Intolerance of Uncertainty, anxiety, and worry in children and adolescents: A meta-analysis

[Psychocorporal approach to functional somatic disorders]

Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly understood, and their management is often inadequately defined. Medications typically show limited effectiveness, while mind-body approaches play a central role, guided by three key principles: establishing an empathetic, respectful, and sincere doctor-patient relationship; promoting regular and gradual physical activity; and implementing cognitive behavioral therapy (CBT). Special attention must be devoted to establishing a trustworthy relationship between the physician and the patient. Recognizing the reality and severity of symptoms and providing a positive diagnosis as well as an explanatory model to account for them rationally are fundamental aspects of patient management. Cognitive and behavioral maintenance factors should be investigated and constitute therapeutic targets. Cognitive factors include focused attention on body functioning and catastrophizing. Patients frequently display avoidance behaviors, particularly in relation to physical exertion, and it is crucial to motivate them to reintroduce gradual physical activity customized to their abilities. This approach has demonstrated efficacy in improving fatigue, pain, and the physical and mental quality of life for patients with FSD. Among psychotherapeutic approaches, the benefit of CBT is well-established. The combination of gradual physical activity and CBT appears to be complementary. Other mind-body approaches such as mindfulness meditation might help although their level of evidence is weaker. Given the prevalence of FSD in the general population, it seems necessary for all physicians to be trained in managing this condition.

Uncertain world: How children's curiosity and intolerance of uncertainty relate to their behaviour and emotion under uncertainty

Curiosity and intolerance of uncertainty (IU) are both thought to drive information seeking but may have different affective profiles; curiosity is often associated with positive affective responses to uncertainty and improved learning outcomes, whereas IU is associated with negative affective responses and anxiety. Curiosity and IU have not previously been examined together in children but may both play an important role in understanding how children respond to uncertainty. Our research aimed to examine how individual differences in parent-reported curiosity and IU were associated with behavioural and emotional responses to uncertainty. Children aged 8 to 12 (n = 133) completed a game in which they were presented with an array of buttons on the screen that, when clicked, played neutral or aversive sounds. Children pressed buttons (information seeking) and rated their emotions and worry under conditions of high and low uncertainty. Facial expressions were also monitored for affective responses. Analyses revealed that children sought more information under high uncertainty than low uncertainty trials and that more curious children reported feeling happier. Contrary to expectations, IU and curiosity were not related to the number of buttons children pressed, nor to their self-reported emotion or worry. However, exploratory analyses suggest that children who are high in IU may engage in more information seeking that reflects checking or safety-seeking than those who are low in IU. In addition, our findings suggest that there may be age-related change in the effects of IU on worry, with IU more strongly related to worry in uncertain situations for older children than younger children.

Negative life events and sleep disturbance among adolescents: Intolerance of uncertainty as mediator and moderator

BACKGROUND

While negative life events (NLEs) have been linked to an increased risk of sleep disturbance among adolescents, the mechanisms of this impact still lack further examination. The current study aimed to explore whether intolerance of uncertainty (IU), a dispositional transdiagnostic vulnerability factor for psychopathology, could act as a mediator and/or moderator in the link from NLEs to sleep disturbance.

METHODS

A longitudinal nested subsample of 54,240 Chinese adolescents (aged 9-19) were surveyed at baseline (Timepoint 1) and six months later (Timepoint 2). They completed questionnaires to assess their IU, NLEs, sleep disturbance and sociodemographic characteristics. Mediation and moderation analyses were conducted to test our hypotheses.

RESULTS

Upon adjusting for covariates, IU was found to mediate the relationship between NLEs and residual changes in sleep disturbance over a six-month period, with the mediation effect accounting for 31.8%. Additionally, the moderating role of IU in this relationship was also identified, suggesting that a high level of IU exacerbated the effect of NLEs on sleep disturbance.

CONCLUSIONS

In conclusion, our findings shed light on the dual roles of IU in the link from NLEs to sleep disturbance, holding significant practical implications for preventing and intervening in sleep disturbance among adolescents. To mitigate the risk of sleep disturbance among adolescents experiencing NLEs, timely assessments of IU and tailored interventions to enhance uncertainty tolerance are necessary.

Reviewing explore/exploit decision-making as a transdiagnostic target for psychosis, depression, and anxiety

In many everyday decisions, individuals choose between trialling something novel or something they know well. Deciding when to try a new option or stick with an option that is already known to you, known as the "explore/exploit" dilemma, is an important feature of cognition that characterises a range of decision-making contexts encountered by humans. Recent evidence has suggested preferences in explore/exploit biases are associated with psychopathology, although this has typically been examined within individual disorders. The current review examined whether explore/exploit decision-making represents a promising transdiagnostic target for psychosis, depression, and anxiety. A systematic search of academic databases was conducted, yielding a total of 29 studies. Studies examining psychosis were mostly consistent in showing that individuals with psychosis explored more compared with individuals without psychosis. The literature on anxiety and depression was more heterogenous; some studies found that anxiety and depression were associated with more exploration, whereas other studies demonstrated reduced exploration in anxiety and depression. However, examining a subset of studies that employed case-control methods, there was some evidence that both anxiety and depression also were associated with increased exploration. Due to the heterogeneity across the literature, we suggest that there is insufficient evidence to conclude whether explore/exploit decision-making is a transdiagnostic target for psychosis, depression, and anxiety. However, alongside our advisory groups of lived experience advisors, we suggest that this context of decision-making is a promising candidate that merits further investigation using well-powered, longitudinal designs. Such work also should examine whether biases in explore/exploit choices are amenable to intervention.

Annual Research Review: Health anxiety in children and adolescents-developmental aspects and cross-generational influences

Health anxiety involves excessive worries about one's health along with beliefs one has an illness or may contract a serious disease. Concerning evidence suggests that health anxiety is on the rise in society, possibly further fueled by the COVID-19 pandemic. Recent classification systems acknowledge that impairing health-related worries and beliefs can emerge in early childhood with significant levels of symptoms persisting throughout childhood, and possibly continuous with diagnostic considerations in adulthood. This narrative review summarizes recent research advances in health anxiety in children and adolescents, focusing on various developmental aspects of health anxiety and related concepts in youths. Findings suggest that health anxiety symptoms in young age groups are associated with impairment, distress, and increased healthcare use, as well as substantial comorbidity with mainly other emotional problems and disorders. Furthermore, longitudinal studies suggest that childhood health anxiety can persist across adolescence, perhaps with links to chronic courses in adulthood. The growing literature was further reviewed, thus extending our understanding of early risk factors, including the potential role of exposure to serious illness and transgenerational transmission of health anxiety. Learning more about developmental trajectories will be highly relevant to inform strategies for early detection and prevention. While modified cognitive behavioral therapies in adults are successful in treating health anxiety, specific interventions have not yet been tested in youths. Given substantial overlaps with other psychopathology, it could be important to develop and explore more transdiagnostic and scalable approaches that take advantage of common factors in psychotherapy, while also including a wider perspective on potential familiar maladaptive illness cognitions and behaviors.

