A transdiagnostic examination of decreased intolerance of uncertainty and treatment outcome

Intolerance of uncertainty (IU) is characterized by negative beliefs and reactions to uncertainty. IU is present in emotional disorders and may be a mechanism of change in treatment . There are two components of IU, prospective and inhibitory IU, that may be differentially associated with outcome. The current study tested associations between pre- and post-treatment changes in the components of IU, symptoms of anxiety and depression, and treatment outcome in a large diagnostically heterogeneous partial hospital sample. Results suggested that social anxiety disorder was associated with greater pre-treatment prospective and inhibitory IU scores than those without the diagnosis. Results also showed that inhibitory IU predicted change in anxiety and depression symptoms and prospective IU and depression reductions predicted improvements in overall psychological health and psychological inflexibility. Only change in depression predicted improvement in interpersonal relationships throughout treatment. Clinical and theoretical implications of the findings are discussed.     

Latent class analysis of indicators of intolerance of uncertainty

Intolerance of Uncertainty (IU ) is a transdiagnostic vulnerability factor involved in depression and anxiety symptoms and disorders. IU encompasses Prospective IU (“Unforeseen events upset me greatly”) and Inhibitory IU (“The smallest doubt can stop me from acting”). Research has yet to explore whether subgroups or classes of people exist characterized by different profiles of IU . This study used latent class analysis to identify such subgroups and examined if different classes of IU were distinct in terms of several cognitive vulnerabilities and psychological symptoms. Data were obtained from 519 students completing a 12‐item measure of IU . Four subgroups were identified, characterized by low IU , predominantly Prospective IU , predominantly Inhibitory IU , and high IU , respectively. People in the high IU class reported cognitive vulnerabilities and depression and anxiety more than people in the low IU class. Inhibitory IU was more strongly associated with poor outcomes than was Prospective IU .     

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.     

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.     

Anxiety sensitivity and intolerance of uncertainty: Evidence of incremental specificity in relation to health anxiety

Anxiety sensitivity (AS) reflects the fear of arousal-related sensations and intolerance of uncertainty (IU) represents the dispositional fear of the unknown. Within cognitive–behavioral models, AS and IU are individual difference variables considered central to the phenomenology of health anxiety. However, prior studies have cast doubt on whether both variables incrementally contribute to our understanding of health anxiety. Addressing limitations of these prior studies, the present study examined the incremental specificity of AS and IU as these two variables relate to health anxiety in a large medically healthy sample of community adults (N = 474). Both AS and IU incrementally contributed to the concurrent prediction of health anxiety beyond both negative affect and one another. However, within these analyses, the physical dimension of AS and the inhibitory dimension of IU were the only AS and IU dimensions to evidence incremental specificity in relation to health anxiety.     

Clarifying the unique associations among intolerance of uncertainty,anxiety, and depression*

Increasing evidence suggests that intolerance of uncertainty (IU) may be a transdiagnostic factor across the anxiety disorders, and to a lesser extent, unipolar depression. Whereas anxiety inherently involves uncertainty regarding threat, depression has traditionally been associated with certainty (e.g. the hopelessness theory of depression). Some theorists posit that the observed relationship between depression and IU may be due to the relationship between depression and anxiety and the relationship between anxiety and IU. The present study sought to elucidate the unique relationships among trait anxiety, depression, and IU in undergraduate (N = 554) and clinical (generalized anxiety disorder; N = 43) samples. Findings suggest that IU may play a larger role in anxiety than depression, although some evidence indicates that inhibitory IU and depression may have a modest but independent relationship.     

The role of fear of anxiety and intolerance of uncertainty in worry: An experimental manipulation

The tendency to fear emotional experiences, such as anxiety, may be an important factor in the maintenance of excessive worry, which is the central feature of generalized anxiety disorder (GAD). The goal of the present study was to clarify the role of fear of anxiety in worry by assessing whether the experimental manipulation of fear of anxiety affects worry level. The study also assessed the combined effects of fear of anxious responding and intolerance of uncertainty (a factor already linked to pathological worry) on level of worry by grouping participants according to their tolerance for uncertainty. The results indicated that participants whose fear of anxiety was increased showed higher levels of worry compared to participants whose fear of anxiety was decreased. This finding provides preliminary support for the causal role of fear of anxiety in worry. Moreover, the results showed that increased fear of anxiety in combination with an intolerance for uncertainty led to the highest levels of worry, which suggests that these constructs have an additive effect on worry. The findings lend support to the integration of new conceptualizations of psychopathology with existing models of excessive worry, which could ultimately increase treatment efficacy for GAD.     

