Modifiability of Neuroticism,
Extraversion, and Agreeableness by
Group Cognitive Behaviour Therapy
for Social Anxiety Disorder
Krystyna Glinski and Andrew C. Page
The University of Western Australia, Australia
The study investigated if the degree of personality pathology among people with
clinical levels of social anxiety disorder was similar to those with personality disorders more generally, if the degree of avoidant personality pathology was correlated
positively with Neuroticism and negatively with Extraversion and facets of
Agreeableness (particularly Trust), and finally if scores on the relevant personality
dimensions improve from pre- to post-treatment. Changes in Neuroticism,
Extraversion, and Agreeableness were examined following group treatment for
social anxiety disorder. The current study employed a within-subjects repeatedmeasures design (N = 25) to investigate whether these traits can be changed by
group treatment for social anxiety disorder. A measure of personality disorder
pathology was found to correlate positively with Neuroticism and negatively with
Agreeableness in the absence of significant relationships with other Five-Factor
Model traits. Treatment was associated with significant reductions in Neuroticism
and there was significant improvement of the Trust facet of Agreeableness. These
results are discussed in terms of the way that group treatment for Social Anxiety
Disorder may be enhanced.
■ Keywords: social phobia, personality disorders, Five Factors model, neuroticism,
agreeableness, avoidant personality disorder.
42
Social anxiety disorder is comorbid with avoidant personality disorder (Widiger,
1992). To the extent that this relationship exists because avoidant personality disorder is at the extreme end of a continuum of social anxiety, the personality profile of
patients presenting for treatment with social anxiety disorder will exhibit characteristics of individuals with personality disorders and therefore treatment should
address these features.
The Five-Factor Model offers a dimensional description of personality in terms
of Neuroticism (N), Extraversion (E), Openness to experience (O), Agreeableness
(A) and Conscientiousness (C; Costa & McCrae, 1992), and Morey et al. (2002)
showed that avoidant personality disorder involves high Neuroticism, low
Extraversion, and low Agreeableness. The elevated Neuroticism and the suppressed
Extraversion are not unexpected given the symptoms of social anxiety disorder.
Anxiety in social situations would be associated with elevated arousal under stress
Address for correspondence: Andrew Page PhD, School of Psychology, University of Western Australia,
35 Stirling Highway, Crawley WA 6009, Australia. E-mail: andrew@psy.uwa.edu.au
Behaviour Change | Volume 27 | Number 1 | 2010 | pp. 42–52
Modifiability of Neuroticism, Extraversion, and Agreeableness
and fear of negative evaluation would be consistent with a preference for solitary
pursuits. More surprisingly, the authors also observed that people with avoidant personality disorder exhibited low Agreeableness.
Low Agreeableness is less unexpected in the context of the broader literature on
personality disorders. A meta-analysis (Saulsman & Page, 2004) showed that when
personality disorders are mapped onto a two-dimensional space defined by
Neuroticism and Agreeableness, each disorder demonstrates a moderate positive
relationship with Neuroticism and a moderate negative relationship with
Agreeableness. The antagonism, or low end of the Agreeableness continuum, is
characterised by cynicism, rudeness, abrasiveness, suspiciousness, uncooperativeness, irritability and manipulative, vengeful and ruthless behaviour (Costa &
Widiger, 2002). Although these traits seem atypical of people with social anxiety
and avoidant personality disorders, there is one facet of Agreeableness that might
explain the covariation. This facet is Trust. Trust is the tendency to attribute benevolent intent to others and an absence of the suspicion that others are dishonest or
dangerous, and it is not unreasonable to expect that people with a high fear of negative evaluation who also lack trust would become particularly anxious in social settings. Consistent with this impression Wilberg, Urnes, Friis, Pedersen, and Karterud
(1999) found that avoidant personality disorder is associated with low Trust.
Likewise, while people with social anxiety disorder possess average levels of
Agreeableness (Bienvenu, Nestadt, Samuels, Costa, Howard, & Eaton, 2001) at the
facet level, Trust is in the low range. Therefore, to the extent that people with social
anxiety disorder show similar profiles to those with personality disorders, it is important to determine the extent to which treatment reduces the personality features
because these traits can reflect a vulnerability to future psychopathology (e.g.,
Andrews, Page, & Neilson, 1993).
Neuroticism is modifiable using cognitive behavioural treatment methods.
