101
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Oglesby ME, Gibby BA, Mathes BM, Short NA, Schmidt NB. Intolerance of uncertainty and post-traumatic stress symptoms: An investigation within a treatment seeking trauma-exposed sample. Compr Psychiatry 2017; 72:34-40. [PMID: 27710835 DOI: 10.1016/j.comppsych.2016.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/02/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Intolerance of uncertainty (IU) has been associated with post-traumatic stress symptoms (PTSS) in the literature. However, no research to date has investigated the relationship between IU and PTSS within a clinical trauma-exposed sample, which is an important next step in the literature and crucial for the generalizability of these findings. Therefore, the current study hypothesized that IU would be related to increased PTSS within a clinical sample of trauma-exposed individuals. Further, we hypothesized that IU would be related to elevated PTSS after accounting for anxiety sensitivity (AS) and negative affect (NA), two known correlates of PTSS. Finally, we examined the relations between IU and the PTSS clusters (i.e., avoidance, emotional numbing, hyperarousal, and re-experiencing) while covarying for AS and NA. METHODS Participants included community adults (n=126) presenting at an outpatient clinic. All participants had previously experienced a traumatic event as defined by the DSM-5 PTSD Criterion A. METHODS Results revealed that IU was significantly associated with increased PTSS above and beyond AS and NA. Further, results indicated that IU was significantly related to the avoidance, hyperarousal, and emotional numbing PTSS clusters, even after covarying for AS and NA. IU was not significantly associated with the PTSS re-experiencing cluster once AS and NA were taken into account. CONCLUSIONS Our results expand upon the extant literature by demonstrating that IU is associated with PTSS above and beyond AS and NA within a clinical trauma-exposed sample. These findings are discussed in terms of promising directions for future research and treatment strategies.
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Affiliation(s)
- Mary E Oglesby
- Florida State University, Tallahassee, FL 32306, United States
| | | | | | - Nicole A Short
- Florida State University, Tallahassee, FL 32306, United States
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102
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Torbit L, Laposa JM. Group CBT for GAD: The Role of Change in Intolerance of Uncertainty in Treatment Outcomes. Int J Cogn Ther 2016. [DOI: 10.1521/ijct_2016_09_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Judith M. Laposa
- Centre for Addiction and Mental Health, Toronto, and University of Toronto
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103
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Laposa JM, Mancuso E, Abraham G, Loli-Dano L. Unified Protocol Transdiagnostic Treatment in Group Format. Behav Modif 2016; 41:253-268. [PMID: 27591430 DOI: 10.1177/0145445516667664] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Barlow et al. published the unified protocol (UP) for transdiagnostic treatment of emotional disorders, focusing on common pathological factors across a variety of diagnoses. The limited UP research to date suggests that this treatment may be particularly useful for anxiety disorders. However, it has largely been evaluated only in individual treatment format. The current study examined the effectiveness of the UP treatment in a group format, with individuals with comorbid anxiety disorder symptoms. Twenty-six individuals with clinically significant anxiety symptoms in at least two of the following areas, social anxiety, worry, or panic, participated in a 14-week manualized group treatment using the UP. Significant decreases were found on general anxiety, worry, social anxiety, panic, depression, and negative affect, and increases on positive affect. The UP may hold promise for a transdiagnostic group treatment of comorbid anxiety symptoms, but further examination of this treatment is warranted.
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Affiliation(s)
- Judith M Laposa
- 1 Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- 2 University of Toronto, Ontario, Canada
| | - Enza Mancuso
- 1 Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Gaby Abraham
- 1 Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- 2 University of Toronto, Ontario, Canada
| | - Laura Loli-Dano
- 1 Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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104
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Izadpanah S, Schumacher M, Arens EA, Stopsack M, Ulrich I, Hansenne M, Grabe HJ, Barnow S. Adolescent harm avoidance as a longitudinal predictor of maladaptive cognitive emotion regulation in adulthood: The mediating role of inhibitory control. J Adolesc 2016; 52:49-59. [PMID: 27494741 DOI: 10.1016/j.adolescence.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/15/2016] [Accepted: 07/16/2016] [Indexed: 11/25/2022]
Abstract
The current study investigates the effect of adolescent harm avoidance (HA) on maladaptive cognitive emotion regulation strategies (mCER) in early adulthood. The mediating role of inhibitory control and the moderating effect of gender on this link were also examined. Longitudinal data from 261 adolescents (147 female) were collected in three phases (T0, T1 and T2) over approximately 10 years. Results revealed that, after controlling for HA in adulthood (T2), female adolescents' HA (T0) significantly predicted mCER strategies after 10 years (T2), whereas male adolescents' HA only predicted catastrophizing. In addition, attentional impulsivity (T1) significantly mediated the relation between HA and mCER, though only among women. There was no significant indirect effect for emotional interference and stop-signal reaction time. Results revealed gender and measure specific associations between HA and inhibitory control and suggest that HA could induce inhibitory deficits leading to mCER.
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Affiliation(s)
- Shahrzad Izadpanah
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Germany.
| | - Maren Schumacher
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Germany.
| | - Elisabeth A Arens
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
| | - Malte Stopsack
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Germany.
| | - Ines Ulrich
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Germany.
| | | | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University of Greifswald, Germany.
| | - Sven Barnow
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Germany.
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105
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Gorka SM, Lieberman L, Phan KL, Shankman SA. Association between problematic alcohol use and reactivity to uncertain threat in two independent samples. Drug Alcohol Depend 2016; 164:89-96. [PMID: 27173662 PMCID: PMC4893928 DOI: 10.1016/j.drugalcdep.2016.04.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent laboratory studies have shown that acute alcohol intoxication selectively and effectively dampens aversive responding to uncertain threat. An emerging hypothesis is that individuals who exhibit heightened reactivity to uncertain threat may be especially motivated to use alcohol to dampen their distress, setting the stage for negative reinforcement processes to drive excessive alcohol use. However, no study to date has directly examined whether current problematic drinkers exhibit heightened reactivity to uncertain threat as would be expected. METHODS The present study was therefore designed to examine the association between current problematic alcohol use and reactivity to uncertain threat during sobriety in two, independent samples. In Study 1 (n=221) and Study 2 (n=74), adult participants completed the same well-validated threat-of-shock task which separately probes responses to temporally predictable and unpredictable threat. Startle potentiation was measured as an index of aversive responding. Problematic alcohol use was defined as number of binge episodes within the past 30days in Study 1 and total scores on a self-report measure of hazardous drinking in Study 2. RESULTS As hypothesized, across both studies greater levels of problematic drinking were associated with greater startle potentiation to unpredictable threat. In Study 2, hazardous drinking scores were also positively associated with startle potentiation to predictable threat. CONCLUSIONS The findings are notably consistent with the notion that heightened reactivity to uncertain threat is an important individual difference factor associated with the onset and/or maintenance of problematic drinking behaviors and may therefore be a novel prevention and intervention target.