A Transdiagnostic Model for Depression, Anxiety, and Obsessive-Compulsive Disorder

ABSTRACT

Depression, obsessive-compulsive disorder (OCD), and anxiety disorders (ADs) can seriously impair functionality. Studies have shown that there are common mechanisms in the emergence of these disorders. This study discussed unpredictability beliefs, family unpredictability, locus of control, intolerance of uncertainty, emotional regulation difficulties, and coping styles. In this study, a model created with these transdiagnostic variables that play a role in the emergence of depression, OCD, and ADs was tested. The sample of the study consisted of 795 people. The model explained a significant part of the variance in psychological symptoms. In addition to various limitations, it is thought that this study has important contributions to the field by examining the relationships between unpredictability beliefs and various variables for the first time, and bringing together many transdiagnostic factors related to psychological symptoms. In addition, it provides valuable information for clinicians as it provides a basis for intervention programs targeting many transdiagnostic mechanisms.

Psychometric properties of the Arabic version of the intolerance of uncertainty scale: a multinational study

INTRODUCTION

It is common for people to experience anxiety when contemplating their unknown future. Studies have shown that those who tend to worry more about their future are more likely to be intolerant of uncertainty. In order to study the way people from the Middle East tackle uncertainty, a valid and reliable scale is needed. In this context, the present study aimed to examine the psychometric properties of the Arabic version of the 12-item Intolerance of Uncertainty Scale (IUS-12) in a community sample of native Arabic-speaking participants from Lebanon, Egypt, and Kuwait.

METHODS

A sample of 2038 university students answered the survey, with a mean age of 22.30 ± 4.15 years and 77.5% females. A Google Form link was dissipated among participants that included some demographic questions, the IUS-12 and the Depression, Anxiety and Stress Scale (DASS-8).

RESULTS

Following the confirmatory factor analysis (CFA), a bi-dimensional model of the Arabic version of the IUS-12 was found. The scale showed an excellent internal reliability for the prospective anxiety (ω = 0.85 / α = 0.85) and inhibitory anxiety (ω = 0.87 / α = 0.87). Additionally, the results illustrated configural, metric, and scalar invariance across genders and countries. Furthermore, Egypt and Lebanon were seen to have statistically significant higher levels of inhibitory anxiety compared to Kuwait, while only Egypt showed statistically significant higher prospective anxiety compared to Kuwait. Finally, higher psychological distress was significantly and positively associated with higher prospective and inhibitory anxiety.

CONCLUSION

The results of this study provide support for the psychometric reliability and validity of the Arabic version of the IUS-12, allowing for its generalizability and suitability for use among individuals from different Arabic-speaking nations.

Investigating the Effects of Transdiagnostic Processes on Anxiety and Depression Symptoms in Autistic Young People: the Mediating Role of Emotion Dysregulation

Internalising symptoms are elevated in autism compared to the general population. Few studies have investigated emotional dysregulation (ED) as a potential mediator between specific transdiagnostic processes and anxiety and depression symptoms in autistic youth. In a sample of 94 autistic young people aged 5-18 years referred to a specialist clinic for an autism evaluation, we tested the effects of ED as a mediator between cognitive inflexibility (CI), intolerance of uncertainty (IU) and alexithymia with anxiety and depression symptoms, using structural equation modelling. Effect sizes were compared to a non-autistic comparison group (n = 84). CI and alexithymia did not significantly predict depression symptoms in autistic young people, directly nor via ED. Relationships between CI/alexithymia and depression were fully mediated by ED in the non-autistic sample. There was a direct effect of CI on anxiety in the non-autistic group but not in those with a diagnosis. IU predicted depression symptoms in the autism group; and ED mediated this relationship only in those who did not receive a diagnosis. IU directly predicted anxiety in both groups and this relationship did not occur via ED. The finding of a direct pathway from IU to anxiety and depression in autistic youth is consistent with the literature. The finding that CI did not predict anxiety or depression in those with autism is novel, as was the finding that ED mediated relationships between alexithymia and anxiety/depression symptoms in both samples. The findings may have important implications for the delivery of psychological interventions for autistic youth.

Examining anxious temperament in anorexia nervosa: Behavioural inhibition and intolerance of uncertainty and their contribution to trait anxiety in adolescents with anorexia nervosa

BACKGROUND

Anorexia nervosa (AN) is a serious and complex psychiatric disorder yet treatment results are suboptimal. Insight into the etiology of this illness is much needed. Research highlights the implication of anxiety-related traits in the development and maintenance of AN. This study investigates firstly, behavioural inhibition and intolerance for uncertainty (IU) in adolescents with and without AN, and secondly relations between these traits.

METHODS

In a cross-sectional study, 165 adolescent girls (AN = 94, HC = 71) completed questionnaires measuring behavioural inhibition, IU and trait anxiety. ANOVAs tested differences between AN and HC groups, and mediation models with IU as a mediator between behavioural inhibition and trait anxiety were run.

RESULTS

AN adolescents reported significantly higher levels of behavioural inhibition, IU and trait anxiety compared to their peers. In both AN and HC, a direct and a total effect of behavioural inhibition on trait anxiety was found. However, only in the AN group IU partially mediated the relation between behavioural inhibition and trait anxiety.

LIMITATIONS

Data is cross-sectional and longitudinal studies are required. A mean illness duration of nearly 2 years may mean early effects of malnourishment and habituation and future studies should include patients with shorter illness duration.

CONCLUSIONS

Results highlight that behavioural inhibition and IU may contribute to anxiety in AN whilst their peers may have developed better executive and social-emotional skills to manage uncertainty. Adolescents with AN may benefit from interventions targeting behavioural inhibition and IU.

Profiles of intolerance of uncertainty, separation anxiety, and negative affectivity in emerging adulthood: A person-centered approach

BACKGROUND

Although Intolerance of uncertainty (IU), separation anxiety, and negative affectivity seem theoretically interrelated, no empirical study has considered them jointly so far. However, deepening this topic is clinically relevant, especially during the delicate phase of emerging adulthood. This study aimed to pinpoint psychological profiles based on IU, separation anxiety symptoms, and negative affectivity in a group of Italian non-clinical emerging adults. Such profiles were then compared in terms of key psychological and psychosocial characteristics.

