Intolerance of uncertainty in adolescents: correlations with worry, social anxiety, and depression

Alexithymia, intolerance to uncertainty and mental health difficulties in adolescents with Type 1 diabetes mellitus

BACKGROUND

Type 1 Diabetes Mellitus (T1DM) represents a serious chronic condition affecting a wide number of people. Discussion of the physical issues associated with T1DM pervades the literature, however, there is less discussion of the psychological consequences. Mental health difficulties, alexithymia and uncertainty are present in this population, and known to be harmful for the onset, maintenance and worsening of T1DM. This study aimed to evaluate the presence of these phenomena in people with T1DM.

METHODS

105 participants aged between 11 and 17 years old (M: 13.88; SD: 2.16) affected by T1DM were included in the sample. To assess the presence of mental health difficulties, SAFA scales (Depression, Anxiety and Somatic symptoms) were included in the protocol together with TAS-20 and IUS-12, which evaluate the presence and role of alexithymia and intolerance to uncertainty in the sample, respectively.

RESULTS

A concerning presence of anxiety, depression and somatic symptoms was found in the sample. Mental health difficulties appeared to be consistently present in the sample, often overcoming pathological thesholds. Alexithymia and uncertainty were also common, highlighting their role in T1DM.

CONCLUSIONS

Active mental health difficulties together with high rates of alexithymia and intolerance to uncertainty were prevalent in the sample of adolescents with diabetes.

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.

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.

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.

Comparing Depression Prevalence and Associated Symptoms with Intolerance of Uncertainty among Chinese Urban and Rural Adolescents: A Network Analysis

The prevalence of depression among adolescents is increasing, which can hinder their healthy development and is intricately linked to the intolerance of uncertainty (IU). IU involves both prospective anxiety and inhibitory anxiety. However, the precise relationship between depressive symptoms and these two components of IU remains unclear, particularly when considering the specific context of rural adolescents in China. A total of 1488 adolescents (male, 848; Meanage = 20, SDage = 1.51, age range from 16 to 24) in China were recruited and divided into urban adolescents (N = 439) and rural adolescents (N = 1049) groups. The Patient Health Questionnaire-9 and Intolerance of Uncertainty Scale-12 were utilized to measure depression and IU. The symptom network approach and the flow network approach were employed. The prevalence of depression was significantly higher (χ2 = 4.09, p = 0.04) among rural adolescents (N = 419, 40.1%) than urban adolescents (N = 152, 34.8%). The node strength of "motor" demonstrated some discrepancy between rural and urban adolescents, while there was no notable disparity in the global strength and structure of the network between the two groups. However, rural adolescents exhibited a significantly higher global strength in the flow network (including depression and IU) than their urban counterparts. In the flow networks of rural adolescents, "guilt" was directly associated with prospective and inhibitory anxiety. These findings highlight the urgent need for interventions that enhance the ability of rural adolescents to cope with uncertainty and prevent their depressive symptoms more effectively.

Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE)

BACKGROUND

Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization and reprocessing (EMDR) therapy. The main goal of this multicenter randomized controlled trial is to investigate whether EMDR therapy plus exposure therapy, relative to supportive counseling plus exposure therapy, improves treatment efficacy, tolerability, and adherence in patients with panic disorder. In addition, we will examine potential predictors of optimal treatment allocation, mechanisms of change as well as the long term effects of treatment. Finally, we will assess cost-effectiveness.

METHODS

A multicenter randomized controlled trial mixed design will be conducted. Participants will be 50 patients, aged ≥ 18, diagnosed with a panic disorder. They will be randomly assigned to one of two conditions: EMDR therapy (i.e., flashforward strategy) or supportive counseling (each consisting of four weekly sessions of 90 min each) prior to exposure therapy (consisting of eight weekly sessions of 90 min each). Assessments will be made pre-treatment (T1), between-treatments (T2), post-treatment (T3), one month post-treatment (FU1) and six months post-treatment (FU2) by an assessor blind to treatment condition. The primary outcome measure is severity of panic-related symptoms. Secondary outcome measures are: tolerability of exposure therapy (initial avoidance, willingness to start exposure therapy, considered drop-out; no-show and drop-out), related symptomatology (generalized anxiety, depression), and functional impairment.

DISCUSSION

The primary goals of this research are to compare the efficacy, tolerability, and adherence of EMDR therapy plus exposure therapy and supportive counseling plus exposure therapy and to identify predictors, moderators, and mediators for treatment success. This multi-center research aims to make a significant contribution to our understanding as to how treatment for patients with anxiety disorders can be optimized, and elucidate who can benefit most from this novel approach.

TRIAL REGISTRATION

ISRCTN-ISRCTN29668369: Improving anxiety treatment by modifying emotional memories before real-life exposure. Registered 27 June 2022-retrospectively registered. ISRCTN-ISRCTN29668369.

The relationship between social anxiety and self-injury of junior high school students: Mediation by intolerance of uncertainty and moderation by self-esteem

Objective

The problem of adolescents' self-injury has gradually attracted social attention, however, a lack of research exists on the internal mechanism between social anxiety and self-injury. This study explored the relationship between social anxiety and self-injury in Chinese junior high school students.

Method

An adolescent self-injury questionnaire, social anxiety scale, intolerance of uncertainty questionnaire and self-injury questionnaire were used to survey 614 junior high school students.

Results

The results showed that: (1) social anxiety had a significant positive predictive effect on self-injury; (2) intolerance of uncertainty had a significant mediating effect between social anxiety and self-injury; and (3) self-esteem had a significant moderating effect on the mediating effect of intolerance of uncertainty.

Conclusion

The study suggested that social anxiety in junior high school students has an impact on self-injury through mediation of intolerance of uncertainty and modulation of self-esteem.