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Affiliation(s)
- Stephanie M. Gorka
- University of Illinois-Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608, United States,Corresponding author. (S.M. Gorka)
| | - Lynne Lieberman
- University of Illinois-Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60607, United States
| | - K. Luan Phan
- University of Illinois-Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608, United States,University of Illinois-Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60607, United States,Jesse Brown VA Medical Center, Mental Health Service Line, 820 S. Damen Avenue, Chicago, IL 60612, United States,University of Illinois-Chicago, Department of Anatomy and Cell Biology, and The Graduate Program in Neuroscience, 808 S. Wood Street Chicago, IL 60612, United States
| | - Stewart A. Shankman
- University of Illinois-Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608, United States,University of Illinois-Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60607, United States
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106
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Shihata S, McEvoy PM, Mullan BA, Carleton RN. Intolerance of uncertainty in emotional disorders: What uncertainties remain? J Anxiety Disord 2016; 41:115-24. [PMID: 27212227 DOI: 10.1016/j.janxdis.2016.05.001] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/03/2016] [Accepted: 05/05/2016] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Sarah Shihata
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Peter M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia.
| | - Barbara Ann Mullan
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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107
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Wright KD, Lebell MANA, Carleton RN. Intolerance of uncertainty, anxiety sensitivity, health anxiety, and anxiety disorder symptoms in youth. J Anxiety Disord 2016; 41:35-42. [PMID: 27302203 DOI: 10.1016/j.janxdis.2016.04.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 04/19/2016] [Accepted: 04/22/2016] [Indexed: 12/30/2022]
Abstract
Intolerance of uncertainty (IU) - difficulty coping with uncertainty and its implications - is traditionally studied in adult populations, but more recently has been explored in children and adolescents. To date, the association between IU and health anxiety has not been explored in a child or adolescent sample. Further, it is unknown whether the relationship between IU and health anxiety may be mediated by anxiety sensitivity (i.e., fear of anxiety-related sensations) in this population. We sought to extend the existing research and expand our understanding of IU as a transdiagnostic construct by exploring the association between IU and health anxiety, anxiety sensitivity, and DSM-IV anxiety disorder symptom categories in 128 youth (M age=12.7years, SD=0.82, range 11-17 years). Participants completed measures of IU, health anxiety, anxiety sensitivity, and anxiety disorder symptom categories. Results demonstrated significant positive associations between IU and all measures. Mediation analyses supported the direct and indirect importance of each IU subscale on health anxiety. Future directions and implications are discussed.
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Affiliation(s)
- Kristi D Wright
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada.
| | - Megan A N Adams Lebell
- Department of Educational Psychology and Special Education, University of Saskatchewan, Saskatoon, SK, Canada
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada
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108
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Carleton RN, Duranceau S, Shulman EP, Zerff M, Gonzales J, Mishra S. Self-reported intolerance of uncertainty and behavioural decisions. J Behav Ther Exp Psychiatry 2016; 51:58-65. [PMID: 26788617 DOI: 10.1016/j.jbtep.2015.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/04/2015] [Accepted: 12/21/2015] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- R Nicholas Carleton
- The Anxiety and Illness Behaviour Laboratory, University of Regina, Regina, SK, Canada.
| | - Sophie Duranceau
- The Anxiety and Illness Behaviour Laboratory, University of Regina, Regina, SK, Canada.
| | | | - Marissa Zerff
- The Anxiety and Illness Behaviour Laboratory, University of Regina, Regina, SK, Canada.
| | - Josh Gonzales
- Risk and Gambling Behaviour Laboratory, University of Regina, Regina, SK, Canada.
| | - Sandeep Mishra
- Risk and Gambling Behaviour Laboratory, University of Regina, Regina, SK, Canada.
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109
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Carleton RN. Fear of the unknown: One fear to rule them all? J Anxiety Disord 2016; 41:5-21. [PMID: 27067453 DOI: 10.1016/j.janxdis.2016.03.011] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/26/2016] [Accepted: 03/26/2016] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- R Nicholas Carleton
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK, Canada.
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110
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Soliman A, Bellaj T, Khelifa M. An integrative psychological model for radicalism: Evidence from structural equation modeling. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.02.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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111
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McEvoy PM, Erceg-Hurn DM. The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty. J Anxiety Disord 2016; 41:96-107. [PMID: 26898177 DOI: 10.1016/j.janxdis.2016.02.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/29/2016] [Accepted: 02/02/2016] [Indexed: 11/20/2022]
Abstract
The search for universal processes associated with symptom change across emotional disorders and different forms of psychotherapy offers hope of increased theoretical parsimony and treatment efficiencies. This study investigated whether intolerance of uncertainty (IU) is a universal process by examining whether changes in IU were associated with changes in symptoms across three different cognitive behavior therapy protocols for depression (n=106), social anxiety disorder (n=88), or generalized anxiety disorder (n=62) in a community mental health clinic. IU was associated with reductions in repetitive negative thinking in all treatments, which is consistent with IU being a transdiagnostic and 'trans-therapy' process of change. Changes in IU were also associated with symptom relief in the social anxiety disorder and generalized anxiety disorder groups, but not in the depression group. Implications of these findings are discussed within the broader literature of transdiagnostic approaches to emotional disorders.
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Affiliation(s)
- Peter M McEvoy
- Centre for Clinical Interventions, Perth, Australia; School of Psychology and Speech Pathology, Curtin University, Perth, Australia.
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112
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Michel NM, Rowa K, Young L, McCabe RE. Emotional distress tolerance across anxiety disorders. J Anxiety Disord 2016; 40:94-103. [PMID: 27161839 DOI: 10.1016/j.janxdis.2016.04.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/06/2016] [Accepted: 04/21/2016] [Indexed: 11/28/2022]
Abstract
Emotional distress tolerance (EDT) has increasingly been recognized as a transdiagnostic vulnerability factor. However, research assessing EDT in anxiety disorder populations is lacking. The current study addressed this gap in the literature by examining EDT in a sample of outpatients with panic, social anxiety, generalized anxiety, or obsessive compulsive disorders (n=674), and by assessing its relationship to symptom severity and impairment. Results showed that poor EDT was common across diagnostic groups. However, correlation and regression analyses suggested that although EDT was associated with symptom severity and impairment, it did not account for unique variance in scores beyond the effect of negative affect, stress, intolerance of uncertainty (IU) and anxiety sensitivity (AS). IU and AS had a stronger relationship with overall symptom severity and impairment in the regression models. Together, findings suggest that although EDT may be transdiagnostic, IU and AS are more relevant to our understanding of anxiety disorders.