METHODS

868 young adults (73 % women) aged 18-26 years entered the study. They completed a socio-demographic survey and self-report tools assessing IU, separation anxiety symptomatology, and personality traits. Subgroups exhibiting distinctive patterns of IU, separation anxiety symptoms, and negative affectivity were identified using latent profile analysis. To deepen disparities in psychological and psychosocial features by profile, analyses of variance and chi-square tests were performed.

RESULTS

Three profiles were detected, respectively with high, low, and moderate levels of the variables considered. In each profile, IU, separation anxiety symptoms, and negative affectivity had a consistent trend. The "High-level" profile had the greatest proportion of women and people who had not spent infancy with both parents.

LIMITATIONS

The sample included mainly women and university students, and data were collected using self-report questionnaires only.

CONCLUSIONS

IU, separation anxiety symptoms, and negative affectivity can co-occur, highlighting the importance of transdiagnostic interventions. Preventive efforts should be directed to emerging adult women and those who did not spend infancy with both parents, as they may be particularly vulnerable to internalizing distress.

Understanding anxiety through uncertainty quantification

Uncertainty has been a central concept in psychological theories of anxiety. However, this concept has been plagued by divergent connotations and operationalizations. The lack of consensus hinders the current search for cognitive and biological mechanisms of anxiety, jeopardizes theory creation and comparison, and restrains translation of basic research into improved diagnoses and interventions. Drawing upon uncertainty decomposition in Bayesian Decision Theory, we propose a well-defined conceptual structure of uncertainty in cognitive and clinical sciences, with a focus on anxiety. We discuss how this conceptual structure provides clarity and can be naturally applied to existing frameworks of psychopathology research. Furthermore, it allows formal quantification of various types of uncertainty that can benefit both research and clinical practice in the era of computational psychiatry.

A culturally adapted unified protocol for transdiagnostic treatment of anxiety disorders in adolescents (UP-A): a randomized waitlist-controlled trial

BACKGROUND

Anxiety disorders are highly prevalent and debilitating conditions that show high comorbidity rates in adolescence. The present article illustrates how Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) was adapted for Iranian adolescents with anxiety disorders.

METHODS

A total of 54 adolescents with comorbid anxiety disorders participated in a randomized, waitlist-controlled trial of group weekly sessions of either UP-A or waitlist control (WLC). Primary and process of change outcomes were assessed at baseline, posttreatment, and 1-month follow-up.

RESULTS

Significant changes were observed over time on major DSM-5 anxiety disorder symptoms (F(2, 51) = 117.09, p < 0.001), phobia type symptoms (F(2, 51) = 100.67, p < 0.001), and overall anxiety symptoms (F(2, 51) = 196.29, p < 0.001), as well as on emotion regulation strategies of reappraisal (F(2, 51) = 17.03, p < 0.001), and suppression (F(2, 51) = 21.13, p < 0.001), as well as on intolerance of uncertainty dimensions including prospective (F(2, 51) = 74.49, p < 0.001), inhibitory (F(2, 51) = 45.94, p < 0.001), and total intolerance of uncertainty (F(2, 51) = 84.42, p < 0.001), in favor of UP-A over WLC.

CONCLUSION

Overall, results provide a cultural application of the UP-A and support the protocol as useful for improving anxiety disorders as well as modifying of emotion regulation strategies and intolerance of uncertainty dimensions in Iranian adolescents. Future directions and study limitations are discussed.

Friendship attachment style, intolerance of uncertainty, and psychological distress among unaccompanied immigrant minors in times of COVID-19

INTRODUCTION

This cross-sectional study used a convergent parallel mixed-method design to investigate friendship attachment style, intolerance of uncertainty, and psychological distress among unaccompanied immigrant minors (UIMs) during the second wave of the COVID-19 pandemic in Italy.

METHOD

Participants were 80 male UIMs (Mage  = 17 years, standard deviation = 0.84) hosted in residential care communities. Individual interviews comprising questionnaires and open-ended questions assessed the constructs of interest. Qualitative data were analyzed through thematic content analysis, whereas descriptive statistics and regression analysis were computed on quantitative data.

RESULTS

Several UIMs mentioned positive relationships with peers, but more than half also felt reluctant to trust others and build new friendships due to events experienced before and during migration. However, in quantitative data, 69% identified themselves with the secure friendship attachment style. Regarding intolerance of uncertainty, participants expressed feelings of worry about the pandemic, but also emphasized their resources in terms of confidence, optimism, and planning skills, as well as being accustomed to uncertainty; indeed, levels of this variable were low-to-medium. In regression analysis, insecure attachment and higher intolerance of uncertainty were each associated with greater psychological distress. Moreover, psychological distress was lower among securely attached UIMs with low (vs. high) levels of intolerance of uncertainty.

CONCLUSION

The findings suggest that, even in conditions of societal insecurity, UIMs display resilience and employ effective coping strategies; however, a lack of trust in peer relationships and the inability to tolerate uncertainty may undermine their psychological adjustment. Implications for developmental theory and practice are discussed.

Exploring the Symptom Profiles of Intolerance of Uncertainty in Autistic Children

Intolerance of uncertainty (IU) is a multidimensional construct involving maladaptive responses to uncertainty. IU is strongly associated with autism and anxiety, yet no studies have examined its symptom profile in autistic children. This study compares IU symptom profiles in autistic and NT children and in autistic children with and without anxiety using the Intolerance of Uncertainty Scale for Children. Compared to NT peers, autistic children exhibited heightened IU symptoms in all domains, affective, behavioral, and cognitive; affective symptoms had the highest association with autism. Autistic children with anxiety also exhibited elevated IU symptoms in all domains compared to those without anxiety; behavioral IU symptoms had the highest association with anxiety. IU symptom profiles should be considered in assessment and treatment.

An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

Modeling and controlling the body in maladaptive ways: an active inference perspective on non-suicidal self-injury behaviors

A significant number of persons engage in paradoxical behaviors, such as extreme food restriction (up to starvation) and non-suicidal self-injuries, especially during periods of rapid changes, such as adolescence. Here, we contextualize these and related paradoxical behavior within an active inference view of brain functions, which assumes that the brain forms predictive models of bodily variables, emotional experiences, and the embodied self and continuously strives to reduce the uncertainty of such models. We propose that not only in conditions of excessive or prolonged uncertainty, such as in clinical conditions, but also during pivotal periods of developmental transition, paradoxical behaviors might emerge as maladaptive strategies to reduce uncertainty-by "acting on the body"- soliciting salient perceptual and interoceptive sensations, such as pain or excessive levels of hunger. Although such strategies are maladaptive and run against our basic homeostatic imperatives, they might be functional not only to provide some short-term reward (e.g. relief from emotional distress)-as previously proposed-but also to reduce uncertainty and possibly to restore a coherent model of one's bodily experience and the self, affording greater confidence in who we are and what course of actions we should pursue.

