Mark Freeston

Newcastle University | NCL · Behavioural Sciences and Psychology

Intolerance of uncertainty (IU) has gained widespread interest as a construct of broad interest from both transdiagnostic and trans-situational perspectives. We have approached this article inspired by the curiosity, clinical observation, consideration of different theoretical perspectives, speculation, optimism and indeed fun that can be seen in S...

Objectives: Formulation is considered a fundamental process of cognitive behavioural therapy for psychosis (CBTp). However, an exploration into the personal impact of different levels of case formulation (CF) from a service user perspective (SU) is lacking, particularly for those experiencing a first episode of psychosis. Design: This Big Q qual...

Clinical practitioners are frequently encouraged, through literature, training, and policy, to learn, understand, refer to and use their knowledge of attachment theory and research when working to meet the needs of children and families. However, there has been very little empirical study of how practitioners understand and perceive the releva...

Background Anxiety related to uncertainty is common in autism. Coping with Uncertainty in Everyday Situations (CUES©) is a parent-mediated group intervention aiming to increase autistic children’s tolerance to uncertain situations. A pilot study was conducted to test its feasibility and acceptability. Methods Parents of 50 autistic children were r...

The distress inherent in obsessive compulsive disorder (OCD) can often lead to partners, family members and friends becoming entangled with the OCD in terms of being drawn into performing certain behaviours to try and reduce the distress of their loved one. In the past this has often been referred to somewhat pejoratively as collusion, or more neut...

Considerable efforts have been made over a long period of time to understand the variability in substance use and the causal factors underlying it. Therefore, this study aimed to compare motives and the context of alcohol and cannabis use based on a novel measure named the Newcastle Substance Use Questionnaire (NSUQ). Participants were recruited fr...

Several models of anxiety in autistic adults have focused on the role of intolerance of uncertainty which has biological and evolutionary bases, as a cognitive explanation for the high prevalence of anxiety in autism. This framework suggests that all people are born with a healthy level of intolerance of uncertainty, and as we develop, this intoler...

Distress caused by sensory processing differences for autistic individuals may be reduced by repetitive behaviours (RRB), including repetitive motor (RMB) and insistence on sameness (ISB) behaviours. Intolerance of uncertainty (IU) and anxiety mediate the relationship between sensory processing and RRB in autistic children. We replicated this model...

Approximately 50% of autistic children experience high anxiety. Intolerance of uncertainty (tendency to react negatively to uncertain situations) is a key mechanism in the development and maintenance of anxiety. This study aimed to provide a descriptive, thematic analysis of the impact on uncertainty on the daily lives of autistic children and th...

Objectives: To investigate a novel methodology and explore whether artificially reducing the depth of penetration during intercourse mattered to women. Design: A single case experimental design ("n of 1") in which a heterosexual couple act as their own control and the study is then replicated in subsequent couples. Participants: Thirty-five co...

Most patients with memory disorders appear to forget at a relatively normal rate. Hence testing retention beyond the initial test session becomes unnecessary. However, it is now well established that a subsample of patients, most notably people with epilepsy, can show substantially increased forgetting rates even when acquisition rate is normal, ra...

Objectives To investigate autistic people’s views on the importance and availability of adjustments to mental and physical healthcare provision. To explore whether specific categories of adjustments can be identified and to identify any differences in their importance and availability between mental and physical healthcare. Design Data from two st...

The Newcastle Substance Use Questionnaire (NSUQ) Motive section is developed based on a novel theoretical background which is instrumental motives. This study aimed to investigate the latent factor structure of the motives of alcohol and cannabis use. There were 285 participants completing the NSUQ-Alcohol, while 62 of them also answered the NSUQ-C...

An amendment to this paper has been published and can be accessed via the original article.

Background Rates of aggression in inpatient secure care are higher than in other psychiatric inpatient settings. People with intellectual disabilities in secure care require adapted psychological treatments. Interpersonal art psychotherapy incorporates the use of creative art making approaches by participants, thus reducing sole reliance upon verba...

Co-morbid mental health diagnoses present challenges for services structured to provide disorder-specific models of treatment, such as those structured around Improving Access to Psychological Therapies (IAPT). Intolerance of uncertainty (IU) has been identified as both disorder specific and transdiagnostic, although little research explores transd...

Evidence supports the use of cognitive behavioural therapy (CBT) for the treatment of patients with schizophrenia spectrum disorders. A case conceptualization (CC) (or case formulation) is seen as the keystone of CBT in terms of making sense of a patient's difficulties, to guide and inform such treatment. Despite the importance placed on CC there i...

