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: 3.69). 09/2012; 43(3):533-45. DOI: 10.1016/j.beth.2011.02.007
Source: PubMed


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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    • "Prior research suggests that individuals with GAD may exhibit low tolerance of uncertainty (Dugas et al., 2004). Although germane to all anxiety disorders (McEvoy & Mahoney, 2012), intolerance of uncertainty is particularly pronounced among individuals with GAD relative to those with SAD (Boswell, Thompson-Hollands, Farchione , & Barlow, 2013). Thus, while the nature of worry and anxiety inherent in GAD may have led to detection of emotional faces at lower frame than for SAD or controls, an alternate explanation is that the untimed nature of the task, which allowed individuals to scroll back and forth through the movie, enabled individuals with GAD to be more careful in their assessments and/or greater concern about missed detections led them to report detection with earlier frames. "
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    ABSTRACT: Few studies have examined potential differences between social anxiety disorder (SAD) and generalised anxiety disorder (GAD) in the sensitivity to detect emotional expressions. The present study aims to compare the detection of emotional expressions in SAD and GAD. Participants with a primary diagnosis of GAD (n = 46), SAD (n = 70), and controls (n = 118) completed a morph movies task. The task presented faces expressing increasing degrees of emotional intensity, slowly changing from a neutral to a full-intensity happy, sad, or angry expressions. Participants used a slide bar to view the movie frames from left to right, and to stop at the first frame where they perceived an emotion. The frame selected thus indicated the intensity of emotion required to identify the facial expression. Participants with GAD detected the onset of facial emotions at lower intensity of emotion than participants with SAD (p = 0.002) and controls (p = 0.039). In a multiple regression analysis controlling for age, race, and depressive symptom severity, lower frame at which the emotion was detected was independently associated and GAD diagnosis (B = -5.73, SE = 1.74, p < 0.01). Our findings suggest that individuals with GAD exhibit enhanced detection of facial emotions compared to those with SAD or controls.
    Cognition and Emotion 09/2015; DOI:10.1080/02699931.2015.1087973 · 2.52 Impact Factor
    • "Intolerance of Uncertainty (IU) has shown to be a useful construct for predicting a range of psychopathology, especially the anxiety disorders (e.g., Carleton, 2012; McEvoy & Mahoney, 2012). Koerner and Dugas (2008) originally argued high IU does not represent a pathological state in itself, but is a trait predictor for the development of psychopathology, especially pathological worry. "
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    ABSTRACT: One means by which Intolerance of Uncertainty (IU) purports to contribute to anxiety is by increasing Threat Perception (TP). This process was examined by comparing two different definitions of uncertainty: ambiguity versus unpredictability. N = 104 participants were measured for IU and then made worry and TP estimates for four different scenario types: Ambiguous Scenarios (where an outcome could be interpreted as threatening), Unpredictable Positive Scenarios (where a surprising and positive outcome was anticipated), as well as Positive and Negative Scenarios (with certain outcome). Both Ambiguous and Unpredictable Positive Scenarios more strongly predicted the relationship between IU and worry scores than (certain) Positive or Negative Scenarios. The relationship between IU and ‘ambiguous worry’ was largely explained by TP estimates, whereas the relationship between IU and ‘Unpredictable Positive Worry’ was largely independent of TP. Results suggest ambiguity and unpredictability are differentially explained by TP such that they produce different types of response. The authors argue ambiguity and unpredictability are explanatory components within IU.
    Behaviour Change 04/2015; 32(01):26-34. DOI:10.1017/bec.2014.27 · 0.51 Impact Factor
    • "Items are rated from 1 (not at all characteristic of me) to 5 (entirely characteristic of me). The IUS-12 has demonstrated excellent internal consistency, convergent , and discriminant validity (Carleton et al., 2007; Khawaja & Yu, 2010; McEvoy & Mahoney, 2012; Carleton et al., 2007). There are no known studies of the psychometric properties of the IUS-12 in African- American or Black participants; however, the full 27-item IUS has demonstrated excellent internal consistency in African-American samples (Norton, 2005). "
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    ABSTRACT: Several models have been proposed to conceptualize worry. Broadly, the models can be classified as cognitive (including the Avoidance Model, the Intolerance of Uncertainty Model, and the Metacognitive Model) and emotion-focused (including Emotion Dysregulation and Acceptance-Based models). Although these models have received strong empirical investigation in primarily non-Hispanic White samples, no known study has examined the applicability to racial and ethnic minority groups. The current study compared the proportion of variance explained by cognitive and emotion-focused models of worry in White and Black samples. Results indicated that cognitive and emotion-focused models significantly predicted worry in both Black and White samples. However, the overall amount of variance in worry explained by the models was less for Black samples. Specifically, controlling for gender, the cognitive models explained 53% of the variance in worry in the White sample compared with 19% in the Black sample. Similarly, the emotion-focused models explained 34% of the variance in worry in the White sample but only 13% in the Black sample. These findings suggest that well-established conceptual frameworks for worry failed to explain the bulk of the variance in worry in Black samples, leaving much unknown. Additional research is needed to identify key variables that may further explain worry in ethnic minority samples.
    Cognitive Behaviour Therapy 03/2015; 44(5). DOI:10.1080/16506073.2015.1013055
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