Intolerance of uncertainty and decisions about delayed, probabilistic rewards

Neuropsychological performance across symptom dimensions of obsessive-compulsive disorder: a comment on the state and critical review of the literature

Introduction: Obsessive-compulsive disorder (OCD) is a heterogeneous disorder, with multiple symptom presentations. Delineating the neuropsychological characteristics associated with previously identified symptom clusters may therefore be useful in assisting to better define symptom subtypes of OCD.Areas covered: This review summarizes the existing literature on the assessment of neuropsychological performance in symptom-based dimensions of OCD. Results of 23 studies are described and the methodological issues and challenges present in this body of literature are discussed.Expert opinion: The current state of the literature precludes a meaningful meta-analysis of cognitive dysfunction across the breadth of symptom dimensions of OCD. This is due primarily to significant methodological differences observed between studies, both in terms of neuropsychological measures and symptom subtyping methods employed, and any resulting meta-analytic results would be biased by varying quality of evidence. Future studies addressing these limitations should include more consistent neuropsychology measures and methods of classifying OCD symptoms with the aim of reproducing the results of previous research to identify more concrete patterns of neuropsychological performance across dimensions; best practices and alternative approaches are discussed.

Intolerance of uncertainty and eating disorder behaviour: Piloting a consumption task in a non-clinical sample

BACKGROUND AND OBJECTIVES

Intolerance of uncertainty (IU) is a transdiagnostic process contributing to the maintenance of anxiety disorders, and is a potential target for treatment. Recent literature has investigated IU as a cognitive process underpinning pathological fear and anxiety in Anorexia Nervosa (AN). The current study was designed to examine trait and state IU, and their relationship to restrictive eating disorder symptoms, anxiety, worry, cognitive rigidity and eating behaviour.

METHODS

A sample of undergraduate women (N = 85) completed measures of eating disorder symptoms, IU, cognitive rigidity and worry. Participants were randomised to complete an eating task under one of two conditions: the "certain" condition received a high-calorie meal and nutritional information, while the "uncertain" condition received the meal alone. During the meal, state IU and state anxiety were examined at three time-points (baseline, pre-eating, post-eating).

RESULTS

Trait IU was correlated with cognitive rigidity, worry, global eating disorder symptoms, and, in particular, dietary restraint. No differences emerged between conditions with respect to eating-related anxiety, or amount of food eaten. Controlling for condition and eating disorder symptoms, state IU predicted pre-eating anxiety. Beyond the contribution of condition, BMI and eating disorder symptoms, state IU predicted consumption, specifically greater dietary restriction.

LIMITATIONS

The study employed a non-clinical sample.

CONCLUSIONS

IU may be implicated in a rigid cognitive style, the anxiety response to energy-dense food, and restrictive eating behaviour. Should these findings be replicated in a clinical sample, then IU might emerge as an adjunctive treatment target for AN.

Delay Discounting as a Transdiagnostic Process in Psychiatric Disorders: A Meta-analysis

IMPORTANCE

Delay discounting is a behavioral economic index of impulsive preferences for smaller-immediate or larger-delayed rewards that is argued to be a transdiagnostic process across health conditions. Studies suggest some psychiatric disorders are associated with differences in discounting compared with controls, but null findings have also been reported.

OBJECTIVE

To conduct a meta-analysis of the published literature on delay discounting in people with psychiatric disorders.

DATA SOURCES

PubMed, MEDLINE, PsycInfo, Embase, and Web of Science databases were searched through December 10, 2018. The psychiatric keywords used were based on DSM-IV or DSM-5 diagnostic categories. Collected data were analyzed from December 10, 2018, through June 1, 2019.

STUDY SELECTION

Following a preregistered Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol, 2 independent raters reviewed titles, abstracts, and full-text articles. English-language articles comparing monetary delay discounting between participants with psychiatric disorders and controls were included.

DATA EXTRACTION AND SYNTHESIS

Hedges g effect sizes were computed and random-effects models were used for all analyses. Heterogeneity statistics, one-study-removed analyses, and publication bias indices were also examined.

MAIN OUTCOMES AND MEASURES

Categorical comparisons of delay discounting between a psychiatric group and a control group.

RESULTS

The sample included 57 effect sizes from 43 studies across 8 diagnostic categories. Significantly steeper discounting for individuals with a psychiatric disorder compared with controls was observed for major depressive disorder (Hedges g = 0.37; P = .002; k = 7), schizophrenia (Hedges g = 0.46; P = .004; k = 12), borderline personality disorder (Hedges g = 0.60; P < .001; k = 8), bipolar disorder (Hedges g = 0.68; P < .001; k = 4), bulimia nervosa (Hedges g = 0.41; P = .001; k = 4), and binge-eating disorder (Hedges g = 0.34; P = .001; k = 7). In contrast, anorexia nervosa exhibited statistically significantly shallower discounting (Hedges g = -0.30; P < .001; k = 10). Modest evidence of publication bias was indicated by a statistically significant Egger test for schizophrenia and at the aggregate level across studies.

