Intolerance of Uncertainty Mediates the Relation Between Generalized Anxiety Disorder Symptoms and Anger

The Perils of the Unknown: Intolerance of Uncertainty and Intimate Partner Violence Across the First Four Pandemic Waves

Theory suggests that intolerance of uncertainty (IU), a tendency to perceive uncertain events as threatening, may serve as a potential risk factor for increased intimate partner violence (IPV) perpetration; however, few studies have investigated this association, and none have taken a longitudinal approach. We investigated the issue in two longitudinal online investigations (initial N = 282 and 1,118), with time periods ranging from just before the COVID-19 pandemic to the fourth pandemic wave, approximately 1.5 years later. IU was a significant predictor of IPV cross-sectionally, and in the short term longitudinally (i.e., over periods of weeks); however, it did not predict IPV over the longer term (i.e., over periods of months or years). In addition, our longitudinal design allowed assessment of IPV trends across pandemic waves. Physical IPV rates remained low and steady across time. Psychological IPV rates showed an increase in the early days of the pandemic, but then dropped and stabilized, albeit at a somewhat higher rate than pre-pandemic. Study 2 had ample representation of LGBTQ+ respondents and showed that the patterns and processes worked similarly for LGBTQ+ and non-LGBTQ+ individuals.

Intolerance of uncertainty heightens negative emotional states and dampens positive emotional states

Individuals high in self-reported Intolerance of Uncertainty (IU) tend to view uncertainty as unbearable and stressful. Notably, IU is transdiagnostic, and high levels of IU are observed across many different emotional disorders (e.g., anxiety, depression). Research has primarily focused on how IU evokes and modulates emotional states such as fear and anxiety. However, recent research suggests that IU may have relevance for a broader range of emotional states. Here, an online survey was conducted to examine whether IU evokes and modulates a range of negative (e.g., fear/anxiety, sadness/upset, anger/frustration, disgust) and positive (e.g., happiness/joy, excitement/enthusiasm, surprise/interest) emotional states. Findings within a community sample (n = 231) revealed that individuals with higher levels of IU report: (1) that uncertainty in general and uncertainty under ambiguity are more likely to evoke negative emotional states and less likely to evoke positive emotional states, (2) that uncertainty under risk is less likely to evoke positive emotional states, and (3) that uncertainty heightens existing negative emotional states and dampens existing positive emotional states. Importantly, these IU-related findings remained when controlling for current experiences of general distress, anxious arousal, and anhedonic depression. Taken together, these findings suggest that IU is involved in evoking and modulating a wide array of emotional phenomena, which likely has relevance for transdiagnostic models and treatment plans for emotional disorders.

Intimate Partner Violence and Mental Health during Lockdown of the COVID-19 Pandemic

BACKGROUND

This study took place in the context of the COVID-19 pandemic. The present research assesses the association between lockdown conditions (such as time spent at home, living environment, proximity to contamination and social contacts), mental health (including intolerance of uncertainty, anxiety and depression) and intimate partner violence within the community. This study evaluates the indirect effect of anxiety and depression on the relationship between intolerance of uncertainty and intimate partner violence (physical assault and psychological aggression).

METHODS

1532 adults (80.8% of women, Mage = 35.34) were recruited from the Belgian general population through an online self-report questionnaire completed during the lockdown (from April 17 to 1 May 2020).

RESULTS

The results demonstrate that the prevalence of physical assault (including both perpetration and victimization) was significantly higher in men, whereas the prevalence of psychological aggression was significantly higher in women. Men reported significantly more violence during lockdown. Women, on the other hand, were more anxious and more intolerant of uncertainty. No difference between men and women was found for depression. Anxiety and depression significantly mediated the relationship between intolerance of uncertainty and physical assault and psychological aggression. Sex did not moderate the mediation.

CONCLUSION

Clinical implications for public health policy are highlighted.

