Intolerance of uncertainty and decisions about delayed, probabilistic rewards

"A Certainty for you Does Not Mean That it is a Certainty for Science": A Phenomenological Analysis of Experiences of Uncertainty in Clinical Reasoning of Nurses in the Postanesthesia Care Unit

PURPOSE

To explore the experiences of uncertainty in the clinical reasoning of nurses in the postanesthesia care unit (PACU).

DESIGN

A phenomenological descriptive design, following Colaizzi's analysis.

METHODS

Semistructured interviews were conducted with 14 nurses from a PACU on their experience of uncertainty in clinical reasoning. The interviews were digitally audio-recorded and transcribed verbatim. Two researchers conducted data analysis independently and followed seven phases: (re)reading the transcripts, extracting significant statements, formulating meanings from significant statements, aggregating formulated meanings into themes, developing a description of the phenomenon's essential structure, generating of the fundamental structure of the phenomenon, validating of the findings through participant feedback. The process employed MAXQDA analytics Pro 2022 software. Consolidated Criteria for Reporting A Qualitative Research checklist was used for reporting.

FINDINGS

From uncertainty experiences in nurses' clinical reasoning, 10 themes emerged: ambiguity and decision latitude, communication, work ethic, difficulty interpreting and predicting outcomes, cognitive performance impairment, incivility, core competence vagueness of postanesthesia nurses, high-tech care, (in)security and risk, and occupational stress.

CONCLUSIONS

The experiences of uncertainty in clinical reasoning of nurses in postanesthesia care units are highly focused on patient safety. Exploring these experiences has made uncertainty more tangible and explicit, which will enable nurses in postanesthesia care units to prepare for adaptive responses to deal with uncertainty when it occurs in clinical practice.

The impact of anxiety and intolerance of uncertainty on climate change distress, policy support, and pro-environmental behaviour

OBJECTIVES

As the threat of climate change continues to grow, bolstering individual-level support for climate change initiatives is crucial. More research is needed to better understand how individual difference factors, such as climate change anxiety and intolerance of uncertainty (IU), may shape how people perceive climate change and respond to climate change messaging. To date, the majority of published studies have not taken these individual difference factors into consideration, and IU has been particularly neglected in the climate change literature. This study examined the independent effects of climate change anxiety and IU on three climate change-related outcomes: climate-related distress, support for climate change policies, and behavioural engagement.

METHODS

Participants were Florida residents (N = 441) who completed an online survey, including measures of climate change anxiety and IU. Participants then watched a video describing climate change consequences and completed three outcome measures: post-video distress, climate change policy support, and behavioural engagement.

RESULTS

Controlling for demographic covariates, both climate change anxiety (β = .43, p < .001) and IU (β = .27, p < .001) were associated with greater post-video distress, but only IU independently predicted greater policy support (β = .10, p = .034) and behavioural engagement (β = .12, p = .017).

CONCLUSIONS

Our findings suggest that IU may be an important factor in promoting pro-environmental behaviour and policy support, but climate change anxiety may increase emotional distress without boosting meaningful behaviours or support. Our findings highlight the potential influence of cognitive factors on climate change engagement and suggest that invoking uncertainty rather than anxiety may be more effective in catalysing effective environmental engagement.

Relationship between Fear of COVID-19, Intolerance of Uncertainty, and Coping Strategies on University Students' Mental Health

BACKGROUND

the mental health of students was particularly affected by the COVID-19 pandemic. The present study therefore examined the relationships between anxiety and depressive symptoms, eating-related problems, coping, fear of COVID-19, and intolerance of uncertainty.

METHODS

2139 French students of 54 universities were recruited in the different regions of France during a French lockdown (between 21 April and 3 May 2021). Six variables were measured: fear of COVID-19, intolerance of uncertainty, coping, anxiety and depressive symptoms, and eating-related problems. To explore the directions of the relationships between our variables of interest, we calculated a directed acyclic graph.

RESULTS

our data highlighted the central roles of intolerance of uncertainty in students' anxiety and depressive symptoms, and the direct role of prospective intolerance of uncertainty on eating-related problems.

CONCLUSIONS

these findings indicate that intolerance of uncertainty should be targeted by interventions designed to help students with high levels of anxiety, depressive symptoms, and/or eating-related problems.

Feeling uncertain despite knowing the risk: Patients with OCD (but not controls) experience known and unknown probabilistic decisions as similarly distressing and uncertain

Patients with obsessive compulsive disorder (OCD) present as risk-averse and avoidant of feared stimuli, yet the literature examining risk aversion in OCD is conflicting. One possible explanation is that patients may exhibit aversion only on ambiguous tasks where the likelihood of possible outcomes is unknown. To test this idea, the current study assigned 30 patients with OCD versus 30 non-psychiatric controls (NPC) to conditions of known versus unknown risk (i.e., probabilities) on the Beads Task. Importantly, the task involved real financial stakes. We also examined self-reported intolerance of uncertainty (IU) as a mechanism. Results revealed a significant risk information x group interaction for certainty about the decision. Specifically, while NPCs felt significantly less certain on the unknown risk (versus known risk) task, the OCD group felt uncertain regardless of risk information. Results also revealed a significant main effect of group for distress after deciding, such that the OCD group was more distressed across all task versions compared to NPCs. Elevated trait IU was associated with higher task-related distress. Results indicate that even when patients with OCD are given information about likelihoods, they still feel uncertain and experience distress. Findings have clinical implications for addressing risk aversion and ambiguity/uncertainty in treatment.

Climate change views examined through a behavioral medicine frame: are there potential target mechanisms for change beyond political ideology?

