Examining incremental explanatory power in accounting for worry severity: negative metacognitive beliefs uniquely predict worry severity following a worry episode

Background and Objectives: Contemporary conceptual models posit that different core variables contribute to worry, including intolerance of uncertainty (IU), metacognitive beliefs, and experiential avoidance. To date, a concurrent investigation of the incremental explanatory power of these variables in accounting for worry severity remains unexamined. The present study sought to address that gap in the literature.

Design/Methods: Participants endorsing frequent worry (N?=?127) completed self-report measures assessing IU, metacognitive beliefs, and experiential avoidance during an online session. Participants later attended an in-person lab-based session where they completed a worry episode and in-vivo worry severity was assessed following the worry episode.

Results: IU, negative metacognitive beliefs, and experiential avoidance each shared a bivariate association with post-episode worry severity. However, in multivariate analyses, only baseline worry severity and negative metacognitive beliefs surrounding the dangerousness and uncontrollability of worry predicted post-episode worry severity.

Conclusions: The present results further underscore links between negative metacognitive beliefs and worry.     

Understanding adolescent worry: the application of a cognitive model

The relationship between worry and 4 cognitive variables, intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance, was examined in an adolescent sample of 528 boys and girls aged 14–18. The participants completed questionnaires assessing worry, somatic anxiety symptoms, and the variables mentioned above. The results show that (a) intolerance of uncertainty, positive beliefs about worry, and negative problem orientation each account for a significant amount of variance in adolescent worry scores in the multiple regression, and (b) the discriminant function derived from the 4 variables is effective in classifying moderate and high worriers into their respective groups (72.8% correct classification). Furthermore, analyses demonstrate that intolerance of uncertainty has the strongest association with worry scores and is the most important variable in discriminating between moderate and high adolescent worriers. These results suggest that intolerance of uncertainty plays a key role in our understanding of adolescent worry.     

Responsibility to continue thinking and worrying: evidence of incremental validity

This two-part study examined the role of the responsibility to continue thinking, beliefs that one needs prolonged thinking about stressful problems, in the prediction of excessive worry. This construct is considered to reflect high levels of motivation to continue inflexible thinking and the use of rigid stop rules. In Study 1, 122 students completed questionnaires. A regression analysis revealed that responsibility accounted for a unique variance beyond negative meta-cognitive beliefs about worry. One hundred and fifty students participated in Study 2, where worry was regressed on emotional instability (Neuroticism), responsibility, and other worry-related cognitive variables (intolerance of uncertainty, positive/negative meta-cognitive beliefs, poor problem-solving orientation, and cognitive avoidance). Again, responsibility was a significant predictor, after controlling for emotional instability (Neuroticism) and other worry-related cognitions. These results indicate the incremental validity of the responsibility to continue thinking.     

Intolerance of Uncertainty Mediates the Relation Between Generalized Anxiety Disorder Symptoms and Anger

Previous research has shown that individuals with generalized anxiety disorder (GAD) report elevated anger compared with nonanxious individuals; however, the pathways linking GAD and anger are currently unknown. We hypothesized that negative beliefs about uncertainty, negative beliefs about worry and perfectionism dimensions mediate the relationship between GAD symptoms and anger variables. We employed multiple mediation with bootstrapping on cross-sectional data from a student sample (N = 233) to test four models assessing potential mediators of the association of GAD symptoms to inward anger expression, outward anger expression, trait anger and hostility, respectively. The belief that uncertainty has negative personal and behavioural implications uniquely mediated the association of GAD symptoms to inward anger expression (confidence interval [CI] = .0034, .1845, P_M = .5444), and the belief that uncertainty is unfair and spoils everything uniquely mediated the association of GAD symptoms to outward anger expression (CI = .0052, .1936, P_M = .4861) and hostility (CI = .0269, .2427, P_M = .3487). Neither negative beliefs about worry nor perfectionism dimensions uniquely mediated the relation of GAD symptoms to anger constructs. We conclude that intolerance of uncertainty may help to explain the positive connection between GAD symptoms and anger, and these findings give impetus to future longitudinal investigations of the role of anger in GAD.     

