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Personality and Individual Differences 94 (2016) 38–43
Contentslists available at ScienceDirect
Personality and Individual Differences
journalhomepage:www.elsevier.com/locate/paid
Fromneuroticismtoanxiety: Examininguniquecontributions of three
transdiagnostic vulnerability factors
a a b a,
Daniel J. Paulus ,SalomeVanwoerden ,PeterJ.Norton ,CarlaSharp ⁎
a University of Houston, Department of Psychology, Houston, TX, USA
b MonashUniversity, School of Psychological Sciences, Clayton, VIC, Australia
article info abstract
Article history: Neuroticism has been implicated in many forms of psychopathology. Additional transdiagnostic factors such as
Received 9 October 2015 shame,psychologicalinflexibility, and emotion dysregulation may explainthe association betweenneuroticism
Received in revised form 17 December 2015 andanxiety.Whilepastworkhas,tosomedegree,evaluatedthesefactorsthatcutacrossdiagnosticcategories,
Accepted7January2016 no study has evaluated them jointly to examine unique explanatory value over and above shared variance
Available online xxxx and/orgeneraldistress.Theindirecteffectsofneuroticismviathreetransdiagnosticfactors(shame,psychological
Keywords: inflexibility, and emotion dysregulation) on anxiety symptoms were evaluated among 97 inpatient adolescents
Neuroticism (63.9%female;Mage15.23;SD=1.43)usingthreeseparatemeasuresofanxiety(twoself-reportandonediag-
Anxiety nosticsymptomcount)aswellasacompositeanxietyseverityoutcomevariablecomprisedofallthreemeasures.
Transdiagnostic Asexpected,neuroticismwassignificantly associatedwith anxiety symptoms and all three transdiagnostic fac-
Shame tors. Neuroticism via shame was the only significant indirect effect and was present in all models. The indirect
Emotionregulation effects were of medium size. Competing models testing alternative pathways were rejected, adding confidence
Psychological flexibility to the significant findings of neuroticism via shame. Data were cross-sectional. For adolescent anxiety, shame
maybeparticularlyimportant.Futureinterventionworkcanexamineeffectsoftargetingshameamongadoles-
cents with high neuroticism and/or anxiety.
©2016ElsevierLtd.Allrights reserved.
1. Introduction Shamehasbeendescribedasariskfactor for the development of
psychological symptoms such as anxiety (e.g., Lewis, 1971), though,
Amongadolescents, anxiety disorders are the most common psy- untilrecently,empiricalstudieshavebeenlimitedduetolackofreliable
chological problems (Kessler et al., 2012). Adolescent anxiety persists, measures of shame (Rizvi, 2010). Shame has been labeled as a self-
predicting later symptomatology in adulthood (Olino, Klein, conscious emotion that emerges when flaws of the self are revealed to
Lewinsohn, Rohde, & Seeley, 2010). One underlying factor that is others (Dearing, Stuewig, & Tangney, 2005). It is associated with a
strongly associated with anxiety is neuroticism (for review, see; range of emotional disorders (Tantam, 1998), correlating significantly
Kotov, Gamez,Schmidt, & Watson,2010), a personality factor that cor- with neuroticism (Woien, Heidi, Patock-Peckham, & Nagoshi, 2003)
responds to and predisposes individuals to experience negative affect and anxiety (Fergus, Valentiner, McGrath, & Jencius, 2010) in adults.
(Watson, Clark, & Tellegen, 1988). Neuroticism has been reliably However, there is a dearth of research examining such associations
studied among youth (Hink et al., 2013), with studies demonstrating amongadolescents. Developmentally, this is a crucial period of study
continuity between youth and adult neuroticism (Caspi & Roberts, asithasbeensuggestedthat,althoughshameispresentearlierinchild-
2001).Neuroticism, though, is a broad factor implicated in the etiology hood,levels of shamemayincreaseduringadolescence(Reimer,1996)
of manyotherformsofpsychopathology(e.g.,Widiger,Verheul, & van andtakeonmaladaptiveforms(Szentágotai-Tătaretal.,2015).Todate,
denBrink, 2009). Thus, additional, more specific, risk factors should be nostudyhasevaluatedshameasapotentialexplanatoryfactorunderly-
identified and examined. The notion of considering both general and ing the association of neuroticism and anxiety among any age group.