The threat of climate change is associated with both profound health consequences and failures by many individuals to take preventive actions. Behavioral science research on health behavior engagement may serve as a lens through which to better understand attitudes associated with the threat of climate change. This study was designed to examine individual differences in attitudinal responses to climate change, understanding the degree to which these responses can be predicted by both political beliefs and more readily modified psychological factors commonly associated with health behavior engagement: locus of control, anxiety sensitivity, delay discounting, and intolerance of uncertainty. Participants (N = 234) were US adults (62% male; 57% Non-Hispanic White; 44% Democrat) who completed an online survey. Stepwise multiple linear regressions examined which variables provided non-redundant prediction in models of climate change beliefs and concerns. In addition to providing support for the role of political affiliation and related ideology in climate change views (9-23% variance), this study underscores the importance of a behavioral health frame in understanding climate change concerns and beliefs. Known risk factors for negative health behaviors - prominently, locus of control, anxiety sensitivity, and delay discounting - contributed strongly to the understanding of these views, accounting for 4-28% of variance. Our findings encourage greater attention to health behavior-related constructs for understanding attitudes relevant to climate change action.

When radical uncertainty is too much: Clinical aspects of Conviction Narrative Theory

We propose extrapolating Conviction Narrative Theory (CNT) to clinical psychology and psychiatry. We demonstrate how CNT principles may benefit assessment, therapy, and possibly even modify public health views of neuropsychiatric disorders. Our commentary focuses on hoarding disorder as a model, elaborates on discrepancies in the scientific literature and suggests how the CNT may resolve them.

Uncertainty aversion predicts the neural expansion of semantic representations

Correctly identifying the meaning of a stimulus requires activating the appropriate semantic representation among many alternatives. One way to reduce this uncertainty is to differentiate semantic representations from each other, thereby expanding the semantic space. Here, in four experiments, we test this semantic-expansion hypothesis, finding that uncertainty-averse individuals exhibit increasingly differentiated and separated semantic representations. This effect is mirrored at the neural level, where uncertainty aversion predicts greater distances between activity patterns in the left inferior frontal gyrus when reading words, and enhanced sensitivity to the semantic ambiguity of these words in the ventromedial prefrontal cortex. Two direct tests of the behavioural consequences of semantic expansion further reveal that uncertainty-averse individuals exhibit reduced semantic interference and poorer generalization. Together, these findings show that the internal structure of our semantic representations acts as an organizing principle to make the world more identifiable.

The link between self-uncertainty and conspicuous consumption: Tolerance of uncertainty as a moderator

This study, based on self-affirmation theory, aims to investigate the impact of self-uncertainty on individual consumption behavior. Self-uncertainty was categorized into moral, cognitive, and interpersonal self-uncertainty, and different types of self-uncertainty were manipulated through four experiments, including a moral dilemma, a recall paradigm, and a picture quiz task written by E-Prime software to examine the effects of different types of self-uncertainty on conspicuous consumption and their possible boundary conditions. Our results show that moral, cognitive, and interpersonal self-uncertainty contribute to a stronger tendency to engage in conspicuous consumption. Our results also suggest that tolerance of uncertainty moderates the effect of self-uncertainty on conspicuous consumption, meaning that subjects with a high tolerance of uncertainty are less inclined to engage in conspicuous consumption than those with a low tolerance of uncertainty, even if they have high self-uncertainty. This study may provide an explanation for conspicuous consumption behavior, further validating the theory of compensatory consumption. Additionally, the results from this study also provide a reference for understanding people's decision-making behavior in an uncertain social context and can provide new guidance to control irrational consumption behavior.

Intolerance of uncertainty and functional connectivity of the anterior insula during anticipation of unpredictable reward

Individuals with high intolerance of uncertainty (IU) tend to display maladaptive cognitive, behavioral, physiological, and/or neural responses during anticipation of uncertain or ambiguous outcomes, both positive and negative in valence. Importantly, high IU has been proposed as a key transdiagnostic phenotypic risk factor for the onset and maintenance of several psychiatric disorders. Within the context of reward processing, high IU has been related to dysfunctional reward anticipation, which may be mediated by hyperactive anterior insula (AIC) response to uncertainty. The present study further investigated the relationship between the AIC and IU by examining the association between individual differences in IU and task-based functional connectivity of the right AIC using functional magnetic resonance imaging (fMRI). Participants (N = 171) completed a self-report measure of IU and a reward anticipation task during fMRI. Generalized psychophysiological interaction (gPPI) analyses were performed with a seed in the right AIC. In the U-threat model, we found that greater self-reported levels of IU were correlated with increased functional connectivity between the right AIC and the dorsal anterior cingulate cortex (dACC) and the right dorsolateral prefrontal cortex (dlPFC). In the P-threat model, we did not find these associations, perhaps indicating that they may be more robust during uncertainty. These preliminary findings suggest that parts of salience and central executive control networks may be impacted by and underlie the expression of IU. Future studies should examine the generalizability of these findings to clinical populations and investigate how disruption of these functional networks may contribute to psychopathology.