Reductions in Neuroticism of around 1.25 standard deviation units (Jorm, 1989)
occur following cognitive behaviour therapy. Extraversion also can improve following treatment (Santor, Bagby, & Joffe, 1997). Thus, despite personality traits being
defined as stable and enduring in nature, personality assessments do reflect changes
in personality traits following treatment. Given that treatment-related changes in
Neuroticism and Extraversion occur, the next issue is whether change in
Agreeableness can occur in therapy.
Three studies speak to the modifiability of Agreeableness. Trull, Useda, Costa,
and McCrae (1995) observed a reduction in Neuroticism and an increase in
Agreeableness after outpatient treatment for a range of psychological disorders.
Piedmont and Ciarrocchi (1999) found a reduction in Neuroticism and increases in
Extraversion, Openness to experience, Conscientiousness and Agreeableness (particularly on the facet of Trust) over a 6-week outpatient drug rehabilitation program.
In contrast, Carter et al. (2001) found no change in Agreeableness among opioiddependent outpatients and only small but significant decreases in Neuroticism and
increases in Extraversion and Conscientiousness. Thus, it remains unclear whether
Agreeableness can be altered by therapy and, more specifically, can these occur in
the context of social anxiety disorder? Cognitive–behavioural group therapy for
social anxiety disorder includes treatment components designed to reduce physical
anxiety symptoms and fear of negative evaluation. Furthermore, although cognitive
behavioural treatments for social anxiety disorder (e.g., Andrews, Creamer, Crino,
Hunt, Lampe, & Page, 2003) do not explicitly address deficits in Agreeableness,
Behaviour Change
43
Krystyna Glinski and Andrew C. Page
they include explicit training in social skills and assertiveness designed to improve
interpersonal relations. The group context also provides a forum within which trust
may be developed as participants are involved with other people during treatment
and therefore improvements in Agreeableness and Trust seem possible.
Thus, the present study asked first, is degree of personality pathology among
people with clinical levels of social anxiety disorder similar to those with personality
disorders more generally? Second, is degree of avoidant personality pathology correlated positively with Neuroticism and negatively with Extraversion and facets of
Agreeableness (particularly Trust)? Third, do scores on the relevant personality
dimensions improve from pre- to post-treatment?
Method
Participants
Twenty-nine participants were recruited from three social anxiety disorder treatment groups, each lasting 9 weeks (2 hours per week). Participants with comorbid
problems, such as depression, panic disorder, agoraphobia, and alcohol dependence
were included in the treatment groups only if these problems were considered secondary to the person’s social anxiety disorder and not sufficiently severe to warrant
treatment prior to attending the group. They completed an assessment interview
with one of five clinicians who established that they met DSM-IV (American
Psychiatric Association, 2003) diagnostic criteria for social anxiety disorder (27
were classified as generalised subtype). Seven participants (29%) also met diagnostic
criteria for avoidant personality disorder. Four participants did not complete the
treatment program and thus did not provide post-treatment data (and data from
another participant were excluded due to extreme outlying data points). On average, the treatment completers attended eight of the nine scheduled therapy sessions.
Of the treatment completers, 40% were female and they had a mean age of 37.2
years (SD = 13.2; range 19 to 62).
44
Materials
The Social Phobia module of the Anxiety Disorders Interview Schedule for DSMIV (ADIS-IV; Brown, Di Nardo, & Barlow, 1994) was used to determine whether
participants met diagnostic criteria for Social Anxiety Disorder. This measure is a
valid and reliable (Brown, Di Nardo, Lehman, & Campbell, 2001) method of determining the presence of an anxiety disorder.
The Avoidant Personality Disorder Module of the Structured Clinical Interview
for DSM-IV Axis II Personality Disorders (SCID-II; First, Spitzer, Gibbon, &
Williams, 1997), which is recognised for high levels of validity and reliability, was
used to assess the presence of avoidant personality disorder.
The PDQ-4+ (Personality Diagnostic Questionnaire — 4+; Hyler, 2003) is a 99item true/false self-report measure that assesses the 10 DSM-IV personality disorders. It also provides an index of the overall level of personality disturbance. In spite
of some doubt about the reliability of the PDQ-4+ for diagnosing the 10 DSM-IV
personality disorders in the absence of supplementary clinical information, the
PDQ-4+ is a useful and valid measure of degree of general personality pathology and is
recommended for use in research as a continuous variable (Hyler, 2003). Each participant’s degree of avoidance was calculated by summing the seven avoidant personality disorder-related items to which they responded true.