Targeting intolerance of uncertainty in treatment: A meta-analysis of therapeutic effects, treatment moderators, and underlying mechanisms

OBJECTIVE

Anxiety-related disorders are among the most prevalent psychiatric conditions and cause significant impairment. Intolerance of uncertainty (IU) contributes to the emergence, maintenance, and symptom severity of anxiety-related disorders, yet information regarding treatment-related changes in IU is limited. This systematic review and meta-analysis examined the efficacy of evidence-based treatments for anxiety-related disorders on IU, explored factors moderating treatment effects of IU, and examined whether therapeutic improvement in IU corresponded with improvements in anxiety symptom severity.

METHODS

PubMED and PsycINFO were searched for randomized controlled trials (RCTs) using the terms "intolerance of uncertainty" AND "treatment" OR "therapy." Data for pre and post-treatment measures and patient, intervention, and trial-level characteristics were extracted from 28 RCTs. Separate random effects models examined the treatment efficacy of interventions on IU and symptom severity. Moderators of therapeutic effects were analyzed via method-of-moments meta-regression or an analog to the analysis of variance.

RESULTS

Across RCTs, interventions exhibited a large therapeutic effect on IU compared to control conditions (g = 0.89). Treatment effects on IU positively corresponded with improved symptom severity and accounted for 36 % of the variance. Interestingly, comorbid depression and certain treatment approaches were associated with larger improvements in IU.

CONCLUSION

Evidence-based treatments are effective in improving IU, highlighting the importance of IU in the treatment of anxiety-related disorders. Moderator analyses identified patient and intervention-level factors to inform approaches to improve therapeutic effects on IU. Future research is needed to optimize interventions targeting IU and evaluate long-term efficacy of interventions on IU for anxiety-related disorders.

Measures of Anxiety Disorder Symptoms in Adolescents

This study examines select psychometric properties (i.e., internal reliability, and factorial, convergent, discriminant, and criterion validity) of three commonly-used measures of anxiety disorder symptoms in adolescents in the context of multi-trait, multi-method matrix analyses. A sample of 331 adolescents (age M = 17.1; 75.3% white; 71.0% female) completed three self-report scales that assess symptoms of separation anxiety, social anxiety, panic, and generalized anxiety, as well as measures of depression, experiential avoidance, and intolerance of uncertainty. Measures of panic disorder symptoms showed poor factorial, convergent, and discriminant validity. A multi-trait, multi-method matrix model to understand the relationships among the measures of separation anxiety, social anxiety, and generalized anxiety symptoms provided a reasonable fit to the data. Measures of separation anxiety showed poor discriminant and criterion validity, suggesting limited relevance of separation anxiety in this adolescent sample. Measures of social anxiety generally showed evidence of adequate-to-good factorial, convergent, and discriminant validity. Measures of generalized anxiety showed adequate -to-good factorial and convergent validity, and poor-to-adequate discriminant validity. The associations of measures of social and generalized anxiety with measures of depression, experiential avoidance, and intolerance of uncertainty were at least partially independent of method variance. The findings of this study add to the growing literature that evaluates the strengths and limitations of these scales for clinical practice and research.

Examination of the level of tolerance of uncertainty and psychological wellness of patients with epilepsy

AIM

This study was conducted to examine the level of intolerance of uncertainty and the psychological well-being of patients with epilepsy (PWE).

METHODS

This descriptive and cross-sectional study was conducted with 201 patients in a university hospital in Van, which is a province in eastern Turkey. Personal information form, intolerance of uncertainty scale, and the psychological well-being scale were prepared by the researcher in line with the literature and used to collect data. An independent sample t-test, one-way analysis of variance (ANOVA), post hoc (Tukey, LSD), correlation, and regression analyses were used to analyze the data.

RESULTS

In this study, the mean total score of PWE for the intolerance to uncertainty scale was found as 37.144 ± 9.202. Among the sub-dimensions, the mean prospective anxiety score was found as 21.821 ± 5.416 and the mean inhibitory anxiety score was 15.323 ± 4.695. The mean total score of the psychological well-being scale was found as 28.975 ± 6.622. It was determined that there was a significant relationship between the total score of the intolerance of uncertainty scale and the total score of the psychological well-being scale of the PWE who participated in the study (F = 14.314; p = 0.000 < 0.05). It was observed that the total score of intolerance of uncertainty was decreased as the total level of psychological well-being was increased (ß = -0.186).

CONCLUSION

It was found that PWE had higher levels of intolerance of uncertainty and lower levels of psychological well-being. It was also determined that the total score of psychological well-being was decreased as the total score of intolerance of uncertainty was increased.

RECOMMENDATIONS

For preventing the negative consequences of intolerance of uncertainty in PWE, it is recommended to inform nurses to increase the level of psychological well-being as a result of raising awareness about their concerns by conducting studies to increase the level of intolerance to uncertainty. It is also recommended to carry out studies on intolerance of uncertainty and psychological well-being in advanced and larger sample groups.

Parents' and children's intolerance of uncertainty and their reactions to COVID-19: A story of remarkable similarity

The COVID-19 viral outbreak is a one in 100 year public health crisis. In addition to the stunning morbidity and mortality rates related to infection, multiple psychiatric sequelae erupted. Unfortunately, children and adolescents are neither immune to infection nor to the emotional consequences associated with the pandemic. Not surprisingly, the field's understanding of the psychological consequences of the viral outbreak are nascent. Consequently, this study examines the relationship between parents' and children's intolerance of uncertainty (IU) and their reactions to COVID-19. Seventy-three parents and 62 children participated in the on-line survey utilizing innovative measures of IU and COVID-19- related thoughts/behaviors. The results revealed remarkable similarities in parents' and children's responses. Parents' and children's reports of the impact of COVID on their lives were highly correlated (r = .53, df = 60, p < .001). Parents' perceptions of children's COVID-19 thoughts and behaviors were strongly aligned with the youths' self-report of their COVID reactions (r = .69, df = 60, p < .001) as well as the appraisal of the virus' impact on their lives (r = .-.42, df = 60, p < .001). Finally, children's reports of their COVID-19 related thoughts and behaviors were significantly linked to their IU (r = .60, df = 60, p < .001). Methodological limitations notwithstanding, the study's findings provide compelling implications for the conceptualization, assessment, and treatment of emotional distress in the peri- and post-pandemic periods.