Sensory sensitivity, intolerance of uncertainty and sex differences predicting anxiety in emerging adults

As multiple vulnerability factors have been defined for anxiety disorders, it is important to investigate the interactions among these factors to understand why and how some individuals develop anxiety. Sensory Sensitivity (SS) and Intolerance of Uncertainty (IU) are independent vulnerability factors of anxiety, but their unique relationship in predicting anxiety has rarely been studied in non-clinical populations. The objective of this investigation was to examine the combined effects of SS and IU on self-reported anxiety in a sample of university students. In addition, with the frequently reported sex bias in anxiety literature, we expected that the combined effects of vulnerability factors would be different for females and males. A convenience sample of 313 university students, ages 17-26 years was recruited. The participants completed the Intolerance of Uncertainty Scale (IUS-12), the Adult/Adolescent Sensory Profile (AASP), and the Beck Anxiety Inventory (BAI). Results of moderated mediation analyses demonstrated a strong partial mediation between SS and anxiety through IU, providing evidence that IU, a cognitive bias against the unknown, was one mechanism that explained how SS was related to anxiety. Further, the effect of IU on anxiety was approximately twice as strong in females. Our results highlight the importance of studying the unique relationships among multiple vulnerability factors to better understand anxiety susceptibility in emerging adults.

Intolerance of Uncertainty and Social Anxiety: An Experimental Investigation

Intolerance of uncertainty (IU) is a cognitive bias that leads to perception and intolerance of uncertainty and has associated negative cognitive, emotional, and behavioural responses. It plays a strong role in social anxiety disorder (SAD; Counsell et al., 2017). Our experimental study examined the impact of uncertainty related to a social stressor on SAD using a speech task. We examined features of SAD including anticipatory anxiety, anxiety during the task, willingness to perform the task, and avoidance of the task. Undergraduate students (N = 110, 88% female) with significant social anxiety completed a series of questionnaires, then were randomised to one of two conditions related to level of uncertainty about an impromptu speech task. The experimental condition (state IU) did not predict any of the outcome variables, while trait IU significantly predicted anxiety levels. Results indicate that increased uncertainty of a social situation does not impact acute anxiety levels in SAD and reinforce the strong role of trait IU as a transdiagnostic cognitive variable. Neither trait nor state IU predicted the willingness and avoidance variables. Results also highlighted the central role of the experience of anxiety on avoidance behaviours, above cognitive factors such as IU.

The Role of Pre-Pandemic Mental Health Status and Personality Traits on Psychological Distress during the COVID-19 Lockdown among Italian Young Adults

The COVID-19 pandemic imposed changes on day-to-day activities and had a detrimental psychological effect on the population, especially among vulnerable individuals, such as adolescents and young adults. The current study aimed to explore variables associated with anxiety, depressive and somatic symptoms in a sample of 608 Italian young adults aged 18 to 25. Data were collected using an online questionnaire administered two months into the COVID-19 lockdown, which explored several areas including sociodemographic information, pre-pandemic and current psychological distress, pre-pandemic and current levels of loneliness, and the traits of intolerance of uncertainty and boredom susceptibility. Results highlighted that having pre-existing mental health issues, being female, and the personality traits of intolerance to uncertainty and boredom susceptibility all played a role in the psychological distress experienced during the pandemic. COVID-19 contributed to negative impacts on young adults' mental health, highlighting the necessity to develop protective psychological intervention tailored for this vulnerable population.

Intolerance of Uncertainty and Emotional Processing in Adolescence: Separating Between-Person Stability and Within-Person Change

Previous research on the relation between Intolerance of Uncertainty (IU) and Emotional Processing (EP) during adolescence is limited. The present study aimed to clarify how IU and EP evolve over time, to what extent they are related, and whether changes in one precede or follow changes in the other. A total of 457 Italian adolescents (53.1% girls) aged 11 to 18 years (M = 14.1 ± 2.27) completed the IU and EP scales on three separate occasions three months apart (T1, T2, and T3). Data were modeled using a Random-Intercept Cross-Lagged Panel Model (RI-CLPM) that separates individual differences between individuals from intraindividual changes. Descriptive analyses showed that IU was relatively stable between T1 and T2 and decreased slightly between T2 and T3. Consistent with the view that emotion regulation improves as adolescents develop, EP difficulties were found to decrease between T1 and T2 and between T2 and T3. The RI-CLPM revealed a strong between-person effect, showing that individual differences in IU and EP remained consistent throughout the study. In addition, significant within-person change was found, with adolescents who increased their IU at T1 and T2 also increasing their EP difficulties at T2 and T3, respectively. The opposite effect had a smaller effect size. In sum, our study showed that IU and EP are intertwined in adolescents and that changes in IU precede corresponding changes in EP. These results suggest a priority of change between IU and EP and confirm the relationship between IU and emotion regulation problems in adolescence.

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.

Pre-pandemic socio-emotional vulnerability, internalizing and externalizing symptoms predict changes in hair cortisol concentrations in reaction to the COVID-19 pandemic in children

The COVID-19 pandemic led to increased distress in many children, particularly in girls. Socio-emotional vulnerability, as well as psychiatric symptomatology prior to or during the initial stages of the pandemic, have been identified as important predictors of this distress. Still, it is unclear whether the pandemic also had physiological repercussions in children. If so, it remains to be determined whether these same predictors could provide insight into inter-individual variability. This longitudinal study aimed to investigate the effects of socio-emotional vulnerability, as well as pre-pandemic internalizing and externalizing symptoms, on hair cortisol concentrations (HCC) in response to the COVID-19 pandemic in healthy youth. In June 2020 (T1), 69 healthy children (M = 11.57 y/o) who visited the laboratory between 2017 and 2019 (T0) provided a 6 cm hair sample. This technique allowed us to quantify cortisol secretion during the three months preceding the COVID-19 pandemic (Segment A) and during the first three months of the first wave of the pandemic in Quebec, Canada (Segment B). At T0, participants completed the Dominic Interactive to assess pre-pandemic internalizing and externalizing symptoms. A socio-emotional composite score (SECS) was derived using a weighted z-score with the following constructs: anxiety sensitivity (Childhood Anxiety Sensitivity Index) measured at T0, trait anxiety (Trait subscale of the State-Trait Anxiety Inventory for Children (STAI-C)), intolerance of uncertainty (Intolerance of Uncertainty Scale for Children), and trait rumination (Children's Response Style Scale) measured at T1. A linear regression was conducted using the percent change in HCC across Segment A and B as the dependent variable, where SECS, pre-pandemic internalizing and externalizing symptoms, and sex were used as predictors. We found a main effect of sex, with girls presenting increased HCC reactivity compared to boys. We also found that SECS and internalizing symptoms negatively predicted HCC, whereas the opposite relationship was found between externalizing symptoms and HCC reactivity. For healthy children, our results suggest that previous psychiatric symptoms and socio-emotional vulnerability may be risk factors for the presentation of diverging cortisol response patterns in response to an adverse life event (such as the COVID-19 pandemic).