Behaviour Change
Modifiability of Neuroticism, Extraversion, and Agreeableness
The following measures were administered prior to and following treatment.
The dimensions of Neuroticism, Agreeableness, Extraversion, Openness to experience, Conscientiousness and the facet of Trust were measured on the NEO-PI-R
(Costa & McCrae, 1992). Internal consistency for the dimension scales ranges from
.86 to .92, and from .56 to .81 for the facet scales (Costa & McCrae, 1992).
Appropriate factor structure and convergent and discriminant validity has been
established for the NEO-PI-R (Costa & McCrae, 1992). In the current study, participants’ scores were evaluated against male and female adult norms to derive T-scores
for the purpose of interpreting levels of personality traits. However, statistical analyses were conducted on raw scores, to preserve the range of scores on each scale.
The Fear of Negative Evaluation scale (FNE-30 items) and Social Avoidance
and Distress Scale (SADS-28 items) measure expectation and distress related to
negative evaluation from others as well as distress in, and avoidance of, social situations (Watson & Friend, 1969). Internal consistency is .94–.96 for the FNE scale
and .94 for the SADS (Watson & Friend, 1969).
The Social Phobia Scale (SPS-20 items) and the Social Interaction Anxiety
Scale (SIAS-20 items; Mattick & Clarke, 1998) assessed fear of being scrutinised
during routine activities and more general social interactions. Individuals with
Social Anxiety Disorder are reported to have a mean score of 32.8 (SD = 14.9) on
the SPS and 49.0 (SD = 15.6) on the SIAS (Heimberg, Mueller, Holt, Hope, &
Liebowitz, 1992). Both scales are reported to have high internal consistency (SPS;
.87 to .94, SIAS; .86 to .94), good construct and discriminant validity, and sensitivity to change in treatment (Orsillo, 2001).
The Gambrill and Richey Assertion Inventory (GRAI: Gambrill & Richey
1975), measures discomfort with assertion (DAI) and probability of engaging in
assertive behaviour (RP). The GRAI has good test–retest reliability, has been
shown to be effective in discriminating between clinical and normal samples, and is
sensitive to treatment change.
The Beck Depression Inventory (BDI-II: Beck, Steer, & Brown, 1996) assessed
the severity of depressive symptoms. The reliability (coefficient alpha estimates are
.92 to .93) and validity of the BDI-II have been well established and the measure is
sensitive to change (Nezu, Ronan, Meadows, & McClure, 2000).
Procedure
Participants self-referred to join one of the regular Social Anxiety Disorder treatment groups. Clinicians were postgraduate clinical psychology trainees under supervision of the second author. They conducted an individual assessment interview
with each participant. During the interview, the Social Phobia module of the
ADIS-IV and the Avoidant Personality Disorder module of the SCID-II were
administered to ascertain whether each participant met criteria for social phobia
and/or avoidant personality disorder. Assessment outcomes were reviewed in clinical supervision to confirm diagnoses. Following the assessment, each potential participant was invited to participate in the current research project and given the
questionnaire package to complete prior to the first group treatment session. At the
end of the treatment program the questionnaire package was readministered.
The Social Anxiety Disorder group treatment used a manual-based program
(Andrews et al., 2003). Initially, participants were provided with psychoeducation
about anxiety and taught controlled breathing and relaxation strategies to assist
anxiety management. The cognitive model of social anxiety and the role of thinkBehaviour Change
45
Krystyna Glinski and Andrew C. Page
ing were then addressed. Participants were taught to monitor and challenge their
unhelpful thinking to reduce anxiety. These strategies were incorporated into
graded exposure to feared interpersonal situations in order to reduce avoidance and
provide effective anxiety management experiences. The final module incorporated
social skills training, development of conversation skills and assertiveness training.
Participants were encouraged to tailor these techniques to their own needs and this
process was facilitated through regular between-session tasks.
Results
Pre-Treatment Analyses
The mean scores on the four Social Anxiety Disorder measures (Table 1) confirmed
that the current participant sample exhibited clinical levels of Social Anxiety
Disorder symptoms. The distributions of scores on the FNE scale and SADS exhibited ceiling effects and therefore a composite Social Phobia Index (SPIndex) was
created by calculating the mean of the z scores for each of the measures. The resulting index did not possess a ceiling effect.