COVID-19 as an undesirable political issue: Conspiracy beliefs and intolerance of uncertainty predict adhesion to prevention measures

Conspiracy theories thrive in moments of crises because they provide straightforward answers that assist individuals in coping with threats. The COVID-19 outbreak is such a crisis and is boosted by the political turmoil related to the politicization of the pandemic in some countries. To assess the role of political partisanship, intolerance of uncertainty (IU), and conspiracy beliefs in our two criterion variables (support for COVID-19 prevention measures and compliance with social distancing), we applied an online questionnaire to 662 participants. Our results indicate direct effects of political partisanship on support for COVID-19 prevention measures and non-compliance with social distancing while IU has not directly affected any of them. We have also found a significant effect of political partisanship on conspiracy theory dimensions involving personal wellbeing (PW) and control of information (CI) but not government malfeasance (GM) ones. Moreover, beliefs in CI theories predicted non-compliance with social distancing. Intolerance of uncertainty, on its turn, predicted the three dimensions of conspiracy beliefs. As to interaction effects, belief in GM, PW, and CI conspiracy theories moderated the effect of political partisanship on support for COVID-19 prevention measures whereas only belief in GM and PW theories moderated the effect of IU on past non-compliance with social distancing. Overall, our results suggest the relevance of diminishing politicization around the virus, providing basic scientific knowledge to the general population, and assisting individuals in coping with uncertainty. Besides, these findings provide insights into developing information campaigns to instruct the population to cope with the pandemic, producing behavioral change at societal and individual levels.

Pattern-setting for improving risky decision-making

Self-control can be defined as making choices in accordance with long-term, rather than short-term, patterns of behavior. Rachlin (2016) suggested a novel technique to enhance self-control, by which individual choices carry the weight of a larger pattern of choices. This report describes a study of 169 college students who made repeated choices between two gambles. The better of the two gambles had a greater win probability but required waiting an uncertain amount of time. Some "patterned" subjects were forced to repeat their previous choices according to a schedule, while control subjects could choose freely on every trial. It was found that on free-choice trials, the patterned subjects chose the better gamble more often than controls. There was stronger evidence for such an effect appearing immediately than for it developing gradually from a process of learning over the course of the task. An additional condition in which subjects were forced to choose the better gamble yielded inconsistent results. Overall, the results support the use of pattern-setting as a strategy to improve decision-making.

The Relationship between Intolerance of Uncertainty and Problematic Social Media Use during the COVID-19 Pandemic: A Serial Mediation Model

The COVID-19 pandemic has brought significant interruptions to life certainty, and there has been a lack of research on the influence of uncertainty. The present research aimed to explore how intolerance of uncertainty, maladaptive coping strategies, and fear of missing out affect social media use in a Chinese community sample (N = 311) during the pandemic. Serial mediation analysis was applied, integrating the mediating role of maladaptive coping strategy and fear of missing out. Intolerance of uncertainty, maladaptive coping strategies, and fear of missing out was positively related to PSMU. Based on the mediation analysis, when age and gender were controlled, the direct effect of intolerance of uncertainty on PSMU was significant. The total indirect effect was also significant. The effect of intolerance of uncertainty on PSMU was mediated by maladaptive coping strategies and fear of missing out. Taken together, maladaptive coping strategies and fear of missing out played a serial mediating role between intolerance of uncertainty and PSMU. The findings imply that strategies to improve the tolerance of uncertainty, reduce fear of missing out, and relevant coping strategies could be potentially helpful in mitigating problematic social media use, especially during the COVID-19 pandemic.

The Application of the Intolerance of Uncertainty Model to Gambling Urge and Involvement

BACKGROUND

Drawing on the intolerance of uncertainty model, this study aimed to examine whether intolerance of uncertainty and emotion regulation difficulties (in terms of impulse control difficulties and limited access to emotion regulation strategies) contributed to individual differences in gambling urge and involvement.

METHODS

Convenience sampling was used to recruit Chinese adult participants who had engaged in buying lottery tickets and other gambling activities in the past year. They were asked to complete an anonymous questionnaire survey, and a total of 580 valid cases (M_age = 34.07, SD = 13.36; 50.4% female) were collected for data analysis.

RESULTS

Path analysis showed that the total effect of intolerance of uncertainty on gambling urge and involvement was significant and positive. However, only impulse control difficulties and not limited access to emotion regulation strategies fully mediated the effect of intolerance of uncertainty.

CONCLUSIONS

As the first study to apply the intolerance of uncertainty model to real-life gambling, it found that individuals' intolerance of uncertainty and impulse control difficulties contributed to more gambling urge and involvement. Improving emotion regulation skill (e.g., impulse control training) may, therefore, be considered in programs for promoting responsible gambling among Chinese gamblers.

Intolerance of Uncertainty and Attitudes towards Vaccination Impact Vaccinal Decision While Perceived Uncertainty Does Not

The COVID-19 pandemic illustrated that intolerance of uncertainty (IU) can hinder problem-solving and lead to avoidance of ambiguous situations. Furthermore, people tend to lack confidence in decisions made in ambiguous contexts. We wanted to investigate the impact of IU on intentions to get vaccinated, to vaccinate one’s children, and to recommend the vaccine in situations with varying degrees of perceived uncertainty. We first conducted a pretest to select six scenarios with different levels of perceived uncertainty. In the core study, 485 participants answered for each of the six scenarios whether they would get vaccinated, vaccinate their children (or imagine doing so, for individuals without children), and whether they would recommend the vaccine. They also completed the IUS-12 (Intolerance of Uncertainty scale) and the VAX (Vaccination Attitudes Examination). Results showed that perceived uncertainty did not influence our measures, but the IUS-12 and VAX predicted the difference in score between the most and least uncertain scenarios. An indirect effect of the IUS-12 on decision confidence through the VAX was found, but with no direct effect. We conclude that, even if future studies should refine these results, Public Policies should be more focused on factors such as IU and attitudes toward vaccination.