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Affiliation(s)
- Natalie M Michel
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare, West 5th Campus, 100 West 5th Street, Hamilton, ON L8 N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | - Lisa Young
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare, West 5th Campus, 100 West 5th Street, Hamilton, ON L8 N 3K7, Canada.
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare, West 5th Campus, 100 West 5th Street, Hamilton, ON L8 N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
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113
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Etkind SN, Koffman J. Approaches to managing uncertainty in people with life-limiting conditions: role of communication and palliative care. Postgrad Med J 2016; 92:412-7. [PMID: 27129911 DOI: 10.1136/postgradmedj-2015-133371] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/12/2016] [Indexed: 12/21/2022]
Abstract
Patients with any major illness can expect to experience uncertainty about the nature of their illness, its treatment and their prognosis. Prognostic uncertainty is a particular source of patient distress among those living with life-limiting disease. Uncertainty also affects professionals and it has been argued that the level of professional tolerance of uncertainty can affect levels of investigation as well as healthcare resource use. We know that the way in which uncertainty is recognised, managed and communicated can have important impacts on patients' treatment and quality of life. Current approaches to uncertainty in life-limiting illness include the use of care bundles and approaches that focus on communication and education. The experience in communicating in difficult situations that specialist palliative care professionals can provide may also be of benefit for patients with life-limiting illness in the context of uncertainty. While there are a number of promising approaches to uncertainty, as yet few interventions targeted at recognising and addressing uncertainty have been fully evaluated and further research is needed in this area.
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Affiliation(s)
- S N Etkind
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - J Koffman
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
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114
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Into the unknown: A review and synthesis of contemporary models involving uncertainty. J Anxiety Disord 2016; 39:30-43. [PMID: 26945765 DOI: 10.1016/j.janxdis.2016.02.007] [Citation(s) in RCA: 468] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 12/15/2022]
Abstract
The current review and synthesis serves to define and contextualize fear of the unknown relative to related constructs, such as intolerance of uncertainty, and contemporary models of emotion, attachment, and neuroticism. The contemporary models appear to share a common core in underscoring the importance of responses to unknowns. A recent surge in published research has explored the transdiagnostic impact of not knowing on anxiety and related pathologies; as such, there appears to be mounting evidence for fear of the unknown as an important core transdiagnostic construct. The result is a robust foundation for transdiagnostic theoretical and empirical explorations into fearing the unknown and intolerance of uncertainty.
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115
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Fergus TA. Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria: A replication and extension examining dimensions of each construct. J Affect Disord 2015; 184:305-9. [PMID: 26141807 DOI: 10.1016/j.jad.2015.06.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preliminary findings suggest that anxiety sensitivity (AS) and intolerance of uncertainty (IU) may confer vulnerability for cyberchondria, defined as repeated internet searches for medical information that exacerbates health anxiety. Prior studies are limited because it remains unclear whether specific AS or IU dimensions differentially relate to certain cyberchondria dimensions. METHODS The present study examined associations among AS, IU, and cyberchondria dimensions using a sample of community adults (N = 578) located in the United States. RESULTS As predicted, physical AS and inhibitory IU were the only AS or IU dimensions to share unique associations with the distress cyberchondria dimension after controlling for the overlap among the AS dimensions, IU dimensions, and health anxiety. Cognitive AS and social AS unexpectedly evidenced unique associations with cyberchondria dimensions. LIMITATIONS The results are limited by the cross-sectional study design and use of a community, rather than clinical, sample. CONCLUSIONS This study provides evidence that specific AS and IU dimensions may confer vulnerability to certain cyberchondria dimensions. Further clarifying associations among AS, IU, and cyberchondria may lead to improvements in our conceptualization and, ultimately, treatment of cyberchondria.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University Waco, TX 76798, United States.
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116
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Shaw AM, Llabre MM, Timpano KR. Affect Intolerance and Hoarding Symptoms: A Structural Equation Modeling Approach. Int J Cogn Ther 2015. [DOI: 10.1521/ijct_2015_8_05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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117
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Distress tolerance in OCD and anxiety disorders, and its relationship with anxiety sensitivity and intolerance of uncertainty. J Anxiety Disord 2015; 33:8-14. [PMID: 25956557 DOI: 10.1016/j.janxdis.2015.04.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 11/20/2022]
Abstract
There is a growing interest in the role of distress tolerance (i.e., the capacity to withstand negative emotions) in the onset and maintenance of anxiety. However, both empirical and theoretical knowledge regarding the role of distress tolerance in the anxiety disorders is relatively under examined. Accumulating evidence supports the relationship between difficulties tolerating distress and anxiety in nonclinical populations; however, very few studies have investigated distress tolerance in participants with diagnosed anxiety disorders. Individuals with social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder with and without agoraphobia (PD/A) and obsessive-compulsive disorder (OCD) completed measures of distress tolerance (DT), conceptually related measures (i.e., anxiety sensitivity (AS), intolerance of uncertainty (IU)), and anxiety symptom severity. Results showed that DT was negatively associated with AS and IU. DT was correlated with GAD, SAD and OCD symptoms, but not PD/A symptoms, in individuals with those respective anxiety disorders. DT was no longer a significant predictor of OCD or anxiety disorder symptom severity when AS and IU were also taken into account. There were no between group differences on DT across OCD and the anxiety disorder groups. Implications for the role of distress tolerance in anxiety pathology are discussed.
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118
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119
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Kertz SJ, Bakhti R, Stevens KT, Curewitz A. Testing Cognitive and Emotion-Focused Models of Worry in Black and White Samples. Cogn Behav Ther 2015; 44:353-64. [PMID: 25730261 DOI: 10.1080/16506073.2015.1013055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Several models have been proposed to conceptualize worry. Broadly, the models can be classified as cognitive (including the Avoidance Model, the Intolerance of Uncertainty Model, and the Metacognitive Model) and emotion-focused (including Emotion Dysregulation and Acceptance-Based models). Although these models have received strong empirical investigation in primarily non-Hispanic White samples, no known study has examined the applicability to racial and ethnic minority groups. The current study compared the proportion of variance explained by cognitive and emotion-focused models of worry in White and Black samples. Results indicated that cognitive and emotion-focused models significantly predicted worry in both Black and White samples. However, the overall amount of variance in worry explained by the models was less for Black samples. Specifically, controlling for gender, the cognitive models explained 53% of the variance in worry in the White sample compared with 19% in the Black sample. Similarly, the emotion-focused models explained 34% of the variance in worry in the White sample but only 13% in the Black sample. These findings suggest that well-established conceptual frameworks for worry failed to explain the bulk of the variance in worry in Black samples, leaving much unknown. Additional research is needed to identify key variables that may further explain worry in ethnic minority samples.