Applicability of the cognitive model of generalized anxiety disorder to adolescents’ sleep quality: A cross-sectional and longitudinal analysis

BackgroundPoor sleep quality is a prevalent health issue among adolescents, and few studies have examined the variables affecting adolescents’ sleep quality from the perspective of the co-occurrence of sleep issues and anxiety disorders. Therefore, the current study investigated whether the cognitive model of generalized anxiety disorder applies to adolescents’ sleep quality.MethodIn Study 1, a total of 2042 adolescents were recruited and they completed questionnaires relating to worry, intolerance of uncertainty (IU), negative problem orientation (NPO), cognitive avoidance (CA), and sleep quality. In Study 2, a total of 379 adolescents participated in a six-month longitudinal survey to verify the model that was obtained in Study 1.ResultsStudy 1 showed the modified cognitive model of generalized anxiety disorder can be applied to adolescents’ sleep quality. Specifically, IU was a higher-order vulnerability factor that directly affected worry, and indirectly fostered worry via NPO and CA, where worry only mediated the relationships between IU, NPO, and sleep quality. However, CA exerted no independent effect on worry or sleep quality beyond the influences of IU and NPO, therefore, it dropped out of the final model. Study 2 partially confirmed the above model again from the longitudinal perspective.ConclusionThe present study constructs a new model to explain adolescents’ sleep quality, providing a foundation for future interventions.     

The relationship between negative urgency and generalized anxiety disorder symptoms: the role of intolerance of negative emotions and intolerance of uncertainty

Background and Objectives: GAD symptoms are associated with greater negative urgency, a dimension of impulsivity defined as the tendency to act rashly when distressed. This study examined the degree to which intolerance of negative emotional states and intolerance of uncertainty account for the association between negative urgency and GAD symptoms. Design: An analysis of indirect effects evaluated whether intolerance of negative emotions and intolerance of uncertainty uniquely account for the association between negative urgency and GAD symptom severity. Methods: Undergraduate students (N?=?308) completed measures of GAD symptoms, trait anxiety, negative urgency, distress tolerance, and intolerance of uncertainty. Results: Greater symptoms of GAD, intolerance of negative emotional states, and intolerance of uncertainty were associated with greater negative urgency. There was an indirect relationship between negative urgency and GAD symptoms through intolerance of negative emotional states and intolerance of uncertainty even when controlling for trait anxiety. Intolerance of negative emotional states and intolerance of uncertainty each had an indirect relationship with GAD severity through negative urgency, suggesting possible bi-directional relations. Conclusions: Future studies should examine the role of intolerance of negative emotional states and intolerance of uncertainty in the impulsive behavior of individuals with GAD, and whether impulsive behavior reinforces these processes.     

Worry and anxiety account for unique variance in the relationship between intolerance of uncertainty and depression

The evidence supporting the relationship between intolerance of uncertainty (IU), a cognitive construct well established in the anxiety literature, and depression is mixed. Some research has demonstrated a direct association between IU and depression, whereas other studies suggest that IU is either unrelated or indirectly related to depression through other pathways, including anxiety. The present study aimed to further elucidate the relationship between IU and depression in an undergraduate sample (N = 221). We posited a model in which worry and anxiety account for unique variance in the association between IU and depression. Results supported this hypothesis. Worry and trait anxiety significantly accounted for unique variance in the relationship between IU and depression. Furthermore, the model that best fit the data included two additional direct paths, from IU to anxiety and from worry to depression, and excluded the direct path from IU to depression. Our findings support the notion that IU and depression are indirectly related through worry and anxiety. Limitations and future directions are discussed.     

Can the components of a cognitive model predict the severity of generalized anxiety disorder?

Over the past decade, a number of well-controlled studies have supported the validity of a cognitive model of generalized anxiety disorder (GAD) that has four main components: intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Although these studies have shown that the model components are associated with high levels of worry in nonclinical samples and with a diagnosis of GAD in clinical samples, they have not addressed the question of whether the model components can predict the severity of GAD. Accordingly, the present study sought to determine if the model components are related to diagnostic severity, worry severity, and somatic symptom severity in a sample of 84 patients with a primary diagnosis of GAD. All model components were related to GAD severity, although positive beliefs about worry and cognitive avoidance were only modestly associated with the severity of the disorder. Intolerance of uncertainty and negative problem orientation had more robust relationships with the severity of GAD (and with worry severity, in particular). When participants were divided into Mild, Moderate, and Severe GAD groups, intolerance of uncertainty and negative problem orientation distinguished the Moderate and Severe GAD groups from the Mild GAD group, even when age, gender, and depressive symptoms were statistically controlled. Overall, the results lend further support to the validity of the model and suggest that intolerance of uncertainty and negative problem orientation are related to the severity of GAD, independently of sociodemographic and associated clinical factors. The theoretical and clinical implications of the findings are discussed.     

