Neuroticism.  This trait refers to the tendency to experience negative emotions frequently and intensively. Aversive reactions (e.g., "its weak to feel this way," "I hate this feeling") to negative emotions prompt the use of emotionally avoidant coping strategies (e.g., self-injurious behaviors, binge eating, substance use) that paradoxically result in more frequent and intense negative emotions (i.e., exacerbating and maintaining neuroticism; Bullis et al., 2019). By contrast, sustained decreases in the frequency of negative emotions, achieved by targeting aversive/avoidant responses to emotions, may constitute decreases in negative affectivity. Transdiagnostic behavioral interventions targeting aversive reactivity have been associated with significantly larger decreases in neuroticism than symptom-focused protocols (Sauer-Zavala, Fournier, et al., 2020) and improvements in negative affectivity in transdiagnostic treatments may even predict symptom reduction. Thus, we target neuroticism by encouraging patients to approach their emotions, rather than avoid them.

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(Low) Agreeableness/Antagonism. This trait is characterized by distrust, manipulativeness, and oppositionality (Mullins-Sweatt et al., 2012), and is associated with strained interpersonal relationships (Anderson et al., 2007; Kotov et al., 2010; Miller et al., 2003). Higher levels of antagonism are associated with insecure attachments to childhood caregivers, which can manifest in adulthood as behaviors that function to protect a person in interpersonal contexts perceived as threatening (Young et al., 2006). Here, attachment insecurity represents an actionable functional mechanism linking the personality trait of antagonism to externalizing symptoms, akin to the role of aversive reactivity in the relation between neuroticism and negative emotions. Emerging research suggests that improving patients’ ability to consider others’ perspectives, along with challenging negative schemas about oneself and others, improves attachment security in adults (Levy et al., 2006; Vogt & Norman, 2019). We target antagonism by encouraging perspective taking, limiting black-and-white thinking, conducting behavioral experiments in relationships, and cultivating mindful awareness of others.

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(Low) Conscientiousness/Disinhibition. This trait, also referred to as trait impulsivity, is characterized by sensation-seeking (the tendency to seek out novel and thrilling experiences), lack of deliberation (the tendency to act without thinking), lack of persistence (an inability to remain focused on a task), and urgency (the tendency to act rashly in response to positive and negative emotional experiences; Cyders et al., 2007; Whiteside et al., 2005). Researchers have suggested that individuals’ expectancies about their performance on certain tasks, along with how much they value these actions, predict conscientious behaviors (e.g., paying bills on time, subjugating impulses that would be gratifying in the short-term; Eccles, 2009). Others have suggested that trait impulsivity is maintained by high reward orientation such that disinhibited individuals will continue to pursue rewards (e.g., relief from negative emotions, substance-related highs) despite negative consequences (Carver & White, 1994; Gray, 1987). Thus, intervention strategies that focus on values, provide immediate (reinforcing) feedback on progress, and engage performance expectancies may be particularly useful for this trait (Magidson et al., 2014).