specific risk factors is in line with Barlow's (2004) triple vulnerability Inadditiontoshame,psychologicalflexibilityisanotherrelevantfac-
model, which states that the development of anxiety results from tortoconsiderwithregardtoneuroticismandanxiety.Itisabroadterm
general genetic, general psychological, and disorder-specific (or semi- conceptualized as an “ability to contact the present moment” and “to
specifice.g.,Taylor, 1998)factors. change or persist in behavior when doing so serves valued ends”
(Hayes,Luoma,Bond,Masuda,&Lillis,2006).Defi
cits in exhibiting psy-
⁎ Corresponding author at: The University of Houston, Department of Psychology, 126 chological flexibility (psychological inflexibility) has been associated
HeyneBuilding,Suite 104, Houston, TX77204, USA. withhigher rates of anxiety in adults and children, and is considered a
E-mail address: csharp2@central.uh.edu (C. Sharp). risk factor for the development of a range of mental health issues
http://dx.doi.org/10.1016/j.paid.2016.01.012
0191-8869/©2016ElsevierLtd.All rights reserved.
D.J. Paulus et al. / Personality and Individual Differences 94 (2016) 38–43 39
(Fergus et al., 2012). Psychological inflexibility is associated with neu- inpatient youth. The current data were collected from 2012 to 2015.
roticism (Latzman & Masuda, 2013), and is a significant predictor of Participants were recruited from an inpatient psychiatric unit that
anxiety (Boelen & Reijntjes, 2008), over and above neuroticism. serves individuals with severe behavioral and emotional disorders
Oneadditional variable of interest is emotion regulation. Emotion who have not responded to previous interventions. Length of stay
regulation is a broad term, whose definition is contentiously discussed ranged from15to86days(M=37.81,SD=12.45).Inclusioncriteria
(Bloch, Moran, & Kring, 2010). Generally, emotion regulation encom- wassufficient proficiency in English to consent to research and com-
passes processes that influence expression of emotional responses pletethenecessaryassessments,andexclusioncriteriawereadiagnosis
thataredevelopedovertime(Gross,2014).Theinabilitytoappropriate- of schizophrenia or another psychotic disorder, an autism spectrum di-
lyregulateemotionhasbeendescribedasemotiondysregulation(Bloch agnosis,oranIQoflessthan70.185consecutiveadmissionstothehos-
et al., 2010) and is considered to be transdiagnostic, common to many pital were approachedforconsent,16declinedparticipation,1revoked
formsofpsychopathology(Werner&Gross,2010).Further,measures consent, and 16 were excluded on the basis of the aforementioned
of the construct explain additional variance in anxiety symptoms, not criteria. Additionally, 55 participants were excluded due to missing
accounted for by other general factors (Cisler, Olatunji, Feldner, & data on one or more measures of interest. Therefore, the final sample
Forsyth,2009),thoughithasnotbeenexaminedasamechanismunder- consisted of 97 adolescents (ages 12–17; Mage 15.23; SD = 1.43), in-
lying the link between neuroticism and anxiety. cluding 63.9% females, and had the following ethnic breakdown: 77.3%
Thecurrentstudyexploredtherelationshipofthreefactors(shame, White, 7.2% Hispanic, 2.1% Asian, and 13.4% mixed or other. Based on
psychological inflexibility, and emotion dysregulation) as potential DSM-IVcriteria,74.4%werediagnosedwithmajordepressivedisorder,
mechanisms underlying the association between neuroticism and 26.7%ADHD,26.7%socialphobia,28.9%obsessivecompulsivedisorder,
anxiety (see Fig. 1), with multiple indices of anxiety as an outcome. 23.3%generalizedanxietydisorder,16.7%oppositionaldefiantdisorder,
Importantly, these three factors have been widely considered to be 17.8%panic disorder, 14.4% agoraphobia, 15.6% separation anxiety dis-
transdiagnostic (i.e., cutting across diagnostic categories) though we order, 9% anorexia, 8.9% post-traumatic stress disorder, 2.2% bulimia,
are unaware of any published research examining their associations 15.6% conduct disorder, and 4.4% bipolar at admission. Additionally,
with anxiety in the same model/study. While evaluating such factors 74.2%self-endorsed anxiety as a reason for their hospitalization.
