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Jones EE, Blandl F, Kreutzer KA, Bryan CJ, Allan NP, Gorka SM. Childhood Adversity and Youth Suicide Risk: The Mediating Role of Intolerance of Uncertainty. PERSONALITY AND INDIVIDUAL DIFFERENCES 2024; 216:112405. [PMID: 37860784 PMCID: PMC10583806 DOI: 10.1016/j.paid.2023.112405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Exposure to adverse childhood experiences (ACEs) is a well-established risk factor for suicidality in adolescence and young adulthood. However, the specific mechanisms underlying this relationship remain unclear. Existing research and theoretical frameworks suggest alterations in cognitive and affective processes may account for this association. Intolerance of uncertainty (IU) exacerbates negative affect and arousal states and may contribute to sustained distress. It is therefore plausible that ACEs may be associated with high IU, and in turn, high IU may be associated with increased suicide risk. The present study directly tests this hypothesis in a cohort of youth (18-19 years) with varying ACE exposure. Participants with and without a history of trauma (N=107) completed a battery of self-report questionnaires to assess ACEs, IU, and suicide risk. Results revealed ACEs were significantly associated with both IU and suicide risk. IU and suicide risk were also correlated. Importantly, findings demonstrated a significant indirect effect of ACEs on suicide risk through IU. Findings converge with broader literature on the relationship between childhood adversity and suicidality and extend previous research by highlighting IU as a mediator of this relationship, positing IU as a potentially viable target for suicide prevention among those with a history of ACEs.
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Affiliation(s)
- Emily E Jones
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
| | - Flora Blandl
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
| | - Kayla A Kreutzer
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
| | - Nicholas P Allan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210
- Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210
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Soltani S, Noel M, Neville A, Birnie KA. Intolerance of Uncertainty in Pediatric Chronic Pain: Dyadic Relationships Between Youth and Parents. THE JOURNAL OF PAIN 2022; 23:1581-1593. [PMID: 35470088 DOI: 10.1016/j.jpain.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/27/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada
| | - Alexandra Neville
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn A Birnie
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada; Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Hunt C, Exline JJ, Fletcher TL, Teng EJ. Intolerance of uncertainty prospectively predicts the transdiagnostic severity of emotional psychopathology: Evidence from a Veteran sample. J Anxiety Disord 2022; 86:102530. [PMID: 35033969 DOI: 10.1016/j.janxdis.2022.102530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/01/2021] [Accepted: 01/09/2022] [Indexed: 11/16/2022]
Abstract
Intolerance of uncertainty (IU) has been conceptualized as a transdiagnostic vulnerability for emotional psychopathology, but few studies have tested whether it prospectively predicts emotional psychopathology, and none have utilized transdiagnostic and clinician-rated outcomes. To fill this gap, the present study tested whether IU prospectively predicted the clinician-rated severity of transdiagnostic emotional psychopathology six months later in a treatment-seeking Veteran sample. Participants completed the Intolerance of Uncertainty 12-item scale (IUS-12) and the Structured Clinical Interview for the DSM-5 (SCID-5) at Time 1 and again six-months later (Time 2); assessed emotional disorders included both anxiety-related disorders (i.e., post-traumatic stress disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder, specific phobia) and depressive conditions (i.e., major depressive disorder and persistent depressive disorder). Linear regression analyses revealed a bidirectional prospective relation between IU and emotional psychopathology, wherein higher Time 1 IUS-12 predicted greater Time 2 emotional disorder severity and greater Time 1 emotional disorder severity predicted higher Time 2 IUS-12. Follow-up analyses revealed that IU prospectively predicted the maintenance (but not the development) of anxiety-related issues, whereas prediction of Time 2 depression was nullified when controlling for Time 1 anxiety pathology. These findings implicate IU as a transdiagnostic vulnerability for emotional psychopathology and suggest the construct can be particularly useful as a treatment target and prognostic indicator for anxiety-related conditions.