Age and gender differences in adolescent worry

The purpose of the present study was to explore gender and age differences in adolescent worry. High school students filled out measures of worry, negative problem orientation, intolerance of uncertainty, and general mental health. Girls and boys of different ages were then compared and the relationships between gender, beliefs about worry, intolerance of uncertainty, negative problem orientation and mental health were also examined. Boys reported greater negative problem orientation and intolerance of uncertainty while girls reported more positive beliefs about worry. Findings also revealed certain age trends, indicating that the variables under study may be under the influence of developmental tasks. Regression analysis was performed and positive beliefs about worry emerged as a significant predictor of worry in both sexes. Positive beliefs about worry and negative problem orientation appear to be the key processes in adolescent anxiety and depression.     

Applicability of a cognitive model of worry to children and adolescents

BackgroundIntolerance of uncertainly (IU), cognitive avoidance (CA) and positive beliefs about worry (PB) independently predict worry frequency in older adolescents and adults, and when targeted together in treatment produce significant reductions in both worry and anxiety in this age range. The present study addresses a gap in the literature by testing whether a cognitive model of excessive worry and anxiety incorporating these process variables is applicable to children and adolescents.MethodPrimary and secondary school students (n = 515; aged 7–19 years) completed modified self-report measures of worry frequency, anxiety, IU, CA and PB and a path analysis undertaken to test whether IU was a higher order variable for CA and PB and whether the relationship between IU/CA/PB and anxiety was mediated by worry frequency.ResultsSignificant (bivariate) correlations were observed between the measures of IU, PB, CA, worry and anxiety across the age range. However separate path models had to be fitted for children (aged 7–12 years) and adolescents (aged 13–19) with PB being dropped from the child model. CA was related to anxiety only through worry in children while IU showed direct paths to worry and anxiety in both children and adolescents.ConclusionsCognitive models of persistent worry in adults and older adolescents may, with some modification, have applicability to children. Further testing and refinement of these cognitive models of worry may lead to improvements in existing treatments for anxious youth.     

Intolerance of uncertainty and emotional distress following the death of a loved one

Abstract

Research has shown that intolerance of uncertainty (IU) – the tendency to react negatively to situations that are uncertain – is involved in worry and generalized anxiety disorder, as well as in other anxiety symptoms and disorders. To our knowledge, no studies have yet examined the association between IU and emotional distress connected with the death of a loved one. Yet, it seems plausible that those who have more difficulties to tolerate the uncertainties that oftentimes occur following such a loss experience more intense distress. The current study examined this assumption, using self-reported data from 134 bereaved individuals. Findings showed that IU was positively and significantly correlated with symptom levels of complicated grief and posttraumatic stress disorder (PTSD), even when controlling for time since loss (the single demographic/loss-related variable associated with symptom levels), and for neuroticism and worry, which are both correlates of IU. Furthermore, IU was specifically related with worry and symptom levels of PTSD, but not complicated grief, when controlling the shared variance between worry, complicated grief severity, and PTSD-severity. The present findings complement prior research that has shown that IU is a cognitive vulnerability factor for worry, and indicate that it may also be involved in emotional distress following loss.     

