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To Be Sure, To Be Sure: Intolerance of Uncertainty Mediates Symptoms of Various Anxiety Disorders and Depression

Centre for Clinical Interventions, University of Western Australia, 223 James Street, Northbridge, Perth, WA 6003, Australia.
Behavior therapy (Impact Factor: 2.85). 09/2012; 43(3):533-45. DOI: 10.1016/j.beth.2011.02.007
Source: PubMed

ABSTRACT The Intolerance of Uncertainty Model was initially developed as an explanation for worry within the context of generalized anxiety disorder. However, recent research has identified intolerance of uncertainty (IU) as a possible transdiagnostic maintaining factor across the anxiety disorders and depression. The aim of this study was to determine whether IU mediated the relationship between neuroticism and symptoms related to various anxiety disorders and depression in a treatment-seeking sample (N=328). Consistent with previous research, IU was significantly associated with neuroticism as well as with symptoms of social phobia, panic disorder and agoraphobia, obsessive-compulsive disorder, generalized anxiety disorder, and depression. Moreover, IU explained unique variance in these symptom measures when controlling for neuroticism. Mediational analyses showed that IU was a significant partial mediator between neuroticism and all symptom measures, even when controlling for symptoms of other disorders. More specifically, anxiety in anticipation of future uncertainty (prospective anxiety) partially mediated the relationship between neuroticism and symptoms of generalized anxiety disorder (i.e. worry) and obsessive-compulsive disorder, whereas inaction in the face of uncertainty (inhibitory anxiety) partially mediated the relationship between neuroticism and symptoms of social anxiety, panic disorder and agoraphobia, and depression. Sobel's test demonstrated that all hypothesized meditational pathways were associated with significant indirect effects, although the mediation effect was stronger for worry than other symptoms. Potential implications of these findings for the treatment of anxiety disorders and depression are discussed.