Anxiety, Anger and Depression Amongst Low-Income Earners in Southwestern Uganda During the COVID-19 Total Lockdown

Background: Low-income earners are particularly vulnerable to mental health, consequence of the coronavirus disease 2019 (COVID-19) lockdown restrictions, due to a temporary or permanent loss of income and livelihood, coupled with government-enforced measures of social distancing. This study evaluates the mental health status among low-income earners in southwestern Uganda during the first total COVID-19 lockdown in Uganda. Methods: A cross-sectional descriptive study was undertaken amongst earners whose income falls below the poverty threshold. Two hundred and fifty-three (n = 253) male and female low-income earners between the ages of 18 and 60 years of age were recruited to the study. Modified generalized anxiety disorder (GAD-7), Spielberger's State-Trait Anger Expression Inventory-2 (STAXI-2), and Beck Depression Inventory (BDI) tools as appropriate were used to assess anxiety, anger, and depression respectively among our respondents. Results: Severe anxiety (68.8%) followed by moderate depression (60.5%) and moderate anger (56.9%) were the most common mental health challenges experienced by low-income earners in Bushenyi district. Awareness of mental healthcare increased with the age of respondents in both males and females. A linear relationship was observed with age and depression (r = 0.154, P = 0.014) while positive correlations were observed between anxiety and anger (r = 0.254, P < 0.001); anxiety and depression (r = 0.153, P = 0.015) and anger and depression (r = 0.153, P = 0.015). Conclusion: The study shows the importance of mental health awareness in low resource settings during the current COVID-19 pandemic. Females were identified as persons at risk to mental depression, while anger was highest amongst young males.

The role of anxiety sensitivity in anger symptomatology: Results from a randomized controlled trial

Anger is often overlooked in the assessment and treatment of pathological anxiety, despite there being evidence that anger is elevated across all anxiety disorders. Anxiety sensitivity (AS), a major risk factor of anxiety disorders, has been shown to modulate anger in response to threat induced hyperarousal. The current study therefore examined if reductions in anxiety sensitivity (AS) mediate reductions in anger symptoms. Outcomes from a randomized control trial evaluating the efficacy of a brief AS mitigation intervention were analyzed. Patients with anxiety and comorbid conditions were randomly assigned to AS reduction (n  = 58) or a repeated contact control condition (n  = 60) and followed up with for three months. Analyses evaluated whether treatment related change in AS mediated later reductions in anger, hostility, verbal aggression, and physical aggression. Results revealed that reductions in AS temporally mediated the effects of treatment on later reductions in anger, hostility, verbal aggression, and physical aggression. Specificity analyses provided further support for the direction and specific variables examined in these models. Results suggest that AS may be a promising treatment target for anger symptoms among those with elevated anxiety symptoms.

Aggressive Worriers: How Aggression Moderates the Association between Intolerance of Uncertainty and Suicidal Desire Constructs

Suicide is a public health concern and has been the tenth leading cause of death in the United States since 2008. The Interpersonal-Psychological Theory of Suicidal Behavior is an empirically supported model of suicide. The theory posits that thwarted belongingness and perceived burdensomeness examine the individual's perceived connectedness to others around them and together create suicidal desire. Anxiety is another widespread public health concern, associated with suicidal ideation and suicide attempts above and beyond the effects of socio-demographic factors and other mental disorders. A key factor in anxiety disorders is intolerance of uncertainty, or the individual's tendency to perceive ambiguous situations and events as being aversive to emotional and behavioral well-being. Additionally, different facets of aggression have been associated with both intolerance of uncertainty and suicidal desire. The current study sought to examine how facets of aggression moderated the associations between intolerance of uncertainty (both prospective and inhibitory) and thwarted belongingness/perceived burdensomeness. Participants were 440 adults recruited online. The hypotheses of aggression facets moderating the association between intolerance of uncertainty and perceived burdensomeness were largely supported with statistical significance for six out of eight models. Similarly, the hypotheses of aggression facets moderating thwarted belongingness were largely supported with significant moderations for seven out of eight models. The results were upheld when using Benjamini-Hochberg test of significance to account for Type I error. Overall, results indicate that aggressive facets can amplify the associations between intolerance of uncertainty and thwarted belongingness/perceived burdensomeness; however, results differed based on the intolerance of uncertainty dimensions.