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Affiliation(s)
- Christopher Hunt
- Michael E. Debakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA
| | - Julie J Exline
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Rd., Cleveland, OH 44106, USA
| | - Terri L Fletcher
- Michael E. Debakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; South Central Mental Illness Research, Education and Clinical Center, 2450 Holcombe Blvd., Houston, TX 77030, USA
| | - Ellen J Teng
- Michael E. Debakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; South Central Mental Illness Research, Education and Clinical Center, 2450 Holcombe Blvd., Houston, TX 77030, USA.
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The Impact of Intolerance of Uncertainty and Cognitive Behavioural Instructions on Safety Learning. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10113-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Difficulty updating threat associations to safe associations has been observed in individuals who score high in self-reported Intolerance of Uncertainty (IU). Here we sought to determine whether an instruction based on fundamental principles of Cognitive Behavioural Therapy could promote safety learning in individuals with higher levels of IU, whilst controlling for self-reported trait anxiety (STICSA).
Methods
We measured skin conductance response, pupil dilation and expectancy ratings during an associative threat learning task in which participants either received a cognitive behavioural instruction or no instruction prior to threat extinction (n = 92).
Results
Analyses revealed that both self-reported IU and STICSA similarly predicted differences in skin conductance response. Only individuals with lower IU/STICSA in the cognitive behavioural instruction condition displayed successful safety learning via skin conductance response.
Conclusions
These initial results provide some insight into how simple cognitive behavioural instructions combined with exposure are applied differently in individuals with varying levels of self-reported anxiety. The results further our understanding of the role of basic cognitive behavioural principles and self-reported anxiety in safety learning.
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But what will the results be?: Learning to tolerate uncertainty is associated with treatment-produced gains. J Anxiety Disord 2019; 68:102146. [PMID: 31669785 DOI: 10.1016/j.janxdis.2019.102146] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/20/2019] [Accepted: 09/18/2019] [Indexed: 12/25/2022]
Abstract
The current study examined the association between changes in intolerance of uncertainty (IU) and treatment outcomes for anxious youth. Participants were youth ages 7 to 17 who received cognitive behavioral therapy for anxiety (N = 73). Youth and their primary caregivers completed a diagnostic interview and self- and parent-report measures at pre- and post-treatment, including the Intolerance of Uncertainty Scale for Children (IUS-C/P; Przeworski, 2006), the Coping Questionnaire (CQ-C/P; Kendall, 1994) and the Multidimensional Anxiety Scale for Children (MASC-C/P; March et al., 1997). Hierarchical regression analyses evaluated the role of change in IU (the IUS-C/P) in predicting changes in functional impairment, coping efficacy, and anxiety severity post-treatment, controlling for demographic variables (age and gender), and baseline levels of IU, anxiety severity, functional impairment, and coping efficacy. Results demonstrated that treatment was associated with improvements across child-, parent- and clinician-report, and decreased IU from pre- to post-treatment was associated with (a) decreased functional impairment, (b) increased coping efficacy and (c) decreased anxiety severity. The findings indicate that a greater reduction in IU over treatment is associated with better outcomes in children and adolescents with anxiety across informants, suggesting the possibility that an increased focus on IU during treatment for youth anxiety may improve treatment outcomes. Future research should assess the causality of this relationship.
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Intolerance of uncertainty and eating disorder behaviour: Piloting a consumption task in a non-clinical sample. J Behav Ther Exp Psychiatry 2019; 65:101492. [PMID: 31202086 DOI: 10.1016/j.jbtep.2019.101492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 12/11/2022]
Abstract
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.
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Anderson EC, Carleton RN, Diefenbach M, Han PKJ. The Relationship Between Uncertainty and Affect. Front Psychol 2019; 10:2504. [PMID: 31781003 PMCID: PMC6861361 DOI: 10.3389/fpsyg.2019.02504] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022] Open
Abstract
Uncertainty and affect are fundamental and interrelated aspects of the human condition. Uncertainty is often associated with negative affect, but in some circumstances, it is associated with positive affect. In this article, we review different explanations for the varying relationship between uncertainty and affect. We identify "mental simulation" as a key process that links uncertainty to affective states. We suggest that people have a propensity to simulate negative outcomes, which result in a propensity toward negative affective responses to uncertainty. We also propose the existence of several important moderators of this process, including context and individual differences such as uncertainty tolerance, as well as emotion regulation strategies. Finally, we highlight important knowledge gaps and promising areas for future research, both empirical and conceptual, to further elucidate the relationship between uncertainty and affect.