CONCLUSIONS AND RELEVANCE

Results of this study appear to provide empirical support for delay discounting as a transdiagnostic process across most of the psychiatric disorders examined; the literature search also revealed limited studies in some disorders, notably posttraumatic stress disorder, which is a priority area for research.

The neural substrates responsible for how trait anxiety affects delay discounting: Right hippocampal and cerebellar connectivity with bistable right inferior parietal lobule

Delay discounting, an indicator of impulsivity, refers to the extent of devaluing future rewards. Studies have found that individuals with trait anxiety generally depreciate the later larger rewards, showing steeper delay discounting rates. However, little is known about the neural substrates responsible for how trait anxiety affects individuals' delay discounting. To address this question, we employed the voxel-based morphometry (VBM) and resting-state functional connectivity (RSFC) methods to explore the neural substrates of trait anxiety responsible for delay discounting. Behavioral results showed that trait anxiety was significantly positively correlated with delay discounting rates. The VBM analysis revealed that gray matter volumes of the right hippocampus (RHPC) and right cerebellum (RCere) were significantly positively correlated with trait anxiety. Moreover, the RSFC results showed that bistable right inferior parietal lobule (RIPL) connectivity with the RHPC and RCere were all inversely associated with trait anxiety. More importantly, mediation analysis indicated that trait anxiety played a completely mediating role in the relation between functional connectivity of RHPC-RIPL and RCere-RIPL and delay discounting. These results suggested that bistable RIPL connectivity with RHPC and RCere could be neural substrates underlying the effect of trait anxiety on delay discounting. On the whole, the current study yields insights into how trait anxiety affects delay discounting and provides a novel account from a neural basis perspective.

Attention and anticipation in response to varying levels of uncertain threat: An ERP study

Individual differences in responding to uncertainty have been proposed as a key mechanism of how anxiety disorders develop and are maintained. However, most empirical work has compared responding to uncertain versus certain threat dichotomously. This is a significant limitation because uncertainty in daily life occurs along a continuum of probability, ranging from very low to high chances of negative outcomes. The current study investigated (1) how varying levels of uncertainty impact attention and anticipatory emotion, and (2) how these effects are moderated by individual differences in risk factors for anxiety disorders, particularly intolerance of uncertainty (IU) and worry. Participants (n = 65) completed a card task in which the probability of shock varied across trials. Two event-related potential components were examined: the P2, an index of attention, and the stimulus-preceding negativity (SPN), an index of anticipation. The P2 tracked the level of uncertainty and was smaller for more uncertain outcomes. Participants higher in IU exhibited greater differences in the P2 across levels of uncertainty. The SPN did not track specific levels of uncertainty but was largest for uncertain threat compared with certain threat and safety. Greater worry was associated with blunting of the SPN in anticipation of all outcomes. Thus, attention appears to be sensitive to variations in uncertainty, whereas anticipation seems sensitive to uncertainty globally. The two processes appear to be distinctly related to anxiety risk factors. These results highlight the value of examining multiple aspects of anticipatory responding to varying levels of uncertainty for understanding risk for anxiety disorders.

Standard of proof and intolerance of uncertainty in obsessive-compulsive disorder and social anxiety disorder

BACKGROUND AND OBJECTIVES

Researchers have identified intolerance of uncertainty (IU) as a dysfunctional thought that contributes to OCD. Case examples of OCD suggest that uncertainty and anxiety persist despite low likelihoods of feared outcomes. In this study we examined how people with OCD react to minimal amounts of uncertainty relative to non-anxious individuals and a clinical comparison group of people with social anxiety disorder (SAD).

METHODS

We created a questionnaire to measure the distress people feel when there is only minimal uncertainty regarding a given outcome and if they prefer situations with the certainty of negative outcomes in the present versus living with uncertainty. Part two of our study tested whether IU is related to performance on neutral and idiographic versions of the Beads Task.

RESULTS

OCD and SAD subjects reacted to hypothetical scenarios involving minimal risk with greater negative affect than did non-anxious subjects; however, after repeating analyses to account for comorbid disorders, OCD subjects' scores did not differ from those of non-anxious subjects. Only SAD subjects showed a preference for negative information in the present versus the uncertainty of a future outcome. Part two of our study revealed that self-reported IU was only marginally associated with performance on the neutral Beads Task.

LIMITATIONS

High rates of comorbidity made it difficult to identify the specific relationship of IU with other anxiety disorders.

CONCLUSIONS

IU for general, non-OCD specific scenarios may not figure prominently in all individuals with OCD, but rather may play a larger, more consistent role in anxiety disorders such as SAD. Additionally, the number of beads or words viewed on Beads Task may be an inadequate behavioral measure of IU.

Effect of resilience on intolerance of uncertainty in nursing university students

PURPOSE

Nursing students must cope in a complex and uncertain society. We identified the relationship between resilience and intolerance of uncertainty (IOU) in nursing students.

METHODS

Data were collected from November 10 to 20, 2016, from 134 Korean nursing students (male = 21, female = 113; first-year = 39, second-year = 39, third-year = 35, and fourth-year = 21), using a questionnaire. The measures in this study included resilience and IOU.