Uncertainty as a driver of the youth mental health crisis

Mental health problems in young people have been on the rise for over a decade, with that trend accelerating during the pandemic. This review proposes that the catalyst effect of the pandemic offers insights into a key driver of increases in youth depression and anxiety: greater uncertainty. Uncertainty about many aspects of everyday life, including social connections, education, job security and health, increased during the pandemic, and this coincided with increasing rates of depression and anxiety. Lab-based developmental cognitive and clinical neuroscience research on tolerance of uncertainty and adolescent mental health shows that when adolescents fail to show age-typical tolerance of uncertainty, they are at greater risk of mental health problems. Avenues for future research to understand and promote tolerance of uncertainty in adolescents are proposed.

Associations between pre-pandemic authoritative parenting, pandemic stressors, and children's depression and anxiety at the initial stage of the COVID-19 pandemic

Large-scale changes due to the Novel Coronavirus (COVID-19) pandemic negatively affected children's mental health. Prior research suggests that children's mental health problems during the pandemic may have been concurrently attenuated by an authoritative parenting style and exacerbated by family stress. However, there is a gap in the literature investigating these mechanisms and whether pre-pandemic authoritative parenting had a lasting positive influence on children's mental health while they were exposed to pandemic-related family stressors. The current study begins to fill this gap by investigating these unique relationships in a sample of 106 4-8 year old children (51% female). Before the pandemic, caregivers completed questionnaires on their parenting style and their children's depression and anxiety symptoms. Shortly after the onset of COVID-19's stay-at-home mandate, parents answered questionnaires about their children's depression and anxiety symptoms and pandemic-related family stressors. Child depression and anxiety symptom severity increased. Higher levels of pandemic-related family stress were associated with increases only in child anxiety scores. Further, greater endorsement of a pre-pandemic authoritative parenting style was associated with smaller changes only in child depression scores. Study findings elucidate unique and complex associations between young children's anxiety and depression symptoms severity and pre-pandemic parenting and pandemic-related family stressors.

Profiles of Intolerance of Uncertainty Among 108,540 Adolescents: Associations with Sociodemographic Variables and Mental Health

Intolerance of uncertainty (IU) is widely considered a transdiagnostic risk and maintaining factor for psychiatric disorders. However, little is known about the overall nature and profile of IU among adolescents. This study aims to investigate the profiles of IU among Chinese adolescents and explore their associations with sociodemographic characteristics and mental health problems. A sample of 108,540 adolescents provided data on IU, sociodemographic characteristics, and mental health via an online platform. Latent profile analysis revealed three profiles: Low IU, Medium IU, and High IU. Girls, older adolescents, and those with specific sociodemographics were more likely to belong to the "High IU" profile. Furthermore, the "High IU" profile was associated with the highest risk of several mental health problems. These findings provided valuable information for early prevention and intervention strategies targeting IU and highlighted the importance of IU-based interventions for mental health among adolescents.

Non-Cognitive Specificities of Intellectually Gifted Children and Adolescents: A Systematic Review of the Literature

For several years, there was a growing interest in intellectual giftedness and in particular in the non-cognitive specificities of gifted individuals. This topic attracted much public attention and sometimes led to contradictions with the scientific literature. The current review synthesizes a broad set of results related to non-cognitive specificities of intellectual gifted in children and adolescents. This synthesis of scientific research on giftedness and its associated non-cognitive features does not support the conclusion that there is a stable profile across gifted individuals that would consistently separate them from non-gifted individuals. A few specificities in some areas are noted, but they are not necessarily being systematic. These specificities often turn out to be in favor of gifted youth, contrary to the view sometimes defended in the general public that gifted individuals suffer from major everyday difficulties. Finally, methodological issues are listed regarding the designs of existing studies, with recommendations for future research in the field.

Developmental Epidemiology of Pediatric Anxiety Disorders

This review summarizes the developmental epidemiology of childhood and adolescent anxiety disorders. It discusses the coronavirus disease of 2019 (COVID-19) pandemic, sex differences, longitudinal course, and stability of anxiety disorders in addition to recurrence and remission. The trajectory of anxiety disorders-whether homotypic (ie, the same anxiety disorder persists over time) or heterotypic (ie, an anxiety disorder shifts to a different diagnosis over time) is discussed with regard to social, generalized, and separation anxiety disorders as well as specific phobia, and panic disorder. Finally, strategies for early recognition, prevention, and treatment of disorders are discussed.

Revisiting uncertainty as a felt sense of unsafety: The somatic error theory of intolerance of uncertainty

Intolerance of uncertainty (IU) has gained widespread interest as a construct of broad interest from both transdiagnostic and trans-situational perspectives. We have approached this article inspired by the curiosity, clinical observation, consideration of different theoretical perspectives, speculation, optimism and indeed fun that can be seen in S. J. Rachman's work. We address some of what we know about IU before considering one way of conceptualizing IU from the standpoint of a felt sense or embodied experience. In the first part, we start with Woody and Rachman's (1994) observations of people with GAD. Second, we consider some key findings from the literature. Third, we consider two important perspectives on uncertainty, namely, Brosschot et al.'s (2016, 2018) influential Generalized Unsafety Theory of Stress and uncertainty as an emotion. In the second part, backing our clinical hunch about the importance of the felt sense of uncertainty, we consider IU from the perspective of interoception and the somatic error theory of anxiety (Khalsa & Feinstein, 2018). We propose the somatic error theory of intolerance of uncertainty, which places the experience of uncertainty at the heart of our understanding of intolerance of uncertainty. This is followed by predictions, unresolved questions, and potential clinical implications. Finally, we revisit Woody and Rachman's (1994) suggestions for treatment as internalizing "a sense of safety in a range of circumstances (p. 750)" and update this from the perspective of the felt sense of uncertainty. We finish by suggesting that uncertainty can be tolerated, perhaps accepted, and even embraced.

Effects of chronic stress on smartphone addiction: A moderated mediation model

Introduction

Based on the compensatory Internet use theory and diathesis-stress model, the present study explores the effects of chronic stress on smartphone addiction (SPA). As intolerance of uncertainty and emotion-related variables are important factors that affect addictive behavior, we explore the mediating role of intolerance of uncertainty and the moderating role of emotion differentiation.

Methods

We conducted a questionnaire survey of 286 participants (13.64% female; M _age = 22.88; SD = 3.77; range = 17-39) on chronic stress, SPA, intolerance of uncertainty, and emotion differentiation. SPSS 28.0 was used to analyze the descriptive statistics and correlations and test the moderated mediation model.