Intolerance of Uncertainty in Pediatric Chronic Pain: Dyadic Relationships Between Youth and Parents

The current study used a dyadic analytic approach (actor-partner interdependence models) to assess the stability and interrelationships of intolerance of uncertainty (IU) among a cohort of youth with chronic pain and their parents (n = 156 dyads). Relationships between parent and youth IU, parent and youth pain interference, and parent and youth internalizing mental health symptoms were examined. At baseline and follow-up, youth and parents completed psychometrically-sound questionnaires to assess their respective IU, pain characteristics, and clinical outcomes (pain interference, anxiety, depressive, and posttraumatic stress symptoms). Our findings support the construct stability of IU over time, as well as intrapersonal (ie, actor) effects of IU on follow-up youth pain interference and mental health symptoms and parents' mental health symptoms (but not parent pain interference). There were no interpersonal (ie, partner) effects over time between youth and parent IU or between youth and parent IU and pain interference or mental health symptoms. These findings align with previous research evidencing IU as a transdiagnostic risk factor for a range of mental health concerns and extend previous findings by showing the stability of parent and youth IU over time and its potential predictive relevance to outcomes in a clinical sample of youth with chronic pain. PERSPECTIVE: This article presents dyadic analyses assessing intrapersonal and interpersonal associations between intolerance of uncertainty (IU) and pain and mental health symptoms in youth with chronic pain and their parents. Analyses evidenced short-term construct stability of IU and intrapersonal (but not interpersonal) effects of IU on pain and mental health symptoms.

The relationship between future self-continuity and intention to use Internet wealth management: The mediating role of tolerance of uncertainty and trait anxiety

This study aimed to analyze the mediating effect of tolerance of uncertainty (TU) and trait anxiety (TA) on future self-continuity (FSC) and intention to use Internet wealth management (IUIWM) systems. A questionnaire survey was distributed online and a total of 388 participants completed questionnaire, The questionnaire included the following scales: Chinese version of the FSC, Intention to Use the Internet Wealth Management, TU, and TA. Pearson correlation was used to investigate the correlation coefficient between variables while the sequential regression method was used to analyze relationship between variables. To analyze the collected data, the SPSS 26.0 was used. A two-step procedure was applied to analyze the mediation effect. Confirmatory factor analysis (CFA) was conducted to test the measurement model. Afterward, the Maximum Likelihood method was used for path analysis, and the Bias-corrected Bootstrap method was used to investigate determine the estimated value and confidence interval of the mediating effect. To analyze the mediation effect, the Mplus 7.0 was used. The results showed that FSC positively predicted individuals’ Internet wealth management systems. Furthermore, TU and TA played complete serial multiple mediating roles between FSC and IUIWM. The role of TA and TU have negative impact on intention to use. This study provides a theoretical basis in personality psychology that Internet financial product suppliers can use to improve the attractiveness of their products. Product managers can subdivide users according to these personality traits to provide customized products.

COVID-19 Related Stresses, Conspiracy Beliefs, Uncertainty, and Non-adherence to Safety Guidelines

INTRODUCTION

Inconsistent use of protective preventive measures and nonadherence of the guidelines set by the World Health Organization regarding the coronavirus are associated with increased morbidity and mortality, as well as increased health care costs.

OBJECTIVE

The purpose of this study was to examine the role of COVID-19 related worries, conspiracy beliefs, and uncertainty in adherence to preventative measures in Iran.

METHOD

In a large survey with data collected online from a volunteer sample of 599 individuals, assessments were made of the distress associated with the anticipated potential consequences associated with the COVID-19 pandemic and the lockdown, extent of agreement with conspiracy beliefs, level of situation-specific uncertainty, and self-reports of compliance with preventive measures. Data were analyzed to explore paths leading to nonadherence to safety guidelines proposed by the medical authorities.

RESULTS

A large majority of individuals report significant distress and worry associated with the COVID-19 pandemic. Results indicate that increasing levels of situation-specific uncertainty intolerance, as well as conspiracy beliefs regarding the coronavirus, are associated with non-compliance with the advised protocols. Specifically, the results show that worries related to the COVID-19 pandemic are linked to non-compliance with preventive measures through conspiracy beliefs and feelings of uncertainty associated with the COVID-19 situation even after gender, education, and perceived socioeconomic status were controlled.

CONCLUSIONS

Findings imply that emotional exhaustion is likely to have set in and become counterproductive as people choose to violate safety guidelines. The authors discuss the theoretical and practical implications of these results.

Correlation Between Intolerance of Uncertainty and Post-Operative Regret in Otolaryngology Patients

OBJECTIVE

To determine if intolerance of uncertainty, depression, anxiety, worry, or stress are related to post-op regret in otolaryngology patients.

METHODS

Adult patients or parents giving consent for pediatric patients meeting criteria for otolaryngologic surgery were recruited and completed the Intolerance of Uncertainty Scale (IUS-12), Penn State Worry Questionnaire (PSWQ), and Depression, Anxiety and Stress Scale-21 (DASS-21) preop and the Decisional Regret (DR) scale 1-month post-op. Pearson correlations were calculated.

RESULTS

The cohort included 109 patients, 73 (67%) males and 36 (33.3%) females. 43 (39.5%) were college graduates and 66 (60.9%) were not. Mean IUS-12 score was 22.9 (95% CI 21.0-24.8), mean PSWQ score was 46.9 (95% CI 44.5-49.3). DASS-21 mean score was 11.9 (95% CI 9.6-14.3). Mean DR score was 11.1 (95% CI 8.6-13.6). IUS-12 subscales Prospective Anxiety mean score was 14.2 (95% CI 12.8-15.5) and Inhibitory Anxiety mean score was 16.5 (95% CI 14.5-18.6). The Pearson correlation coefficient for post-op DR and total preop IUS was .188 (P = .027) and the correlation coefficient for post-op DR and preop Prospective Anxiety subscale of IUS score was .174 (P = .037). Correlations with PSWQ and DASS-21 scores and DR were not statistically significant.