RESULTS

Differences in IOU relating to participants' general characteristics showed that IOU was high when the major satisfaction was rated as "middle" rather than "high." Participants' IOU was significantly negatively correlated with the following resilience subdomains: self-regulation skills, interpersonal skills, and positive tendencies. In particular, higher positive tendencies led to lower levels of IOU.

CONCLUSION

It is vital to devise strategies to advance nursing students' satisfaction toward their major and positive tendencies to reduce the level of IOU. This will prepare nursing students for various programs and improve their outcomes at school.

Look before you leap: the role of negative urgency in appraisals of ambiguous and unambiguous scenarios in individuals high in generalized anxiety disorder symptoms

Negative interpretation bias, the propensity to make threatening interpretations of ambiguous information, is associated with symptoms of generalized anxiety disorder (GAD). Apart from its relationship with intolerance of uncertainty (IU), little is known about what explains the presence of this cognitive bias in GAD. One factor may be negative urgency (NU), the tendency to take rash action when distressed, which is related to GAD symptoms and to cognitive biases in nonclinical populations. The aim of the present study was to examine the relationship between NU and interpretation bias in individuals high in GAD symptoms (N = 111). IU, trait anxiety, and other forms of impulsivity were examined concurrently as competing correlates of interpretation bias. Greater NU and IU were found to be unique correlates of greater threatening interpretations of ambiguous scenarios. Greater NU was also a unique correlate of greater threatening interpretations of negative and positive scenarios. No other forms of impulsivity were uniquely related to interpretation bias. The findings suggest that greater NU may have a role in the tendency for individuals high in GAD symptoms to make threatening interpretations in response to ambiguous scenarios, overtly threatening situations, and situations without indication of threat or danger. Theoretical implications of these findings are discussed.

Does neuropsychological performance in OCD relate to different symptoms? A meta-analysis comparing the symmetry and obsessing dimensions

BACKGROUND

Investigations of neuropsychological functioning in obsessive-compulsive disorder (OCD) have produced mixed results for deficits in executive functioning (EF), attention, and memory. One potential explanation for varied findings may relate to the heterogeneity of symptom presentations, and different clinical or neurobiological characteristics may underlie these different symptoms.

METHODS

We investigated differences in neuropsychological functioning between two symptoms groups, obsessing/checking (O/C) and symmetry/ordering (S/O), based on data suggesting an association with different motivations: harm avoidance and incompleteness, respectively. Ten studies (with 628 patients) were included and each investigation assessed at least one of 14 neuropsychological domains.

RESULTS

The S/O domain demonstrated small, negative correlations with overall neuropsychological functioning, performance in EF, memory, visuospatial ability, cognitive flexibility, and verbal working memory. O/C symptoms demonstrated small, negative correlations with memory and verbal memory performance. A comparison of functioning between symptom groups identified large effect sizes showing that the S/O dimension was more strongly related to poorer neuropsychological performance overall, and in the domains of attention, visuospatial ability, and the subdomain of verbal working memory.

CONCLUSIONS

Findings support existing evidence suggesting that different OCD symptoms, and their associated core motivations, relate to unique patterns of neuropsychological functioning, and, potentially dysfunction in different neural circuits.

Individual Differences in Uncertainty Tolerance Are not Associated With Cognitive Control Functions in the Flanker Task

Abstract. Cognitive control refers to the ability to make correct decisions concurrent to distracting information, and to adapt to conflicting stimulus configurations, eventually promoting goal-directed behavior. Previous research has linked individual differences in cognitive control to psychopathological conditions such as anxiety. However, a link with uncertainty tolerance (UT) has not been tested so far, although both constructs describe cognitive and behavioral performance in ambiguous situations, thus they share some similarities. We probed cognitive control in web-based experimentation (jsPsych) with a simple flanker task (N = 111) and a version without confounds in episodic memory (N = 116). Both experiments revealed two well-established behavioral indices: congruency effects (CEs) and congruency-sequence effects (CSEs). Only small-to-zero correlations emerged between CEs, UT, and need for cognitive closure (NCC), a personality trait inversely related to UT. A subtle correlation (r = .18) was noted in Experiment 2 between NCC and CSE. Throughout, Bayesian analyses provided anecdotal-to-moderate evidence for the null-hypotheses.

Intolerance of uncertainty and conditioned place preference in opioid addiction

Several personality factors have been implicated in vulnerability to addiction by impacting learning and decision making. One such factor is intolerance of uncertainty (IU), the tendency to perceive uncertain situations negatively and avoid them. Conditioned place preference (CPP), which compares preference for contexts paired with reward, has been used to examine the motivation for both drug and non-drug rewards. However, preference for locations associated with non-drug reward, as well as the potential influence of IU, has not been thoroughly studied in individuals with addiction. In the current study, we examined CPP using a computer-based task in a sample of addicted individuals undergoing opioid maintenance treatment and never-addicted controls. Patients were confirmed to have higher IU than controls. In the CPP task, the two groups did not differ in overall time spent in the previously-rewarded context. However, controls were more likely than patients to immediately return to this context. Contrary to our predictions, IU was not a significant predictor of preference for the previously-rewarded context, although higher IU in controls was associated with a higher number of rewards obtained in the task. No such relationship was found in patients.