What’s in a name? Intolerance of uncertainty,other uncertainty-relevant constructs,and their differential relations to worry and generalized anxiety disorder*

A number of studies have examined the association of intolerance of uncertainty (IU) to trait worry and generalized anxiety disorder (GAD). However, few studies have examined the extent of overlap between IU and other psychological constructs that bear conceptual resemblance to IU, despite the fact that IU-type constructs have been discussed and examined extensively within psychology and other disciplines. The present study investigated (1) the associations of IU, trait worry, and GAD status to a negative risk orientation, trait curiosity, indecisiveness, perceived constraints, self-oriented and socially prescribed perfectionism, intolerance of ambiguity, the need for predictability, and the need for order and structure and (2) whether IU is a unique correlate of trait worry and of the presence versus absence of Probable GAD, when overlap with other uncertainty-relevant constructs is accounted for. N = 255 adults completed self-report measures of the aforementioned constructs. Each of the constructs was significantly associated with IU. Only IU, and a subset of the other uncertainty-relevant constructs were correlated with trait worry or distinguished the Probable GAD group from the Non-GAD group. IU was the strongest unique correlate of trait worry and of the presence versus absence of Probable GAD. Indecisiveness, self-oriented perfectionism and the need for predictability were also unique correlates of trait worry or GAD status. Implications of the findings are discussed, in particular as they pertain to the definition, conceptualization, and cognitive-behavioral treatment of IU in GAD.     

Distress and Avoidance in Generalized Anxiety Disorder: Exploring the Relationships with Intolerance of Uncertainty and Worry

Theory and research suggest that treatments targeting experiential avoidance may enhance outcomes for patients with generalized anxiety disorder (GAD). The present study examined the role of experiential avoidance and distress about emotions in a treatment-seeking sample with a principal diagnosis of GAD compared with demographically matched nonanxious controls and sought to explore their shared relationship with two putative psychopathological processes in GAD: intolerance of uncertainty and worry. Patients with GAD reported significantly higher levels of experiential avoidance and distress about emotions compared with nonclinical controls while controlling for depressive symptoms, and measures of these constructs significantly predicted GAD status. Additionally, experiential avoidance and distress about anxious, positive, and angry emotions shared unique variance with intolerance of uncertainty when negative affect was partialed out, whereas only experiential avoidance and distress about anxious emotions shared unique variance with worry. Discussion focuses on implications for treatment as well as future directions for research.     

Differentiating intolerance of uncertainty from three related but distinct constructs

Individual differences in uncertainty have been associated with heightened anxiety, stress and approach-oriented coping. Intolerance of uncertainty (IU) is a trait characteristic that arises from negative beliefs about uncertainty and its consequences. Researchers have established the central role of IU in the development of problematic worry and maladaptive coping, highlighting the importance of this construct to anxiety disorders. However, there is a need to improve our understanding of the phenomenology of IU. The goal of this paper was to present hypotheses regarding the similarities and differences between IU and three related constructs – intolerance of ambiguity, uncertainty orientation, and need for cognitive closure – and to call for future empirical studies to substantiate these hypotheses. To assist with achieving this goal, we conducted a systematic review of the literature, which also served to identify current gaps in knowledge. This paper differentiates these constructs by outlining each definition and general approaches to assessment, reviewing the existing empirical relations, and proposing theoretical similarities and distinctions. Findings may assist researchers in selecting the appropriate construct to address their research questions. Future research directions for the application of these constructs, particularly within the field of clinical and health psychology, are discussed.     

无法忍受不确定性与担忧：对记忆偏差与解释偏差的检验

旨在是探索记忆偏差与解释偏差在无法忍受不确定性(IU)与个体担忧之间的机制作用。实验1采用伴随学习任务范式,计算被试对中性词语和不确定词的回忆量。结果发现,IU对记忆偏差的预测不显著,记忆偏差在IU与担忧倾向之间的中介作用不显著。实验2采用情境评估任务范式收集被试在不确定情境下的担忧评分和解释倾向。结果发现,IU可以正向预测被试在不确定情境下的担忧评分,被试对情境的解释倾向在IU与担忧评分的关系中起到中介作用。概言之,高IU个体存在一定的信息加工偏差     

Intolerance of uncertainty predicts analogue posttraumatic stress following adverse life events

ABSTRACT

BACKGROUND AND OBJECTIVES: There is evidence that intolerance of uncertainty (IU) is associated with elevated post-traumatic stress (PTS) symptoms. There is a scarcity of research examining whether IU is prospectively related to PTS following exposure to negative life events. Using data from a Dutch student-sample, we examined the degree to which IU predicts post-traumatic stress symptoms associated with negative stressful life events (analogue posttraumatic stress (PTS)).