CONCLUSION

Intolerance of uncertainty is a psychological construct that is associated with post-op DR. More work is needed to determine whether screening for IU and behavior modification directed at IU for those with high levels would improve post-op decisional regret.

Times Are Harsh, Be Kind to Yourself! Anxiety, Life Satisfaction, and the Mediating Role of Self-Compassion

The present research aimed to explore the indirect effect of self-compassion on the relationship between two dimensions of intolerance of uncertainty (i.e., prospective and inhibitory anxiety) and life satisfaction. One hundred sixty-four Romanian adult participants formed our sample from the country's eastern side. Their ages ranged between 18 and 61 (M = 23.45, SD = 7.70, 72% females). The study was conducted in 2021, when the Delta wave of COVID-19 was at its peak. Our findings suggested significant negative associations between prospective anxiety, self-compassion, and life satisfaction. A similar negative significant association was suggested between inhibitory anxiety and self-compassion. Age did not significantly correlate with any of our primary variables. Mediation analyses indicated a total mediating effect of self-compassion on the relationship between participants' prospective and inhibitory anxiety and their life satisfaction. We discuss the implications of our findings, considering their relevance for therapeutical interventions aimed to promote psychological wellbeing when facing adversity.

Anhedonia in Anxiety Disorders

Humans, like other animals, are fundamentally motivated to pursue rewarding outcomes and avoid aversive ones. Anxiety disorders are conceptualized, defined, and treated based on heightened sensitivity to perceived aversive outcomes, including imminent threats as well as those that are uncertain yet could occur in the future. Avoidance is the central strategy used to mitigate anticipated aversive outcomes - often at the cost of sacrificing potential rewards and hindering people from obtaining desired outcomes. It is for these reasons that people are often motivated to seek treatment. In this chapter, we consider whether and how anhedonia - the loss of interest in pursuing and/or reduced responsiveness to rewarding outcomes - may serve as a barrier to recovering from clinically impairing anxiety. Increasingly recognized as a prominent symptom in many individuals with elevated anxiety, anhedonia is not explicitly considered within prevailing theoretical models or treatment approaches of anxiety. Our goal, therefore, is to review what is known about anhedonia within the anxiety disorders and then integrate this knowledge into a functional perspective to consider how anhedonia could maintain anxiety and limit treatment response. Our overarching thesis is that anhedonia disrupts the key processes that are central to supporting anxiety recovery. We end this chapter by considering how explicitly targeting anhedonia in treatment can optimize outcomes for anxiety disorders.

Exploring the impacts of implicit context association and arithmetic booster in impulsivity reduction

People have a higher preference for immediate over delayed rewards, and it is suggested that such an impulsive tendency is governed by one's ability to simulate future rewards. Consistent with this view, recent studies have shown that enforcing individuals to focus on episodic future thoughts reduces their impulsivity. Inspired by these reports, we hypothesized that administration of a simple cognitive task linked to future thinking might effectively modulate individuals' delay discounting. Specifically, we used one associative memory task targeting intervention of context information, and one working memory task targeting enhancement of individual's ability to construct a coherent future event. To measure whether each type of cognitive task reduces individuals' impulsivity, a classic intertemporal choice task was used to quantify individuals' baseline and post-intervention impulsivity. Across two experiments and data from 216 healthy young adult participants, we observed that the impacts of intervention tasks were inconsistent. Still, we observed a significant task repetition effect such that the participants showed more patient choices in the second impulsivity assessment. In conclusion, there was no clear evidence supporting that our suggested intervention tasks reduce individuals' impulsivity, and that the current results call attention to the importance of taking into account task repetition effects in studying the impacts of cognitive training and intervention.

Assessment of intolerance of uncertainty: Validation of a modified anagram task

BACKGROUND AND OBJECTIVES

Intolerance of uncertainty (IU) is an individual difference factor that reflects difficulty tolerating emotional distress in the context of uncertainty and is a robust transdiagnostic risk factor for emotional disorders. A limitation of prior research on IU is the heavy reliance on self-report measures to assess this construct. The aim of the present study was to examine the validity of a brief, computerized anagram task modified to assess IU (the PACT Anagram Task; PAT).

METHODS

Participants were 221 unselected undergraduate students (71% female; M_age = 19; 89% Caucasian) who completed the PAT and a series of self-report measures of convergent, discriminant, and incremental validity, and measures of anxiety and depression symptoms online for course credit.

RESULTS

Greater PAT-Distress was positively correlated measures of convergent validity and demonstrated incremental validity in relation to self-reported IU above and beyond attentional control. None of the PAT indicators were associated with compassion or empathic concern, evidencing discriminant validity. PAT-Distress and PAT-Answers were each associated with greater worry above and beyond self-reported IU.

LIMITATIONS

Study limitations include the cross-sectional design and lack of diversity in terms of sample demographics. Furthermore, we did not examine convergence between this task and other behavioral measures of IU.

CONCLUSION

Subjective distress following completion of the PAT may serve as one indicator of IU. Further research is needed in order to replicate these results and validate the use of the PAT in clinical samples.