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Affiliation(s)
- Sarah J Kertz
- a Department of Psychology, Southern Illinois University , Life Science II 6502, Carbondale , IL 62901 , USA
| | - Rinad Bakhti
- a Department of Psychology, Southern Illinois University , Life Science II 6502, Carbondale , IL 62901 , USA
| | - Kimberly T Stevens
- a Department of Psychology, Southern Illinois University , Life Science II 6502, Carbondale , IL 62901 , USA
| | - Alana Curewitz
- a Department of Psychology, Southern Illinois University , Life Science II 6502, Carbondale , IL 62901 , USA
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Fergus TA, Bardeen JR, Orcutt HK. Examining the Specific Facets of Distress Tolerance That Are Relevant to Health Anxiety. J Cogn Psychother 2015; 29:32-44. [PMID: 32759150 DOI: 10.1891/0889-8391.29.1.32] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Researchers have called for examinations of associations between distinct facets of distress tolerance and specific forms of psychopathology. We examined associations between five facets of distress tolerance (intolerance of uncertainty, ambiguity, frustration, negative emotion, and physical discomfort) and health anxiety using a large community sample of adults. Structural equation modeling was used to examine associations. Intolerance of uncertainty, negative emotion, and physical discomfort were the only facets of distress tolerance that shared unique associations with health anxiety after accounting for the overlap among the facets of distress tolerance. Intolerance of physical discomfort shared an especially strong unique association with health anxiety. These results highlight facets of distress tolerance that are particularly relevant to health anxiety. Conceptual and therapeutic implications are discussed.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas
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121
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Oglesby ME, Albanese BJ, Chavarria J, Schmidt NB. Intolerance of Uncertainty in Relation to Motives for Alcohol Use. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9665-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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122
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Kertz SJ, Stevens KT, McHugh RK, Björgvinsson T. Distress intolerance and worry: the mediating role of cognitive variables. ANXIETY STRESS AND COPING 2014; 28:408-24. [PMID: 25314145 DOI: 10.1080/10615806.2014.974571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Sarah J Kertz
- a Psychology Department , Southern Illinois University , Carbondale , IL , USA
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123
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Moscovitch DA, Rowa K, Paulitzki JR, Antony MM, McCabe RE. What If I Appear Boring, Anxious, or Unattractive? Validation and Treatment Sensitivity of the Negative Self Portrayal Scale in Clinical Samples. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9645-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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124
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Barahmand U, Haji A. The impact of intolerance of uncertainty, worry and irritability on quality of life in persons with epilepsy: Irritability as mediator. Epilepsy Res 2014; 108:1335-44. [DOI: 10.1016/j.eplepsyres.2014.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/06/2014] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
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125
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Gorka SM, Lieberman L, Nelson BD, Sarapas C, Shankman SA. Aversive responding to safety signals in panic disorder: the moderating role of intolerance of uncertainty. J Anxiety Disord 2014; 28:731-6. [PMID: 25173980 PMCID: PMC4160405 DOI: 10.1016/j.janxdis.2014.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
An inability to inhibit aversive responding during conditions that signal safety may be a core dysfunction associated with anxiety disorders. However, there has been inconsistent evidence as to whether individuals with panic disorder (PD) exhibit aversive responding during safety signals. It is therefore possible that only certain subgroups of PD patients, particularly those with high levels of intolerance of uncertainty (IU), evidence this type of abnormal responding. The aim of the current study was to examine whether IU moderates the association between PD and startle potentiation during (a) safety and (b) threat periods during a threat-of-shock task. Participants included 172 adults, 74 of which had current diagnoses of PD. Results indicated that at high levels of IU, PD was associated with greater startle potentiation during safety. At low levels of IU, PD was not associated with startle potentiation during safety. IU did not moderate the effect of PD on threat responding. These results suggest that PD patients with high levels of IU fail to inhibit aversive responding during safety, possibly due to a tendency to interpret distal threat as distressing.
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126
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Einstein DA. Extension of the Transdiagnostic Model to Focus on Intolerance of Uncertainty: A Review of the Literature and Implications for Treatment. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2014; 21:280-300. [PMID: 25400336 PMCID: PMC4204511 DOI: 10.1111/cpsp.12077] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 11/09/2013] [Accepted: 11/28/2013] [Indexed: 11/26/2022]
Abstract
This study reviews research on the construct of intolerance of uncertainty (IU). A recent factor analysis (Journal of Anxiety Disorders, 25, 2012, p. 533) has been used to extend the transdiagnostic model articulated by Mansell (2005, p. 141) to focus on the role of IU as a facet of the model that is important to address in treatment. Research suggests that individual differences in IU may compromise resilience and that individuals high in IU are susceptible to increased negative affect. The model extension provides a guide for the treatment of clients presenting with uncertainty in the context of either a single disorder or several comorbid disorders. By applying the extension, the clinician is assisted to explore two facets of IU, "Need for Predictability" and "Uncertainty Arousal."
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Affiliation(s)
- Danielle A Einstein
- Address correspondence to Danielle A. Einstein, Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW 2109, Australia. E-mail:
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127
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Medical information seeking: impact on risk for anxiety psychopathology. J Behav Ther Exp Psychiatry 2014; 45:402-7. [PMID: 24818986 DOI: 10.1016/j.jbtep.2014.04.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Increased utilization of online medical information seeking demands investigation of potentially detrimental effects of these activities. The present study investigated whether viewing medical websites may adversely affect anxiety sensitivity (AS), a well-established risk factor for the development of psychopathology. METHODS Participants (N = 52) were randomly assigned to view medical symptom related websites or general health and wellness control websites. AS was measured before and after the website viewing. RESULTS Individuals in the medical website group reported higher AS compared to the control group at post-manipulation after controlling for baseline health anxiety and baseline AS. Additionally, intolerance of uncertainty (IU), an individual difference variable assessing negative beliefs about uncertainty, significantly moderated this effect such that medical website viewing only affected AS in participants with high IU but not in participants with low IU. LIMITATIONS The limitations of the current study include the lack of individualization of the website viewing and the short duration of the website viewing. CONCLUSIONS The results of this study provide initial evidence that exposure to online medical information could increase risk for anxiety psychopathology in individuals with elevated IU. Additionally, these results provide support for a learning based model of the etiology of AS.