Scores on the measure of general personality disorder pathology (PDQ-4+)
ranged from 20 to 63 and had a mean of 39.25 (SD = 12.11). This is in the original
authors’ patients in therapy without a significant personality disturbance range (Hyler,
2003), but is above the cut-off of 28–29 suggested in other studies (e.g., Fossati et
al., 1998) to indicate a substantial likelihood of significant personality disturbance. Thus,
the current sample reported a range of personality disorder pathology characteristics
consistent with what might be expected for a treatment-seeking social anxiety disorder sample with some degree (29%) of comorbidity with avoidant personality disorTABLE 1
Pre- and Post-Treatment Means (Standard Deviation in parentheses) for Measures
of Social Anxiety and the NEO Personality Scores
Measure
Pre Treatment
M
46
(SD)
Post Treatment
M
(SD)
FNE
26.83
(3.70)
16.67
(9.10)
SADS
22.63
(4.77)
11.79
(7.45)
SIAS
54.42
(10.12)
37.71
(13.28)
SPS
34.83
(14.38)
23.58
(14.41)
SPIndex
.00
(.70)
–1.86
(1.25)
GRAI-DAI
130.74
(15.98)
109.17
(22.23)
GRAI-RP
130.05
(10.37)
113.5
(20.97)
BDI
18.55
(10.25)
9.82
(8.19)
Neuroticism
131.54
(22.66)
114.92
(27.90)
Extraversion
82.29
(19.96)
93.63
(23.22)
Openness
115.79
(16.75)
119.71
(15.92)
Agreeableness
121.42
(14.02)
122.50
(9.70)
Trust
16.83
(5.30)
18.88
(5.01)
Conscientiousness
95.38
(19.81)
97.92
(20.60)
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Modifiability of Neuroticism, Extraversion, and Agreeableness
der. The degree of avoidant personality pathology (avoidance) was calculated by
summing the number of avoidant personality disorder-related items to which they
responded true on the PDQ-4+ (M = 6.04, SD =1.27).
T scores on the NEO-PI-R personality dimensions were used for the purpose of
comparison with the norms reported for the NEO-PI-R (Costa & McCrae, 1992).
The mean Neuroticism score of 73.33 (SD = 7.98) was in the very high range.
Extraversion score of 35.54 (SD = 10.09) was in the low range. The mean Openness
to Experience score of 53.04 (SD = 9.58) was in the average range. The mean
Agreeableness score of 48.96 (SD = 9.98) was in the average range (Bienvenu et al.,
2001). On the facet of Trust, the mean was in the low range (M = 39.58, SD =
12.25). Mean Conscientiousness score of 35.00 (SD = 9.82) was in the low range.
The correlations between the five personality factors and the two measures of
personality disorder pathology were examined to determine whether they follow the
same patterns as those found in previous research with personality disorders
(Saulsman & Page, 2003; 2004). Spearman’s Rho correlations were used on account
of the non-normal distribution of the avoidance and Neuroticism variables. Given
that raw scores on the NEO-PI-R show a systematic gender difference (Costa &
McCrae, 1992), partial correlations were used to portion out the effect of gender in
this analysis. Table 2 shows moderate correlations between the general measure of
personality disorder pathology (PDQ-4+) and the FFM traits of Neuroticism and
Agreeableness. The positive correlation with Neuroticism and negative correlation
with Agreeableness, in the absence of significant correlations with the other FFM
traits, is consistent with previous research findings about the common factors in personality disorder pathology. Saulsman and Page’s (2004) meta-analysis also reported
the mean correlations between the FFM traits and avoidant personality disorder,
and the mean for all personality disorders combined. These means represent a comparison point for the current research. In Figure 1a the mean correlations between
the FFM traits and the general measure of personality disorder pathology in this
study are contrasted with the mean correlations reported by Saulsman and Page
(2004). The correlations in the current research show a similar pattern, in that the
strongest correlations present are a positive correlation with Neuroticism and a negative relationship with Agreeableness, the proposed common factors in personality
TABLE 2
Intercorrelations Between PDQ-4+, Avoidance, SPIndex, Measures of FFM Personality
Dimensions and the Facet of Trust Among 24 People with Social Anxiety Disorder
Measure
Avoidance
N
PDQ-4+
.38
.44*
Avoidance
—
.23
—
N
E
O
A
Trust
C
Note: * p < .05
Behaviour Change
E
O
A
Trust
–.10
.01
–.52*
–.48*
–.07
–.22
–.10
.15
—
.17
—
C
SPIndex
–.55*
.24
.20
–.50*
–.01
.39
–.08
–.29
–.25
.43*
–.09
.36
.36
–.46*
.15
.15
–.23
.10
—
.75*
–.20
.04
—
–.02
–.32
—
–.25
47
Krystyna Glinski and Andrew C. Page
a)
b)
Combined Personality Disorders
(Saulsman & Page, 2004)
0.6
0.2
0
-0.2
-0.4
Avoidant Personality Disorder
(Saulsman & Page, 2004)
0.6
General Personality Pathology
(PDQ4+ Current Study)
0.4
Correlation
Correlation
0.4
Avoidant Personality Pathology
(Avoidance Current Study)
0.2
0
-0.2
-0.4
-0.6
-0.6
N
E
O
A
Five Factor Model Personality Traits
C
N
E
O
A
C
Five Factor Model Personality Traits
FIGURE 1
Comparison of correlations between FFM traits and (a) general personality disorder and
(b) avoidant personality disorder pathology between the current study and the meta-analysis by Saulsman and Page (2004).