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

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

Is cognitive inflexibility a missing link? The role of cognitive inflexibility, alexithymia and intolerance of uncertainty in externalising and internalising behaviours in young people with autism spectrum disorder

BACKGROUND

Internalising (anxiety and low mood) and externalising (aggressive or outburst behaviours, and irritability) difficulties are very common in autism spectrum disorder (ASD) across the life span, relatively stable over time and often associated with poorer quality of life. Understanding the cognitive mechanisms underlying internalising and externalising difficulties in ASD is essential for developing targeted supports and interventions. In the present study, we investigated established and less-researched cognitive factors hypothesised to contribute to internalising and/or externalising difficulties in ASD, namely cognitive inflexibility (CI), intolerance of uncertainty (IU) and alexithymia. Based on previous models and clinical experience, we hypothesised that IU would lead to internalising symptoms, with alexithymia contributing to this pathway, and that CI would have a direct effect on externalising behaviours and may indirectly contribute to internalising symptoms via increasing IU.

METHODS

Our sample consisted of 95 5- to 18-year-olds presenting to a specialist neurodevelopmental clinic and receiving a diagnosis of ASD. Parents/caregivers completed questionnaires assessing ASD symptomatology, internalising and externalising difficulties, CI, IU and alexithymia. Structural equation modelling was used to examine the hypothesised pathways and relationships between the main variables of interest.

RESULTS

Cognitive Inflexibility played a significant direct role in the pathway from ASD symptoms to externalising symptoms in ASD, and indirect role via IU in the pathway to internalising problems. Relationships between alexithymia and both internalising and externalising symptoms were weaker, with alexithymia predicting internalising difficulties via IU only.

CONCLUSIONS

The finding of a direct pathway from CI to externalising behaviours is novel, as is the indirect role of CI in internalising symptomatology. Of the three cognitive mechanisms examined, only CI significantly predicted externalising symptoms. Possible implications for interventions and supports targeting these cognitive processes in ASD are discussed.

Cognitive behavioral based group psychotherapy focusing on repetitive negative thinking: Decreased uncontrollability of rumination is related to brain perfusion increases in the left dorsolateral prefrontal cortex

Repetitive negative thinking (RNT) is a core process underlying various psychiatric disorders. 'Uncontrollability of rumination (UOR)' is one the most maladaptive factors of rumination, but little is known on how cognitive behavioral focused RNT psychotherapy may alter brain activity. In a subsample of 47 patients suffering from RNT who also underwent brain imaging (registered RCT trial NCT01983033), we evaluated the effect of cognitive behavioral based group psychotherapy (CBGP) (n = 25) as compared to a delayed treatment control group (DTCG) (n = 22) on frontolimbic brain perfusion with a focus on UOR. This RNT construct was measured using the subscale 'uncontrollability' of the Dutch version of the Rumination on Sadness Scale (LARSS-U). Brain perfusion was assessed with arterial spin labeling (ASL)-fMRI. LARSS-U scale scores significantly decreased in the CBGP cohort whereas no significant changes emerged in the DTCG group. Compared to the DTCG, this decrease on UOR in the CBGP group was related to significant perfusion increases in the left (dorsolateral) prefrontal cortex, part of the executive network. Besides the fact that CBGP significantly reduced RNT, this attenuation of uncontrollable ruminative thoughts was related to brain perfusion increases areas documented to be involved in the top down control of adaptive emotion regulation and the inhibition of ruminative processes.

A Preliminary Exploration of Behaviours Associated with Negative Urgency in Individuals High and Low in Chronic Worry

While chronic worry is typically associated with cautious and harm-avoidant behaviours, there is evidence that people high in chronic worry are characterised by negative urgency (NU), that is, the propensity to act rashly when experiencing negative affect. The present study was a preliminary examination of how rash action and impulsive decision-making manifest for chronic worriers compared to individuals low in worry. In total, 93 participants who endorsed high and low worry and NU responded to open-ended questions about their experience of NU on Amazon Mechanical Turk. Themes were identified using a data-driven approach. Participants high in chronic worry endorsed significantly greater NU compared to those low in worry. However, the types of NU behaviours were similar across participants, with a majority of responses involving initiating interpersonal conflict. Other themes included spending money, excessive eating, alcohol use, and aggressive behaviours. The manifestations of NU were largely consistent with those described in the model of NU. Although individuals higher in chronic worry engaged in NU behaviours to a greater extent, the types of behaviours were similar to those reported by people lower in worry. More research is needed to understand the characteristics of NU-motivated behaviour in individuals high in chronic worry.

Intolerance of uncertainty, rumination, post-traumatic stress symptoms and aggression during COVID-19: a serial mediation model

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic can be identified as a source of traumatic stress. Previous studies have shown that post-traumatic stress and intolerance of uncertainty are associated with aggressive behaviour.

