Inside the Neurotic Mind

CHICAGO — A brief history of where neuroticism has been, and a briefer glimpse of where it’s going, framed the James McKeen Cattell Fellow Award address by David Barlow on Friday afternoon at the 24th APS Annual Convention.

Psychologists have a much clearer understanding of neuroticism today than when it was first described in the 1940s by Hans Eysenck. Today’s diagnostics for negative affect (http://en.wikipedia.org/wiki/Negative_affectivity) suggest a strong biological component — meaning some degree of heritability— and a strong psychological component, stemming from early experiences like trauma or even parenting style.

“These two vulnerabilities, when they line up properly, and they become activated by stress, then they develop a generalized anxiety syndrome,” said Barlow, a professor of both psychology and psychiatry at Boston University and the founder of the Center for Anxiety and Related Disorders. “They become generally anxious — you might say neurotic.”

Another element of neuroticism — the third of what Barlow called the “triple-vulnerability” model that emerged in the late 1980s — is a specific vulnerability, or a particular form the anxiety takes, such as obsessive-compulsiveness or certain phobias.

Often the neurotic temperament creates its own negative feedback loop. People with this predisposition don’t handle intense emotions well, Barlow explained, and as a result try to suppress or avoid them. When those efforts fail, as they generally do, they only serve to perpetuate negative affect.

Along similar lines, neuroticism also tends to be accompanied by several pervasive avoidance behaviors. These include situational avoidance (a person fearful of social setting might avoid a party), subtle avoidance (someone fearful of losing control might become a perfectionist), and cognitive avoidance (for instance, watching television to distract from unpleasant thoughts).

Fortunately, says Barlow, neuroticism is more malleable than therapists once thought. He and his colleagues have developed a treatment — a so-called “unified protocol” — that addresses many of these temperamental factors at once. While it’s a break from the individual treatments of the past, early results are encouraging.

“Time marches on and ideas change,” Barlow said. “Hopefully for the better.”

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