DESIGN: This was a prospective survey-study.

METHODS: A group of 193 undergraduate students completed self-report measures of Inhibitory IU, Prospective IU, and anxiety sensitivity (at Time 1, T1). One year later (at T2), participants rated adverse life-events experienced between T1 and T2, and completed a questionnaire tapping PTS associated with the most distressing event experienced in this time-frame. We hypothesized that pre-event Inhibitory IU and—to a lesser extent—Prospective IU would predict analogue PTS, after covarying for anxiety sensitivity.

RESULTS: As predicted, pre-event Inhibitory IU predicted post-event analogue PTS, even when controlling for anxiety sensitivity. With respect to distinct analogue PTS clusters, Inhibitory IU predicted PTS avoidance and PTS hyperarousal, but was unrelated to PTS reexperiencing.

CONCLUSIONS: This study confirm that IU, particularly Inhibitory IU, may convey risk for elevated PTS following adverse life events.     

Political intolerance: the role of intergroup threat and negative intergroup emotion

This study investigated whether the perception of intergroup threat, and intergroup emotion, are related to political intolerance. One hundred and twenty three South African undergraduate students (females?=?76%; males?=?24%; White?=?65%; Coloured?=?24%; Indian?=?8%; Chinese?=?2%; mean age =?19.8, SD?=?3.03 years) were randomly assigned to either a heightened (n?=?68) or low intergroup threat condition (n?=?55). Data on intergroup threat, intergroup emotion and political intolerance were collected utilising a questionnaire. T-test effect comparisons including multiple regression analyses were computed to determine effects of intergroup threat and negative intergroup emotion on political intolerance. Results revealed negative intergroup emotion and perceived intergroup threat to predict political intolerance. Negative intergroup emotion mediated the relationship between perceived threat and political intolerance. These findings suggest that intergroup threat may lead to the rise of negative intergroup emotion which in turn creates an environment conducive to the development of political intolerance.     

A Taxometric Investigation of the Latent Structure of Worry: Dimensionality and Associations With Depression, Anxiety, and Stress

Worry has been described as a core feature of several disorders, particularly generalized anxiety disorder (GAD). The present study examined the latent structure of worry by applying 3 taxometric procedures (MAXEIG, MAMBAC, and L-Mode) to data collected from 2 large samples. Worry in the first sample (Study 1) of community participants (n = 1,355) was operationalized by worry engagement, absence of worry, and the worry feature of trait anxiety. Worry in the second sample (Study 2) of undergraduate participants (n = 1,171) was operationalized by the tendency to experience worry, intolerance of uncertainty, beliefs about worry, and symptoms of GAD. Results across both samples provided converging evidence that worry is best conceptualized as a dimensional construct, present to a greater or lesser extent in all individuals. Findings from Study 2 also indicated that the latent dimension of worry generally has an equal association with symptoms of depression, anxiety, and stress across the entire continuum. These findings are discussed in relation to the conceptualization and assessment of worry in GAD and related disorders.     

Intolerance of uncertainty and difficulties in emotion regulation: Proposal for an integrative model of generalized anxiety disorder

Introduction

The Intolerance of Uncertainty Model (IUM) is a well-tested model of generalized anxiety disorder (GAD).

Metacognitions,intolerance of uncertainty and worry: An investigation in adolescents

BackgroundCognitive models of Generalized Anxiety Disorder have mainly been tested in adult samples to date. Studies investigating whether the concepts are also applicable to worry in adolescents are largely lacking. The goal of the present study was to test the relationship between worry and key cognitive variables (positive and negative metacognitions; intolerance of uncertainty) in adolescents.MethodSecondary school students (N = 521) completed self-report measures of worry frequency, metacognitions, intolerance of uncertainty, and depression.ResultsResults showed a significant association between metacognitions, intolerance of uncertainty and worry, even after controlling for depression. In regression analyses, a substantial proportion of the variance of worry could be accounted for by the cognitive variables of interest.ConclusionsThe findings support the relevance of metacognitions and intolerance of uncertainty for understanding cognitive mechanisms underlying worry in adolescents. It appears useful to combine them into a more comprehensive integrated model.