A model for learning based on the joint estimation of stochasticity and volatility

Previous research has stressed the importance of uncertainty for controlling the speed of learning, and how such control depends on the learner inferring the noise properties of the environment, especially volatility: the speed of change. However, learning rates are jointly determined by the comparison between volatility and a second factor, moment-to-moment stochasticity. Yet much previous research has focused on simplified cases corresponding to estimation of either factor alone. Here, we introduce a learning model, in which both factors are learned simultaneously from experience, and use the model to simulate human and animal data across many seemingly disparate neuroscientific and behavioral phenomena. By considering the full problem of joint estimation, we highlight a set of previously unappreciated issues, arising from the mutual interdependence of inference about volatility and stochasticity. This interdependence complicates and enriches the interpretation of previous results, such as pathological learning in individuals with anxiety and following amygdala damage.

"I Know What I Like" - Indecisiveness Is Unrelated to Behavioral Indicators of Evaluation Difficulties

Indecisiveness, the subjective inability to make satisfying decisions, is an individual difference trait that may impede effective actions. Mechanisms underlying indecisiveness are largely unknown. In four studies, we tested the prediction that indicators of evaluation difficulty were associated with indecisiveness in simple evaluations. Across studies, indecisiveness was measured via self-report while evaluation difficulties were derived behaviorally from three indicators: difficulty distinguishing between similar evaluation objects (i.e., standard deviation of evaluation ratings), evaluation duration (reaction times), and implicit evaluations (evaluative priming effect) using familiar everyday objects. Study 1 (N = 151) was based on attractiveness evaluations of portraits. Studies 2a (N = 201) and 2b (N = 211) used chocolate as evaluation objects and manipulated to what extent the evaluations were equivalent to a decision. In Study 3 (N = 80) evaluations were measured implicitly through evaluative priming using food pictures. Contrary to our predictions, indecisiveness showed no reliable association to any indicator of evaluation difficulty, regardless of type of evaluation object, equivalence of evaluation and decision, and whether evaluation difficulty was based on explicit or implicit evaluations. All null findings were supported by Bayes factors. These counterintuitive results are a first step toward investigating evaluation processes as potential mechanisms underlying indecisiveness, showing that for both explicit and implicit measurements, indecisiveness is not characterized by difficulties when evaluating familiar everyday objects.

The Shackles of Fear: A Moderated Mediation Model of How Fear of Aging May Increase Older Adults' Vulnerability to Fraud

Objectives: Older adults are disproportionately vulnerable to frauds of many kinds, and fear of aging has been conjectured to be a primary factor in older adults' vulnerability to fraud; however, no study has examined how and when fear of aging is associated with older adults' vulnerability to fraud.Methods: In this cross-sectional study, a sample of 251 Chinese older adults (M = 68.1, SD = 6.43) completed measures regarding fear of aging, intolerance of uncertainty, self-control, and vulnerability to fraud.Results: The results revealed that intolerance of uncertainty partially mediated the association between fear of aging and vulnerability to fraud. This indirect effect of fear of aging on vulnerability to fraud was only significant for older adults with lower levels of self-control.Conclusions: The association between fear of aging and older adults' vulnerability to fraud through intolerance of uncertainty varies as a function of self-control.Clinical implications: Clinicians may focus on reducing the fear of aging, decreasing intolerance of uncertainty, and enhancing self-control as promising pathways to develop effective interventions and outreach strategies aimed at protecting older adults from fraud.

Intolerance of uncertainty and decisions about delayed, probabilistic rewards: A replication and extension of Luhmann, C. C., Ishida, K., & Hajcak, G. (2011)

Intolerance of Uncertainty (IU) is thought to lead to maladaptive behaviours and dysfunctional decision making, both in the clinical and healthy population. The seminal study reported by Luhmann and collaborators in 2011 [1] showed that IU was negatively associated with choosing a delayed, but more probable and valuable, reward over choosing an immediate, but less probable and valuable, reward. These findings have been widely disseminated across the field of personality and individual differences because of their relevance for the understanding of the role of IU in the development and maintenance of anxiety-related disorders. Given their importance it would be desirable to have replications of this study, but none have been carried out so far. The current study has been designed to replicate and extend Luhmann et al.’s results. Our sample will include 266 healthy participants (more than five times the sample size used by Luhmann et al.) to detect with a power of 95% the effect size that can be detected with a power of 33% in the original study. To increase our chances of getting such a sample size, the experiment will be conducted online, To increase our chances of getting such a sample size, the experiment will be conducted online, adding check trials to the original decision-making task to monitor participants’ engagement. Additionally, we will explore the role of impulsivity in the relationship between IU and willingness to wait. This study will add empirical evidence about the role of IU in decision making and, in case of replication of Luhmann et al.’s results, will support the hypothesis that high-IU individuals may engage in inefficient or costly behaviour in exchange for less time enduring an uncertain situation.

Functional connectivity of the anterior insula associated with intolerance of uncertainty in youth

Intolerance of uncertainty (IU) is a trait characteristic marked by distress in the face of insufficient information. Elevated IU has been implicated in the development and maintenance of anxiety disorders, particularly during adolescence, which is characterized by dramatic neural maturation and the onset of anxiety disorders. Previous task-based work implicates the bilateral anterior insula in IU. However, the association between anterior insula intrinsic functional connectivity (iFC) and IU has not been examined in adolescents. Fifty-eight healthy youth (mean age = 12.56; 55% boys) completed the Intolerance of Uncertainty Scale for Children (IUSC-12) and a 6-minute resting state fMRI scan. Group-level analyses were conducted using a random-effects, ordinary least-squares model, including IUSC-12 scores (Total, Inhibitory subscale, Prospective subscale), and three nuisance covariates (age, sex, and mean framewise displacement). IUSC-12 Inhibitory subscale scores were predictive of iFC between the left and right anterior insula and right prefrontal regions. IUSC-12 Prospective subscale scores significantly predicted iFC between the anterior insula and the anterior cingulate cortex. IUSC-12 total scores did not predict significant iFC of the bilateral anterior insula. Follow-up analyses, including anxiety (MASC Total Score) in the models, failed to find significant results. This could suggest that the associations found between IUSC-12 scores and anterior insula iFC are not unique to IU and, rather, reflect a broader anxiety-related connectivity pattern. Further studies with larger samples are needed to tease apart unique associations. These findings bear significance in contributing to the literature evaluating the neural correlates of risk factors for anxiety in youth.