in isolation mayhelptoidentifyfeaturesassociatedwithpsychopathol- The study was approved by the appropriate institutional review
ogy, it says little about the utility of constructs over and above other board. All adolescents admitted to an inpatient psychiatric unit were
established ones. This study aimed to concurrently evaluate these approachedonthedayofadmissionaboutparticipation.Informedcon-
three, well-established, factors to determine statistical significance sent was provided by parents first, and if granted, assent from adoles-
over and above effects of one another. Moreover, to date, no study has cents was obtained. Adolescents were collectively assessed by
evaluatedthesefactors,individually,orconcurrently,asindirectexplan- doctoral-level clinical psychology students and/or trained clinical re-
atory variables underlyingthelinkbetweenneuroticismandanxietyin search assistants. The assessments were conducted independently and
adolescents. We hypothesized that each of these three factors would in private within the first two weeks following admission.
represent distinct, though related, constructs and that each factor
would,uniquely,explaintheassociationbetweenneuroticismandanx-
iety, over and above their shared variance. 2.1. The computerized diagnostic interview schedule for children (C-DISC)
2. Method TheC-DISC(Shaffer,Fisher,Lucas,Dulcan,&Schwab-Stone,2000)is
a structured computer-assisted diagnostic interview used to assess
Datafrom97adolescentswereavailablefor the current study, col- DSM-IV Axis I psychiatric disorders in children and adolescents. The
lected as part of a larger research study evaluating emotions among numberofsymptomsforeachanxietydisorderthatwereendorsedon
Fig. 1. Proposed model.
40 D.J. Paulus et al. / Personality and Individual Differences 94 (2016) 38–43
the C-DISC was used as a composite index of anxiety severity (C-DISC- 2.6. Avoidance and Fusion Questionnaire for Youth (AFQ-Y)
ANX),oneoftheoutcomevariablesinthisstudy.
TheAFQ-Y(Greco,Lambert, &Baer, 2008) is a 17-item self-report
2.2. Multidimensional Anxiety Scale for Children (MASC) measureassessing psychological inflexibility. Responses are scored on
a 5-point Likert scale from 0 (not at all true) to 4 (very true). The
TheMASC(March,Parker,Sullivan, Stallings, & Conners, 1997)isa AFQ-Yhasdemonstratedadequatereliabilityandvalidityinadolescent
transdiagnostic self-report measure of anxiety, containing 39 items, samples (Greco et al., 2008). Internal consistency in this sample was
which are rated on a 4-point Likert scale from 0 (never true) to 3 good (α=.88).
(often true). It demonstrates good concurrent and predictive validity
(Marchetal., 1997). MASC scores in this study had excellent internal 2.7. Difficulties in Emotion Regulation Scale (DERS)
consistency (α =0.93).
The DERS (Gratz & Roemer, 2004) is a 36-item multidimensional
2.3. Youth self-report-anxiety problems (YSR) self-report measure. Items are scored on a 5-point Likert scale from 1
(almost never [0–10%]) to 5 (almost always [91–100%]), with higher
TheYSR(Achenbach,1991)isabroad-bandmeasureofpsychopa- scores indicating greater difficulties in emotion regulation. The DERS
thology. The measure contains 112 problem items, each scored on a hasdemonstratedadequatereliabilityandvalidityinacommunitysam-
3-point Likert scale (0 = not true, 1 = somewhat or sometimes true, ple of adolescents (Neumann, van Lier, Gratz, & Koot, 2010). Internal
or 2 = very or often true) and converted to t scores. The anxiety prob- consistency for this sample was excellent (α =0.94).
lemsubscale (YSR-ANX)hasbeenshowntopredictthepresenceofan Analyses were conducted using the PROCESS macro for SPSS v.20
anxiety disorder in adolescents (Ferdinand, 2008). The affective prob- (Hayes, 2012). Bootstrapping with 10,000 re-samples was performed
lemsubscale(YSR-AFF)correspondstoDSM-IVsymptomsofmajorde- to obtain95%confidenceintervalsforthespecificindirecteffects.Effect
2
pressive disorder and dysthymia (Ferdinand, 2008). The externalizing sizes (Κ ) were calculated for the specific indirect effects, (Preacher &
scale (YSR-EXT) is a superordinate factor representing conflict with Kelley,2011).UsingAMOSforSPSS20(Arbuckle,2011),acompositela-
others and with others' expectations for behavior. tent variable (C-DISC-ANX) was created; this standardized value was
imputed from the six variables indexing the number of diagnostic
2.4. Big Five Inventory, Neuroticism (BFI-N) symptomsendorsedforeachanxietydisorder(panicdisorder,agora-
phobia, social anxiety disorder, generalized anxiety disorder, specific
The BFI (John, Donahue, & Kentle, 1991) is a 44-item self-report phobia, and separation anxiety disorder), which was as a dependent
questionnaire assessing the Big Five personality dimensions. The BFI-N variable. Additionally, a total composite ‘anxiety severity’ variable
is made up of 8 phrases, which are rated on a 5-point Likert scale from (ANX-TOT)wascreatedusingtheaforementionedsixsymptomcount
1 (Disagree Strongly) to 5 (Agree Strongly). All scales have been variables, theMASC,andtheYSR-ANXasindicators.Theassociationbe-
deemed reliable with a clear factor structure as well as convergent tweenneuroticism and anxiety with three indirect explanatory vari-
and discriminant validity (Benet-Martínez & John, 1998; John & ables (shame, psychological inflexibility, and emotion dysregulation)
Srivastava, 1999) and have been used in past studies with adolescents wastestedwiththreeseparateindicesofanxiety (MASC, YSR-ANX,C-
(Marks, Hine, Blore, & Phillips, 2008). BFI-N internal consistency was DISC-ANX)aswellasthecompositeoutcome(ANX-TOT).