Cognitive content-specificity in future expectancies: role of hopelessness and intolerance of uncertainty in depression and GAD symptoms

The present study examined cognitive content-specificity in future-event predictions associated with symptoms of depression and generalized anxiety disorder (GAD). College undergraduates (N=284) completed measures of depression, GAD, and rated their certainty that a given set of positive and negative outcomes were or were not likely to happen in their future. Participants also completed measures of hopelessness and intolerance of uncertainty (IU). Individuals (N=263) completed the same measures again 6 weeks later. Certainty in an absence of positive future outcomes was associated with symptoms of depression but not GAD, and hopelessness mediated this relationship - concurrently and when examining change scores over 6 weeks. Certainty in negative outcomes was concurrently associated with both symptoms of depression and GAD, and hopelessness partially mediated these relationships. IU predicted concurrent increases in depression and GAD symptoms, and negative-outcome certainty partially mediated the IU-depression but not the IU-GAD symptom relationship. Change in certainty did not mediate the relationship between changes in IU and GAD symptoms but partially mediated the relationship between change in IU and depression symptoms over time. Hopelessness appears to play a unique role in the relationship between reduced anticipation of positive future outcomes and depression. Although less clearly suggested by the data, IU may contribute to both depression and GAD symptoms but may do so through different pathways.     

Intolerance of uncertainty and perceived threat

The present study examined the relations between dimensions of intolerance of uncertainty (i.e., desire for predictability and uncertainty paralysis) and perceptions of threat (i.e., perceptions of the probabilities and costs of future undesirable outcomes) in a sample of 239 college students. Uncertainty paralysis was positively associated with both perceived probabilities and perceived costs for negative outcomes. Desire for predictability was positively associated with perceived costs for negative outcomes but was not associated with perceived probabilities for negative outcomes. When probability estimates for low base rate outcomes were examined separately, desire for predictability was negatively associated with perceived probabilities. Finally, perceived threat partially mediated the relations between dimensions of intolerance of uncertainty and worry. The results of the present study suggest mechanisms through which dimensions of intolerance of uncertainty might lead to excessive worry.     

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.     

Intolerance of uncertainty,causal uncertainty,causal importance,self-concept clarity and their relations to generalized anxiety disorder

Although numerous studies have provided support for the notion that intolerance of uncertainty plays a key role in pathological worry (the hallmark feature of generalized anxiety disorder (GAD)), other uncertainty-related constructs may also have relevance for the understanding of individuals who engage in pathological worry. Three constructs from the social cognition literature, causal uncertainty, causal importance, and self-concept clarity, were examined in the present study to assess the degree to which these explain unique variance in GAD, over and above intolerance of uncertainty. N = 235 participants completed self-report measures of trait worry, GAD symptoms, and uncertainty-relevant constructs. A subgroup was subsequently classified as low in GAD symptoms (n = 69) or high in GAD symptoms (n = 54) based on validated cut scores on measures of trait worry and GAD symptoms. In logistic regressions, only elevated intolerance of uncertainty and lower self-concept clarity emerged as unique correlates of high (vs. low) GAD symptoms. The possible role of self-concept uncertainty in GAD and the utility of integrating social cognition theories and constructs into clinical research on intolerance of uncertainty are discussed.     

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.     

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.     

An examination of the potential lingering effects of smartphone use on cognition

Smartphones might offer an extension of our own cognitive abilities, potentially preventing practice of certain forms of cognition. Our first study established that heavier usage of smartphones was negatively correlated with social problem solving and delayed gratification, as well as positively correlated with some aspects of critical thinking. Studies 2 and 3 involved experiments where participants were assigned to either a lower or higher smartphone usage group. In both experiments, higher usage of smartphones led only to a diminished ability to interpret and analyze the deeper meaning of information. However, Study 3 showed that, after a 4‐week interval, the difference in the ability to interpret and analyze meaning between lower and higher phone usage groups was no longer evident. The findings of this study suggest that, even in the rare cases where smartphones might alter cognition, this effect is likely transitory.     