Computational Dysfunctions in Anxiety: Failure to Differentiate Signal From Noise

BACKGROUND

Differentiating whether an action leads to an outcome by chance or by an underlying statistical regularity that signals environmental change profoundly affects adaptive behavior. Previous studies have shown that anxious individuals may not appropriately differentiate between these situations. This investigation aims to precisely quantify the process deficit in anxious individuals and determine the degree to which these process dysfunctions are specific to anxiety.

METHODS

One hundred twenty-two subjects recruited as part of an ongoing large clinical population study completed a change point detection task. Reinforcement learning models were used to explicate observed behavioral differences in low anxiety (Overall Anxiety Severity and Impairment Scale score ≤ 8) and high anxiety (Overall Anxiety Severity and Impairment Scale score ≥ 9) groups.

RESULTS

High anxiety individuals used a suboptimal decision strategy characterized by a higher lose-shift rate. Computational models and simulations revealed that this difference was related to a higher base learning rate. These findings are better explained in a context-dependent reinforcement learning model.

CONCLUSIONS

Anxious subjects' exaggerated response to uncertainty leads to a suboptimal decision strategy that makes it difficult for these individuals to determine whether an action is associated with an outcome by chance or by some statistical regularity. These findings have important implications for developing new behavioral intervention strategies using learning models.

I don't know where to look: the impact of intolerance of uncertainty on saccades towards non-predictive emotional face distractors

Attentional bias to uncertain threat is associated with anxiety disorders. Here we examine the extent to which emotional face distractors (happy, angry and neutral) and individual differences in intolerance of uncertainty (IU), impact saccades in two versions of the "follow a cross" task. In both versions of the follow the cross task, the probability of receiving an emotional face distractor was 66.7%. To increase perceived uncertainty regarding the location of the face distractors, in one of the tasks additional non-predictive cues were presented before the onset of the face distractors and target. We did not find IU to impact saccades towards non-cued face distractors. However, we found IU, over Trait Anxiety, to impact saccades towards non-predictive cueing of face distractors. Under these conditions, IU individuals' eyes were pulled towards angry face distractors and away from happy face distractors overall, and the speed of this deviation of the eyes was determined by the combination of the cue and emotion of the face. Overall, these results suggest a specific role of IU on attentional bias to threat during uncertainty. These findings highlight the potential of intolerance of uncertainty-based mechanisms to help understand anxiety disorder pathology and inform potential treatment targets.

Intolerance of uncertainty in opioid dependency - Relationship with trait anxiety and impulsivity

Intolerance of uncertainty (IU) is the tendency to interpret ambiguous situations as threatening and having negative consequences, resulting in feelings of distress and anxiety. IU has been linked to a number of anxiety disorders, and anxiety felt in the face of uncertainty may result in maladaptive behaviors such as impulsive decision making. Although there is strong evidence that anxiety and impulsivity are risk factors for addiction, there is a paucity of research examining the role of IU in this disorder. The rate of opioid addiction, in particular, has been rising steadily in recent years, which necessitates deeper understanding of risk factors in order to develop effective prevention and treatment methods. The current study tested for the first time whether opioid-dependent adults are less tolerant of uncertainty compared to a healthy comparison group. Opioid dependent patients undergoing methadone maintenance therapy (n = 114) and healthy comparisons (n = 69) completed the following scales: Intolerance of Uncertainty Scale, the Barrett Impulsivity Scale, and the State Trait Anxiety Inventory. Analysis revealed that these measures were positively correlated with each other and that opioid-dependent patients had significantly higher IU scores. Regression analysis revealed that anxiety mediated the relationship between IU and impulsivity. Hierarchical moderation regression found an interaction between addiction status and impulsivity on IU scores in that the relationship between these variables was only observed in the patient group. Findings suggest that IU is a feature of addiction but does not necessarily play a unique role. Further research is needed to explore the complex relationship between traits and how they may contribute to the development and maintenance of addiction.

The Role of Threat Level and Intolerance of Uncertainty (IU) in Anxiety: An Experimental Test of IU Theory

Intolerance of uncertainty (IU) has been proposed as an important transdiagnostic variable within mood- and anxiety-related disorders. The extant literature has suggested that individuals high in IU interpret uncertainty more negatively. Furthermore, theoretical models of IU posit that those elevated in IU may experience an uncertain threat as more anxiety provoking than a certain threat. However, no research to date has experimentally manipulated the certainty of an impending threat while utilizing an in vivo stressor. In the current study, undergraduate participants (N = 79) were randomized to one of two conditions: certain threat (participants were told that later on in the study they would give a 3-minute speech) or uncertain threat (participants were told that later on in the study they would flip a coin to determine whether or not they would give a 3-minute speech). Participants also completed self-report questionnaires measuring their baseline state anxiety, baseline trait IU, and prespeech state anxiety. Results indicated that trait IU was associated with greater state anticipatory anxiety when the prospect of giving a speech was made uncertain (i.e., uncertain condition). Further, findings indicated no significant difference in anticipatory state anxiety among individuals high in IU when comparing an uncertain versus certain threat (i.e., uncertain and certain threat conditions, respectively). Furthermore, results found no significant interaction between condition and trait IU when predicting state anticipatory anxiety. This investigation is the first to test a crucial component of IU theory while utilizing an ecologically valid paradigm. Results of the present study are discussed in terms of theoretical models of IU and directions for future work.