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Affiliation(s)
- Eric C. Anderson
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, United States
- Department of Medicine, Tufts University Medical Center, Boston, MA, United States
| | | | - Michael Diefenbach
- Departments of Medicine, Urology, and Psychiatry, Northwell Health, New York, NY, United States
| | - Paul K. J. Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, United States
- Department of Medicine, Tufts University Medical Center, Boston, MA, United States
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Gillett CB, Bilek EL, Hanna GL, Fitzgerald KD. Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment. Clin Psychol Rev 2018; 60:100-108. [DOI: 10.1016/j.cpr.2018.01.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/12/2017] [Accepted: 01/31/2018] [Indexed: 12/15/2022]
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Hui C, Zhihui Y. Group cognitive behavioral therapy targeting intolerance of uncertainty: a randomized trial for older Chinese adults with generalized anxiety disorder. Aging Ment Health 2017; 21:1294-1302. [PMID: 27592635 DOI: 10.1080/13607863.2016.1222349] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES China has entered the aging society, but the social support systems for the elderly are underdeveloped, which may make the elderly feel anxiety about their health and life quality. Given the prevalence of generalized anxiety disorder (GAD) in the elderly, it is very important to pay more attention to the treatment for old adults. Although cognitive behavioral therapy targeting intolerance of uncertainty (CBT-IU) has been applied to different groups of patients with GAD, few studies have been performed to date. In addition, the effects of CBT-IU are not well understood, especially when applied to older adults with GAD. METHOD Sixty-three Chinese older adults with a principal diagnosis of GAD were enrolled. Of these, 32 were randomized to receive group CBT-IU (intervention group) and 31 were untreated (control group). GAD and related symptoms were assessed using the Penn State Worry Questionnaire, Intolerance of Uncertainty Scale-Chinese Version, Beck Anxiety Inventory, Beck Depression Inventory, Why Worry-II scale, Cognitive Avoidance Questionnaire, Generalized Anxiety Disorder Questionnaire-IV, and Generalized Anxiety Disorder Severity Scale across the intervention. The changes between pre and after the intervention were collected, as well as the six-month follow-up. F test and repeated-measures ANOVA were conducted to analyze the data. RESULTS Compared to control group, the measures' scores of experimental group decreased significantly after the intervention and six-month follow-up. Besides the main effects for time and group were significant, the interaction effect for group × time was also significant. These results indicated the improvement of the CBT-IU group and the persistence of effect after six months. CONCLUSION Group CBT-IU is effective in Chinese older adults with GAD. The effects of CBT-IU on GAD symptoms persist for at least six months after treatment.
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Affiliation(s)
- Chen Hui
- a Department of Psychology, School of Humanities and Social Sciences , Beijing Forestry University , Beijing , P. R. China
| | - Yang Zhihui
- a Department of Psychology, School of Humanities and Social Sciences , Beijing Forestry University , Beijing , P. R. China
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Kesby A, Maguire S, Brownlow R, Grisham JR. Intolerance of Uncertainty in eating disorders: An update on the field. Clin Psychol Rev 2017; 56:94-105. [PMID: 28710918 DOI: 10.1016/j.cpr.2017.07.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 01/12/2023]
Abstract
Pathological fear and anxiety regarding food, eating, weight and body shape are at the core of eating disorder (ED) psychopathology. To manage anxiety, patients develop complicated repertoires of ritualistic and repetitive behaviours, which can lead to total functional impairment. Yet the cognitive processes underlying anxiety, fear, and anxiety-driven behaviours in EDs remain poorly understood. Intolerance of Uncertainty (IU) is defined as a tendency to react negatively on an emotional, cognitive, and behavioural level to uncertain situations and events. There is substantial evidence that IU is a transdiagnostic process that contributes to the maintenance of anxiety disorders; however, IU may also be relevant to the understanding and treatment of EDs. The current review summarises the growing literature examining IU in relation to ED symptoms, including restriction, bingeing, purging, ritualised behaviours, reassurance-seeking and body checking. Extending from the obsessive-compulsive disorder (OCD) and anxiety disorder literature, we propose that IU provides a novel theoretical and clinical framework from which to understand the anxiety, fixation with rules and rituals, and the cognitively rigid profile that is characteristic of ED presentations. We conclude with suggestions for future research, and discuss IU as a potential treatment target for core features of EDs and comorbid symptoms.
