We describe an approach to anxiety, depressive, trauma-related, and other disorders, which we conceptualize as “emotional disorders” because of shared underlying dimensions uncovered by the study of traits or temperaments. We then explicate a functional model of emotional disorders based largely, but not exclusively, on the temperament of neuroticism and describe common factors that account for the development and maintenance of these conditions. We conclude by describing, and presenting supporting data for, a unified transdiagnostic approach to the treatment of emotional disorders that directly targets the underlying temperament of neuroticism and associated temperamental characteristics.

This chapter provides an overview of the nature of panic disorder and agoraphobia. The key features of panic disorder are (1) one or more episodes of abrupt, intense fear or discomfort (i.e., a panic attack) and (2) persistent anxiety or worry about the recurrence of panic attacks, their consequences, or life changes as a result of the attacks. Individuals with panic disorder often avoid, feel hesitant about, or feel nervous in situations where they expect panic attacks or other physical symptoms to occur. Typically, these situations are ones where one may not be able to escape or find help. Avoiding situations from which escape might be difficult or where help may be unavailable in the event of a panic attack or other physical symptoms is called agoraphobia. The chapter then outlines the typical agoraphobia situations. The kind of treatment that is described in this program is called cognitive behavioral therapy (CBT) and it is designed to educate and to teach constructive ways of coping.

The present study expands on the growing body of research on the effects of cognitive behavioral therapy (CBT) on positive affect. More specifically, we explore how CBT may promote increases in the Joviality subscale of the Positive and Negative Affect Schedule–Expanded Form (PANAS-X), a measure of self-rated affect that captures positive emotions, including joy and excitement, and how change in joviality may be associated with concurrent symptom change. We utilized data from a randomized equivalence trial comparing the efficacy of the unified protocol (UP) for transdiagnostic treatment of emotional disorders, a transdiagnostic CBT, against various well-established single disorder protocols (SDP) and waitlist control. First, we generated affect profiles for patients receiving CBT (either UP or SDP) or waitlist control, based on their baseline and posttreatment positive affect (PA) and negative affect (NA), compared with a clinical reference sample. We found that the affect profile for most patients receiving CBT shifted from high NA/low PA to low NA/high PA. Further, participants receiving CBT were more likely than individuals in the waitlist control to achieve this outcome. We then examined the PANAS-X Joviality subscale, which has been subject to very limited previous research. Change in joviality was associated with improvement in symptoms of both anxiety (B = −0.81, p = .00) and depression (B = −0.94, p = .00). Joviality increased more rapidly in individuals with more severe anxiety but not severe depression. We discuss the possible clinical implications of these preliminary results, including the role of treatment innovations incorporating a focus on increasing positive affect, particularly the emotions associated with joviality, while simultaneously decreasing negative affect.

This chapter focuses on the process of continuing to face one’s fear of physical symptoms, and learning to face fear of activities that produce physical symptoms as well as feared agoraphobia situations. Avoidance (both direct and indirect) is to be prevented. Usually, avoidance happens because of the continued mistaken belief that the symptoms are harmful. It is thus important to remember that the symptoms are not harmful. As with the symptom exercises, the use of medication has to be considered, particularly medications that either block all of one’s feelings or that one relies on to reduce one’s fear at the moment. In the end, it will be essential for one to face the symptoms and the anxiety directly, even at very intense levels, or when alone, or at times when already feeling anxious, or without the influence of benzodiazepines, because these are the conditions in which symptoms happen in normal day-to-day life, now or in the future.

This edition of the Mastery of Your Anxiety and Panic: Workbook for Brief Six-Session Version for Primary Care and Related Settings outlines a time-limited treatment for those dealing with panic disorder and agoraphobia. If a patient primarily seeks treatment from a family doctor, this guide will be useful. The program described is based on the principles of cognitive behavioral therapy (CBT). It can be delivered by a general practitioner or other health or mental health care provider in primary care or related settings in up to six sessions. A modified version of the more intensive 12-session program that currently exists, this treatment represents an introduction of the skills and techniques for overcoming panic disorder that patients can easily learn and continue on their own.