48
disorders. It is noteworthy that social anxiety disorder symptoms did not correlate
significantly with the personality disorder pathology measure (Rho = .20, p =.35)
and that the presence of social anxiety disorder symptoms was correlated positively
with Neuroticism and negatively with Extraversion, but not with Agreeableness or
Trust. Thus, the personality factors associated with personality disorder pathology
show a different pattern from those associated with social anxiety disorder symptomatology, even within the same sample.
In Figure 1b the mean correlations between the FFM traits and avoidance (the
measure of avoidant personality disorder pathology) are contrasted with the mean correlations reported by Saulsman and Page (2004). Avoidant personality disorder
pathology has a positive relationship with Neuroticism and a strong negative relationship with Extraversion. A negative relationship with Agreeableness was also present.
To determine the extent to which variability in personality disorder pathology
could be accounted for by the factors of Neuroticism and Agreeableness, but not by
Extraversion, Openness to experience and Conscientiousness, a hierarchical multiple
regression was conducted. In the first step gender, Neuroticism and Agreeableness
were entered as predictors simultaneously as one block and in the second step
Extraversion, Openness to Experience and Conscientiousness were entered simultaneously as one block (Pedhazur, 1997). In terms of the prediction of PDQ-4+ scores, step
one accounted for 41% of variance (R = .64, R2 = .41, F(3, 20) = 4.64, p = .01) and
both Neuroticism (β = .46) and Agreeableness (β = –.43) emerged as significant predictors. Consistent with Saulsman and Page (2004), step two did not account for
additional variance (F change (3,17) = .91, p = .46; ∆R2 = .08).
Post-Treatment Analyses
A repeated-measures multivariate analysis of variance (MANOVA) was compared
pre and post treatment scores on the four dependent variables: SPIndex, depression
(BDI), assertiveness discomfort (GRAI-DAI) and assertiveness response probability
(GRAI-RP). Significant differences were found between the two time-points on the
dependent measures, Wilks’s Λ = .20, F(4,17) = 17.51, p < .01. The multivariate η2
Behaviour Change
Modifiability of Neuroticism, Extraversion, and Agreeableness
based on Wilks’s Λ was strong, .81. There were significant improvements in social
anxiety disorder symptoms, F(1,20) = 71.02, p < .001, assertiveness discomfort,
F(1,20 = 42.34, p < .001, assertiveness probability, F(1,20) = 23.51, p < .001, and
depression, F(1,20 = 18.84, p < .001. Significant reductions were observed on the
SPIndex from pre- to post-treatment and an inspection of change on the FNE and
SADS indicated that, on average, participants’ symptoms improved significantly in
treatment. On the FNE, the participants’ mean score reduced from 26.83 to 16.67
which, when compared to norms on the measure, indicates a reduction in symptoms
from the clinical social anxiety disorder range to the range reported by a college student sample (Watson & Friend, 1969). Similarly, on the SADS, compared to published norms, participants moved from the social anxiety disorder range into the
range reported by college student samples.
On the assertiveness measures, the current sample’s pre-treatment scores indicated that they were less assertive than the college student means reported by
Gambrill and Richey (1975). At post treatment, scores remained elevated compared to college norms but had reduced significantly. However, both pre and post
treatment the mean scores would be classified as unassertive. On the BDI, mean
scores moved from the mild to the minimal depression range.