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Affiliation(s)
- Alice Kesby
- School of Psychology, UNSW Australia, Sydney, NSW, Australia.
| | - Sarah Maguire
- Boden Institute, University of Sydney, Sydney, NSW, Australia
| | - Rachel Brownlow
- Boden Institute, University of Sydney, Sydney, NSW, Australia
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Stevens K, Rogers T, Campbell M, Björgvinsson T, Kertz S. A transdiagnostic examination of decreased intolerance of uncertainty and treatment outcome. Cogn Behav Ther 2017. [DOI: 10.1080/16506073.2017.1338311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kimberly Stevens
- Psychology Department, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Travis Rogers
- Psychology Department, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Moselle Campbell
- Psychology Department, Southern Illinois University Carbondale, Carbondale, IL, USA
| | | | - Sarah Kertz
- Psychology Department, Southern Illinois University Carbondale, Carbondale, IL, USA
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Shihata S, McEvoy PM, Mullan BA, Carleton RN. Intolerance of uncertainty in emotional disorders: What uncertainties remain? J Anxiety Disord 2016; 41:115-24. [PMID: 27212227 DOI: 10.1016/j.janxdis.2016.05.001] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/03/2016] [Accepted: 05/05/2016] [Indexed: 01/04/2023]
Abstract
The current paper presents a future research agenda for intolerance of uncertainty (IU), which is a transdiagnostic risk and maintaining factor for emotional disorders. In light of the accumulating interest and promising research on IU, it is timely to emphasize the theoretical and therapeutic significance of IU, as well as to highlight what remains unknown about IU across areas such as development, assessment, behavior, threat and risk, and relationships to cognitive vulnerability factors and emotional disorders. The present paper was designed to provide a synthesis of what is known and unknown about IU, and, in doing so, proposes broad and novel directions for future research to address the remaining uncertainties in the literature.
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Affiliation(s)
- Sarah Shihata
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Peter M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia.
| | - Barbara Ann Mullan
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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Carleton RN. Fear of the unknown: One fear to rule them all? J Anxiety Disord 2016; 41:5-21. [PMID: 27067453 DOI: 10.1016/j.janxdis.2016.03.011] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/26/2016] [Accepted: 03/26/2016] [Indexed: 12/14/2022]
Abstract
The current review and synthesis was designed to provocatively develop and evaluate the proposition that "fear of the unknown may be a, or possibly the, fundamental fear" (Carleton, 2016) underlying anxiety and therein neuroticism. Identifying fundamental transdiagnostic elements is a priority for clinical theory and practice. Historical criteria for identifying fundamental components of anxiety are described and revised criteria are offered. The revised criteria are based on logical rhetorical arguments using a constituent reductionist postpositivist approach supported by the available empirical data. The revised criteria are then used to assess several fears posited as fundamental, including fear of the unknown. The review and synthesis concludes with brief recommendations for future theoretical discourse as well as clinical and non-clinical research.
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Affiliation(s)
- R Nicholas Carleton
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK, Canada.