Aims: This study explored the relationship between depressive rumination, non-depressive rumination, intolerance of uncertainty (IU) and paranoia. Method: Using a single group design, the relationship between rumination, IU, depression, positive symptoms of psychosis and paranoia was studied in 24 participants with treatment resistant psychosis. Re...

The paper forms part of a series of papers outlining the theoretical framework for a new model of uncertainty distress (this paper), treatment implications arising from the model, and empirical tests of the model. We define uncertainty distress as the subjective negative emotions experienced in response to the as yet unknown aspects of a given situ...

Intolerance of Uncertainty (IU) is an individual´s "tendency to be bothered or upset by the (as yet) unknown elements of a situation, whether the possible outcome is negative or not." This construct, originally proposed in the context of Generalised Anxiety Disorder (GAD), is now considered a transdiagnostic construct. The Intolerance of Uncertaint...

BACKGROUND: Comorbidity between obsessive compulsive disorder (OCD) and psychotic disorders has long been a subject of interest and speculation, with much overlap being reported. The current review seeks to: (1) Investigate the prevalence of co-occurring OCD and psychosis, reporting pooled prevalence rates; and (2) Explore variability in reported r...

This paper is in response to the commentary written by Richard Woods in which he attempts to provide support for his Monotropism autism theory and the research indicating that Demand Avoidance Phenomena may not be developmentally persistent (Woods, 2019). We acknowledge the continuing controversy around the proposed construct of PDA and the clinica...

BACKGROUND Comorbidity between obsessive compulsive disorder (OCD) and psychotic disorders has long been a subject of interest and speculation, with much overlap being reported. The current review seeks to: (1) Investigate the prevalence of co-occurring OCD and psychosis, reporting pooled prevalence rates; and (2) Explore variability in reported ra...

This preprint further articulates the relationship between uncertainty and threat by taking an everyday situation. It shows how the IU/PU model starts with the Salkovskis (1991) threat model but proposes that uncertainty will further contribute to overestimation of threat, underestimation of coping and rescue, the multiplication of safety-seeking b...

The paper forms part of a series of two papers outlining the theoretical framework for a new model of uncertainty distress (paper one) as well as treatment implications (paper two) arising from the model. We define uncertainty distress as the subjective negative emotions experienced in response to the as yet unknown aspects of a given situation. In...

We acknowledge Green’s viewpoint and agree that currently the literature does not support the validity of PDA as an independent syndrome. However, the controversy is real and exists for a reason. We therefore argue that it is important to move beyond labelling and the potentially unhelpful implications of discussion around whether or not it is a co...

Background: Anxiety is common in autistic adults and significantly limits everyday opportunities and quality of life. Evidence-based psychological therapies offered by mental health services often fail to meet the needs of autistic adults. The development of appropriate treatments for mental health conditions and, in particular, anxiety has been i...

Objective: Significant anxiety often occurs in the presence of ADHD symptoms; however, the reasons are not well understood. We aimed to establish whether the relations between ADHD symptons and anxiety are bidirectional or unidirectional. Method: Weexamined the developmental relations between ADHD and anxiety symptoms across adolescence (ages 13,...

Background: Anxiety is highly prevalent in autistic adults and can cause a significant impact on functioning and quality of life. There are no existing measures of anxiety designed and validated specifically for autistic adults. In this study, we aimed to adapt an existing anxiety measure designed for autistic children, in collaboration with autist...

Background: Anxiety is a common diagnosis in children with autism spectrum disorder (ASD). One key mechanism underlying anxiety is intolerance of uncertainty, which is a tendency to react negatively on an emotional, cognitive, and behavioural level to uncertain situations and events. We developed the first intervention programme specifically targe...

Background Pathological demand avoidance (PDA) is a proposed subtype of autism spectrum disorder (ASD), characterised by extreme avoidance of demands. Demand avoidant behaviour has been proposed to be driven by an anxious need to be in control, although has never been explicitly studied. Emerging evidence suggests intolerance of uncertainty (IU) an...

Fears and phobias are common in people on the autism spectrum and can impact on their ability to undertake usual daily activities. Graded exposure to the anxiety-provoking stimulus is a recognized method of treatment for fears/phobias in the nonautistic population but may pose specific difficulties for autistic people. For example, real-life exposu...

The Italian Intolerance of Uncertainty Scale-Revised.

Intolerance of Uncertainty is a trans-diagnostic process that spans a range of emotional disorders and it is usually measured through the Intolerance of Uncertainty Scale-12. The current study aims at investigating some issues in the assessment of Intolerance of Uncertainty (IU) through the Italian Intolerance of Uncertainty Scale-Revised, a measur...