Change over time on the five NEO personality dimensions was assessed using a
repeated-measures MANOVA with gender as a factor, to control for gender differences inherent in the NEO scales. Significant differences were found between the two
time-points on the dependent measures, Wilks’s Λ =.33, F(5,18) = 7.44, p < 0.01. The
multivariate η2 based on Wilks’s Λ was strong, .67 (Table 1). There was a reduction in
Neuroticism, F(1,22) = 35.75, p < .001, and an increase in Extraversion, F(1,22) =
19.02, p < .001, but there was no change in Agreeableness, F(1,22) = .07, p = .79,
Openness to Experience, F(1,22) = 3.68, p = .07, or Conscientiousness, F(1,22) =
1.77, p = .20. In all cases the main effect of gender and the interaction between
gender and time did not reach statistical significance. A univariate ANOVA, used to
test the hypothesis that the facet of Trust would change during treatment, showed a
statistically significant increase, F(1, 22) = 6.35, p = .02, in Trust scores over time. No
other facet of Agreeableness changed significantly.
Discussion
Prior to treatment the participants exhibited clinical levels of social anxiety disorder and a range of personality disorder pathology. Mean scores on the NEO-PI-R
factors showed that Neuroticism was in the very high range, Agreeableness was in
the average range and Trust was in the low range. There were moderate relationships
between general personality disorder pathology and the FFM dimensions of
Neuroticism (positive) and Agreeableness (negative), which together accounted for
41% of variance in general personality disorder pathology. This finding replicates
the patterns previously reported (Saulsman & Page, 2004).
Moving to consider the specific hypotheses, it was predicted that during treatment Neuroticism would decrease, while Extraversion and Agreeableness (and
specifically Trust) would increase. Results showed a reduction in Neuroticism and
an increase in Extraversion and Trust from pre- to post-treatment. However, no significant change was observed on the dimension of Agreeableness. Overall, these
findings lend support to the position that facets of the FFM personality dimensions
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49
Krystyna Glinski and Andrew C. Page
50
can change but the treatment could not effect an observable wholesale change on
Agreeableness in the current sample and timeframe.
One consideration when interpreting these results is the difficulty of assessing
whether change in the scores on a personality trait measure reflects change in the
underlying personality construct. First, changes may reflect only superficial alterations in participants’ selection of response options rather than changes in their personality. Second, changes on the scores may reflect changes in the behavioural
expression of a personality trait. Lastly, they may reflect change in the underlying
personality trait itself. Different theoretical definitions of personality offer various
pragmatic views on whether it is possible to alter a personality trait (Heatherton &
Nichols, 1994). Some researchers suggest that the biological and genetic underpinnings of personality traits may not be amenable to change through a behavioural
intervention, which would only influence the way in which the underlying trait is
expressed (Brody, 1994). However, Costa and McCrae’s (1992) define the FFM personality traits as sets of behaviours. By this definition, a treatment that alters these
behaviours in a way that makes them more adaptive would be considered to have a
clinically useful effect on personality. It seems reasonable in the current study to
infer that changes on the NEO-PI-R scores indicate some degree of behavioural
change. The use of a behavioural measure of Trust and Agreeableness in future
research could clarify the degree of personality change that occurs in treatment.
This study found that scores on the facet of Trust changed from pre- to post-therapy. If this change is attributable to the treatment intervention (group cognitive–
behaviour therapy that addresses interpersonal issues), it could indicate that the
treatment was effective in increasing the tendency to attribute benevolent intent to
others and reducing the suspicion that others are dishonest or dangerous, but was
ineffective in altering the other five facets of Agreeableness. Future research is
required to determine whether the other facets of Agreeableness can be changed,
given that an alternative interpretation is that Trust is the only facet amenable to
change. Additional intervention strategies to target the remaining facets may be
required for the development of an ‘agreeableness therapy’.