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Into the unknown: A review and synthesis of contemporary models involving uncertainty. J Anxiety Disord 2016; 39:30-43. [PMID: 26945765 DOI: 10.1016/j.janxdis.2016.02.007] [Citation(s) in RCA: 460] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 12/15/2022]
Abstract
The current review and synthesis serves to define and contextualize fear of the unknown relative to related constructs, such as intolerance of uncertainty, and contemporary models of emotion, attachment, and neuroticism. The contemporary models appear to share a common core in underscoring the importance of responses to unknowns. A recent surge in published research has explored the transdiagnostic impact of not knowing on anxiety and related pathologies; as such, there appears to be mounting evidence for fear of the unknown as an important core transdiagnostic construct. The result is a robust foundation for transdiagnostic theoretical and empirical explorations into fearing the unknown and intolerance of uncertainty.
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Hodgson AR, Freeston MH, Honey E, Rodgers J. Facing the Unknown: Intolerance of Uncertainty in Children with Autism Spectrum Disorder. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:336-344. [PMID: 26868412 DOI: 10.1111/jar.12245] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Anxiety is a common problem for children with autism spectrum disorder (ASD). Recent research indicates that intolerance of uncertainty (IU) may be an important aspect of anxiety for this population. IU is the belief that uncertainty is upsetting, and not knowing what is going to happen is negative. There is little known about the phenomenology of IU in children with ASD. We therefore present data from parent focus groups exploring this concept in children with ASD. METHODS Participants were asked to differentiate IU from dislike of change and fear, and to discuss examples of IU and the strategies they use to manage it. Their experiences of IU and strategies are presented. RESULTS IU was evident across novel and familiar situations and parents used a variety of strategies to manage IU. Their experiences of IU and strategies used are presented. CONCLUSIONS Participants were able to identify and provide examples of IU suggesting that it is a recognizable construct among children with ASD.
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Affiliation(s)
- Anna R Hodgson
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Mark H Freeston
- Institute of Neuroscience, Newcastle University, Newcastle, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Emma Honey
- Institute of Neuroscience, Newcastle University, Newcastle, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Jacqui Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle, UK
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Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder. J Anxiety Disord 2015; 33:90-4. [PMID: 26037493 PMCID: PMC4480197 DOI: 10.1016/j.janxdis.2015.05.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 11/21/2022]
Abstract
Growing evidence suggests that intolerance of uncertainty (IU) is a cognitive vulnerability that is a central feature across diverse anxiety disorders, including generalized anxiety disorder (GAD). Although cognitive behavioral therapy (CBT) has been shown to reduce IU, it remains to be established whether or not reductions in IU mediate reductions in worry. This study examined the process of change in IU and worry in a sample of 28 individuals with GAD who completed CBT. Changes in IU and worry, assessed bi-weekly during treatment, were analyzed using multilevel mediation models. Results revealed that change in IU mediated change in worry (ab = -0.20; 95% CI [-.35, -.09]), but change in worry did not mediate change in IU (ab = -0.16; 95% CI [-.06, .12]). Findings indicated that reductions in IU accounted for 59% of the reductions in worry observed over the course of treatment, suggesting that changes in IU are not simply concomitants of changes in worry. Findings support the idea that IU is a critical construct underlying GAD.
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Jensen D, Heimberg RG. Domain-Specific Intolerance of Uncertainty in Socially Anxious and Contamination-Focused Obsessive–Compulsive Individuals. Cogn Behav Ther 2014; 44:54-62. [DOI: 10.1080/16506073.2014.959039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Carleton RN. The intolerance of uncertainty construct in the context of anxiety disorders: theoretical and practical perspectives. Expert Rev Neurother 2014; 12:937-47. [DOI: 10.1586/ern.12.82] [Citation(s) in RCA: 276] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Prevalence of psychotic-like experiences in young adults with social anxiety disorder and correlation with affective dysregulation. J Nerv Ment Dis 2013; 201:1053-9. [PMID: 24284640 DOI: 10.1097/nmd.0000000000000050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Social anxiety disorder (SAD) is associated with psychotic-like experiences (PLEs) and is a frequent diagnosis in the prodromal phases of psychosis. We investigated whether psychopathological factors could discriminate which subjects with SAD are more likely to develop PLEs. A sample of 128 young adults with SAD was split into two subsamples according to the presence of clinically relevant PLEs. Correlations between PLEs and other psychopathological markers were explored. The SAD with PLEs group showed higher level of anxiety, depression, and intolerance of uncertainty (IU) compared with the SAD without PLEs group. A limitation of this study is that the cross-sectional design precluded the analysis of causality. In our sample, the presence of PLEs is related to higher levels of depression, anxiety, and IU. The current findings are consistent with hypotheses suggesting that cognitive disturbances, together with social anxiety, may result in PLEs.