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128
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Fetzner MG, Asmundson GJG, Carey C, Thibodeau MA, Brandt C, Zvolensky MJ, Carleton RN. How do elements of a reduced capacity to withstand uncertainty relate to the severity of health anxiety? Cogn Behav Ther 2014; 43:262-74. [PMID: 24961385 DOI: 10.1080/16506073.2014.929170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Intolerance of uncertainty (IU)--a multidimensional cognitive vulnerability factor--is associated with a variety of anxiety disorders and health anxiety (HA). To date, few studies have assessed whether IU dimensions (prospective and inhibitory IU) are differentially associated with HA and whether their contributions are independent of anxiety sensitivity (AS). This study addressed these issues using independent community (n = 155; 81% women) and undergraduate (n = 560; 86% women) samples. Results indicated that prospective IU, but not inhibitory IU, had significant positive associations with HA in community dwellers and undergraduate students. AS somatic and cognitive concerns were also significant predictors among both samples. In addition, severity of IU dimensions among individuals reporting elevated HA were compared against individuals diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive-compulsive disorder. Results indicated minimal differences between those with elevated HA and each of the anxiety disorder diagnoses. Findings lend support to the unique transdiagnostic nature of IU and support commonalities between HA and anxiety disorders.
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129
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Carleton RN, Thibodeau MA, Osborne JW, Taylor S, Asmundson GJ. Revisiting the fundamental fears: Towards establishing construct independence. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2014.01.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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130
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Carleton RN, Duranceau S, Freeston MH, Boelen PA, McCabe RE, Antony MM. "But it might be a heart attack": intolerance of uncertainty and panic disorder symptoms. J Anxiety Disord 2014; 28:463-70. [PMID: 24873884 DOI: 10.1016/j.janxdis.2014.04.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/21/2014] [Accepted: 04/21/2014] [Indexed: 11/29/2022]
Abstract
Panic disorder models describe interactions between feared anxiety-related physical sensations (i.e., anxiety sensitivity; AS) and catastrophic interpretations therein. Intolerance of uncertainty (IU) has been implicated as necessary for catastrophic interpretations in community samples. The current study examined relationships between IU, AS, and panic disorder symptoms in a clinical sample. Participants had a principal diagnosis of panic disorder, with or without agoraphobia (n=132; 66% women). IU was expected to account for significant variance in panic symptoms controlling for AS. AS was expected to mediate the relationship between IU and panic symptoms, whereas IU was expected to moderate the relationship between AS and panic symptoms. Hierarchical linear regressions indicated that IU accounted for significant unique variance in panic symptoms relative to AS, with comparable part correlations. Mediation and moderation models were also tested and suggested direct and indirect effects of IU on panic symptoms through AS; however, an interaction effect was not supported. The current cross-sectional evidence supports a role for IU in panic symptoms, independent of AS.
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Affiliation(s)
| | | | - Mark H Freeston
- Institute of Neuroscience, Newcastle University, Newcastle Cognitive and Behavioural Therapies Centre, Newcastle-upon-Tyne, United Kingdom
| | - Paul A Boelen
- Department of Clinical and Health Psychology, Utrecht University, The Netherlands
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University and Anxiety Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada
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131
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Britton GI, Davey GCL. Interrelationships between negative mood and clinical constructs: a motivational systems approach. Front Psychol 2014; 5:393. [PMID: 24817861 PMCID: PMC4012205 DOI: 10.3389/fpsyg.2014.00393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/14/2014] [Indexed: 11/13/2022] Open
Abstract
A series of three experiments was designed to test predictions from a motivational systems approach to understanding the role of clinical constructs in anxiety-based problems. Negative mood, inflated responsibility, and intolerance of uncertainty (IU) were separately manipulated within analog samples to examine their effect on the other two factors. In the first experiment (n = 59) the negative mood group scored significantly higher in terms of inflated responsibility than the positive mood group. In the second experiment (n = 63) the high responsibility group scored significantly higher in terms of both negative mood and IU than the low responsibility group. In the third experiment (n = 61) the high IU group scored significantly higher in terms of negative mood than the low IU group. Tests of indirect effects revealed an indirect effect of IU on inflated responsibility through negative mood and an indirect effect of negative mood on IU through inflated responsibility, suggesting all three constructs are causally interrelated. The findings are consistent with contemporary transdiagnostic views of clinical constructs, and support a view of anxiety that is underpinned by a coordinated and interdependent motivational system evolved to manage threat.
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Affiliation(s)
- Gary I Britton
- School of Psychotherapy and Psychology, Regent's University London London, UK
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132
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Clementi MA, Alfano CA. Targeted Behavioral Therapy for childhood generalized anxiety disorder: a time-series analysis of changes in anxiety and sleep. J Anxiety Disord 2014; 28:215-22. [PMID: 24289931 DOI: 10.1016/j.janxdis.2013.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/22/2013] [Accepted: 10/26/2013] [Indexed: 11/19/2022]
Abstract
This study examined the efficacy of Targeted Behavioral Therapy (TBT), a newly developed intervention targeting features of childhood generalized anxiety disorder (GAD). Using a time-series design, 4 children (7-12 years) with primary GAD were treated with TBT, which includes sleep improvement strategies, systematic desensitization for reducing intolerance of uncertainty, and in vivo exposures for anxiety. Diagnostic interviews and questionnaires were administered at baseline, post-treatment and 3 months follow-up. Anxiety symptoms and sleep characteristics/problems were rated weekly during a 4-week baseline and 14-weeks of treatment. Two children remitted at post-treatment and no child had a GAD diagnosis at follow-up. Child but not parent report revealed improvements in both worry and sleep. Despite improvements from pre- to post-assessment, considerable symptom fluctuation observed during the baseline period preclude conclusion that symptom changes are specifically attributable to the course of treatment. Overall, preliminary support is provided for the efficacy of TBT for childhood GAD.
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Affiliation(s)
- Michelle A Clementi
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204, USA.
| | - Candice A Alfano
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204, USA.