Therefore, it is of interest to speculate about other interventions that could
target the remaining five facets of Agreeableness if one were to be treating disorders
where all facets are elevated. One facet is Altruism, on which a low score describes
individuals who are self-centred and reluctant to become involved in helping
others. Guidance for improving Altruism may be drawn from the growing literature
on organisational citizenship, which investigates volunteering, helping and cooperating with others, and team-building (Borman, 2004). The construct of Compliance
is related to interpersonal conflict and it is plausible that low scorers could improve
their conflict resolution skills in interventions that increase cooperation and awareness of one’s role within a system, such as group-based interpersonal psychotherapy
(e.g., Vinogradov, Cox, & Yalom, 2003). Training in empathy skills, which has been
researched in populations of helping professionals (e.g., Barone, Hutchings,
Kimmel, Traub, Cooper, & Marshall’s, 2005) may also increase the trait of
Tendermindedness and could potentially influence the frequency of altruistic
behaviours. Suggestions for modifying Modesty come from Seligman’s (1995) work
on learned optimism, which uses principles of cognitive therapy to enable people to
make accurate assessments of their own strengths and weaknesses, so that they are
neither self-effacing nor conceited. Finally, dialectical behaviour therapy (Linehan,
1993) offers an ‘interpersonal effectiveness skills’ module, which contains a number
Behaviour Change
Modifiability of Neuroticism, Extraversion, and Agreeableness
of components likely to improve Agreeableness by facilitating assertive, validating
and respectful communication. It is clear from this discussion of the array of alternative treatment options for low Agreeableness that considerable research will be
required before the nature of an effective ‘agreeableness therapy’ is established.
What can be concluded from this study is that Neuroticism and at least one of
the facets of Agreeableness change from pre- to post-treatment. This replicates previous research on change in Neuroticism and provides preliminary evidence that a
specific treatment intervention targeting interpersonal concerns may be able to
change Trust. The findings suggest that other treatment elements may further
enhance the degree to which therapy may change agreeableness; a development
that may be particular useful for people social anxiety disorder and avoidant personality disorder.
References
American Psychiatric Association. (2003). Diagnostic and statistical manual of mental disorders (4th
ed., text revision). Washington, DC: Author.
Andrews, G., Creamer, M., Crino, R., Hunt, C., Lampe, L., & Page, A. (2003). The treatment of
anxiety disorders: Clinician guides and patient manuals (2nd ed.). New York: Cambridge
University Press.
Andrews, G., Page, A.C., & Neilson, M.D. (1993). Sending your children away: Controlled stress
decreases neurotic vulnerability. Archives of General Psychiatry, 50, 585–589.
Barone, D.F., Hutchings, P.S., Kimmel, H.J., Traub, H.L., Cooper, J.I., & Marshall, C.M. (2005).
Increasing empathic accuracy through practice and feedback in a clinical interviewing course.
Journal of Social and Clinical Psychology, 24, 156–171.
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Manual for the BDI-II. San Antonio, TX: The
Psychological Corporation.
Bienvenu, O.J., Nestadt, G., Samuels, J.F., Costa, P.T., Howard, W.T., & Eaton, W. W. (2001).
Phobic, panic, and major depressive disorders and the five-factor model of personality. The
Journal of Nervous and Mental Disease, 189, 154–161.
Borman, W.C. (2004). The concept of organizational citizenship. Current Directions in Psychological
Science, 13, 238–241.
Brody, M. (1994). .5 + or –.5: Continuity and change in personal dispositions. In T.T. Heatherton
& J.L. Weinberger (Eds.), Can personality change? (pp. 59–81). Washington DC: American
Psychological Association.
Brown, T.A., Di Nardo, P., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV.
San Antonio TX: The Psychological Corporation.
Brown, T.A., Di Nardo, P.A., Lehman, C.L., & Campbell, L.A. (2001). Reliability of DSM-IV
anxiety and mood disorders: Implications for the classification of emotional disorders. Journal
of Abnormal Psychology, 110, 49–58.
Carter, J.A., Herbst, J.H., Stoller, K.B., King, V.L., Kidorf, M.S., Costa, P.T., Jr. et al. (2001).
Short-term stability of NEO-PI-R personality trait scores in opioid-dependent outpatients.
Psychology of Addictive Behaviours, 15, 255–260.
Costa, P.T., Jr., & McCrae, R.R. (1992). Revised NEO personality inventory (NEO-PI-R) and NEO
five-factor inventory (NEO-FFI) [Professional manual]. Odessa, FL: Psychological Assessment
Resources.
Costa, P.T., Jr., & Widiger, T.A. (2002). Introduction: Personality disorders and the five-factor
model of personality. In P.T. Costa, Jr & T.A. Widiger (Eds.), Personality disorders and the fivefactor model of personality (2nd ed., pp. 3–14). Washington, DC: American Psychological
Association.
First, M.B., Spitzer, R.L., Gibbon, M., & Williams, J.B.W. (1997). Structured clinical interview for
DSM-IV personality disorders (SCID-II). Washington, DC: American Psychiatric Press Inc.