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Whiting SE, Jenkins WS, May AC, Rudy BM, Davis TE, Reuther ET. The Role of Intolerance of Uncertainty in Social Anxiety Subtypes. J Clin Psychol 2013; 70:260-72. [DOI: 10.1002/jclp.22024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Mahoney AEJ, McEvoy PM. Changes in intolerance of uncertainty during cognitive behavior group therapy for social phobia. J Behav Ther Exp Psychiatry 2012; 43:849-54. [PMID: 22204898 DOI: 10.1016/j.jbtep.2011.12.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/07/2011] [Accepted: 12/07/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent research suggests that intolerance of uncertainty (IU), most commonly associated with generalized anxiety disorder, also contributes to symptoms of social phobia. This study examines the relationship between IU and social anxiety symptoms across treatment. METHOD Changes in IU, social anxiety symptoms, and depression symptoms were examined following cognitive behavior group therapy (CBGT) for social phobia (N=32). RESULTS CBGT led to significant improvements in symptoms of social anxiety and depression, as well as reductions in IU. Reductions in IU were associated with reductions in social anxiety but were unrelated to improvements in depression symptoms. Reductions in IU were predictive of post-treatment social phobia symptoms after controlling for pre-treatment social phobia symptoms and changes in depression symptoms following treatment. LIMITATIONS The relationship between IU and social anxiety requires further examination within experimental and longitudinal designs, and needs to take into account additional constructs that are thought to maintain social phobia. CONCLUSIONS Current findings suggest that the enhancing tolerance of uncertainty may play a role in the optimal management of social phobia. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression, University of New South Wales at St Vincent's Hospital, Level 4 O'Brien Centre, 394-404 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
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Mahoney AEJ, McEvoy PM. Trait Versus Situation-Specific Intolerance of Uncertainty in a Clinical Sample with Anxiety and Depressive Disorders. Cogn Behav Ther 2012; 41:26-39. [DOI: 10.1080/16506073.2011.622131] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Mahoney AEJ, McEvoy PM. A transdiagnostic examination of intolerance of uncertainty across anxiety and depressive disorders. Cogn Behav Ther 2011; 41:212-22. [PMID: 22032195 DOI: 10.1080/16506073.2011.622130] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Intolerance of uncertainty (IU) has been identified as a potential maintaining factor for generalised anxiety disorder; however, there is a growing evidence to suggest that IU may contribute to other anxiety and depressive disorders. Moreover, certain components of IU (namely prospective and inhibitory IU) have been shown to be differentially associated with symptoms of emotional disorders. The aim of this study was to determine the extent to which individuals with various anxiety and depressive disorders endorsed IU, firstly as a trait variable (with prospective and inhibitory components) and secondly in reference to regularly occurring, diagnostically relevant situations (situation-specific IU). The degree to which diagnosis predicted IU was examined in a highly comorbid clinical sample (N=218). Regardless of specific diagnoses, the degree of comorbidity emerged as a significant predictor of prospective IU and situation-specific IU. Conversely, specific diagnoses of social phobia, generalised anxiety disorder, depression, and obsessive compulsive disorder were uniquely related to inhibitory IU. These findings suggest that IU is a transdiagnostic construct and have implications for current diagnosis-specific and transdiagnostic theory and clinical practice.
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Affiliation(s)
- Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, Australia.
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