goodinthis sample (α =0.84).
3. Results
2.5. The Test of Self-Conscious Affect — Adolescent Version (TOSCA)
Nooutlierswerediscovered,asdistributionsapproximatednormal-
The TOSCA (Tangney, Wagner, Gavlas, & Gramazow, 1991)isa ity with all total score values demonstrating acceptable values of skew-
15-item self-report measure assessing global shame-proneness in ado- ness and kurtosis (b|1.40|). There was no indication of collinearity
lescentsandconsistsofvarioussocialscenariosofpositiveandnegative amongthedirectandindirectpredictors.Meansandstandarddeviation
valences to which participants must imagine their likely reaction. For are provided in Table 1. The total (path c) and direct (path cʹ) effects of
each scenario, participants rate how likely they would be to respond BFI-NoneachoutcomearepresentedinTable2.
in a given manner on a scale of 1 (not at all likely) to 5 (very likely). For all models tested, there were significant specific indirect effects
Responses are summed to a total shame-proneness scale (TOSCA-S). (patha∗b)ofBFI-NviaTOSCA-S(β'sbetween.07–.11;seeTable3);ef-
2 between .06–.12) were mediuminsize. Indirecteffects of
All TOSCAsubscaleshavedemonstratedgoodreliabilityandconvergent fect sizes (Κ
validity with measures of psychopathology (Tangney & Dearing, 2002) BFI-N via DERS and AFQ-Y, respectively, were non-significant in all
amonghealthy adolescents. Internal consistency of the TOSCA-S was models. Totestthespecificityof theindirect effects, competing models
excellent in this sample (α =0.90). wererun,usingtheMEDIATEmacroforSPSS(Hayes&Preacher,2014),
Table 1
Means,standarddeviationsandbivariate correlationsamongvariables(n =97).
Variable Mean/n(SD/%) 1 2 3 4 5 6 7 8 9 10 11
1. C-DISC-ANX 0.0 (1.0) 1
2. MASC 59.3 (14.4) .61** 1
3. YSR-ANX 64.5 (9.7) .61** .71** 1
4. ANX-TOT 0.0 (1.0) .91** .82** .83** 1
5. YSR-AFF 74.3 (12.2) .42** .49** .59** .54** 1
6. YSR-EXT 61.2 (11.3) −.02 −.03 .05 −.03 .20 1
7. Age 15.2 (1.4) −.19 −.16 −.23* −.20 −.13 .09 1
8. Sex (% female) 62(63.9) −.08 .10 .11 .01 .07 .29** .32** 1
9. BFI-N 3.9 (0.8) .44** .58** .68** .62** .57** .03 −.15 −.23* 1
10. TOSCA-S 50.5 (12.3) .46** .57** .61** .61** .45** −.19 −.34** −.28** .52** 1
11. AFQ-Y 33.7 (13.7) .42** .53** .61** .56** .58** .09 .04 .07 .57** .57** 1
12. DERS 114.2 (28.5) .31** .45** .47** .42** .62** .19 −.16 −.13 .63** .50** .64**
*pb.05,**pb.01;numbersacrossheadercorrespondwithvariablesnumbered1–11.