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

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

Uncertainty about others' trustworthiness increases during adolescence and guides social information sampling

Adolescence is a key life phase for developing well-adjusted social behaviour. An essential component of well-adjusted social behaviour is the ability to update our beliefs about the trustworthiness of others based on gathered information. Here, we examined how adolescents (n = 157, 10-24 years) sequentially sampled information about the trustworthiness of peers and how they used this information to update their beliefs about others' trustworthiness. Our Bayesian computational modelling approach revealed an adolescence-emergent increase in uncertainty of prior beliefs about others' trustworthiness. As a consequence, early to mid-adolescents (ages 10-16) gradually relied less on their prior beliefs and more on the gathered evidence when deciding to sample more information, and when deciding to trust. We propose that these age-related differences could be adaptive to the rapidly changing social environment of early and mid-adolescents. Together, these findings contribute to the understanding of adolescent social development by revealing adolescent-emergent flexibility in prior beliefs about others that drives adolescents' information sampling and trust decisions.

Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters

The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.

A longitudinal investigation of psychological distress in children during COVID-19: the role of socio-emotional vulnerability

BACKGROUND

Although the COVID-19 pandemic has increased the incidence of distress in youth, some children show increased resilience, emphasizing the need to better understand the predictors of distress in youth.

OBJECTIVE

This longitudinal study aimed to assess the combined impact of known socio-emotional predictors of stress-related psychopathology, namely anxiety sensitivity, anxiety trait, intolerance to uncertainty, and rumination, on COVID-related distress in healthy youth.

METHOD

A total of 92 parent-child dyads that previously participated in a laboratory-based experiment assessing observational fear learning in families between 2017 and 2019 (T0) were recontacted. Of them, 84 children aged between 9 and 14 agreed to participate. They completed online questionnaires in June 2020 (T1), September 2020 (T2), December 2020 (T3), and March 2021 (T4). Participants were free of mental illness at T0 and T1. To create a socio-emotional composite score (SECS), we measured anxiety sensitivity (Childhood Anxiety Sensitivity Index) at T0, trait anxiety (Trait subscale of the State-Trait Anxiety Inventory for Children (STAI-C)), intolerance to uncertainty (Intolerance of Uncertainty Scale for Children), and trait rumination (Children's Response Style Scale) at T1 and created a weighted z-score. To assess symptoms of anxiety, post-traumatic stress (PTS), and depression in reaction to COVID-19, participants completed the State subscale of the STAI-C, the Children's Revised Impact of Event Scale, and the Children's Depression Inventory at T1-T4. Three general linear models were run with sex, age group (9-11 and 12+ years old), and SECS as predictors.

RESULTS

Analyses revealed a SECS*Time interaction, with higher SECS predicting elevated anxiety symptoms at T1 and T4, and elevated PTS symptoms at T1 and T2.

CONCLUSION

These results suggest that healthy youth endorsing high levels of socio-emotional vulnerability to psychopathology have a higher risk of suffering from anxiety and PTS, but not depressive symptoms, in the year following a major stressor.

How deep is your thought? The relations between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa

BACKGROUND

Inherent to anorexia nervosa are repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. The relation between these cognitive processes and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study investigated associations between prospective (desire for predictability) and inhibitory (uncertainty paralysis) intolerance of uncertainty, and weight and shape concerns and the mediating role of worry in these associations.

METHODS

In a cross-sectional study, 93 adolescent girls with anorexia nervosa completed questionnaires measuring the variables of interest. A mediation model with worry as a mediator between inhibitory and prospective intolerance of uncertainty and weight and shape concerns was tested.

RESULTS

A total and direct effect of inhibitory intolerance of uncertainty on weight and shape concerns was found. Worry did not mediate this relation.

CONCLUSIONS

These results confirm the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls with anorexia nervosa. Adolescent girls with anorexia nervosa often experience repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and is often divided into two components; prospective intolerance of uncertainty (desire for predictability) and inhibitory intolerance of uncertainty (uncertainty paralysis). The relation between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study aims to investigate study relations between prospective and inhibitory intolerance of uncertainty, worry, and weight and shape concerns. A total of 93 adolescent girls with anorexia nervosa completed three questionnaires, measuring prospective and inhibitory intolerance of uncertainty worry, and weight and shape concerns, respectively. The results of this study confirmed the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls.

Item bias on the geriatric depression scale (GDS): investigating the quality and generalizability of GDS on Chinese and Korean community-dwelling elderly population

BACKGROUND

Although some previous studies have reported the impact of cultural factors on individuals' cognition and decision making, a shortage of research has led to this comparison study for Chinese and Korean elderly, a growing population with depression. This study aimed to explore depression levels in Chinese and South Korean elderly individuals by focusing on testing the generalizability of the Geriatric Depression Scale (GDS).

METHODS

The data of 493 community-dwelling Chinese and Korean elderly individuals over the age of 60 years were used to examine GDS. To test the dimensionality, item quality, and reliability of the GDS, the item response theory, Rasch analysis was performed. The detection of differential item functioning (DIF) of the GDS between the two countries was determined by performing a hybrid ordinal logistic regression.

