An Innovative Approach to Anxiety Depression and Trauma

Neuroticism is a personality characteristic defined by a tendency to feel frequent and severe unpleasant emotion, such as worry, despair, or fury.
Neuroticism may suggest a common predisposition to a variety of emotional illnesses, such as anxiety, depression, and trauma-related disorders.
The “unified protocol for transdiagnostic therapy of emotional disorders,” sometimes known as UP, is a revolutionary treatment for emotional disorders.
Are psychological illnesses such as anxiety and depression actually distinct from one another? Is it possible that these are both symptoms of the same condition?

Recent research by David Barlow and colleagues from Boston University, published in the October 2021 issue of Current Directions in Psychological Science, suggests that some psychological disorders (or “emotional disorders,” as they refer to them)—such as anxiety disorders, mood disorders, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and dissociative disorders—are variations of the same syndrome. And neuroticism is at the heart of this condition.

Neuroticism is a personality characteristic that exists in many people.
Many years ago, psychologist Hans Eysenck proposed that mental diseases are caused by interactions between stressful experiences and the personality attribute neuroticism.

What is the definition of neuroticism?

In an interview, David Barlow characterized neuroticism as “the propensity to feel frequent and severe negative emotions in reaction to numerous causes of stress, as well as a general sense of inadequacy and beliefs of a lack of control over powerful negative emotions and stressful situations.”

Naturally, when someone feels that tough and possibly stressful situations are unexpected and uncontrolled, they are more inclined to avoid the events or react poorly to both the events and the unpleasant emotional feelings that accompany them.

One method neurotic individuals use to attempt to decrease or prevent bad feelings is avoidant coping (also called avoidance coping). Avoidant coping strategies include diversion, reassurance-seeking, avoiding anxiety-provoking activities or circumstances, and participating in safety behaviors. Even worrying may be related with avoidant coping since one of the functions of concern is to keep the person from directly feeling negative emotions.

Because avoidant coping briefly alleviates pain, it may seem to be a viable long-term approach for minimizing unpleasant feelings. But this is not the case. In the long term, those who adopt avoidant coping methods are more likely to experience more frequent or strong negative feelings.

Additionally, participating in behavioral avoidance implies that there are less chances to confront one’s erroneous ideas. As a result, corrective learning never happens. For example, a person who has a fear of dogs and avoids them at all costs would never learn that most dogs are safe.

A new model of emotional problems is being developed.

“Emotion-motivated avoidant coping,” as the term suggests, is what keeps both neuroticism and emotional illnesses in check. According to the authors, “it is this aversive reactivity to emotional experiences and the resulting emotion-motivated avoidant coping that serve as a link between neuroticism and emotional disorders, and that serve as…the transdiagnostic functional mechanism fundamental to all disorders of emotion.”

However, the type of avoidant coping and the specific emotions avoided are not the same in every person. As seen in Picture 1, a person’s unique learning experiences (located on the left side of the figure) combine with the trigger or focal point of their emotional experiences, resulting in a specific negative emotional reaction. This reaction, depending on the individual’s genetic predisposition (i.e., their degree of neuroticism), may result in an emotional disorder (or no disorder at all).

Arash Emamzadeh is an Iranian actor and director (adapted from Barlow et al., 2021)
Arash Emamzadeh is the author of this article (adapted from Barlow et al., 2021)
Consider the issue of phobias. Learning experiences are critical in the formation of phobias. For example, one neurotic kid may acquire a dog phobia as a result of being bitten by a dog, but another neurotic child may develop social phobia as a result of seeing his or her parents’ worried conduct in social circumstances.

What happens to a person who does not acquire any phobias or mental illnesses? Does this imply that the individual never had an encounter that may have triggered the trigger? No, not at all. Indeed, triggers (such as loss or trauma) are fairly prevalent. For example, according to Barlow et al., four out of every five persons suffer from intrusive thoughts associated with OCD, and one out of every three people suffer from panic episodes while under stress. People with a low degree of neuroticism, on the other hand, are more likely to be able to react to unpleasant emotions in a healthy and adaptive manner, rather than ignoring or repressing them. So that they do not get afflicted by a mental disease (see the lower pathway in Figure 1).

The tiny fraction of the population that does acquire OCD, panic disorder, and other emotional illnesses, on the other hand, responds in maladaptive ways: The “existence of a neurotic disposition combined with early learning experiences…predisposes sensitivity to certain emotional triggers” in these people. For example, many people who suffer from panic disorder remember their parents “sensitizing” them to the “dangers of inexplicable bodily feelings such as high heart rate.”

In summary, distinguishing between mental diseases only on the basis of triggers, as the diagnosis manuals (e.g., the DSM-5) do, misses the profound parallels that exist between many emotional disorders.

Treatment of emotional illnesses

In terms of therapy, Barlow and colleagues have devised a cognitive behavioral intervention known as the unified protocol for transdiagnostic treatment of emotional disorders. The protocol is divided into eight modules:

Setting objectives and sustaining motivation entails many steps, including identifying issues and goals, addressing the reason for change, weighing the advantages and disadvantages of change, and so on.
Identifying and understanding emotions (such as anxiety, wrath, and guilt), as well as their functions, causes, and repercussions
Mindful emotion awareness is defined as increasing one’s awareness of one’s emotions, especially in a present-focused and nonjudgmental manner.
Cognitive flexibility is defined as the ability to detect “thought traps” (e.g., catastrophizing) and the ability to increase cognitive flexibility by participating in cognitive reappraisal (i.e. changing how one thinks about a situation).
Managing one’s emotional responses: Identifying and replacing maladaptive emotion-driven behaviors (e.g., procrastination, avoidance, self-harm).
Understanding and facing somatic feelings: Getting frequent exposure to unpleasant physical sensations (e.g., fast heart rate, dizziness) in order to improve tolerance of such symptoms.
Emotion exposures: Getting frequent exposure to emotional triggers, such as scary feelings and circumstances, in order to enhance one’s emotional tolerance.
Recognizing successes and looking to the future: Reviewing the patient’s development and discussing future goals for retaining the gains.
As can be seen, rather than focusing on the triggers of specific psychological disorders, the unified protocol for transdiagnostic treatment of emotional disorders addresses what is common to many emotional disorders: the tendency to react negatively to emotional experiences and the tendency to avoidant coping.

According to a recent review, the unified protocol for transdiagnostic treatment of emotional disorders appears to be effective for the treatment of borderline personality disorder, anxiety, depression, generalized anxiety disorder, panic disorder (both with and without agoraphobia), obsessive-compulsive disorder, and social phobia.