D.J. Paulus et al. / Personality and Individual Differences 94 (2016) 38–43 41
Table 2 neuroticismviapsychologicalflexibilityoremotionregulation.Thispat-
Standardizedregression coefficients. ternwasconsistentwhenlookingatdiagnosticsymptomsendorsedon
Y Model β SE p CI (l) CI (u) theC-DISCastheoutcome(model1)aswellastwotransdiagnosticself-
BFI-N ➔TOSCA-S(a ) .30 .10 .004 .10 .50 report measures of anxiety symptoms (models 2–3) and a composite
1 outcomevariable comprised of the dependent variables of models 1–3
BFI-N ➔AFQ-Y(a ) .41 .10 b.001 .21 .61
2 (model4).Theseeffectsweresignificantwhencontrollingforage,sex,
BFI-N ➔DERS(a3) .38 .09 b.001 .20 .57
TOSCA-S➔C-DISC-ANX(b1) .22 .13 .106 −.05 .48 2
C-DISC-ANX depression, and externalizing and, as evidenced by Κ , the indirect ef-
AFQ-Y➔C-DISC-ANX(b ) .18 .14 .202 −.10 .47
2 fects of neuroticism via shame were of medium size. Reverse models
DERS➔C-DISC-ANX(b ) −.18 .14 .193 −.45 .09
3 were run, yielding non-significant effects, adding confidence to the
BFI-N ➔C-DISC-ANX(c) .28 .12 .018 .05 .51
BFI-N ➔C-DISC-ANX(cʹ) .21 .13 .108 −.05 .47 specified model with shame as the indirect variable between neuroti-
BFI-N ➔TOSCA-S(a ) .30 .10 .004 .10 .50 cismandanxiety.
1
BFI-N ➔AFQ-Y(a ) .41 .10 b.001 .21 .61
2 Giventhatneuroticismisabroadpersonalityfactorthatisrelatedto
BFI-N ➔DERS(a3) .38 .09 b.001 .20 .57 manyformsofpsychopathology(Widigeretal.,2009)thecurrentstudy
TOSCA-S➔MASC(b ) .36 .11 b.001 .15 .58
MASC 1 mayprovidesomedegreeofspecificitywithregardtotheeffectofhow
AFQ-Y➔MASC(b ) .05 .12 .672 −.18 .28
2 neuroticism may manifest into anxiety. Specifically, increased neuroti-
DERS➔MASC(b ) −.01 .11 .925 −.23 .21
3
BFI-N ➔MASC(c) .54 .10 b.001 .34 .74 cism is associated with greater shame, which, in turn, is associated
BFI-N ➔MASC(cʹ) .42 .11 b.001 .21 .63 withgreateranxiety,thoughfutureworkisneededtoevaluatesuchas-
BFI-N ➔TOSCA-S(a ) .30 .10 .004 .10 .50
1 sociationslongitudinally.Importantly,theseresultsappeartobespecific
BFI-N ➔AFQ-Y(a ) .41 .10 b.001 .21 .61
2 to shame, and not ‘general distress’ as there were no significant
BFI-N ➔DERS(a3) .38 .09 b.001 .20 .57
TOSCA-S➔YSR-ANX(b ) .32 .09 b.001 .15 .49 associations of neuroticism via psychological inflexibility or emotion
YSR-ANX 1
AFQ-Y➔YSR-ANX(b ) .15 .09 .118 −.04 .34
2 dysregulation. Indeed, neuroticism was highly correlated with shame,
DERS➔YSR-ANX(b ) −.16 .09 .079 −.34 .02
3 psychological inflexibility, and emotion dysregulation, which, in turn,
BFI-N ➔YSR-ANX(c) .61 .08 b.001 .45 .78 wereall correlated with all indices of anxiety. Nevertheless, evaluating
BFI-N ➔YSR-ANX(cʹ) .52 .09 b.001 .35 .69 all three of these factors concurrently identified shame as the only sig-
BFI-N ➔TOSCA-S(a ) .30 .10 .004 .10 .50
1
BFI-N ➔AFQ-Y(a ) .41 .10 b.001 .21 .61
2 nificant mediator of the neuroticism/anxiety association, over and
BFI-N ➔DERS(a3) .38 .09 b.001 .20 .57 abovetheeffects of psychological inflexibility and emotion dysregula-
TOSCA-S➔ANX-TOT(b ) .37 .10 b.001 .16 .57
ANX-TOT 1 tion. Such findings suggest that shame may be an important target
AFQ-Y➔ANX-TOT(b ) .13 .11 .255 −.09 .35
2 amongadolescentswithincreasedneuroticismand/or anxiety.Indeed,
DERS➔ANX-TOT(b ) −.19 .11 .083 −.40 .03
3
BFI-N ➔ANX-TOT(c) .51 .10 b.001 .32 .71 psychological inflexibility and emotion dysregulation are well-
BFI-N ➔ANX-TOT(cʹ) .42 .10 b.001 .22 .62 established transdiagnostic constructs that are consistently associated
with anxiety, though the current results suggest that shame may
warrant clinical attention. These findings echo calls (e.g., Brown &
whichallowsfortheexaminationofthedirect,indirect,andtotaleffects Naragon-Gainey,2013)toconsidermultipleriskfactorsinmodelscon-
of multiple predictors on an outcome variable through a proposed currently. Although many risk factors might correlate or predict symp-
mediator. Reverse models revealed non-significant indirect effects of toms in isolation, models including multiple mid-level factors allow
TOSCA-SviaBFI-N(β'sbetween.02–.05)inallmodels(i.e., confidence for investigations of predictors' strength over and above other relevant
intervals contained 0). factors, bolstering confidence in results.