RESULTS

The four-dimensional framework of the GDS, categorized into agitation, cognitive concerns, dysphoria, and vigor/withdrawal was fit for measuring depression levels in Chinese and Korean elderly individuals. In addition, good item quality and reliability of the GDS indicate that almost all items in this scale contribute to measuring the intended trait. Meanwhile, 18 out of 28 items of the GDS were detected as country-related DIF with five items having a large effect size.

CONCLUSIONS

Although China and Korea are close geographically and culturally, the item bias shown by severe country-related DIF implies that different cultural backgrounds impact how the elderly interpret GDS items. The cultural issues related to the specific DIF items, the implication to accuracy of individual scores estimation, and the optimal decision to treat individuals were discussed.

Clinical Characteristics of Predominantly Unilateral Oral Cenesthopathy With and Without Neurovascular Contact

Oral cenesthopathy (OC) is characterized by unusual oral discomfort without corresponding evidence, and it has often been categorized as "delusional disorder, somatic type". Regarding possible causative factors of OC, involvement of neurovascular contact (NVC) of the trigeminal nerve, which transmits not only pain but also thermal, tactile, and pressure sensations, has never been observed yet. This study aimed to investigate the relationship between clinical characteristics of unilateral OC and the presence of trigeminal nerve NVC. This is a retrospective comparative study that involved 48 patients having predominantly unilateral OC who visited the Psychosomatic Dentistry Clinic of Tokyo Medical and Dental University between April 2016 and February 2019. Magnetic resonance imaging was performed to assess NVC presence. The Oral Dysesthesia Rating Scale (Oral DRS) was used to assess the various oral sensations and functional impairments besides psychometric questionnaires. Clinical characteristics were retrospectively obtained from the patients' medical charts. NVC was present in 45.8% (22/48) of the patients. There was no significant difference in sex, age, psychiatric history, oral psychosomatic comorbidity, and psychometric questionnaire scores between patients with and without NVC. However, compared to the patients with NVC, the patients without NVC had significantly higher scores for overall subjective severity of OC symptoms (p = 0.008). Moreover, patients having predominantly unilateral OC without NVC showed significantly higher scores in symptom severity and functional impairment of the following parameters: movement (p = 0.030), work (p = 0.004), and social activities (p = 0.010). In addition, compared with the patients with NVC, the patients without NVC showed significantly higher averages of the total symptom severity scale (SSS) and functional impairment scale (FIS) scores in the Oral DRS (p = 0.015 and p = 0.031, respectively). Furthermore, compared with the patients with NVC, the patients without NVC had significantly higher numbers of corresponding symptoms in both the SSS and FIS (p = 0.041 and p = 0.007, respectively). While NVC may be involved in the indescribable subtle OC symptoms, more complex mechanisms may also exist in OC patients without NVC, which yield varying and more unbearable oral symptoms.

Intolerance of Uncertainty, Anxiety and Depression in the Context of Covid-19 in Indonesia

"This Covid-19 pandemic brings uncertainty and may lead to mental problems. Yet, in this context, no study has examined the relationship between intolerance of uncertainty (IU) and either anxiety or depression during pandemic among Indonesians. This study investigated the pathway between IU, anxiety and depression serially mediated by cognitive appraisals (perceived severity, controllability, and knowledge) and emotional and behavioural responses to COVID-19. Online psychological measures were administered to 406 participants, including the IUS-12, the DASS-21, cognitive appraisal scales, and emotional and behavioural response scale. An indirect pathway was found between IU and depression, and the effect was serially mediated by perceived of severity and emotional and behavioural responses to COVID-19. Perceived knowledge and perceived controllability of COVID-19 did not significantly contribute to the model. A similar pathway was found for IU predicting anxiety. As conclusion, IU represents a risk factor for heightened emotional and behavioural difficulties that eventually, could lead to either anxiety or depression during COVID-19."

Development of the Perth Adolescent Worry Scale (PAWS)

Tools to assess worry among adolescents exist but do not capture the content of worries. This study reports on the development of a brief, psychometrically sound measure of worry for use with adolescents. Phase 1 involved identification of 27 potential items from existing instruments as well as item generation identified in interviews with students, teachers, school psychologists, and parents. In Phase 2, the candidate items were completed by 835 Australian adolescents (317 males, 508 females, 10 unspecified; Mean age = 13.55, SD = 1.31) from Grades 5 to 10. These data were randomly split in half, and an exploratory factor analysis on the first half identified a two-factor solution with 12 items: Peer Relationships (6 items) and Academic Success and the Future (6 items). On the second half of the data, confirmatory factor analyses supported the factor structure and supported strong invariance across age, socioeconomic status, and presence/absence of a diagnosed neurodevelopmental disorder. Weak invariance was evident across sex. Differences across groups are reported as are correlations with indicators of psychological wellbeing. In conclusion, the Perth Adolescent Worry Scale provides both applied professionals and researchers with a short, easy-to-administer, and psychometrically strong instrument to evaluate adolescents’ everyday worries.

Social Anxiety and Depression in Romantic Relationships: A Three-Sample Exploration

Introduction: Social anxiety contributes to a variety of interpersonal difficulties and dysfunctions. Socially anxious adults are less likely to marry and more likely to divorce than are non-anxious adults. The present pre-registered study investigated incremental variance accounted for by social anxiety in relationship satisfaction, commitment, trust, and social support. Methods: Three independent samples of adults (N = 888; 53.7% female; Mage = 35.09 years) involved in a romantic relationship completed online self-report questionnaires. Both social anxiety and depression were significantly correlated with relationship satisfaction, commitment, dyadic trust, and social support. Hierarchical regression analyses were conducted with each sample to investigate the incremental variance accounted for by each of social anxiety and depression in relationship satisfaction, commitment, dyadic trust, and social support. Subsequent meta-analyses were run to determine the strength and replicability of the hierarchical models. Results: Results suggest that social anxiety is a robust predictor of unique variance in both perceived social support and commitment. Depression was a robust predictor of unique variance in relationship satisfaction, dyadic trust, social support, and commitment. Discussion: These results help to further understanding of social anxiety in romantic relationships and provide direction for future research and clinical intervention.

