Assessing Theories of State and Trait Change in Neuroticism and Symptom Improvement in the Unified Protocol

Nicole E. Stumpp, Matthew W. Southward, Shannon Sauer-Zavala

Research output: Contribution to journalArticlepeer-review


Researchers have shown neuroticism decreases with treatment (Roberts et al., 2017), although it is unclear if this reflects fleeting state-level changes (state-artifact position) or trait-level change (cause-correction hypothesis). These theories further propose that changes in neuroticism predict symptom change (cause-correction hypothesis) or are predicted by symptom change (state-artifact position). We compared these theories in a clinical trial of the Unified Protocol (UP). Participants (N = 38; Mage = 34.55, 71.1% female, 78.9% Caucasian) meeting DSM-5 criteria for a primary emotional disorder completed up to 12 weekly sessions of the UP. Neuroticism exhibited state-level changes by Session 6 but trait-level changes by Session 12. Within-person reductions in neuroticism exhibited bidirectional relations with anxiety symptom change but predicted unidirectional session-to-session reductions in depression. These findings provide relatively more nuanced support for the cause-correction hypothesis that the UP leads to trait changes in neuroticism that tend to precede symptom change.

Original languageEnglish
JournalBehavior Therapy
StateAccepted/In press - 2023

Bibliographical note

Funding Information:
M.W.S.’s efforts on this project were partially supported by the National Institute of Mental Health under award number K23MH126211. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institute of Health.

Publisher Copyright:
© 2023 Association for Behavioral and Cognitive Therapies


  • anxiety
  • change mechanisms
  • depression
  • neuroticism
  • Unified Protocol

ASJC Scopus subject areas

  • Clinical Psychology


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