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133
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Carleton RN. The intolerance of uncertainty construct in the context of anxiety disorders: theoretical and practical perspectives. Expert Rev Neurother 2014; 12:937-47. [DOI: 10.1586/ern.12.82] [Citation(s) in RCA: 276] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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134
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Carleton RN, Fetzner MG, Hackl JL, McEvoy P. Intolerance of Uncertainty as a Contributor to Fear and Avoidance Symptoms of Panic Attacks. Cogn Behav Ther 2013; 42:328-41. [DOI: 10.1080/16506073.2013.792100] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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135
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Boulter C, Freeston M, South M, Rodgers J. Intolerance of Uncertainty as a Framework for Understanding Anxiety in Children and Adolescents with Autism Spectrum Disorders. J Autism Dev Disord 2013; 44:1391-402. [DOI: 10.1007/s10803-013-2001-x] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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136
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Norr AM, Oglesby ME, Capron DW, Raines AM, Korte KJ, Schmidt NB. Evaluating the unique contribution of intolerance of uncertainty relative to other cognitive vulnerability factors in anxiety psychopathology. J Affect Disord 2013; 151:136-42. [PMID: 23778202 DOI: 10.1016/j.jad.2013.05.063] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 05/24/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intolerance of uncertainty (IU) is a cognitive vulnerability factor associated with a wide range of anxiety psychopathology. Other cognitive vulnerabilities such as anxiety sensitivity (AS), distress tolerance (DT), and discomfort intolerance (DI) have also been investigated as constructs of interest across anxiety disorders. As researchers increasingly uncover viable transdiagnostic vulnerabilities to anxiety, it becomes important to determine the degree of overlap between these constructs. METHODS The present studies examined the unique relationships between IU, other vulnerability factors (AS, DT, and DI) and social anxiety, obsessive-compulsive, and worry symptoms across two nonclinical samples (n=217, n=241). RESULTS Findings were highly consistent across samples. IU was significantly associated with anxiety symptoms in all analyses, even when accounting for other transdiagnostic risk variables. Anxiety sensitivity, was uniquely related to social anxiety and obsessive-compulsive symptoms in all analyses, but was related to worry in only one study. Distress tolerance was only uniquely associated with worry. Discomfort intolerance was not uniquely related to the anxiety symptoms in any analyses. LIMITATIONS Future research should attempt to replicate the findings in a clinical population and utilize a longitudinal design. CONCLUSIONS The robust and incremental relationships between IU and anxiety symptoms suggests the potential benefit of targeting IU in the context of transdiagnostic anxiety treatments.
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Affiliation(s)
- Aaron M Norr
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306-4301, USA
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137
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Fergus TA, Bardeen JR. Anxiety sensitivity and intolerance of uncertainty: Evidence of incremental specificity in relation to health anxiety. PERSONALITY AND INDIVIDUAL DIFFERENCES 2013. [DOI: 10.1016/j.paid.2013.05.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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138
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Rasmussen NH, Smith SA, Maxson JA, Bernard ME, Cha SS, Agerter DC, Shah ND. Association of HbA1c with emotion regulation, intolerance of uncertainty, and purpose in life in type 2 diabetes mellitus. Prim Care Diabetes 2013; 7:213-221. [PMID: 23685023 DOI: 10.1016/j.pcd.2013.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/28/2013] [Accepted: 04/16/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The extant literature lacks breadth on psychological variables associated with health outcome for type 2 diabetes mellitus (T2DM). This investigation extends the scope of psychological information by reporting on previously unpublished factors. OBJECTIVE To investigate if intolerance of uncertainty, emotion regulation, or purpose in life differentiate T2DM adults with sustained high HbA(1c) (HH) vs. sustained acceptable HbA(1c) (AH). SUBJECTS AND METHODS Cross-sectional observational study. Adult patients with diagnosed T2DM meeting inclusionary criteria for AH, HH, or a nondiabetic reference group (NDR) were randomly selected and invited to participate. Patients who consented and participated resulted in a final sample of 312 subgrouped as follows: HH (n = 108); AH (n = 98); and NDR (n = 106). Data sources included a survey, self-report questionnaires, and electronic medical record (EMR). RESULTS HH individuals with T2DM reported lower purpose in life satisfaction (p = 0.005) compared to the NDR group. The effect size for this finding is in the small-to-medium range using Cohen's guidelines for estimating clinical relevance. The HH-AH comparison on purpose in life was nonsignificant. The emotion regulation and intolerance of uncertainty comparisons across the three groups were not significant. CONCLUSIONS The present study determined that lower purpose in life satisfaction is associated with higher HbA(1c). In a T2DM patient with sustained high HbA(1c), the primary care clinician is encouraged to consider screening for purpose in life satisfaction by asking a single question such as "Do the things you do in your life seem important and worthwhile?" The patient's response will assist the clinician in determining if meaning or purpose in life distress may be interferring with diabetes self-care. If this is the case, the clinician can shift the conversation to the value of behavioral and emotional health counseling.
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Affiliation(s)
- Norman H Rasmussen
- Department of Psychiatry and Psychology, Division of Integrated Behavioral Healthcare, Mayo Clinic, Rochester, MN, USA; Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
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139
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Zlomke KR, Jeter KM. Stress and worry: examining intolerance of uncertainty's moderating effect. ANXIETY STRESS AND COPING 2013; 27:202-15. [DOI: 10.1080/10615806.2013.835400] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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140
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Dash SR, Meeten F, Davey GCL. Systematic information processing style and perseverative worry. Clin Psychol Rev 2013; 33:1041-56. [PMID: 24056060 DOI: 10.1016/j.cpr.2013.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/13/2013] [Accepted: 08/19/2013] [Indexed: 12/14/2022]
Abstract
This review examines the theoretical rationale for conceiving of systematic information processing as a proximal mechanism for perseverative worry. Systematic processing is characterised by detailed, analytical thought about issue-relevant information, and in this way, is similar to the persistent, detailed processing of information that typifies perseverative worry. We review the key features and determinants of systematic processing, and examine the application of systematic processing to perseverative worry. We argue that systematic processing is a mechanism involved in perseverative worry because (1) systematic processing is more likely to be deployed when individuals feel that they have not reached a satisfactory level of confidence in their judgement and this is similar to the worrier's striving to feel adequately prepared, to have considered every possible negative outcome/detect all potential danger, and to be sure that they will successfully cope with perceived future problems; (2) systematic processing and worry are influenced by similar psychological cognitive states and appraisals; and (3) the functional neuroanatomy underlying systematic processing is located in the same brain regions that are activated during worrying. This proposed mechanism is derived from core psychological processes and offers a number of clinical implications, including the identification of psychological states and appraisals that may benefit from therapeutic interventions for worry-based problems.