OBJECTIVE

In the present study, we aimed to test a serial mediation model, considering rumination and post-traumatic stress symptoms (PTSS) as mediators that link intolerance of uncertainty and aggression, while controlling the confounding effect of crisis-induced health and socioeconomic stressors during the COVID-19 pandemic.

METHOD

A total of 714 participants [533 (74.6%) females, 176 (24.7%) males, aged 18-64 years (M _age = 25.16, SD _age = 9.34)] completed the following self-reported scales: Aggression Scale, COVID-19 stressors checklist, Short Version of the Intolerance of Uncertainty Scale, Impact of Event Scale with Modifications for COVID-19, and Ruminative Thought Style Questionnaire.

RESULTS

The results revealed that there was an association between intolerance of uncertainty and aggressive behaviours. Moreover, the results of serial mediation analysis showed that intolerance of uncertainty predicts aggressive behaviours via rumination and PTSS. Besides, socioeconomic stressors are significantly associated with the level of PTSS and aggression, while health stressors are not significantly association with the level of PTSS and aggression.

CONCLUSIONS

The findings provide several contributions to understand the link between intolerance of uncertainty and aggressive behaviours during the COVID-19 pandemic, and confirm the importance of early psychological intervention, especially for those who are more likely to ruminate and suffer from PTSS, to prevent aggression and violence in the long run. In addition to health-related regulations, it is important to take the social and economic aspects of the crisis into account and develop intervention strategies accordingly. Nevertheless, the limitations of cross-sectional mediation analysis in explaining causal relationships should be kept in mind, and future studies should extend these findings using longitudinal data.

Hostility in medication-resistant major depression and comorbid generalized anxiety disorder is related to increased hippocampal-amygdala 5-HT2A receptor density

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are severe and difficult-to-treat psychiatric illnesses with high rates of comorbidity. Although both disorders are treated with serotonergic based psychotropic agents, little is known on the influence of the serotonergic neurotransmitter system on the occurrence of comorbid GAD when clinically depressed. To investigate this poorly understood clinical question, we examined the involvement of frontolimbic post-synaptic 5-HT_2A receptors in 20 medication-resistant depressed (MRD) patients with half of them diagnosed with comorbid GAD with ¹²³I-5-I-R91150 SPECT. To explore whether 5-HT_2A receptor-binding indices (BI) associated with comorbid GAD could be related to distinct psychopathological symptoms, all were assessed with the symptom Checklist-90-Revised (SCL-90-R). MRD patients with comorbid GAD displayed significantly higher 5-HT_2A receptor BI in the hippocampal-amygdala complex, compared to MRD patients without GAD. Correlation analyses revealed that the 5-HT_2A receptor BI in these areas were significantly related to the SCL-90-R subscale hostility (HOS), especially for those MRD patients with comorbid GAD. Comorbid MRD-GAD may be characterized with increased hippocampal-amygdala 5-HT_2A receptor BI which could represent enhanced levels in hostility in such kinds of patients. Adapted psychotherapeutic interventions may be warranted.

Parent and child emotion and distress responses associated with parental accommodation of child anxiety symptoms

OBJECTIVE

Parental accommodation contributes to the maintenance of child anxiety and related symptoms. The current study examines the contributions of parent and child factors to parental accommodation in a sample of anxious youth.

METHODS

Sixty-four treatment-seeking youth (6-16 years) and their mothers, as well as a subset of fathers (N = 41) reported on parental accommodation, parental distress and emotion regulation, child psychopathology, child externalizing behaviors, and child intolerance of uncertainty.

RESULTS

Parental accommodation was not related to parental distress or emotion regulation. Parents who viewed their child as being more symptomatic (e.g., anxious, externalizing, and intolerant of uncertainty) were more likely to engage in accommodation. For mothers, child anxiety and externalizing symptoms were notable predictors of accommodation.

CONCLUSIONS

Parent perceptions of child symptomology is an important factor significantly related to accommodation behaviors. This finding can be used to inform programming designed to target parental responses to child anxiety and related disorders.

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.