Future Expectations and Internet Addiction Among Adolescents: The Roles of Intolerance of Uncertainty and Perceived Social Support

Internet addiction is a common and challenging problem among adolescents. Previous studies have shown that future time orientation is an important protective factor against internet addiction. In this study, the mediating effect of intolerance of uncertainty and the moderating role of perceived social support were examined on the association between future expectations, regarded as the "prospective life course" perspective of future time orientation, and internet addiction among adolescents. A total of 1,006 Chinese adolescents (54% male and 46% female; Mage = 15.42 years, SD = 1.32) recruited from middle schools completed questionnaires. Results indicated that future expectations were significantly negatively associated with internet addiction, and the link was mediated by intolerance to uncertainty in adolescents. Further, the latent moderated structural equation showed that perceived social support moderated the association between future expectations and intolerance of uncertainty. The association was significant only for adolescents with a higher level of perceived social support. The findings of this study provide specific guidelines for how to prevent adolescent internet addiction.

A Competition of Critics in Human Decision-Making

Recent experiments and theories of human decision-making suggest positive and negative errors are processed and encoded differently by serotonin and dopamine, with serotonin possibly serving to oppose dopamine and protect against risky decisions. We introduce a temporal difference (TD) model of human decision-making to account for these features. Our model involves two critics, an optimistic learning system and a pessimistic learning system, whose predictions are integrated in time to control how potential decisions compete to be selected. Our model predicts that human decision-making can be decomposed along two dimensions: the degree to which the individual is sensitive to (1) risk and (2) uncertainty. In addition, we demonstrate that the model can learn about the mean and standard deviation of rewards, and provide information about reaction time despite not modeling these variables directly. Lastly, we simulate a recent experiment to show how updates of the two learning systems could relate to dopamine and serotonin transients, thereby providing a mathematical formalism to serotonin's hypothesized role as an opponent to dopamine. This new model should be useful for future experiments on human decision-making.

The Impact of Intolerance of Uncertainty on Test Anxiety: Student Athletes During the COVID-19 Pandemic

Test anxiety caused by intolerance of uncertainty has a negative impact on the physical and mental health of student athletes, especially in the context of the coronavirus disease 2019 (COVID-19) pandemic. A total of 556 grade three high school student athletes in Chongqing, China, were investigated using the Test Anxiety Scale (TAS), Intolerance of Uncertainty Scale-12 (IUS-12), Perceived Social Support Scale, and Coping Style Scale for Middle School Students. Results reveal that more than half the student athletes experienced test anxiety, and the severity was above average during the COVID-19 pandemic. There was a significant correlation between intolerance of uncertainty, perceived social support, coping style, and test anxiety. A positive correlation was found between test anxiety, intolerance of uncertainty, and coping style toward emotions, and a negative correlation between test anxiety, perceived social support, and coping style toward problems. Intolerance of uncertainty has a direct predictive effect on test anxiety, and perceived social support and coping style play a chain mediator role between intolerance of uncertainty and test anxiety. By constructing the mediating effect model, we can, to some extent, reveal the mechanism of the influence of intolerance of uncertainty on test anxiety. This study has a certain reference value for the prevention of test anxiety in student athletes in the context of the COVID-19 pandemic.

Engaging in Risky and Impulsive Behaviors to Alleviate Distress Mediates Associations Between Intolerance of Uncertainty and Externalizing Psychopathology

Despite increasing recognition that intolerance of uncertainty is a transdiagnostic dimension of psychopathology, very little research has investigated its relevance for externalizing psychopathology and related risky/impulsive behavior. Ninety-five unselected adults (ages 19-55, 53% men) recruited from the community completed a measure of intolerance of uncertainty, externalizing traits and problems, and risky/impulsive behavior. Higher levels of intolerance of uncertainty were associated with greater endorsement of externalizing symptoms (e.g., aggression, alcohol/marijuana use, problematic impulsivity) and last-month risky and impulsive behaviors. Relations between intolerance of uncertainty and externalizing symptoms/risky behaviors were mediated by a motivation to engage in these behaviors to avoid distress, but not by the motivation to experience pleasurable emotions. Findings suggest that difficulty tolerating uncertainty may confer risk for the externalizing spectrum of psychopathology by increasing the likelihood that an individual will engage in risky behaviors to alleviate distressing or unpleasant emotions.

How is intolerance of uncertainty related to negative affect in individuals with substance use disorders? The role of the inability to control behaviors when experiencing emotional distress

We used structural equation modeling to assess the role of impaired emotional awareness and clarity (Impaired Awareness/Clarity) and inability to control behaviors when experiencing emotional distress (Inability to Control Behaviors) as an account for the relationship between intolerance of uncertainty (IU) and negative affect (NA) in individuals with Substance Use Disorders (SUDs) and healthy controls (HCs) used for comparison. One-hundred and thirty-one individuals with SUDs (42.75% female; mean age = 39.74 ± 11.83) and 131 sex-matched HCs (mean age = 40.02 ± 12.34) entered the study. Participants completed questionnaires assessing the constructs of interest. Single-group analyses aimed to identify a baseline model for each group and test the hypothesized direct/indirect relations' overall significance. Then, a multigroup analysis tested the invariance of model parameters between SUD and HC groups. The model in which IU had both direct and indirect relationships with NA through Impaired Awareness/Clarity and Inability to Control Behaviors was a good fit to the data. The indirect relationship of IU with NA through Inability to Control Behaviors was significant and moderate-sized. The relationship involving Impaired Awareness/Clarity and Inability to Control Behaviors was small-sized and significant in single group analysis only. The multigroup analysis supported the association of IU with NA through Inability to Control Behaviors in the SUD group. Overall, our study highlights the crucial role of the Inability to Control Behaviors in SUDs and suggests that its association with IU might fuel NA in this population.