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141
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Helsen K, Goubert L, Vlaeyen JWS. Observational learning and pain-related fear: exploring contingency learning in an experimental study using colored warm water immersions. THE JOURNAL OF PAIN 2013; 14:676-88. [PMID: 23582378 DOI: 10.1016/j.jpain.2013.01.771] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/09/2013] [Accepted: 01/29/2013] [Indexed: 11/24/2022]
Abstract
UNLABELLED This study investigated observational learning of pain-related fear and subsequent extinction after first-hand exposure to the feared stimulus. Moreover, the specific contingencies that are learned when observing others in pain were explored. A differential fear-conditioning paradigm was used, showing video models displaying either a painful (CS+ color; aversively conditioned stimulus) or a neutral (CS- color; neutrally conditioned stimulus) facial expression in the presence of a colored warm water task (WWT; observation phase). In 1 condition (open WWT cover), the model's hand was immersed in the colored liquid, while in the other condition (closed WWT cover), no contact was displayed between the model and the liquid. During exposure, participants subsequently immersed their own hand into each WWT with equal temperatures. Results revealed successful acquisition of pain-related fear. Participants with higher levels of pain catastrophizing, intolerance of uncertainty, trait fear of pain, or dispositional empathy were more prone to develop pain-related fear. Pain-related fear extinguished quickly after direct exposure to both WWTs. Contingencies between the color of the WWT and either the painful facial expressions or the assumed properties of the colored liquid were learned in both conditions. Clinical implications and limitations of the current study are discussed, providing avenues for future research in observational learning of pain-related fear. PERSPECTIVE Pain-related fear promotes the development as well as the continuation of chronic pain. A better understanding of the acquisition and extinction of this fear may help to improve pain treatment programs. Furthermore, we intended to identify individuals who are more prone to develop pain-related fear.
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Affiliation(s)
- Kim Helsen
- Research Group on Health Psychology, University of Leuven, Leuven, Belgium.
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142
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Intolerance of Uncertainty and PTSD Symptoms: Exploring the Construct Relationship in a Community Sample with a Heterogeneous Trauma History. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-013-9531-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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143
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Gerolimatos LA, Edelstein BA. Anxiety-related constructs mediate the relation between age and health anxiety. Aging Ment Health 2013; 16:975-82. [PMID: 22640370 DOI: 10.1080/13607863.2012.688192] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Few studies have examined health anxiety in older adults, and it is unknown which factors account for age-related differences in health anxiety. Given similarities between health anxiety and the anxiety disorders, anxiety-related constructs, including anxiety sensitivity, intolerance of uncertainty, emotion regulation, and anxiety control, were examined as mediators of the relation between age (older vs. young adults) and health anxiety. METHODS Eighty-six older adults aged 60 and older and 117 young adults aged 18 to 30 completed several self-report measures of health anxiety and anxiety-related constructs. RESULTS Young adults reported higher levels of health anxiety than older adults. Anxiety sensitivity and intolerance of uncertainty partially mediated the relation between age and health anxiety. Perceived anxiety control, reappraisal, and suppression did not mediate the relation between age and health anxiety. CONCLUSIONS Anxiety sensitivity and intolerance of uncertainty are predisposing characteristics that appear to partially explain age-related differences in health anxiety. These constructs may be necessary targets for assessment and interventions among older and young adults.
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144
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McEvoy PM, Mahoney AEJ. To be sure, to be sure: intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behav Ther 2012; 43:533-45. [PMID: 22697442 DOI: 10.1016/j.beth.2011.02.007] [Citation(s) in RCA: 245] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 11/05/2010] [Accepted: 02/23/2011] [Indexed: 11/24/2022]
Abstract
The Intolerance of Uncertainty Model was initially developed as an explanation for worry within the context of generalized anxiety disorder. However, recent research has identified intolerance of uncertainty (IU) as a possible transdiagnostic maintaining factor across the anxiety disorders and depression. The aim of this study was to determine whether IU mediated the relationship between neuroticism and symptoms related to various anxiety disorders and depression in a treatment-seeking sample (N=328). Consistent with previous research, IU was significantly associated with neuroticism as well as with symptoms of social phobia, panic disorder and agoraphobia, obsessive-compulsive disorder, generalized anxiety disorder, and depression. Moreover, IU explained unique variance in these symptom measures when controlling for neuroticism. Mediational analyses showed that IU was a significant partial mediator between neuroticism and all symptom measures, even when controlling for symptoms of other disorders. More specifically, anxiety in anticipation of future uncertainty (prospective anxiety) partially mediated the relationship between neuroticism and symptoms of generalized anxiety disorder (i.e. worry) and obsessive-compulsive disorder, whereas inaction in the face of uncertainty (inhibitory anxiety) partially mediated the relationship between neuroticism and symptoms of social anxiety, panic disorder and agoraphobia, and depression. Sobel's test demonstrated that all hypothesized meditational pathways were associated with significant indirect effects, although the mediation effect was stronger for worry than other symptoms. Potential implications of these findings for the treatment of anxiety disorders and depression are discussed.
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Affiliation(s)
- Peter M McEvoy
- Centre for Clinical Interventions, University of Western Australia, 223 James Street, Northbridge, Perth, WA 6003, Australia.
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145
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Meeten F, Dash SR, Scarlet ALS, Davey GCL. Investigating the effect of intolerance of uncertainty on catastrophic worrying and mood. Behav Res Ther 2012; 50:690-8. [PMID: 22982084 DOI: 10.1016/j.brat.2012.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 08/01/2012] [Accepted: 08/08/2012] [Indexed: 10/28/2022]
Abstract
Intolerance of uncertainty (IU) is a construct known to influence catastrophic worry and is often observed in Generalized Anxiety Disorder (GAD). Research into the psychological manifestations of GAD suggests IU is associated with worry, but has not confirmed a causal link. The current study investigated the relationship between catastrophic worry and IU in a non-clinical undergraduate and postgraduate population (n = 46), with a mean age of 26.8 (SD = 5.52 years), where 71.74% were women. Participants received either a high or low IU manipulation, mood was measured throughout the study on 100 point visual analogue scales (VAS), and worry was measured using the catastrophising interview (CI). The high IU group generated significantly more catastrophising steps than the low IU group. Increased levels of sadness and anxiety were observed in the high as compared to the low IU group post IU manipulation, and this difference was maintained throughout the CI interview. A mediation analysis revealed that sadness and anxiety did not significantly mediate the relationship between IU and number of CI steps. These findings have implications for GAD treatment, as they suggest that manipulating IU affects measures of worry and its associated emotional and behavioural symptoms.
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Affiliation(s)
- F Meeten
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK.