Intolerance of uncertainty and reactions to the COVID-19 pandemic

The COVID-19 pandemic has presented a threat to mental health worldwide. The current study aims to investigate the role of intolerance of uncertainty in cognitive, emotional and behavioral reactions to this pandemic and propose a path model of these reactions. In the first two months of the COVID-19 pandemic in Slovakia, participants in a general sample (n = 1,011) as well as an older adult sample (n = 655) completed measures regarding intolerance of uncertainty, mental health (anxiety, well-being, perceived stress) and adherence to preventive measures. Two rounds of data collection were carried out in the first sample. Intolerance of uncertainty was found to be related to mental health indicators and the structural equation model showed a direct and indirect effect on them as well as on the adherence to preventive measures. However, the comparison of data from different time points has brought inconsistent results. The findings highlight the role of intolerance of uncertainty in reaction to threat and indicate the potential of uncertainty reduction e.g., getting clear messages from authorities, as a way of decreasing mental health problems.

A longitudinal examination of the interpersonal fear avoidance model of pain: the role of intolerance of uncertainty

Youth with chronic pain and their parents face uncertainty regarding their diagnosis, treatment, and prognosis. Given the uncertain nature of chronic pain and high comorbidity of anxiety among youth, intolerance of uncertainty (IU) may be critical to the experience of pediatric chronic pain. This study longitudinally examined major tenets of the Interpersonal Fear Avoidance Model of Pain and included parent and youth IU as key factors in the model. Participants included 152 youth with chronic pain (Mage = 14.23 years; 72% female) and their parents (93% female). At baseline, parents and youth reported on their IU and catastrophic thinking about youth pain; youth reported on their fear of pain, pain intensity, and pain interference; and parents reported on their protective responses to child pain. Youth reported on their pain interference 3 months later. Cross-lagged panel models, controlling for baseline pain interference, showed that greater parent IU predicted greater parent pain catastrophizing, which, in turn, predicted greater parent protectiveness, greater youth fear of pain, and subsequently greater youth 3-month pain interference. Youth IU had a significant indirect effect on 3-month pain interference through youth pain catastrophizing and fear of pain. The results suggest that parent and youth IU contribute to increases in youth pain interference over time through increased pain catastrophizing, parent protectiveness, and youth fear of pain. Thus, parent and youth IU play important roles as risk factors in the maintenance of pediatric chronic pain over time and may be important targets for intervention.

Maladaptive metacognitive beliefs mediated the effect of intolerance of uncertainty on depression

Both elevated intolerance of uncertainty (IU) and maladaptive metacognitive beliefs (MBs) were associated with depression. However, the relationship between MBs and IU in clinical depression is unclear. The current study aimed to investigate the putative impairment of MBs and IU in major depressive disorder (MDD) and explore the relationship between these two factors with depressive symptoms. Metacognition Questionnaire-30 Items (MCQ-30), Intolerance of Uncertainty Scale-Short Form (IUS-12) and clinical rating scales were administered to 53 patients with MDD and 56 healthy controls (HCs). Stepwise regressions were performed to explore independent contributions of MBs and IU on depression. Mediation analysis was used to examine associations among variables. Patients with MDD reported higher IUS-12 and MCQ-30 scores than HCs. Stepwise regressions revealed a unique contribution of negative MBs concerning the consequences of not controlling thoughts (MCQ-NC) on depression symptoms while controlling the effects of age, gender, anxiety symptoms and IU. MCQ-NC and negative MBs concerning the uncontrollability and danger of negative thinking (MCQ-NEG) completely mediated the effects of IU on depression and anxiety symptoms. Our results provided clear evidence that maladaptive negative MBs are directly associated with depression symptoms, and mediated the effect of IU on depression and anxiety symptoms, suggesting that IU and MBs influence clinical symptoms in a hierarchical manner.

Psychometric Evaluation of the Intolerance of Uncertainty Scale for Children (IUSC): Findings From Clinical and Community Samples in Iran

OBJECTIVE

The present study examined the psychometric properties of a Persian version of the Intolerance of Uncertainty Scale for Children (IUSC; Comer et al, 2009).

METHOD

Participating youth (n = 346) 8 to 18 years of age were nonreferred community youth (n = 279) or youth who met diagnostic criteria for an anxiety disorder (n = 67) and their parents.

RESULTS

Across child- and parent-report data, confirmatory factor analysis supported a shortened 12-item version of the IUSC, and the confirmatory factor analysis also confirmed a theory-driven correlated two-factor structure of the IUSC-12. (i.e., prospective/inhibitory IU). Results further supported reliability and validity of parent- and child-reports of the Persian IUSC-12 via evidence of internal consistency, 4-week retest, significant associations with established measures of internalizing problems, and the ability of the measure to reliably distinguish the clinical sample from the community sample.

CONCLUSION

Findings demonstrate sound psychometric properties of the Persian version of the IUSC-12 and provide additional support for the reliability and validity of the measure and its use in non-Western cultures. Findings are discussed in terms of implications for assessment, treatment, and study of anxiety and related internalizing problems in Iranian youth.

Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19

The novel coronavirus (COVID-19) pandemic has caused widespread disruption to our traditional way of life and mental health therapy has not been spared. A combination of increased anxiety, diminished social opportunities, and the shift to telehealth service provision presents particular challenges for the treatment of social anxiety in youth, which relies heavily on exposures to social situations with peers, adults, or other feared social stimuli. The objective of this commentary is to provide guidance to clinicians working with youth with social anxiety on how to maintain ethical, evidence-informed provision of exposure therapy in light of these unusual circumstances. We first present an overview of how COVID-19 may uniquely impact youth with social anxiety and highlight the importance of continuing to provide exposure-based treatments during this time. We then discuss guiding principles for delivering exposure therapy during COVID-19. We focus on providing practical examples of how common social anxiety exposures can be adapted and delivered successfully through telehealth while abiding by COVID-19 social distancing guidelines. Finally, we discuss key recommendations to assist clinicians in moving treatment forward while considering changing safety guidelines pertaining to COVID-19.