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    • "It is important to understand what makes therapy work because understanding mechanisms of change can improve the identification of appropriate, better, different, and new treatments (Kazdin, 2007, 2009). Much of the extant literature suggests that cognitive variables mediate the outcomes of diagnosis-specific anxiety treatment (Arch, Wolitzky-Taylor, Eifert, & Craske, 2012; Hofmann, 2004; Hofmann et al., 2007; McEvoy & Mahoney, 2012; Smits et al., 2004). "
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    ABSTRACT: The efficacy of cognitive-behavioral therapy (CBT) for anxiety is well established. Investigations into the mechanisms of change in CBT report changes in cognitive vulnerabilities mediating improvements over the course of treatment. As anxiety disorders share certain risk factors, there is a trend toward CBT emphasizing these vulnerabilities, including negative affectivity (NA) and also more specific constructs such as anxiety sensitivity (AS) and intolerance of uncertainty (IU). The purpose of this investigation was to analyze potential mediators of anxiety reduction over the course of transdiagnostic group CBT. NA, AS, and IU all decreased over the course of treatment. Among the potential mediators, change in NA had a significant relationship with change in anxiety but change in AS and change in IU did not. Neither the main effect of primary diagnosis nor the interactions between potential mediators and primary diagnoses were significant, indicating that there were no differential changes in anxiety or the potential mediators across primary diagnoses. Results strongly point toward NA as an overarching mediator of anxiety reduction during transdiagnostic group CBT.
    Journal of Anxiety Disorders 10/2014; 28(8). DOI:10.1016/j.janxdis.2014.09.017 · 2.96 Impact Factor
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    • "Nedavno, istraživači su došli na ideju da povežu različite aspekte NN sa različitim anksioznim i depresivnim simptomima, pretpostavljajući da je ovaj konstrukt transdijagnostički medijator. Naime, u prvoj medijacionoj studiji na uzorku osoba koje su u potrazi za tretmanom, McEvoy i Mahoney (McEvoy & Mahoney, 2012) su pokazali da postoji medijatorska uloga Prospektivne anksioznosti između simptoma GAP, OKP i Neuroticizma, odnosno medijatorska uloga Inhibitorne anksioznosti između simptoma socijalne fobije, panike, depresije i Neuroticizma. U prilog tome govori i istraživanje sprovedeno na nekliničkom uzorku na našem govornom području u kojoj se pokazalo da anksioznost u susretu sa budućom neizvesnošću (Prospektivna anksioznost) delimično objašnjava vezu između Negativnog afektiviteta, kao generalnog faktora vulnerabilnosti, i simptoma brige, dok inhibitorna, tj. "
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    ABSTRACT: U savremenim modelima psihopatologije, Netolerancija na neizvesnost figurira kao važan transdijagnostički konstrukt. Svrha ovog rada je bila provera metrijskih karakteristika skale koja je namenjena proceni ovog konstrukta budući da je skala adaptirana za srpsko govorno područje sa engleskog i francuskog. Prema preporukama autora originalne skale, formirana je skraćena verzija. Na uzorku studenata (1328), koji su prospektivno praćeni svakih šest meseci tokom tri godine, sprovedena je konfirmatorna faktorska analiza koja je sugerisala da skraćena skala, u skladu sa njenim engleskim i francuskim parnjacima, meri dva faktora: Prospektivnu i Inhibitornu ankioznost. Skraćena skala ima dobru internu konzistenciju, homogenost i reprezentativnost, pri čemu skraćena i duga verzija skale visoko koreliraju. Duga i kratka verzija imaju komparabilne veze sa odgovorajućim konvergentnim i divergentnim merama, što sugeriše da skraćivanje skale nije narušilo njenu konstrukt validnost. U prilog tome svedoči i rezultat da obe verzije skale prospektivno predviđaju simptome anksioznosti i depresije i to povrh varijanse deljene sa Negativnim afektivitetom. Konačno, rezultati hijerarhijske regresije indikuju da subskala Inhibitorne anksioznosti poseduje i odgovarajuću diskriminitavnu validnost. Generalno, skraćena srpska verzija skale se može preporučiti za merenje netolerancije na neizvesnost, pri čemu su date preporuke za dalje usavršavanje skale. Ključne reči: netolerancija na neizvesnost, validacija, anksioznost, depresivnost 2 Rad je nastao u okviru projekta "Nasledni, sredinski i psihološki činioci mentalnog zdravlja" koji finansira Ministarstvo prosvete, nauke i tehnološkog razvoja Republike Srbije (broj ON179006). Standardizcaiju upitnika finansijsкi je pomogao Pokrajinski sekretarijat za nauku i tehnološki razvoj Vojvodine u okviru projekta br. 114 – 451–1647/2011–01.
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    • "Lastly, future work should consider adapting the current task to further promote the study of behavioral differences in anxious individuals. For instance, manipulating the Pavlovian contingency between the warning signal and the aversive event (e.g., compare probabilistic versus deterministic designs) or the instrumental contingency of the hiding response [e.g., manipulate the frequency of the protective outcome (AR)] might add uncertainty to the task, and thus, better dissociate individual differences (McEvoy and Mahoney, 2012). Moreover, adapting the current task for acquisition across multiple sessions would allow the study of the " warm-up " phenomenon , where the subject starts a training session at a lower performance level than what was performed at the end of the previous training session. "
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    ABSTRACT: While avoidance behavior is often an adaptive strategy, exaggerated avoidance can be detrimental and result in the development of psychopathologies, such as anxiety disorders. A large animal literature shows that the acquisition and extinction of avoidance behavior in rodents depends on individual differences (e.g., sex, strain) and might be modulated by the presence of environmental cues. However, there is a dearth of such reports in human literature, mainly due to the lack of adequate experimental paradigms. In the current study, we employed a computer-based task, where participants control a spaceship and attempt to gain points by shooting an enemy spaceship that appears on the screen. Warning signals predict on-screen aversive events; the participants can learn a protective response to escape or avoid these events. This task has been recently used to reveal facilitated acquisition of avoidance behavior in individuals with anxiety vulnerability due to female sex or inhibited personality. Here, we extended the task to include an extinction phase, and tested the effect of signals that appeared during "safe" periods. Healthy young adults (n = 122) were randomly assigned to a testing condition with or without such signals. Results showed that the addition of safety signals during the acquisition phase impaired acquisition (in females) and facilitated extinction of the avoidance behavior. We also replicated our recent finding of an association between female sex and longer avoidance duration and further showed that females continued to demonstrate more avoidance behavior even on extinction trials when the aversive events no longer occurred. This study is the first to show sex differences on the acquisition and extinction of human avoidance behavior and to demonstrate the role of safety signals in such behavior, highlighting the potential relevance of safety signals for cognitive therapies that focus on extinction learning to treat anxiety symptoms.
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