Intolerance of Uncertainty Scale: Measurement invariance among adolescent boys and girls and relationships with anxiety and risk taking

BACKGROUND AND OBJECTIVES

Adolescence-related increases in both anxiety and risk taking may originate in variability in Intolerance of Uncertainty (IU), rendering the study of IU of importance. We therefore studied the psychometric properties of the Intolerance of Uncertainty Scale-Short version (IUS-12), including its associations with trait anxiety and risk taking, among adolescents.

METHODS

A sample of 879 Dutch adolescents, from diverse educational levels, and with an equal distribution of boys and girls, was classically tested. To obtain indices of IU, and self-reported trait anxiety and need for risk taking, questionnaires were administrated; to obtain an index of risk taking behavior, adolescents performed a risk taking task.

RESULTS

Multi-group Confirmatory Factor Analyses revealed that the IUS-12 consists of a Prospective and an Inhibitory IU subscale, which are partially measurement invariant across sex. Cronbach's alphas and item-total correlations revealed that the IUS-12 and its subscales have reasonable-to-good internal consistency. Correlational analyses support convergent validity, as higher IUS-12 scores were related to, respectively, higher and lower levels of self-reported trait anxiety and need for risk taking. However, we found no relationship between IUS-12 scores and risk taking behavior, operationalized by performance on the risk taking task.

LIMITATIONS

A community, instead of clinical, sample was included. Also, IU was measured by a paper-and-pencil version of the IUS-12, instead of a computerized version.

CONCLUSIONS

The IUS-12 has good psychometric properties and may be a central measure to assess IU, which enables to explain the adolescence-related increase in both anxiety and risk taking.

Prediction Error Representation in Individuals With Generalized Anxiety Disorder During Passive Avoidance

OBJECTIVE

Deficits in reinforcement-based decision making have been reported in generalized anxiety disorder. However, the pathophysiology of these deficits is largely unknown; published studies have mainly examined adolescents, and the integrity of core functional processes underpinning decision making remains undetermined. In particular, it is unclear whether the representation of reinforcement prediction error (PE) (the difference between received and expected reinforcement) is disrupted in generalized anxiety disorder. This study addresses these issues in adults with the disorder.

METHOD

Forty-six unmedicated individuals with generalized anxiety disorder and 32 healthy comparison subjects group-matched on IQ, gender, and age performed a passive avoidance task while undergoing functional MRI. Data analyses were performed using a computational modeling approach.

RESULTS

Behaviorally, individuals with generalized anxiety disorder showed impaired reinforcement-based decision making. Imaging results revealed that during feedback, individuals with generalized anxiety disorder relative to healthy subjects showed a reduced correlation between PE and activity within the ventromedial prefrontal cortex, ventral striatum, and other structures implicated in decision making. In addition, individuals with generalized anxiety disorder relative to healthy participants showed a reduced correlation between punishment PEs, but not reward PEs, and activity within the left and right lentiform nucleus/putamen.

CONCLUSIONS

This is the first study to identify computational impairments during decision making in generalized anxiety disorder. PE signaling is significantly disrupted in individuals with the disorder and may lead to their decision-making deficits and excessive worry about everyday problems by disrupting the online updating ("reality check") of the current relationship between the expected values of current response options and the actual received rewards and punishments.

Examination of the Intolerance of Uncertainty Construct in Youth With Generalized Anxiety Disorder

Intolerance of uncertainty (IU) is a dispositional characteristic reflecting negative cognitive, behavioral, and emotional reactivity in response to events or situations that are uncertain. Although closely associated with a generalized anxiety disorder (GAD) diagnosis in adulthood, IU has received little attention in youth. The goal of this study was to examine the construct in children with GAD and nonanxious children, including its incremental validity in predicting GAD severity and worry beyond anxiety. Ninety-eight children 6 to 11 years of age (51% male; 57% Caucasian) were assessed. The sample included 24 with a GAD diagnosis only (i.e., pure GAD), 36 with GAD plus at least one other disorder (i.e., comorbid GAD), and 38 healthy control children. Clinician, parent, and child reports of IU, anxiety, worry, and GAD severity were collected. Significant differences in levels of IU were found across all three groups; the highest levels in children with comorbid GAD, followed by children with pure GAD, and healthy controls. IU significantly contributed to worry but not GAD severity beyond the effects of anxiety. A significantly larger proportion of self-reported IU data were missing for younger (e.g., 6-8 years) as compared to older children, raising question about the validity of the construct in younger children. Overall findings suggest that IU is not specific to a GAD diagnosis in childhood. IU may instead serve as a broad cognitive risk factor for more severe (e.g., comorbid) forms of affective psychopathology. Future directions for research, including developmental considerations, are discussed.

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.