Evaluating the psychometric properties of the intolerance of uncertainty scale for children in a preadolescent sample

Intolerance of Uncertainty (IU) is a dispositional tendency to react negatively to uncertainty. The Intolerance of Uncertainty Scale for Children (IUS-C) is designed to measure IU in children but there has been limited investigation into the psychometric properties of this scale. Using data from 227 preadolescent children and 204 parents, we examined (a) readability and whether any items were difficult to understand for children and parents, (b) factor structure, (c) test-retest reliability, and (d) the agreement between child and parent forms of the IUS-C. Results revealed that the reading age of the IUS-C may be too high for preadolescent children and that both children and parents found some items difficult to understand. Model fit with the full IUS-C was not adequate for either parent or child forms. For both forms, selecting items aligned with the IUS-12 led to adequate model fit. For both child-report and parent-report, a one-factor model was supported. Test-retest reliability of total score for all versions was high over a 2-week period (child form: ICC = .82 for 27 item and ICC = .73 for 12 items; parent form: ICC = .87 for 27 item and ICC = .86 for 12 item) but agreement between child and parent forms was consistently poor (r = .24 for 27 item and r = .29 for 12 item). Overall, the results suggest that IUS-C-12 is most appropriate for preadolescent children and their parents. The reading age remains slightly high for preadolescent children so it may be beneficial for future research to consider developing a child-report version with lower reading age.

Exploring the cognitive, emotional and sensory correlates of social anxiety in autistic and neurotypical adolescents

BACKGROUND

Social anxiety is common in autistic adolescents. While emerging evidence indicates the importance of several mechanisms (including intolerance of uncertainty (IU), alexithymia and sensory processing) for maintaining anxiety, limited research has explored how these factors are associated with social anxiety in autistic adolescents.

METHODS

We investigated whether IU, emotional and sensory processing are related to social anxiety in autistic and neurotypical adolescents, gathering experimental and questionnaire data from 61 autistic and 62 neurotypical 11- to 17-year-olds recruited to have similarly high levels of anxiety.

RESULTS

In autistic and neurotypical adolescents matched for social anxiety, similar significant associations were observed between social anxiety and IU, alexithymia, maladaptive emotion regulation, sensory hypersensitivity and interoceptive sensibility. Taking a dimensional approach, we found that child- and parent-reported IU, alexithymia and sensory hypersensitivity mediated the relationship between autistic traits and social anxiety symptoms in the combined group of adolescents.

CONCLUSIONS

Our findings indicate that similar correlates of social anxiety are evident in autistic and neurotypical youths experiencing social anxiety and further our understanding of mechanisms that may contribute towards social anxiety in both groups.

The Co-occurrence of Pediatric Chronic Pain and Anxiety: A Theoretical Review of a Developmentally Informed Shared Vulnerability Model

The development and maintenance of pediatric chronic pain and anxiety are complex, underscoring the need to better understand the interactive forces contributing to their co-occurrence. The shared vulnerability model (SVM) was developed to explain the co-occurrence of chronic pain and posttraumatic stress disorder in adults. Although many core tenets have been well supported by pediatric research, the SVM has yet to be extended to pediatric pain populations. We propose a developmentally informed pediatric SVM for advancing our understanding of the co-occurrence of pediatric chronic pain and anxiety disorders. The proposed SVM postulates that youth at increased risk for the development of chronic pain and/or anxiety share predisposing vulnerabilities, including anxiety sensitivity, and that these shared vulnerabilities give rise to negative emotional responses (child and parent) in the context of stressful events. Consequences of fear and anxiety, including avoidance behavior, further contribute to the development of chronic pain, anxiety, and their co-occurrence. The parental, school, and peer contexts in which these problems develop and are maintained in youth are pertinent to integrate into a SVM, as pediatric chronic pain and anxiety disorders share several social-contextual risk and maintenance factors. We also highlight new areas of inquiry.

Integrating and differentiating personality and psychopathology in cognitive behavioral therapy

A large body of literature supports the strong association between personality features and psychopathology. This research has, however, had little influence on day-to-day therapeutic practice, particularly in cognitive behavioral approaches that have traditionally focused on addressing the symptoms of categorically defined diagnoses. Indeed, there are few CBT protocols aimed at altering the personality features. Recently, however, the CBT literature has displayed an increased focus on identifying alternative higher-order, dimensional mechanisms that may underscore the development and maintenance of broad classes of psychopathology (e.g., aversive reactivity to emotions, reward sensitivity, and performance expectancies). There is ample evidence linking these processes to DSM disorder severity; however, they may also represent a functional link between the personality domains and the disorder symptoms organized beneath them. The functional mechanisms through which an individual's personality confers risk for psychopathology may be naturally amenable to cognitive behavioral elements, and targeting these processes in treatment has the potential to address both disorder symptoms and underlying personality vulnerabilities. Thus, the identification of intermediate functional mechanisms may help bridge the gap between personality science and clinical practice.

Intolerance of Uncertainty and Parental Accommodation: Promising Targets for Personalized Intervention for Youth Anxiety

PURPOSE OF REVIEW

After reviewing predictors of differential outcomes of cognitive behavioral therapy (CBT) for pediatric anxiety, we identify and discuss recent evidence for the role of (a) intolerance of uncertainty (IU) and (b) parental accommodation as meaningful targets for personalized intervention.

RECENT FINDINGS

Few studies to date have identified promising, theory-driven predictors of differential CBT outcomes. Recent findings suggest that increased IU and high levels of parental accommodation are associated with a poorer response to CBT. Several adaptations of CBT and new interventions targeting either IU or parental accommodation have been developed and found to be efficacious in preliminary studies. IU and parental accommodation are promising constructs for personalizing intervention, both in the identification of who will respond to treatment and in the development of targeted intervention. We recommend that future work test if individuals high in IU and/or parental accommodation will respond more optimally to treatments that specifically target these constructs. The results of this future work may help to move the field closer to personalized intervention.