Trait anger and anger attacks in relation to depressive and anxiety disorders

BACKGROUND

Patients with various psychiatric disorders may suffer from feelings of anger, sometimes leading to maladaptive (e.g., aggressive) behaviors. We examined to what extent depressive and anxiety disorders, relevant clinical correlates, and sociodemographics determined the level of trait anger and the prevalence of recent anger attacks.

METHODS

In the Netherlands Study of Depression and Anxiety (NESDA), the Spielberger Trait Anger Subscale and the Anger Attacks Questionnaire were analyzed in patients with depressive (n = 204), anxiety (n = 288), comorbid (n = 222), and remitted disorders (n = 1,107), as well as in healthy controls (n = 470) based on DSM-IV criteria.

RESULTS

On average, participants were 46.2 years old (SD = 13.1) and 66.3% were female. Trait anger and anger attacks were most prevalent in the comorbid group (M = 18.5, SD = 5.9, and prevalence 22.1%), followed by anxiety disorder, depressive disorder, remitted disorder, and controls (M = 12.7; SD = 2.9, and prevalence 1.3%). Major depressive disorder, social phobia, panic disorder, and generalized anxiety disorder were most strongly associated to trait anger and anger attacks.

LIMITATIONS

Due to a cross-sectional design, it was not possible to provide evidence for temporal or causal relationships between anger and depressive and anxiety disorders.

CONCLUSIONS

Trait anger and anger attacks are linked to depressive and anxiety disorders, although the strength of the relationship differed among both anger constructs.

Does intolerance of uncertainty mediate improvement in anger during group CBT for GAD? A preliminary investigation

BACKGROUND

Individuals with generalized anxiety disorder (GAD) have elevated intolerance of uncertainty (IU) and anger, and IU mediates the relationship between GAD symptoms and anger.

AIMS

The current pilot study examined whether group cognitive behavioural therapy (CBT) improves anger in people with GAD, and the degree to which change in IU mediates improved anger.

METHOD

Individuals diagnosed with GAD completed measures of worry, IU, and facets of anger, before and at the end of group CBT for GAD.

RESULTS

Worry, IU, and internally felt and outwardly expressed anger, reduced significantly over treatment, but anger control (inwardly and outwardly) did not. CBT for GAD led to improvement in both internally felt and outwardly expressed anger, even though anger is not directly targeted in this treatment. Improvement in IU significantly mediated improvement in internally felt and outwardly expressed anger.

CONCLUSIONS

This preliminary study contributes to the literature on the importance of IU in understanding worry and other symptoms such as elevated anger, experienced by people with excessive worry.

Rejection sensitivity and borderline personality disorder features: A mediation model of effortful control and intolerance of ambiguity

Although past research suggests that borderline personality disorder (BPD) patients' rejection hypersensitivity may be an important factor underlying these patients' interpersonal problems, the role of cognitive factors in this association is still not well understood. The present study examined whether cognitive factors such as effortful control and intolerance of ambiguity mediated the association between rejection sensitivity and BPD features. A sample of 256 young adults completed self-report questionnaires assessing rejection sensitivity, effortful control, intolerance of ambiguity, and BPD features. Results showed that effortful control and intolerance of ambiguity mediated the association between rejection sensitivity and BPD features. The present study showed the role of cognitive aspects including both effortful control and intolerance of ambiguity in the relationship between rejection sensitivity and BPD features. However, there is a need for further research to experimentally investigate how rejection sensitivity may impact cognitive capacities in interpersonal contexts among individuals with BPD features.

Ventrolateral prefrontal cortex activation during social exclusion mediates the relation between intolerance of uncertainty and trait aggression

Intolerance of uncertainty (IU) is an important individual difference factor that may contribute to trait-like aggression. Deficient engagement of the ventrolateral PFC (vlPFC) during social situations may also be a mechanism that links these two constructs. The aim of the current study was to test a proposed mediation model whereby IU is associated with trait aggression through neural activation of the vlPFC during a social exclusion task. Fifty-three adults with a range of impulsive-aggressive traits completed validated assessments of IU and trait aggression, and the 'Cyberball' social exclusion task during functional magnetic resonance imaging (fMRI). Results supported the mediation model such that greater levels of IU were associated with greater trait aggression through hypoactivation of the vlPFC during social exclusion. This study is the first to provide evidence suggesting that individuals higher in IU have difficulties engaging regulatory neural processes, which in-turn may increase the propensity for aggression.