The Personality Trait of Intolerance to Uncertainty Affects Behavior in a Novel Computer-Based Conditioned Place Preference Task

Recent work has found that personality factors that confer vulnerability to addiction can also affect learning and economic decision making. One personality trait which has been implicated in vulnerability to addiction is intolerance to uncertainty (IU), i.e., a preference for familiar over unknown (possibly better) options. In animals, the motivation to obtain drugs is often assessed through conditioned place preference (CPP), which compares preference for contexts where drug reward was previously received. It is an open question whether participants with high IU also show heightened preference for previously rewarded contexts. To address this question, we developed a novel computer-based CPP task for humans in which participants guide an avatar through a paradigm in which one room contains frequent reward (i.e., rich) and one contains less frequent reward (i.e., poor). Following exposure to both contexts, subjects are assessed for preference to enter the previously rich and previously poor room. Individuals with low IU showed little bias to enter the previously rich room first, and instead entered both rooms at about the same rate which may indicate a foraging behavior. By contrast, those with high IU showed a strong bias to enter the previously rich room first. This suggests an increased tendency to chase reward in the intolerant group, consistent with previously observed behavior in opioid-addicted individuals. Thus, the personality factor of high IU may produce a pre-existing cognitive bias that provides a mechanism to promote decision-making processes that increase vulnerability to addiction.

Intolerance of Uncertainty: A Temporary Experimental Induction Procedure

Background and Objectives

Intolerance of uncertainty (IU) is a trans-diagnostic construct involved in anxiety and related disorders. Research focused on cross-sectional reporting, manipulating attitudes toward objective and impersonal events or on treatments designed to reduce IU in clinical populations. The current paper presents an experimental procedure for laboratory manipulations of IU and tests mediation hypotheses following the Intolerance of Uncertainty Model.

Methods

On pre-test, undergraduate volunteers (Study 1, n = 43;68% women. Study 2, n = 169;83.8% women) were asked to provide an idiosyncratic future negative life event. State-IU, Worry, Positive and Negative Affect were assessed after that a standardized procedure was used to identify event’s potential negative consequences. The same variables were assessed on post-test, after that participants were asked to read-through increasing and decreasing IU statements.

Results

Temporary changes on IU were consistently reproduced in both studies. Participants receiving increasing IU instructions reported greater state-IU, Worry and Negative Affect than those receiving decreasing IU instructions. However, this latter condition was not different from a control one (Study 2). Both studies revealed significant indirect effects of IU induction instructions on Worry and Negative Affect through state-IU.

Limitations

Both studies used undergraduate psychology students samples, younger than average population and predominantly female. Experimental manipulation and outcome measures belongs to the same semantic domain, uncertainty, potentially limiting generalizability.

Conclusions

Results supported the feasibility and efficacy of the proposed IU manipulation for non-clinical sample. Findings parallel clinical research showing that state-IU preceded Worry and Negative Affect states.

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

The current paper presents a future research agenda for intolerance of uncertainty (IU), which is a transdiagnostic risk and maintaining factor for emotional disorders. In light of the accumulating interest and promising research on IU, it is timely to emphasize the theoretical and therapeutic significance of IU, as well as to highlight what remains unknown about IU across areas such as development, assessment, behavior, threat and risk, and relationships to cognitive vulnerability factors and emotional disorders. The present paper was designed to provide a synthesis of what is known and unknown about IU, and, in doing so, proposes broad and novel directions for future research to address the remaining uncertainties in the literature.

Self-reported intolerance of uncertainty and behavioural decisions

Intolerance of Uncertainty (IU) appears to be a robust transdiagnostic risk factor related to anxiety and depression. Most transdiagnostic IU research has used the self-report Intolerance of Uncertainty Scale-Short Form; however, there is comparatively little research exploring presumed behavioral correlates of IU. The current study was designed to assess relationships between self-reported IU and decisions in uncertainty-based behavioral tasks (specifically, the Wisconsin Card Sorting Task, the Risky Gains Task, and the Modified Iowa Gambling Task). Participants comprised compensated community members (n = 108; 69% women) and undergraduates (n = 98; 78% women). Community member compensation was not contingent on performance, but undergraduate compensation was partially contingent on performance. Results replicated prior research, with both samples producing small (r = .19) to moderate (r = -.29) correlations (ps < .05) between self-reported IU and outcome variables from each of the behavioral tasks. The relationships were larger in the undergraduate sample, likely due to the compensation incentive. In general, the results suggest that increasing IU is associated with increasingly risk adverse behaviors; however, the relationship appears complex and in need of substantial additional research to understand how clinically-significant IU would impact pathology-related behaviours.

Fear of the unknown: One fear to rule them all?

The current review and synthesis was designed to provocatively develop and evaluate the proposition that "fear of the unknown may be a, or possibly the, fundamental fear" (Carleton, 2016) underlying anxiety and therein neuroticism. Identifying fundamental transdiagnostic elements is a priority for clinical theory and practice. Historical criteria for identifying fundamental components of anxiety are described and revised criteria are offered. The revised criteria are based on logical rhetorical arguments using a constituent reductionist postpositivist approach supported by the available empirical data. The revised criteria are then used to assess several fears posited as fundamental, including fear of the unknown. The review and synthesis concludes with brief recommendations for future theoretical discourse as well as clinical and non-clinical research.