Community sample dataset. (CSV)

Undergraduate sample dataset. (CSV)

Little research has focused on autism in adulthood. Little is known about the concerns autistic adults may have, particularly about their futures, to inform support and social work practice. The objective of this study was to explore the nature of the worries autistic adults have about their futures. Four focus groups were conducted with autistic a...

Self-Practice/Self-Reflection (SP/SR) has been proposed both as an adjunct to therapy training programmes, and also as a means for therapist development among experienced therapists. Research suggests it develops aspects of knowledge and skill that may not be addressed through other training methods. With increasing interest in SP/SR, a growing evi...

The development and conceptual relationship of the constructs of threat appraisal (TA) and intolerance of uncertainty (IU) are explored in the context of anxiety disorders. A narrative review tracking the development of these constructs and their relationship is undertaken. There is some evidence to suggest that the interaction between the componen...

Background: : The life span nature of anxiety and depression has led to an interest in whether assessments designed for use with children and young people are also valid for adults. The Revised Children's Anxiety and Depression Scales (RCADS) is a commonly used measure and we aimed to explore its structural validity in adults. Methods: : We examine...

Intolerance of uncertainty (IU) is indicated as an important transdiagnostic process variable in a range of anxiety disorders. Anxiety is very common in autistic adults. This study evaluates a manualised treatment programme for autistic adults, which focused on IU. An eight session programme (CUES-A©) was developed and delivered to four autistic ad...

Intolerance of Uncertainty is a transdiagnostic risk and maintenance factor in a range of anxiety disorders and major depressive disorder. However, the mechanism of action in the development and maintenance of anxiety disorders is poorly understood, with the relationship between the constructs of uncertainty and threat appraisal remaining unclear....

Intolerance of uncertainty (IU) is indicated as an important transdiagnostic process variable in a range of anxiety disorders. Anxiety is very common in children with autism spectrum disorders (ASD). This study aimed to develop a parent group based manualised treatment programme for young people with ASD, which focused on IU. An eight session progr...

There has been limited application of cognitive behavioural therapy (CBT) to the treatment of distressing visual hallucinations (VH) in people with psychosis. Preliminary research applying interventions to a novel presenting issue are enhanced by utilizing designs that allow strong inferences to be made about the effect of the intervention. Hence,...

Family members are often the primary caregiver for autistic adults and this responsibility may impact on the carer’s wellbeing and quality of life. 109 family members of autistic adults completed an online survey assessing their wellbeing relating to their caring role for their autistic relative. Family members who were supporting an autistic relat...

Background Art psychotherapy has greater potential for use with adults with mild to moderate learning disabilities as it places less of a burden on verbal interaction to achieve positive therapeutic, psychological, and behavioural goals. The feasibility study objectives include testing procedures, outcomes, validated tools, recruitment and attritio...

This article describes a systematic investigation into intolerance of uncertainty (IU) behaviours. This involved systematic searches of IU behaviours, developing an expert consensus of the different types of IU behaviour and classifying behaviours into these categories.

Very little is known about autism and adulthood. Family members are often the primary support for autistic adults and frequently express concerns about what the future will hold and what support will be available for their relative. 120 family members of autistic adults completed an online survey exploring concerns about the future for their relati...

Differences and similarities between intrusive thoughts typical of obsessive–compulsive disorder, generalized anxiety disorder, and hypochondriasis are relevant for their differential diagnosis, formulation, and psychological treatment. Previous research in non-clinical samples pointed out the relevance of some process variables, such as responsibi...

In M. H. Freeston (Chair), Targeting Intolerance of Uncertainty in the treatment of anxiety: Rationale, description and preliminary outcomes.

Intrusive thoughts are typical symptoms of anxiety-related, mood and psychotic disorders. Freeston, Ladouceur, Thibodeau, and Gagnon (1991) developed the Cognitive Intrusions Questionnaire to address the features and processing of intrusive thoughts regardless of the theoretically related disorder. This study aims to assess the psy-chometric proper...

Objective: Intolerance of uncertainty (IU) and not just right experiences (NJREs) have been claimed putative vulnerability factors for obsessive–compulsive disorder (OCD). The aim of the present study was to test whether IU could represent a trans-diagnostic construct accountable for OC checking behaviors and whether NJREs could embody an OCD-speci...

The Intolerance of Uncertainty Model (IUM) of Generalized Anxiety Disorder (GAD) attributes a key role to Intolerance of Uncertainty (IU), and additional roles to Positive Beliefs about Worry (PBW), Negative Problem Orientation (NPO), and Cognitive Avoidance (CA), in the development and maintenance of worry, the core feature of GAD. Despite the rol...