The Relationship Between Anger and Anxiety Symptoms in Youth with Anxiety Disorders

This study examined the relationship between anger and anxiety in youth in an outpatient anxiety treatment clinic. Participants included 40 primarily female and Caucasian youth, all diagnosed with a primary anxiety disorder. Youth provided ratings of anger, anxiety, and depressive symptoms. We also obtained parent and clinician ratings of anxiety severity. Analyses supported a significant relationship between trait anger and anxiety severity. When rated by youth, trait anger was significantly related to physical symptoms of anxiety and harm avoidance. Youth report of anger symptoms was not related to parent or clinician report of youth anxiety severity. Assessing symptoms of anger in youth with anxiety disorders may be important, as it may be related to higher anxiety symptom severity for some youth. Future research in larger samples is needed to understand the co-occurrence of different components of anger and anxiety disorders and its impact on prognosis and treatment process.

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

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

Experimental manipulation of avoidable feelings of uncertainty: Effects on anger and anxiety

Though anger and anxiety are related, putative explanations for this association remain unclear. Beliefs about one's state of uncertainty may be a pathway-the belief that one's uncertain state is unavoidable might lead to anxiety, whereas the belief that one's uncertain state is avoidable might lead to both anxiety and anger. To test this hypothesis, participants experienced an uncertainty induction and were then assigned to the avoidable uncertainty condition (experimental group) or the unavoidable uncertainty condition (control group). State anger and anxiety were assessed at baseline, following the uncertainty induction, and following the "avoidableness" manipulation. The uncertainty induction was successful; participants reported higher levels of anxiety at post-induction compared to baseline. As expected, the experimental group reported increases in anger from post-induction to post-manipulation whereas the control group reported decreases in anger. These findings suggest that when one's state of uncertainty is avoidable, anger is experienced alongside anxiety.

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

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

Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders--differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety

BACKGROUND

Ineffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review.

SCOPE AND METHODOLOGY

We first propose a neuroeconomic model of the decision-making process with separate stages for the prechoice evaluation of expected utility of future options; choice execution and postchoice management; the appraisal of outcome against expectation; and the updating of value estimates to guide future decisions. According to the proposed model, decision making is mediated by neuropsychological processes operating within three domains: (a) self-referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (b) executive functions, such as working memory, inhibition, and planning, that regulate the implementation of decisions; and (c) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralized cortical components of the default mode network, dorsal corticostriatal circuits underpinning higher order cognitive and behavioral control, and ventral frontostriatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes.

FINDINGS AND CONCLUSION

Based on clinical insights and considering each of the decision-making stages in turn, we outline disorder-specific hypotheses about impaired decision making in four childhood disorders: attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision making in ADHD is deficient (i.e. inefficient, insufficiently reflective, and inconsistent) and impulsive (biased toward immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative, and pessimistic, while in anxiety, it is hesitant, risk-averse, and self-deprecating. A survey of current empirical indications related to these disorder-specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research.

The relationship between negative urgency and generalized anxiety disorder symptoms: the role of intolerance of negative emotions and intolerance of uncertainty

BACKGROUND AND OBJECTIVES

GAD symptoms are associated with greater negative urgency, a dimension of impulsivity defined as the tendency to act rashly when distressed. This study examined the degree to which intolerance of negative emotional states and intolerance of uncertainty account for the association between negative urgency and GAD symptoms.

DESIGN

An analysis of indirect effects evaluated whether intolerance of negative emotions and intolerance of uncertainty uniquely account for the association between negative urgency and GAD symptom severity.

METHODS

Undergraduate students (N = 308) completed measures of GAD symptoms, trait anxiety, negative urgency, distress tolerance, and intolerance of uncertainty.

RESULTS

Greater symptoms of GAD, intolerance of negative emotional states, and intolerance of uncertainty were associated with greater negative urgency. There was an indirect relationship between negative urgency and GAD symptoms through intolerance of negative emotional states and intolerance of uncertainty even when controlling for trait anxiety. Intolerance of negative emotional states and intolerance of uncertainty each had an indirect relationship with GAD severity through negative urgency, suggesting possible bi-directional relations.

CONCLUSIONS

Future studies should examine the role of intolerance of negative emotional states and intolerance of uncertainty in the impulsive behavior of individuals with GAD, and whether impulsive behavior reinforces these processes.