Enhancing the ecological validity of the Beads Task as a behavioral measure of intolerance of uncertainty

To broaden the measurement of intolerance of uncertainty (IU) beyond self-report methods, recent research has examined the Beads Task as a behavioral measure of IU. In the present study, we enhanced this task to increase its ecological validity by maximizing decisional uncertainty and the importance of a correct response. Undergraduate participants (n=102) completed the Beads Task with instructions that they would complete the Cold Pressor Task (CPT) if they answered incorrectly. As hypothesized, baseline CPT endurance time and self-reported pain level were weakly associated with later Beads Task distress during the decision-making process. Furthermore, in vivo Beads Task distress was associated with self-report inhibitory IU, which measures avoidance and paralysis in the face of uncertainty, but not with prospective IU, perfectionism, or general psychological distress after making statistical adjustments for multiple comparisons. Comparisons to previous work using the Beads Task, clinical implications, and avenues for future research are discussed.

Abnormal decision-making in generalized anxiety disorder: Aversion of risk or stimulus-reinforcement impairment?

There is preliminary data indicating that patients with generalized anxiety disorder (GAD) show impairment on decision-making tasks requiring the appropriate representation of reinforcement value. The current study aimed to extend this literature using the passive avoidance (PA) learning task, where the participant has to learn to respond to stimuli that engender reward and avoid responding to stimuli that engender punishment. Six stimuli engendering reward and six engendering punishment are presented once per block for 10 blocks of trials. Thirty-nine medication-free patients with GAD and 29 age-, IQ and gender matched healthy comparison individuals performed the task. In addition, indexes of social functioning as assessed by the Global Assessment of Functioning (GAF) scale were obtained to allow for correlational analyzes of potential relations between cognitive and social impairments. The results revealed a Group-by-Error Type-by-Block interaction; patients with GAD committed significantly more commission (passive avoidance) errors than comparison individuals in the later blocks (blocks 7,8, and 9). In addition, the extent of impairment on these blocks was associated with their functional impairment as measured by the GAF scale. These results link GAD with anomalous decision-making and indicate that a potential problem in reinforcement representation may contribute to the severity of expression of their disorder.

An investigation of the role of intolerance of uncertainty in hoarding symptoms

BACKGROUND

Hoarding disorder (HD) is a common, debilitating mental illness and public health burden. Understanding the factors that contribute to hoarding is critical for identifying treatment targets. As a relatively new diagnostic entity, this research remains in its initial stages. Intolerance of uncertainty (IU) is thought to be a vulnerability factor for generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD), and may also be relevant to HD. We investigated the possible association between IU and hoarding in two sets of analyses.

METHOD

First, we administered self-report measures of IU and hoarding symptoms to unscreened undergraduate students (N=456) and used regressions to probe their association controlling for relevant covariates. Second, in a clinical sample, we compared IU across groups of patients with HD (N=26), GAD (N=26), OCD (N=51), other anxiety disorders (N=91) and healthy controls (N=29).

RESULTS

In the student sample, IU predicted hoarding symptoms above and beyond relevant covariates, including hoarding-related beliefs. In the clinical sample, HD patients evidenced greater IU relative to healthy individuals and the mixed anxiety group, and comparable levels of IU to the GAD and OCD groups.

LIMITATIONS

This study relied exclusively on self-report questionnaires and a cross-sectional design.

CONCLUSIONS

IU is associated with hoarding behavior and, as we discuss, conceptual models might benefit from the study of IU as a potentially contributing factor. Directions for future research are discussed.

Prospection and the Present Moment: The Role of Episodic Foresight in Intertemporal Choices between Immediate and Delayed Rewards

Humans are capable of imagining future rewards and the contexts in which they may be obtained. Functionally, intertemporal choices between smaller but immediate and larger but delayed rewards may be made without such episodic foresight. However, we propose that explicit simulations of this sort enable more flexible and adaptive intertemporal decision-making. Emotions triggered through the simulation of future situations can motivate people to forego immediate pleasures in the pursuit of long-term rewards. However, we stress that the most adaptive option need not always be a larger later reward. When the future is anticipated to be uncertain, for instance, it may make sense for preferences to shift toward more immediate rewards, instead. Imagining potential future scenarios and assessment of their likelihood and affective consequences allows humans to determine when it is more adaptive to delay gratification in pursuit of a larger later reward, and when the better strategy is to indulge in a present temptation. We discuss clinical studies that highlight when and how the effect of episodic foresight on intertemporal decision-making can be altered, and consider the relevance of this perspective to understanding the nature of self-control.

Intolerance of uncertainty in body dysmorphic disorder

Intolerance of uncertainty (IU) is a transdiagnostic construct associated with several anxiety and related disorders. Three studies were conducted to explore the potential relationship between IU and body dysmorphic disorder (BDD). Study 1 revealed a positive relationship between IU and BDD symptoms above symptoms of anxiety and depression in an unselected student sample (N=88). Study 2 demonstrated a similar relationship between IU and BDD symptoms above negative affectivity and intolerance of ambiguity in a community sample (N=116). Study 3 found that a clinical BDD sample (N=23) reported greater IU than healthy controls (N=20), though this relationship was accounted for by symptoms of anxiety and depression. Greater IU predicted functional impairment in the clinical sample above BDD symptoms and past-week anxiety and depression. The observed relationship between IU and BDD symptoms provides preliminary support for the relevance of IU to this population.