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146
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From Higher-Order to Underlying Constructs: Examining the Relationships Between Affect and Fundamental Fears. COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-012-9468-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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147
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Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. J Anxiety Disord 2012; 26:468-79. [PMID: 22366534 DOI: 10.1016/j.janxdis.2012.01.011] [Citation(s) in RCA: 415] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 01/23/2012] [Accepted: 01/27/2012] [Indexed: 11/23/2022]
Abstract
Intolerance of uncertainty (IU) - a dispositional characteristic resulting from negative beliefs about uncertainty and its implications - may be an important construct in anxiety disorders and depression. Despite the potential importance of IU, clinical data on the construct remains relatively scant and focused on generalized anxiety disorder and obsessive-compulsive disorder. The present study systematically investigated IU, as measured by the Intolerance of Uncertainty Scale-12 (IUS-12), across groups diagnosed with anxiety disorders (i.e., social anxiety disorder, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder) or depression (clinical sample: n=376; 61% women), as well as undergraduate (n=428; 76% women) and community samples (n=571; 67% women). Analysis of variance revealed only one statistically significant difference in IUS-12 scores across diagnostic groups in the clinical sample; specifically, people with social anxiety disorder reported higher scores (p<.01; η(2)=.03) than people with panic disorder. People diagnosed with an anxiety disorder or depression reported significantly and substantially higher IUS-12 scores relative to community and undergraduate samples. Furthermore, IUS-12 score distributions were similar across diagnostic groups as demonstrated by Kernel density estimations, with the exception of panic disorder, which may have a relatively flat distribution of IU. Response patterns were invariant across diagnostic groups as demonstrated by multi-group confirmatory factor analyses, but varied between clinical and nonclinical samples. Overall, the findings suggest IU may serve as an important transdiagnostic feature across anxiety disorders and depression. In addition, robust support was found for the proposed 2-factor model of the IUS-12. Comprehensive findings, implications, and future research directions are discussed.
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148
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Schützler L, Carleton RN, Witt CM. The illness/injury sensitivity index: validation of a German version of the ISI-R. Cogn Behav Ther 2012; 41:223-9. [PMID: 22423593 DOI: 10.1080/16506073.2011.640345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Three fundamental fears-anxiety sensitivity, fear of negative evaluation, and illness/injury sensitivity-are considered integral components of anxiety-related psychopathology and also bear connections with chronic pain. Scales measuring the first two fears, the Anxiety Sensitivity Index and the Fear of Negative Evaluation Scale, have been translated into German; however, the nine-item Illness/Injury Sensitivity Index-Revised (ISI-R) that measures fears of injury and illness has not been available in German language yet. The aim of this study therefore was a translation of the ISI-R into German language and an initial validation of the translated scale in two different samples. The German ISI-R was translated by both professionals and laypersons, and a final version was decided on by consensus. In Study 1, participants included 96 undergraduate students (85% women) who completed the German version of the ISI as part of a larger study. An exploratory factor analysis with oblique rotation was conducted and suggested a two-factor-solution with one factor representing fears of illness and the other fears of injury. This factor structure was confirmed via a confirmatory factor analysis (CFA) in Study 2. Participants included 117 community members (79% women). Convergent validity was supported using a visual analogue scale for fear of illness in both samples and the German translation of the Whiteley Index in Study. Overall, the results supported the German translation of the ISI-R. Comprehensive results, limitations, and directions for future research are discussed.
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Affiliation(s)
- Lena Schützler
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany.
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149
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Stewart AM, Polak E, Young R, Schultz IZ. Injured workers' construction of expectations of return to work with sub-acute back pain: the role of perceived uncertainty. JOURNAL OF OCCUPATIONAL REHABILITATION 2012; 22:1-14. [PMID: 21656253 DOI: 10.1007/s10926-011-9312-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Little is known about the formation of expectations of return to work (RTW) from the perspective of injured workers with back injuries. This modified grounded theory study uses a biopsychosocial approach that considers the workers' complex social circumstances, to unpack the multidimensional construct of expectations of RTW from the injured worker's perspective. METHOD Initial semi-structured interviews were conducted with 18 individuals with sub-acute back pain, who were off work between 3 and 6 months. Follow-up interviews were conducted with 7 participants for the purposes of member checking. The interview data was coded, compared and analyzed over the course of data collection, until saturation was reached. RESULTS Data analysis revealed that expectations of return-to-work are constructed based on perceived uncertainty which subsumes five inter-related categories (1) perceived lack of control over the return-to-work process, (2) perceived lack of recognition by others of the impact of the injury, (3) perceived inability to perform the pre-injury job, (4) fear of re-injury, and (5) perceived need for workplace accommodations. Expectations, once formed, were influenced by the worker's experience of coping with perceived uncertainty. CONCLUSION Perceived uncertainty plays a key role in injured workers' formation of expectations of return-to-work. Implications are discussed regarding how this perceived uncertainty plays a role in the development of (re)injury prevention and rehabilitation programs. The importance of further research on perceived uncertainty is presented, along with potential future research considerations.
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Affiliation(s)
- Alison M Stewart
- Department of Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, BC, Canada.
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150
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Hui Choi WH, Lee GL, Chan CHY, Cheung RYH, Lee ILY, Chan CLW. The relationships of social support, uncertainty, self-efficacy, and commitment to prenatal psychosocial adaptation. J Adv Nurs 2012; 68:2633-45. [PMID: 22360348 DOI: 10.1111/j.1365-2648.2012.05962.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS To report a study of the relations of prenatal psychosocial adaptation, social support, demographic and obstetric characteristics, uncertainty, information-seeking behaviour, motherhood normalization, self-efficacy, and commitment to pregnancy. BACKGROUND Prenatal psychosocial assessment is recommended to identify psychosocial risk factors early to prevent psychiatric morbidities of mothers and children. However, knowledge on psychosocial adaptation and its explanatory variables is inconclusive. DESIGN This study was non-experimental, with a cross-sectional, correlational, prospective design. METHODS The study investigated Hong Kong Chinese women during late pregnancy. Convenience sampling methods were used, with 550 women recruited from the low-risk clinics of three public hospitals. Data was collected between January-April 2007. A self-reported questionnaire was used, consisting of a number of measurements derived from an integrated framework of the Life Transition Theory and Theory of Uncertainty in Illness. Explanatory variables of psychosocial adaptation were identified using a structural equation modelling programme. RESULTS The four explanatory variables of the psychosocial adaptation were social support, uncertainty, self-efficacy, and commitment to pregnancy. In the established model, which had good fit indices, greater psychosocial adaptation was associated with higher social support, higher self-efficacy, higher commitment to pregnancy, and lower uncertainty. CONCLUSION The findings give clinicians and midwives guidance in the aspects to focus on when providing psychosocial assessment in routine prenatal screening. Since there are insufficient reliable screening tools to assist that assessment, midwives should receive adequate training, and effective screening instruments have to be identified. The explanatory role of uncertainty found in this study should encourage inquiries into the relationship between uncertainty and psychosocial adaptation in pregnancy.
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