsequently, Wave 2 pain variables were modeled based on Wave 1 neuroticism, controlling for Wave 1 pain and demographics. Results Elevated neuroticism at Wave 1 prospectively predicted increased odds of high frequency of headaches (odds ratio = 1.4, 95% CI [1.2, 1.8], p = .001) and stomachaches at Wave 2 (odds ratio = 1.5, 95% CI [1.1, 2.0], p = .004). Conclusions This is the first known study to examine and find evidence for the prospective relationship between neuroticism and pain among a nationally representative sample of adolescents. Results indicated that after controlling for baseline pain, elevated neuroticism longitudinally predicted increased odds of high frequency of pain, one year later. Given recent advances in treatment for neuroticism, clinicians should be aware of these relationships and incorporate multidisciplinary treatments in the care of adolescents who experience high levels of pain.

Homeless individuals experience higher rates of mental illness than the general population, though this group is less likely to receive evidence-based psychological treatment for these difficulties. One explanation for this science-to-service gap may be that most empirically supported interventions are designed to address a single disorder, which may not map on to the substantial comorbidity present in safety-net samples, and create a high training burden for often underresourced clinicians who must learn multiple protocols to address the needs of their patients. One solution may be to prioritize the dissemination of transdiagnostic interventions that can reduce therapist burden and simultaneously address comorbid conditions. The purpose of the present article is to describe the process of conducting a pilot study administering the Unified Protocol (UP), a transdiagnostic treatment for the range of emotional disorders, at a community-based organization that provides health care and other services to homeless individuals and families in Boston, Massachusetts. Therapists on a specialized behavioral health unit received didactic training in the intervention, followed by weekly consultation while they provided the UP to patients on their caseload. Qualitative and quantitative data were collected from both patients and therapists. Barriers to use of the UP by therapists, as well as to conducting research in this setting, will be discussed, along with the solutions that were used. Clinical Impact StatementQuestion: Can transdiagnostic cognitive-behavioral therapy be feasibly administered in a safety-net setting? Findings: Both patients and therapists found treatment with the Unified Protocol to be highly acceptable, though there were challenges to administration (e.g., provider turnover, patient attendance, and patient crisis) that impacted its delivery. Meaning: Transdiagnostic interventions, like the Unified Protocol, confer a number of advantages that may make dissemination of evidencebased practices for mental health in safety-net settings more feasible. Next Steps: A larger effectiveness study designed to address the remaining challenges is a necessary next step in assessing the fit of this intervention in a safety-net context.

Objectives: This study explored the associations between domains of experiential avoidance and severity and functions of non-suicidal self-injury (NSSI). Methods: Undergraduates reporting a history of repeated engagement in NSSI (N = 150) completed measures of experiential avoidance, psychopathology, and self-injury. Results: Procrastination, a specific domain of experiential avoidance, was related to the severity of self-injurious behavior; however, procrastination did not account for significant incremental variance in the NSSI severity over and above the contributions of depression and anxiety. Correlational and hierarchical regression analyses indicated that procrastination and repression/denial domains of experiential avoidance were associated with automatic negative and automatic positive reinforcement functions of NSSI (respectively) and accounted for significant incremental variance after controlling for depressive and anxiety symptoms. Both repression/denial and distress aversion also explained a significant proportion of variance in engagement in NSSI for interpersonal reasons when controlling for the contributions of depression and anxiety. Conclusions: These findings provide preliminary support for the notion that unique relationships exist among distinct forms of experiential avoidance and both severity and functions of NSSI. Clinical and theoretical implications for these results are discussed.

The integrated intervention was associated with substantially higher short-term and long-term abstinence rates than the enhanced standard intervention. These data provide promising initial evidence supporting the benefits of an integrated anxiety-depression/smoking cessation program specifically tailored for people living with HIV.