Results

We find that (1) intolerance of uncertainty, SPA, and chronic stress are positively correlated with each other. Positive emotion differentiation is positively correlated with intolerance of uncertainty and negative emotion differentiation. (2) Intolerance of uncertainty plays a mediating role in chronic stress and SPA. (3) Positive emotion differentiation significantly moderates the relationship between chronic stress and SPA. Under the condition of low positive emotion differentiation, chronic stress is more effective in predicting SPA.

Discussion

These findings may contribute to intervention and prevention programs for SPA. Thus, the intervention and prevention of SPA can start from two directions-reduce the intolerance of uncertainty and enhance the ability to experience positive emotion differentiation.

Neural responding during uncertain threat anticipation in pediatric anxiety

Excessive fear responses to uncertain threat are a key feature of anxiety disorders (ADs), though most mechanistic work considers adults. As ADs onset in childhood and confer risk for later psychopathology, we sought to identify conditions of uncertain threat that distinguish 8-17-year-old youth with AD (n = 19) from those without AD (n = 33), and assess test-retest reliability of such responses in a companion sample of healthy adults across three sites (n = 19). In an adapted uncertainty of threat paradigm, visual cues parametrically signaled threat of aversive stimuli (fear faces) in 25 % increments (0 %, 25 %, 50 %, 100 %), while participants underwent functional magnetic resonance imaging (fMRI). We compared neural response elicited by cues signaling different degrees of probability regarding the subsequent delivery of fear faces. Overall, youth displayed greater engagement of bilateral inferior parietal cortex, fusiform gyrus, and lingual gyrus during uncertain threat anticipation in general. Relative to healthy youth, AD youth exhibited greater activation in ventrolateral prefrontal cortex (vlPFC)/BA47 during uncertain threat anticipation in general. Further, AD differed from healthy youth in scaling of ventral striatum/sgACC activation with threat probability and attenuated flexibility of responding during parametric uncertain threat. Complementing these results, significant, albeit modest, cross-site test-retest reliability in these regions was observed in an independent sample of healthy adults. While preliminary due to a small sample size, these findings suggest that during uncertainty of threat, AD youth engage vlPFC regions known to be involved in fear regulation, response inhibition, and cognitive control. Findings highlight the potential of isolating neural correlates of threat anticipation to guide treatment development and translational work in youth.

Abbreviated version of Penn State Worry Questionnaire for Chinese adolescents: Age, gender and longitudinal invariance

The abbreviated version of Penn State Worry Questionnaire (PSWQ-A) has been widely used to assess worry. However, its measurement invariance has been not yet warranted. With a cross-sectional and a longitudinal sample of Chinese adolescents (N1 = 1,329, N2 = 408), this study examined age, gender, and longitudinal invariance of PSWQ-A. Results supported strict invariance, including configural, metric, scalar, and error level, across gender and age in the cross-sectional sample; strict longitudinal measurement invariance was also supported in the longitudinal sample. This study suggests the application of the PSWQ-A in measuring adolescent worry and a basis for comparisons of different populations and occasions for worry.

The assessment of Intolerance of uncertainty in youth: An examination of the Intolerance of Uncertainty Scale-Revised in Italian nonclinical boys and girls

Intolerance of Uncertainty (IU) is a transdiagnostic factor involved in several psychological disorders. Adolescence is characterized by elevated uncertainty and psychopathological vulnerability, but insufficient attention has been paid to IU at this age. This study aimed to investigate the factor structure and psychometric properties of the Intolerance of Uncertainty Scale-Revised (IUS-R) in Italian preadolescents and adolescents. 862 Italian students (57.3% girls) aged 11-17 (M = 14.8 ± 1.91) completed the IUS-R and measures of internalizing and externalizing symptoms, and psychological well-being. To test the factor structure of the IUS-R, one-factor, two-factor, and bifactor models were compared; measurement invariance, reliability, and validity were also addressed. Results showed that the bifactor model outperformed alternative factor models, and a general factor was needed to model the IUS-R. Bifactor model indices supported using the total score to assess IU reliably. Configural and metric invariance by age and sex were fully supported, while the IUS-R achieved partial scalar invariance. Significant correlations emerged for the IUS-R total score with psychopathological constructs, while no relationships with psychological well-being were found. Compared to adult normative data, higher total IUS-R scores were detected, suggesting that IU may be a phase-specific characteristic of adolescence. Our findings support using the IUS-R to measure IU across the lifespan. The recommended use of the total score and its associations with psychopathological dimensions highlight the transdiagnostic nature of IU in adolescence. Therefore, including IU when implementing interventions to prevent maladaptive outcomes in teenagers would be beneficial.

Intolerance of uncertainty and future career anxiety among Chinese undergraduate students during COVID-19 period: Fear of COVID-19 and depression as mediators

Uncertainty is mushrooming throughout COVID-19, and intolerance of uncertainty (IoU) nudges people into mental health difficulties involving fear, depression, and anxiety. The objective of this study was to investigate the role of depression and fear of COVID-19 (FoC) in the association between IoU and future career anxiety (FCA) among Chinese university students during the COVID-19 pandemic. This study involved 1,919 Chinese undergraduate students from 11 universities in eight Chinese cities with an online self-administered survey that included demographic information, IoU, FoC, depression, and FCA completed by all participants. Our study demonstrated a positive relationship between IoU and FCA and the chain mediation effect of FoC and depression. Thus, understanding how FoC affects FCA not only informs university career professionals and assists students in preparing for employment, but also motivates schools to offer career opportunities workshops and, most importantly, provides mental health support to help students effectively cope with uncertainty and overcome COVID-19-related stress.

Intolerance of Uncertainty and Health-Related Anxiety in Youth amid the COVID-19 Pandemic: Understanding and Weathering the Continuing Storm

The COVID-19 pandemic is a public health crisis that continues to impact individuals worldwide. While children may be less susceptible to severe medical complications, they are nonetheless vulnerable to stress and anxiety associated with the pandemic. However, current understanding of psychological functioning and potential strategies to mitigate distress amid a pandemic is naturally limited. Consequently, this article is an attempt to fill that gap. Existing literature on pandemics, health-related anxieties, intolerance of uncertainty, and psychopathological sequelae is summarized within the context of the COVID-19 outbreak. Conclusions from the empirical data and emerging theoretical models are reviewed and synthesized. Finally, several potentially engaging and effective examples of developmentally appropriate interventions targeting intolerance of uncertainty and health-related anxieties in pediatric patients during the peri- and post-pandemic periods are described.