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.

Intolerance of uncertainty in youth: Psychometrics of the Intolerance of Uncertainty Index-A for Children

Intolerance of uncertainty (IU) is a cognitive vulnerability for pathological anxiety. The current study adapted the Intolerance of Uncertainty Index-A for Children (IUI-A-C), and created a single-item Intolerance of Uncertainty Clinician-Rated Index (IUCR), both of which assess a youth's general inability to endure uncertainty. Psychometric properties of these two measures were evaluated. Participants were 146 youth aged 7-17 years seeking treatment for anxiety. The IUI-A-C evidenced individual item performance (i.e., correlations between each item and the total remainder score > .40, ps <.001), internal consistency, convergent validity with the IUCR and self-report measures of anxiety and functional impairment, divergent validity with ADHD severity, and retest reliability with a mean interval of over four weeks. The IUCR also evidenced convergent validity with the IUI-A-C and self-report measures of anxiety and functional impairment and divergent validity with ADHD severity. The IUI-A-C predicted composite principal diagnosis severity but did not predict composite GAD diagnosis severity. The IUI-A-C and IUCR have utility as measures of IU in youth. The role of IU in specific anxiety disorders and future research are discussed.

A Preliminary Investigation of Cognitive Features Associated With Worry Among African American Youth

Although knowledge of the cognitive factors that place children at risk for worry has grown, little is known about these processes within African American youth. The present study investigated cognitive factors associated with worry in a sample of 47 African American children, ages 8 to 13. Participants completed self-report measures of worry, intolerance of uncertainty, positive and negative beliefs about worry, and negative problem orientation. Results supported the hypothesis that cognitive factors demonstrated significant positive associations with worry. Based on a model predicting worry from all cognitive factors, negative beliefs about worry emerged as the only individual predictor. This is the first study to examine cognitive factors associated with worry in an African American sample of children and provides initial support for the applicability of these cognitive factors in future examinations of worry within this population. Future research should continue to explore cognitive as well as other factors that predispose African America children to worry.

The experience of intolerance of uncertainty for young people with a restrictive eating disorder: a pilot study

PURPOSE

Research is consistently reporting elevated levels of intolerance of uncertainty (IU) in individuals with an eating disorder (ED). Less is known about the phenomenology of uncertainty for this clinical group. The present study aims to advance our understanding of the relationship between IU and restrictive EDs by providing insight into young people's subjective experiences of uncertainty.

METHODS

Thirteen young people with a restrictive ED were recruited from multi-family therapy groups run within the Maudsley Centre for Child and Adolescent Eating Disorders at the South London and Maudsley NHS Foundation Trust. Three focus groups were conducted asking young people to discuss their views, experiences and coping strategies when faced with uncertainty.

RESULTS

Data were analysed using interpretative phenomenological analysis which yielded five superordinate themes: (1) young people perceived uncertainty as something negative; (2) high levels of anxiety and stress were identified as primary responses to uncertainty; (3) ED behaviours were given a functional role in reducing uncertainty; (4) need to control various aspects of young peoples' lives was of high importance; (5) young people discussed how they struggled to find ways to cope with uncertainty and often used behaviours associated with the eating disorder psychopathology as coping strategies.

CONCLUSION

Young people's experiences of what uncertainty is like for them revealed a dynamic interplay between ED symptoms and fear of uncertainty. Findings support IU as a relevant concept for young people suffering from a restrictive ED and indicate that further exploration of IU from both theoretical and clinical perspectives could be fruitful.

LEVEL OF EVIDENCE

V.

Intolerance of uncertainty moderates the relations among religiosity and motives for religion, depression, and social evaluation fears

OBJECTIVES

Intolerance of uncertainty (IU) underlies several psychological disorders, and religion may help some individuals cope with IU and/or protect against psychological symptoms. It was hypothesized that IU would moderate the relations between coping motives for being religious, as well as religiosity, and common psychological disorder symptoms: Depression and social evaluation fears.

METHODS

Study 1 included 473 self-reporting community members (M _age  = 48, 48% female, 80% Protestant/Catholic). Study 2 included 412 self-reporting undergraduates ( M _age  = 19, 71% female, 76% Protestant/Catholic).

RESULTS

For Study 1, coping-based motives related to greater depression for young adults with above-average IU and to lower depression for young adults with below-average IU. For Study 2, religiosity related to lower depression and fear of negative evaluation for individuals with above-average IU and to greater fear of positive evaluation for individuals with below-average IU.

CONCLUSION

IU may be an important mechanism between aspects of religion and psychological disorder symptoms.

Relationships between autism spectrum disorder and intolerance of uncertainty

Intolerance of uncertainty (IU) is a dispositional risk factor involving maladaptive responding under conditions of uncertainty. Recent data indicate that IU is likely elevated in youth with autism spectrum disorder (ASD) and is positively correlated with anxiety. This study examined whether IU may be associated with ASD independent of anxiety. Relationships between anxiety, ASD, and IU were examined in 57 children with ASD without co-occurring intellectual disability and 32 control participants, ages 7-16 years. Hierarchal linear regressions were run to examine whether ASD variables, including emotion dysregulation, were predictive of IU when controlling for anxiety. Severity of social communication deficits, repetitive behaviors, and emotion dysregulation were each related to IU when controlling for the effects of anxiety. When these variables were entered into the regression model together, emotion dysregulation was the only significant predictor of IU. These findings suggest that IU is directly related to features of ASD possibly due to shared genetic, neurological, or psychological underpinnings. Autism Res 2018, 11: 636-644. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

Youth with ASD without co-occurring intellectual disability experience high levels of intolerance of uncertainty (IU), which is related to anxiety. This study found that IU may also have a relationship with certain aspects of ASD, particularly emotion dysregulation.

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

BACKGROUND

Intolerance of uncertainty (IU) has been implicated in the development and maintenance of worry and anxiety in adults and there is an increasing interest in the role that IU may play in anxiety and worry in children and adolescents.

