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This commentary on the chapter from Bach and Presnall-Shvorin (this volume) describes the use of the five-factor model (FFM) in treatment planning. Specifically, Bach and Presnall-Shvorin describe how knowledge of a patient’s personality profile can enhance the therapeutic alliance and assist in the selection of treatment components. Their focus is largely at the facet level of the five broad domains, resulting in a large number of intervention strategies necessary to provide adequate coverage for disorder-based sequelae of the FFM. Using neuroticism as an exemplar, this commentary focuses on how clinicians can streamline treatment by understanding functional processes that explain associations between FFM domains and their downstream disorder manifestations. This may allow for a limited number of treatment elements (i.e., five) that may be applicable to the broad range of psychopathology, perhaps increasing treatment efficiency and increasing the likelihood that empirically supported interventions are routinely employed.
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.
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.
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.
Treatment effects on neuroticism may be most robust when this trait is explicitly targeted.
The goal of this chapter is to highlight several imperatives for continued progress with regard to treatment development for mental health conditions. Specifically, the importance of identifying core, transdiagnostic processes that can become the focus of treatment is emphasized, along with developing dimensional classification systems that reliably assess these targets. Additionally, techniques to confirm that components included in the treatment packages indeed engage these core processes are highlighted with the goal of ensuring that interventions are comprised of only active ingredients. Next, considerations for conducting treatment outcome studies specifically with transdiagnostic interventions are addressed. Finally, the rationale for moving away from the development of nomothetic, one-size-fits-all treatment protocols, in favor of personalized approaches are highlighted.
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