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.

Intolerance of uncertainty and startle potentiation in relation to different threat reinforcement rates

Fear conditioning research on threat predictability has primarily examined the impact of temporal (i.e., timing) predictability on the startle reflex. However, there are other key features of threat that can vary in predictability. For example, the reinforcement rate (i.e., frequency) of threat is a crucial factor underlying fear learning. The present study examined the impact of threat reinforcement rate on the startle reflex and self-reported anxiety during a fear conditioning paradigm. Forty-five participants completed a fear learning task in which the conditioned stimulus was reinforced with an electric shock to the forearm on 50% of trials in one block and 75% of trials in a second block, in counter-balanced order. The present study also examined whether intolerance of uncertainty (IU), the tendency to perceive or experience uncertainty as stressful or unpleasant, was associated with the startle reflex during conditions of low (50%) vs. high (75%) reinforcement. Results indicated that, across all participants, startle was greater during the 75% relative to the 50% reinforcement condition. IU was positively correlated with startle potentiation (i.e., increased startle response to the CS+ relative to the CS-) during the 50%, but not the 75%, reinforcement condition. Thus, despite receiving fewer electric shocks during the 50% reinforcement condition, individuals with high IU uniquely demonstrated greater defense system activation when impending threat was more uncertain. The association between IU and startle was independent of state anxiety. The present study adds to a growing literature on threat predictability and aversive responding, and suggests IU is associated with abnormal responding in the context of uncertain threat.

How is the Beads Task related to intolerance of uncertainty in anxiety disorders?

Intolerance of uncertainty (IU) is a cognitive bias associated with anxiety disorders that has only been reliably measured using self-report instruments. The current study investigated relationships between a probabilistic inference task - the Beads Task - and self-report IU. Individuals with anxiety disorders (ANX) and non-anxious controls (NAC) completed self-report measures as well as the Beads Task at three levels of difficulty. The Beads Task successfully induced task-related uncertainty as the decision became more difficult. While the two groups did not differ on the observable performance related measures, the ANX group was significantly more distressed during the task than were the NACs. Moreover, among the ANX group, self-reported IU was correlated with draws to decision and distress during the task. The Beads Task appears to provoke distress associated with uncertainty for anxious individuals, rather than altering their behavioral responses; thus, clinical implications and avenues for future research are discussed.

Intolerance of uncertainty mediates reduced reward anticipation in major depressive disorder

BACKGROUND

Reduced reward sensitivity has long been considered a fundamental deficit of major depressive disorder (MDD). One way this deficit has been measured is by an asymmetry in electroencephalogram (EEG) activity between left and right frontal brain regions. MDD has been associated with a reduced frontal EEG asymmetry (i.e., decreased left relative to right) while anticipating reward. However, the mechanism (or mediator) of this association is unclear. The present study examined whether intolerance of uncertainty (IU) mediated the association between depression and reduced reward anticipation.

METHODS

Data were obtained from a prior study reporting reduced frontal EEG asymmetry while anticipating reward in early-onset MDD. Participants included 156 individuals with early-onset MDD-only, panic disorder-only, both (comorbids), or controls. Frontal EEG asymmetry was recorded during an uncertain reward anticipation task. Participants completed a self-report measure of IU.

RESULTS

All three psychopathology groups reported greater IU relative to controls. Across all participants, greater IU was associated with a reduced frontal EEG asymmetry. Furthermore, IU mediated the relationship between MDD and frontal EEG asymmetry and results remained significant after controlling for neuroticism, suggesting effects were not due to broad negative affectivity.

LIMITATIONS

MDD participants were limited to those with early-onset depression. Measures were collected cross-sectionally, precluding causal relationships.

CONCLUSIONS

IU mediated the relationship between MDD and reduced reward anticipation, independent of neuroticism. Explanations are provided regarding how IU may contribute to reduced reward anticipation in depression. Overall, IU appears to be an important mechanism for the association between depression and reduced reward anticipation.

"What if I make a mistake?": intolerance of uncertainty is associated with poor behavioral performance

Intolerance of uncertainty (IU) has been posited as ubiquitous across experiences of anxiety; however, studies testing how IU impacts behavior remain scant. The current study examined the impact of IU on performance during a keyboard typing task, a relatively complex and common behavior. A total of 40 members of the university community completed the task and measures of IU, trait anxiety, negative affect, and state anxiety. Heart rate and skin conductance were also assessed during the task as indices of state anxiety. IU was independently and substantially associated with slower typing speed (part r = -0.68) beyond other measured psychological and physiological variables but was not associated with typing errors. Prospective and inhibitory IU, as manifestations of IU, did not seemingly differ in their relationship with performance. IU may negatively impact day-to-day behaviors and contribute to undesired consequences. Further research is needed to explore whether this relationship warrants consideration in models of anxiety disorders.