The Prediction of Worry in Non-Clinical Individuals: The Role of Intolerance of Uncertainty,Meta-Worry,and Neuroticism

The present study investigated the relation between intolerance of uncertainty (IU), meta-worry, and neuroticism on the one hand, and worry on the other hand, in a sample of 105 university students. Two different operationalizations of worry were used: trait worry and idiosyncratic worry. Results showed that IU, meta-worry, and neuroticism correlated significantly with trait worry. Further, IU and meta-worry were strongly related but made a unique and independent contribution to trait worry. Finally, IU and meta-worry could be considered as partial mediators of the relation between neuroticism and trait-like worry. Relations of IU, meta-worry, and neuroticism with idiosyncratic worry were weak or even absent, although neuroticism was associated with idiosyncratic worry when the stressful event was more imminent. In conclusion, not IU and meta-worry, but the general vulnerability factor of neuroticism appeared to possess the most declarative value in relation to both trait and idiosyncratic worry.     

Cognitive flexibility mediates the relation between intolerance of uncertainty and safety signal responding in those with panic disorder

There is a growing literature associating anxiety disorders with an inability to inhibit defensive responding during safety conditions of threatening tasks. However, investigations on the relation between panic disorder (PD) and defensive responding to safety have yielded mixed results. A recent study from our laboratory revealed that intolerance of uncertainty (IU) moderates this association, such that only individuals with PD and a high IU exhibit heightened startle potentiation during safety. The mechanism underlying this relationship is unknown. Given that safety conditions typically alternate with periods of threat, cognitive flexibility (i.e., the ability to adjust one's habitual responding to a situation, given the input of new information) may be involved in the ongoing reappraisal of danger and adjustment of defensive responding. Thus, the present study sought to investigate whether deficits in cognitive flexibility mediate the association between IU and defensive responding to safety among a sample of 71 adults diagnosed with PD. As hypothesised, cognitive flexibility mediated the relationship between IU and heightened startle potentiation during safety conditions. This finding suggests that within this subgroup, a failure to inhibit defensive responding during safety conditions may be due to deficits in cognitive flexibility.     

Stability of aggression among adolescents over time: A south African study

In a study spanning 5 years, data were collected on the aggressiveness of over 1,700 male and female subjects. Subjects who were the more aggressive grade 8 (standard 6) pupils at the beginning of the study were discovered to be the more aggressive grade 12 (standard 10) pupils. It is concluded that, whatever its causes, aggression can be viewed as a persistent trait that may be influenced by situational variables but reveals substantial consistency over time. The findings of studies by Huesmann and Eron in the United States as well as Olweus in Scandinavia were thus supported in this South African investigation.     

Distress intolerance and worry: the mediating role of cognitive variables

Background and Objectives: Distress intolerance (DI) has been identified as a potential risk factor for a variety of maladaptive avoidance behaviors, including worry. However, mechanisms linking DI to specific behaviors remain poorly understood. One hypothesis is that DI is a general vulnerability that confers risk of particular avoidance behaviors via more specific, lower-order vulnerabilities. The current study examined associations between DI and worry-related cognitions. Design: A multiple mediator model tested the hypothesis that worry-related variables (intolerance of uncertainty [IU], cognitive avoidance, beliefs about worry, and negative problem orientation) mediated the association between DI and worry. Methods: An undergraduate student (n = 281) and a clinical (n = 123) sample completed self-report measures. Results: Across samples, worry was associated with higher levels of DI, IU, cognitive avoidance, beliefs about worry, and negative problem orientation. Mediation results differed somewhat between the two samples. In the undergraduate sample, IU, negative beliefs about worry, and positive beliefs about worry mediated the association between DI and worry. In the clinical sample, negative problem orientation and negative beliefs about worry mediated the association between DI and worry. Conclusions: Results provide initial evidence that DI may be associated with worry via unique risk factors.     

The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder

Distress tolerance (DT) and intolerance of uncertainty (IU) have been identified as transdiagnostic processes that predict symptom severity across a range of distinct anxiety disorders. However, the joint effect of these two variables on therapeutic outcome has not yet been examined. It is possible that DT and IU may both impact on treatment response to cognitive-behavioural therapy (CBT) in clients with anxiety, as clients with weak DT and strong IU may be less likely to engage in exposure and cognitive restructuring tasks across treatment due to their associated distress. The purpose of this study was to examine the interaction of DT and IU as predictors of post-treatment symptom severity and treatment response to group CBT in participants with primary DSM-IV-TR diagnosed social anxiety disorder (SAD). Participants (N = 95) with SAD completed 12 weeks of manualized group CBT. Results of multilevel longitudinal analysis demonstrated an interaction effect, such that lower DT and higher IU predicted higher SAD symptom severity across the course of therapy. The findings are discussed in terms of clinical implications for the disorder-specific and transdiagnostic treatment of anxiety disorders.