Negative Affectivity, Authoritarianism, and Anxiety of Infection Explain Early Maladjusted Behavior During the COVID-19 Outbreak

During the first phase of the COVID-19 outbreak, Italy experienced problems of public order and maladjusted behavior. This study assessed the role of negative affectivity, right-wing authoritarianism, and anxiety of COVID-19 infection in explaining a variety of the maladjusted behaviors (i.e., “China-phobic” discrimination, panic buying) observed with an Italian sample. Specifically, we examined the effect of Negative Affectivity and Right-Wing Authoritarianism on maladjusted behaviors, and the moderating role of anxiety of infection. Seven hundred and fifty-seven Italian participants completed an online survey between March 3rd to the 7th 2020, which was immediately before the lockdown. A moderated-mediation model was tested using a structural equation modeling approach. Results indicated that both Negative Affectivity and Right-Wing Authoritarianism were positively associated with COVID-19-related maladjusted behavior, and that Right-Wing Authoritarianism mediated the relationship between Negative Affectivity and maladjusted behavior. Furthermore, the effect of Right-Wing Authoritarianism on maladjusted behavior was greater for those with high anxiety of infection, and the indirect effect of Negative Affectivity on maladjusted behavior through Right-Wing Authoritarianism was moderated by infection anxiety. Findings highlight potential psychological paths that may inform communication strategies and public health initiatives aimed at promoting healthy behavior during an outbreak.

Behavioral Inhibition/Activation Systems and Depression Among Females With Substance Use Disorder: The Mediating Role of Intolerance of Uncertainty and Anhedonia

Previous studies have shown that the behavioral inhibition/activation systems (BIS/BAS) have substantial effects on substance use disorder and emotional disorders, and substance use disorder and emotional disorders often occur; in particular, females with substance use disorder are more likely to also have serious emotional disorders including depression than their male counterparts. However, the associations between the BIS/BAS and depression in females with substance use disorder have received little attention. Furthermore, the underlying mechanisms of these relations are largely unknown. The present study examines the mediating roles of intolerance of uncertainty and anhedonia in the associations between the BIS/BAS and depression among females with substance use disorder from the Research Domain Criteria (RDoC) framework. A total of 303 females with substance use disorder from a compulsory substance abuse detention center were tested using a cross-sectional survey involving BIS/BAS Scales, Intolerance of Uncertainty Scale, Snaith-Hamilton Pleasure Scale, and Center for Epidemiologic Studies Depression Scale. The path analysis model revealed that both the BIS and BAS had a direct effect on depression, that the BIS had an indirect effect on depression through intolerance of uncertainty, and that the BAS had an indirect effect on depression via anhedonia. These findings contribute to a more thorough understanding of how the BIS/BAS influence depression among females with substance use disorder and suggest that the utility of targeting these associations in treatments would help reduce depression in females with substance use disorder.

Examining the Link Between Intolerance of Uncertainty and Positive and Negative Urgency in Veterans With Comorbid Posttraumatic Stress Disorder and Substance Use Disorders

Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are highly comorbid among the veteran population. Impulsivity, particularly negative and positive urgency, are prevalent within this dual-diagnosis population and associated with negative outcomes. One possible correlate of negative/positive urgency is intolerance of uncertainty (IU). IU is associated with exacerbated PTSD symptom severity and increased risk for substance use. However, few studies have examined the link between IU and negative/positive urgency in dual-diagnosis populations. This study aimed to examine whether there was a significant association between trait IU and baseline negative and positive urgency in veterans seeking treatment for both PTSD and SUD. In a sample of 114 veterans from a 6-week residential treatment program, IU was significantly associated with higher negative and positive urgency. Further research is warranted to extend these findings and examine whether IU plays an important role in negative/positive urgency for dual-diagnosis populations.

Acute stress enhances tolerance of uncertainty during decision-making

Acute stress has been shown to influence reward sensitivity, feedback learning, and risk-taking during decision-making, primarily through activation of the hypothalamic pituitary axis (HPA). However, it is unclear how acute stress affects decision-making among choices that vary in their degree of uncertainty. To address this question, we conducted two experiments in which participants repeatedly chose between two options-a high-uncertainty option that offered highly variable rewards but was advantageous in the long-term, and a low-uncertainty option that offered smaller yet more consistent rewards. The Socially Evaluated Cold Pressor Task (SECPT) was utilized to induce acute stress. Participants in Experiment 1 (N = 114) were exposed to either the SECPT or a warm-water control condition and then completed the decision-making under uncertainty task. Compared to the control condition, those exposed to the acute stress manipulation chose the high-uncertainty option that provided highly variable but larger rewards over the option that provided stable, smaller rewards. Experiment 2 (N = 95) incorporated a salivary cortisol measure. Results replicated the behavioral findings in Experiment 1 and demonstrated that the acute stress manipulation increased salivary cortisol. This work suggests that moderate acute stress is associated with tolerance of outcome variability in contexts that depend on learning to maximize 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.