For adolescents, in general, shame is related to self-esteem during
4. Discussion this key period of development (Reimer, 1996) and some have dubbed
it a “fundamental”factorinpsychotherapywithadolescents,notingthe
Thisstudyevaluatedtheassociationbetweenneuroticismandanxi- effects of shame on development (Anastasopoulos, 1997). Overt thera-
ety among adolescents with three indirect explanatory variables: peutic focus on shame could be a fruitful avenue for anxiety treatment,
shame, psychological inflexibility, and emotion dysregulation. In line orthepreventionofanxietydevelopmentinthispopulation.Shamehas
with predictions, neuroticism was significantly associated with all been associated with negative beliefs about one's self/ideas (Matos,
three proposed mediators andwith all indices of anxiety. Partially con- Pinto-Gouveia, & Duarte, submitted for publication) consistent with
sistent with hypotheses, neuroticism had significant indirect effects via the negative thinking styles of anxiety disorders (e.g., Barlow, Allen, &
shame in all models tested; yet, there were no significant effects of Choate, 2004) and concentrating on such maladaptive expectations
could potentially alter the trajectory of at-risk youth who are prone to
shame. It is important for future work to examine additional forms of
Table 3 psychopathologytoseeifshameexplainstheassociationswithneurot-
General andspecific indirect effects. icism, or if it is unique to anxiety, as it is possible that shame is a broad
2 factor linking neuroticism with other forms of psychological distress.
Y Model β SE CI (l) CI (u) Κ
C-DISC-ANX M :Totalindirecteffect .07 .07 −.05 .23 Withregardtotheassociationbetweengeneralriskfactorsandspe-
1–3 cifi factors’ (e.g., shame)
M:TOSCA-S .07 .04 .01 .18 .06 c manifestations, investigating ‘semi-specific
1
M:AFQ-Y .08 .06 −.02 .23 .07 that explain such associations is imperative, as treatments are being
2
M:DERS −.07 .05 −.21 .01 .04
3 developed, which focus on specific crosscutting features that underlie
MASC M1–3: Total indirect effect .13 .07 .01 .27 disorders, rather than symptom-clusters themselves (e.g., Luoma,
M:TOSCA-S .11 .05 .04 .22 .12
1 Kohlenberg, Hayes, & Fletcher, 2012) have been developed with the
M:AFQ-Y .02 .05 −.07 .15 .02
2
M:DERS −.01 .04 −.09 .06 .01 goal of impacting specific mechanisms in treatment. In addition to
3
YSR-ANX M1–3: Total indirect effect .10 .06 −.01 .22 developing these interventions, it is important for research to identify
M:TOSCA-S .10 .04 .03 .21 .11
1 specific mechanisms in operation, as well as the populations for which
M:AFQ-Y .06 .04 −.01 .17 .07
2 they are most relevant.
M:DERS −.06 .04 −.17 .01 .06
3 Indeed, calls have been made for a shift in paradigm for nosological
ANX-TOT M1–3: Total indirect effect .09 .07 −.03 .23
M:TOSCA-S .11 .05 .04 .23 .12 systems. One such proposal is the NIMH Research Domain Criteria
1
M:AFQ-Y .05 .05 −.02 .18 .06
2 (RDoC),whichseeksnewwaysofdefiningandclassifyingpsychological
M:DERS −.07 .05 −.19 .01 .08
3 disorders by utilizing crosscutting features that highlight the overlap
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