METHOD

We conducted a systematic review and meta-analysis to summarize existing research on IU with regard to anxiety and worry in young people, and to provide a context for considering future directions in this area of research. The systematic review yielded 31 studies that investigated the association of IU with either anxiety or worry in children and adolescents.

RESULTS

The meta-analysis showed that IU accounted for 36.00% of the variance in anxiety and 39.69% in worry. Due to the low number of studies and methodological factors, examination of potential moderators was limited; and of those we were able to examine, none were significant moderators of either association. Most studies relied on questionnaire measures of IU, anxiety, and worry; all studies except one were cross-sectional and the majority of the studies were with community samples.

LIMITATIONS

The inclusion of eligible studies was limited to studies published in English that focus on typically developing children.

CONCLUSIONS

There is a strong association between IU and both anxiety and worry in young people therefore IU may be a relevant construct to target in treatment. To extend the existing literature, future research should incorporate longitudinal and experimental designs, and include samples of young people who have a range of anxiety disorders.

Factor structure of the intolerance of uncertainty scale for children

Intolerance of uncertainty (IU), a dispositional negative orientation toward uncertainty and its consequences, has been studied in adults, but research has only recently examined IU in youth. Despite some advances, little is known about the factor structure of measures of IU in youth. The present study used confirmatory factor analysis to examine the structure of IU as measured by the Intolerance of Uncertainty Scale for Children (IUSC; Comer et al., 2009) in a sample of youth (N=368) 9-18 years of age (M_age=12.47) with and without anxiety disorders and their mothers. Findings demonstrated multiple acceptable factor structures: a correlated factors 2-factor structure and a bifactor model where a general factor underlies all items. While the bifactor model provides better fit and reliability to the data, multivariate analyses indicated that the 2-factor structure distinguishes apprehensive anxiety regarding future events (prospective IU) from present-focused inhibition of behavior due to uncertainty and negative reactions to the presence of uncertainty (inhibitory IU); a total IU score predicted all anxiety domains for self- and parent-reports except for parent-report harm avoidance. Findings are discussed in terms of consistency of IU across adult and youth samples, and how results can inform treatment efforts and etiologic models of IU and anxiety.

What's the Worry with Social Anxiety? Comparing Cognitive Processes in Children with Generalized Anxiety Disorder and Social Anxiety Disorder

Social anxiety disorder (SAD) in children is often comorbid with generalized anxiety disorder (GAD). We investigated whether worry, intolerance of uncertainty, beliefs about worry, negative problem orientation and cognitive avoidance, that are typically associated with GAD, are present in children with SAD. Participants included 60 children (8-12 years), matched on age and gender. Groups included children: with primary GAD and without SAD (GAD); with primary SAD and without GAD (SAD); and without an anxiety disorder (NAD). GAD and SAD groups scored significantly higher than the NAD group on worry, intolerance of uncertainty, negative beliefs about worry and negative problem orientation, however, they did not score differently from each other. Only the GAD group scored significantly higher than the NAD group on cognitive avoidance. These findings further understanding of the structure of SAD and suggest that the high comorbidity between SAD and GAD may be due to similar underlying processes within the disorders.

Intolerance of Uncertainty Scale: Measurement invariance among adolescent boys and girls and relationships with anxiety and risk taking

BACKGROUND AND OBJECTIVES

Adolescence-related increases in both anxiety and risk taking may originate in variability in Intolerance of Uncertainty (IU), rendering the study of IU of importance. We therefore studied the psychometric properties of the Intolerance of Uncertainty Scale-Short version (IUS-12), including its associations with trait anxiety and risk taking, among adolescents.

METHODS

A sample of 879 Dutch adolescents, from diverse educational levels, and with an equal distribution of boys and girls, was classically tested. To obtain indices of IU, and self-reported trait anxiety and need for risk taking, questionnaires were administrated; to obtain an index of risk taking behavior, adolescents performed a risk taking task.

RESULTS

Multi-group Confirmatory Factor Analyses revealed that the IUS-12 consists of a Prospective and an Inhibitory IU subscale, which are partially measurement invariant across sex. Cronbach's alphas and item-total correlations revealed that the IUS-12 and its subscales have reasonable-to-good internal consistency. Correlational analyses support convergent validity, as higher IUS-12 scores were related to, respectively, higher and lower levels of self-reported trait anxiety and need for risk taking. However, we found no relationship between IUS-12 scores and risk taking behavior, operationalized by performance on the risk taking task.

LIMITATIONS

A community, instead of clinical, sample was included. Also, IU was measured by a paper-and-pencil version of the IUS-12, instead of a computerized version.

CONCLUSIONS

The IUS-12 has good psychometric properties and may be a central measure to assess IU, which enables to explain the adolescence-related increase in both anxiety and risk taking.

Intolerance of uncertainty, social anxiety, and generalized anxiety: Differences by diagnosis and symptoms

Research suggests that Intolerance of Uncertainty (IU) is related to the severity of suffering in Generalized Anxiety Disorder (GAD). However, its role in Social Anxiety Disorder (SAD) has not been extensively studied. This study examines IU in a clinical sample of 248 individuals referred to a tertiary care clinic. Few individuals had a diagnosis of pure SAD or pure GAD, but we examined differences of IU scores by diagnostic category. We further examined the relationships between IU scores, social anxiety scores, and worry through a structural equation model. We found that diagnostic category (SAD versus GAD) accounted for little variability in IU scores, but IU scores were strongly related to symptoms of both GAD and SAD. Results highlight that IU is related to both social anxiety and worry; however aspects of IU associated with being unable to act or avoiding uncertainty are more strongly associated with SAD symptoms, whereas aspects of IU more associated with general stress and perceiving uncertainty as unfair are more strongly associated with GAD symptoms. Our results suggest that IU is an important concept for both social anxiety and generalized anxiety, however the relationship between IU and symptoms of these disorders manifests differently.