Intensive Cognitive-Behavioral Therapy for Anxiety Disorders in Adolescents: A Case Study

Anxiety disorders are one of the most common psychiatric conditions in youth and can contribute to impairment in social, academic, and family functioning. Cognitive-behavioral therapy (CBT) has been shown to be efficacious in treating youth anxiety disorders; however, for a multitude of reasons, fewer than 20% of adolescents with anxiety disorders receive services for anxiety-related problems. Intensive treatments, which rely on the same traditional components of CBT but are delivered over a shorter period of time or in a fewer number of sessions, may be particularly helpful for anxiety disorders and can offer a number of advantages over standard CBT. Despite emerging evidence supporting the advantages of the intensive approach, there are few established intensive treatment programs for youth with anxiety disorders. Further, no treatment to date has comprehensively targeted the entire spectrum of comorbid adolescent anxiety disorders in a combined intensive and transdiagnostic format, even though non-intensive (i.e., weekly delivered) CBT has been tested using a transdiagnostic approach. We developed an intensive, six-session intervention based on Angelosante and colleagues’ 2009 The Adolescent Panic Control Treatment with In-Vivo Exposures (Angelosante et al., 2009) and other empirically-supported treatments for youth to target all anxiety disorders in adolescents. We present a case study on an adolescent with multiple comorbid anxiety and related disorders who received intensive CBT treatment as a way to illustrate the clinical benefit and utility of an intensive, transdiagnostic approach. Findings support the acceptability and feasibility of transdiagnostic treatment of youth anxiety.

Intolerance of uncertainty and psychophysiological reactivity in anticipation of unpredictable threat in youth

OBJECTIVE

Intolerance of uncertainty (IU) is a key transdiagnostic feature of internalizing psychopathology. An increasing body of research suggests that IU is associated with increased psychophysiological reactivity in anticipation of unpredictable threat. However, most studies examining the psychophysiological correlates of IU have been conducted in adults. There is a critical need to understand the relationship between IU and psychophysiological reactivity in anticipation of unpredictable threat during adolescence, a key developmental period associated with increased exploration of situations with uncertain outcomes. Thus, the present study examined the association between (1) youth IU and (2) parental IU (as an indicator of risk) in relation to youth defensive motivation (startle reflex) and attention (startle probe N100 and P300) in anticipation of unpredictable threat.

METHODS

The sample included 193 13 to 22-year-old (M = 17.33, SD = 1.97) females and a biological parent. Participants and their parent completed a self-report measure of prospective and inhibitory IU. Youth startle potentiation, probe N100 enhancement, and probe P300 suppression (indicating increased attention to threat) were measured in anticipation of predictable and unpredictable threat.

RESULTS

Youth prospective IU and inhibitory IU were not related to youth psychophysiological reactivity to predictable or unpredictable threat. Greater parental prospective IU was associated with greater youth startle potentiation and probe N100 enhancement in anticipation of unpredictable threat.

CONCLUSION

The present study suggests that parental IU, but not concurrent IU, is associated with heightened defensive motivation and attentional engagement in anticipation of unpredictable threat in youth.

The Prevalence of Fear of Childbirth and Its Association With Intolerance of Uncertainty and Coping Styles Among Pregnant Chinese Women During the COVID-19 Pandemic

Background

Fear of childbirth (FOC) is one of the most common psychological symptoms among pregnant women and significantly relates to cesarean section, anxiety, and depression. However, it is not clear the prevalence and risk factors of FOC among Chinese pregnant women since the outbreak of the COVID-19 pandemic.

Aims

The objective of this study was to examine the associations between coping styles, intolerance of uncertainty, and FOC.

Method

From December 2021 to April 2022, a cross-sectional survey was conducted in two hospitals in China through convenient sampling. The cross-sectional survey was conducted among 969 pregnant women, which included the Childbirth Attitude Questionnaire (CAQ), Intolerance of Uncertainty Scale-12 (IUS-12), and Simplified Coping Style Questionnaire (SCSQ).

Results

The total prevalence of FOC was 67.8%. The percentages of women with mild (a score of 28-39), moderate (40-51), and severe FOC (52-64) were 43.6, 20.2, and 4.0%, respectively. The regression results indicated that primiparas, unplanned pregnancy, few spousal support, intolerance of uncertainty, and negative coping styles were significant risk factors of FOC. Women who adopt positive coping strategies experienced a lower level of childbirth fear.

Conclusion

These findings suggest that cultivating positive coping styles and obtaining sufficient childbirth information may be helpful for mothers' mental health. Regular screening assessment of perinatal psychological symptoms, such as the high level of intolerance of uncertainty and negative coping styles, should be adopted to reduce the risk of fear of childbirth.

Does educational stress mediate the relationship between intolerance of uncertainty and academic life satisfaction in teenagers during the COVID-19 pandemic?

The present study aims to investigate the mediator role of educational stress in the relationship between intolerance to uncertainty and academic life satisfaction among teenagers. The sample consisted of 257 female and 202 male high school students with an average age of 16.03 (SD = 1.21) continuing their education in the spring semester of the 2020-2021 academic year in Turkey. The data were collected via an online survey. Analyses revealed that intolerance of uncertainty directly and indirectly via educational stress affects the academic life satisfaction of teenagers. Educational stress partially mediates the relationship. It was also found that the full mediation model has a good fit with the data. The academic life satisfaction of teenagers was harmed by their tendencies in tolerating the uncertainties they have been facing during the COVID-19 pandemic and elevated levels of educational stress.

Uncertain in the face of change: Lack of contingency shift awareness during extinction is associated with higher fear-potentiated startle and PTSD symptoms in children

Intolerance of uncertainty is a transdiagnostic risk factor for fear-related disorders and is associated with higher levels of anxiety in children and adolescents. It is unclear how uncertainty relates to development of psychopathology in children who have experienced trauma in early life. The present study used a fear-potentiated startle paradigm in children to examine associations between uncertainty (assessed as unawareness of a change in reinforcement during fear extinction) and symptoms of anxiety and posttraumatic stress disorder (PTSD), as well as startle potentiation to threat and safety cues. Results showed that unaware children had strong positive associations between trauma exposure and PTSD symptoms, whereas aware children did not. Uncertainty interacted with anxiety in that children who were both unaware and had higher anxiety displayed higher fear-potentiated startle to safety cues and did not show discrimination between threat and safety during fear conditioning. These results suggest that anxious children who persist in associating a threat cue with an aversive event during extinction, after repeated presentations of the no longer reinforced conditioned stimulus, may express psychophysiological phenotypes related to PTSD.

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.