Fossati, A., Maffei, C., Bagnato, M., Donati, D., Donini, M., Fiorilli, M., et al. (1998). Brief comBehaviour Change
51
Krystyna Glinski and Andrew C. Page
52
munication: Criterion validity of the personality diagnostic questionnaire-4+ (PDQ-4+) in a
mixed psychiatric sample. Journal of Personality Disorders, 12, 172–178.
Gambrill, E.D., & Richey, C.A. (1975). An assertion inventory for use in assessment and research.
Behaviour Therapy, 6, 550–561.
Heatherton, T.F., & Nichols, P.A. (1994). Conceptual issues in assessing whether personality can
change. In T.T. Heatherton & J.L. Weinberger (Eds.), Can personality change? (pp. 3–18).
Washington, DC: American Psychological Association.
Heimberg, R.G., Mueller, G.P., Holt, C.S. Hope, D.A., & Liebowitz, M.R. (1992). Assessment of
anxiety in social interaction and being observed by others: The social interaction anxiety scale
and the social phobia scale. Behaviour Therapy, 23, 53–73.
Hyler, S.E. (2003). Personality questionnaire, PDQ-4+. New York: New York State Psychiatric
Institute.
Jorm, A.F. (1989). Modifiability of trait anxiety and neuroticism: A meta-analysis of the literature.
Australian and New Zealand Journal of Psychiatry, 23, 21–29.
Linehan, M.M. (1993). Skills training manual for treating borderline personality disorder. New York:
The Guilford Press.
Livesley, W.J. (2004). Introduction to the special feature on recent progress in the treatment of
personality disorder. Journal of Personality Disorders, 18, 1–2.
Mattick, R.P., & Clarke, J.C. (1998). Development and validation of measures of social phobia
scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470.
Morey, L.C., Gunderson, J.G., Quigley, B.D., Shea, M.T., Skodol, A.E., McGlashan, T.H., Stout,
R.L., & Zanarim, M.C. (2002). The representation of borderline, avoidant, obsessive-compulsive and schizotypal personality disorders by the five-factor model. Journal of Personality
Disorders, 16, 215–234.
Nezu, A.M., Ronan, G.F., Meadows, E.A., & McClure, K.S. (Eds.). (2000). Practitioner’s guide to
empirically based measures of depression. New York: Kluwer Academic/Plenum Publishers.
Orsillo, S.M. (2001). Measures for social phobia. In M.M. Antony, S.M. Orsillo & L. Roemer
(Eds.), Practitioner’s guide to empirically based measures of anxiety, (pp. 165–187). New York:
Kluwer Academic / Plenum Publishers.
Pedahazur, E.J. (1997). Multiple regression in behavioural research: Explanation and prediction (3rd
ed.). Fort Worth, TX: Harcourt Brace College Publishers.
Piedmont, R.L., & Ciarrocchi, J.W. (1999). The utility of the revised NEO personality inventory
in an outpatient, drug rehabilitation context. Psychology of Addictive Behaviours, 13, 231–226.
Saulsman, L.M., & Page, A.C. (2003). Can trait measures diagnose personality disorders? Current
Opinion in Psychiatry, 16, 83–88.
Saulsman, L.M., & Page, A.C. (2004). The five-factor model and personality disorder empirical
literature: A meta-analytic review. Clinical Psychology Review, 23, 1055–1085.
Santor, D.A., Bagby, R.M., & Joffe, R.T. (1997). Evaluating stability and change in personality and
depression. Journal of Personality and Social Psychology, 73, 1354–1362.
Seligman, M.E.P. (1995). The optimistic child. Sydney, Australia: Random House.
Trull, T.J., Useda, J.D., Costa, P.T., Jr., & McCrae, R.R. (1995). Comparison of the MMPI-2 personality psychopathology five (PSY-5), the NEO-PI, and the NEO-PI-R. Psychological
Assessment, 7, 508–516.
Vinogradov, S., Cox, P.D., & Yalom, I. D. (2003). Group therapy. In R.E. Hales & S.C. Yudofsky
(Eds.), The American psychiatric publishing textbook of clinical psychiatry (4th ed., pp. 1333–
1371). Washington DC: American Psychiatric Publishing Inc.
Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting
and Clinical Psychology, 33, 448-457.
Wilberg, T., Urnes, O., Friis, S., Pedersen, G., & Karterud, S. (1999). Borderline and avoidant personality disorders and the five-factor model of personality: A comparison between DSM-IV
diagnoses and NEO-PI-R. Journal of Personality Disorders, 13, 226–240.
Behaviour Change