Decision-making in uncertain contexts: The role of autonomic markers in resolving indecision

Although impulsivity is associated with an increased willingness to make risky decisions, uncertainty intolerance may also contribute to maladaptive decision-making behavior, where individuals neglect to pursue potential rewards even when probabilities for success are in their favor. Several theories have sought to explain the neural systems that guide decision-making in this context, with evidence supporting a role for increased sympathetic activation. However, it remains unclear whether the sympathetic system is associated with greater apprehension in response to uncertain outcomes, or whether it serves to guide behavioral decisions in the context of this uncertainty. Furthermore, although postulated as a within-person process, most research has examined the association between decision behavior and sympathetic activation at the between-person level. We hypothesize that in the context of uncertainty between-person differences in skin conductance will be associated with longer deliberation times; whereas within-person trial-level increases in skin conductance will be associated with a tendency to reject uncertain options. Data were collected from n = 56 children aged 7-11 years, using a computerized card game in which children chose to accept or reject cards of varying point value at varying levels of probability. Skin conductance level (SCL) was recorded throughout the task. No significant between-person associations emerged. However, within-person analyses indicated that momentary deliberation time moderated the association between momentary skin-conductance and decision outcome. This moderation was such that for trials during which the individual deliberated longer (i.e., was more indecisive), a concurrent increase in skin conductance was associated with a significantly higher likelihood of rejecting the card. The within-person nature of these results suggests that skin conductance may help in resolving indecision in the context of uncertainty.

Minimising young children's anxiety through schools (MY-CATS): protocol for a cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of an online parent-led intervention compared with usual school practice for young children identified as at risk for anxiety disorders

BACKGROUND

Identifying and supporting young children who are at risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prevention and early intervention programmes. Delivering an online intervention through schools to parents of young children who have one or more of these risks could maximise reach. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of delivering an online parent-led intervention, compared with usual school provision only, for children (aged 4-7) identified as at risk for anxiety disorders on the basis of at least one risk factor. We also aim to identify the characteristics of children who do and do not benefit from intervention and mechanisms of change from the intervention.

METHODS

The design will be a parallel group, superiority cluster randomised controlled trial, with schools (clusters) randomised to intervention or usual school practice arms in a 1:1 ratio stratified according to level of deprivation within the school. The study will recruit and randomise at least 60 primary/infant schools in England, and on the basis of recruiting 60 schools, we will recruit 1080 trial participants (540 per arm). Parents of all children (aged 4-7) in sampled Reception, Year 1, and Year 2 classes will be invited to complete screening questionnaires. Children who screen positive on the basis of anxiety symptoms, and/or behavioural inhibition, and/or parent anxiety symptoms will be eligible for the trial. Parents/carers of children in schools allocated to the intervention arm will be offered a brief online intervention; schools in both arms will continue to provide any usual support for children and parents throughout the trial. Assessments will be completed at screening, baseline (before randomisation), 6 weeks, 12 weeks, and 12 months post-randomisation. The primary outcome will be the absence/presence of an anxiety disorder diagnosis at 12 months.

DISCUSSION

The trial will determine if delivering an online intervention for parents of young children at risk of anxiety disorders identified through screening in schools is effective and cost-effective.

TRIAL REGISTRATION

ISRCTN 82398107 . Prospectively registered on Jan. 14, 2021.

Development of a behavioural measure of Intolerance of Uncertainty in preadolescent children: Adaptation of the beads task

BACKGROUND AND OBJECTIVES

Intolerance of Uncertainty (IU) may be important for the development and maintenance of anxiety disorders but research with preadolescent children has relied entirely on questionnaire measures to assess IU. Here we aimed to develop a behavioural measure of IU that was appropriate for preadolescent children by adapting the beads task (Jacoby, Abramowitz, Buck, & Fabricant, 2014).

METHODS

Participants were 51 typically developing children (26 female; 7-11 years). We examined first whether preadolescent participants could understand and complete the task, then how participants responded to varying levels of uncertainty. We also conducted exploratory analyses regarding associations between task measures and questionnaire measures of IU, anxiety and worry.

RESULTS

Overall, the adapted Beads Task appears suitable for preadolescent children and is able to capture reactions to uncertainty. At least some of these reactions are related to questionnaire measures of IU and anxiety. Implications and areas for future research are discussed to provide insights into how behavioural tasks examining responses to uncertainty can improve our understanding of IU.

LIMITATIONS

The sample size was relatively small. There was no control task or condition without uncertainty.

CONCLUSIONS

Overall, the adapted Beads Task appears suitable for preadolescent children and is able to capture reactions to uncertainty. This type of behavioural task would be appropriate for use in future research that aims to improve our understanding of IU in children.

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.

The Impact of Anxiety in Children on the Autism Spectrum

The recognition of anxiety as one of the most commonly co-occurring diagnoses for individuals on the autism spectrum has led to increased research on symptomatology and treatment, but there is limited research documenting the impact of this anxiety. To address this, this study reports on the Child Anxiety Life Interference Scale (CALIS, parent version) in a community sample of 121 parents of children on the autism spectrum. Scores indicate that the anxiety is impacting upon the child's engagement in activities both in and outside of home as well as impacting upon parent life. Explanatory variables differed for CALIS subscales. As the child's difficulties with uncertainty and parent level of anxiety were the variables that explained the most variance, these may be important foci for effective interventions.

Neural substrates of human fear generalization: A 7T-fMRI investigation

Fear generalization - the tendency to interpret ambiguous stimuli as threatening due to perceptual similarity to a learned threat - is an adaptive process. Overgeneralization, however, is maladaptive and has been implicated in a number of anxiety disorders. Neuroimaging research has indicated several regions sensitive to effects of generalization, including regions involved in fear excitation (e.g., amygdala, insula) and inhibition (e.g., ventromedial prefrontal cortex). Research has suggested several other small brain regions may play an important role in this process (e.g., hippocampal subfields, bed nucleus of the stria terminalis [BNST], habenula), but, to date, these regions have not been examined during fear generalization due to limited spatial resolution of standard human neuroimaging. To this end, we utilized the high spatial resolution of 7T fMRI to characterize the neural circuits involved in threat discrimination and generalization. Additionally, we examined potential modulating effects of trait anxiety and intolerance of uncertainty on neural activation during threat generalization. In a sample of 31 healthy undergraduate students, significant positive generalization effects (i.e., greater activation for stimuli with increasing perceptual similarity to a learned threat cue) were observed in the visual cortex, thalamus, habenula and BNST, while negative generalization effects were observed in the dentate gyrus, CA1, and CA3. Associations with individual differences were underpowered, though preliminary findings suggested greater generalization in the insula and primary somatosensory cortex may be correlated with self-reported anxiety. Overall, findings largely support previous neuroimaging work on fear generalization and provide additional insight into the contributions of several previously unexplored brain regions.