Aim: The Laval model of worry and GAD (Dugas, Ladouceur, Gagnon, & Freeston, 1998) assigns a central role to Intolerance of Uncertainty (IU) and additional roles to Positive Beliefs about Worry (PBW), Negative Problem Orientation (NPO), and Cognitive Avoidance (CA). Although the role of all components has been supported in multiple studies, there a...

Aim: Intolerance of Uncertainty (IU) and Not Just Right Experiences (NJREs) have been proposed as putative vulnerability factors for obsessive-compulsive disorder (OCD). Previous findings highlighted a specific association between IU and checking behaviours while NJREs have been shown to be related to various OC symptoms. The aims of the current st...

Aim: Under DSM 5 there is a clear recognition of performance anxiety in specific areas of people’s activities as an important form of social anxiety. Performance anxiety in sport is recognized as not only impacting on performance, but is also associated with broader psychological disturbance and a reason for people leaving sports. The purpose of th...

Emotional acceptance, alexithymia, and intolerance of uncertainty (IU) contribute to anxiety disorders in neurotypical populations. Their association with anxiety in people diagnosed with autism spectrum disorder (ASD) has not been studied. We aimed to model the contributions of these constructs on the relationship between dimensional measures of a...

Background: A Psychomotor DANCe Therapy INtervention (DANCIN) using Latin Ballroom (Danzón) in care homes has previously been shown to enhance well-being for both residents with dementia and staff. The aim of this study was to understand the effect of this approach on the mood and behavior of individual people living with mild to moderate dementia....

Many children with autism spectrum disorder (ASD) experience high levels of anxiety. A widely used measure for typically developing children is the Revised Child Anxiety and Depression Scale (RCADS). However, such anxiety measures may require adaptation to accommodate characteristics of those with ASD. An adapted version of the RCADS was created ba...

Background: Anxiety is a common problem for children with autism spectrum disorder (ASD). Recent research indicates that intolerance of uncertainty (IU) may be an important aspect of anxiety for this population. IU is the belief that uncertainty is upsetting, and not knowing what is going to happen is negative. There is little known about the phen...

Generalised Anxiety Disorder (GAD) can have a significant detrimental effect on the lives of sufferers. Research into the psychological process involved in worry has an important role in the prevention and treatment of problems such as GAD. Negative problem orientation (NPO) has been identified as an important psychological construct involved in wo...

This paper describes a service development which arose from an adult mental health inpatient ward team who wanted to be able to work more effectively to help patients who had major difficulties with emotion regulation. It was proposed that enhancing mindfulness through a Mindfulness-based Cognitive Therapy (MBCT) programme within the core staff tea...

A growing body of research has provided evidence for intolerance of uncertainty (IU)—a dispositional characteristic resulting from negative beliefs about uncertainty and its implications—as a possible transdiagnostic maintaining factor across a range of anxiety disorders. No studies have yet examined IU in performance anxiety in sport. The purpose...

Intolerance of uncertainty refers to a set of negative beliefs about uncertainty and its consequences; it is thought to play a key role in the development and maintenance of pathological worry, but its transdiagnostic nature has been recently demonstrated. The Intolerance of Uncertainty Scale (IUS) represents the main instrument designed to measure...

Individuals with body dysmorphic disorder (BDD) often experience negative distorted images of their appearance, and research suggests these may be linked to memories of adverse events such as bullying or teasing. This study evaluates imagery re-scripting (ImR) as an intervention for BDD. In this article we present a multiple-baseline single case ex...

Introduction: Intolerance of Uncertainty (IU) has been identified as an important trans-diagnostic construct. No studies have yet examined IU in performance anxiety in sport, although it is possible that IU plays a role in anxiety responses that can be experienced in competitive sport situations. Performance anxiety is now specified as a sub-type o...

People with psychosis often report distressing visual hallucinations (VH). In contrast to auditory hallucinations, there is little empirical evidence on effective interventions. The effectiveness of a novel-focused cognitive-behavioural therapy (CBT) intervention for VH was explored using a multiple baseline single case design with four participant...

Broad and narrow specificity are current issues within cognitive models of psychopathology. The aim of this study was to describe the nature of the relationship between inflated responsibility (measured with the Responsibility Attitudes Scale [RAS]) and obsessive-compulsive symptoms (measured with the Yale-Brown Obsessive Compulsive Scale self-repo...

Questionnaires generate numerical scores, but endorsing different sets of items could produce the same score despite reflecting qualitatively different configurations of clinical features. Formal psychological assessment (FPA) attempts to overcome this by identifying the clinical features entailed by observed response patterns. This study illustrat...

Biased processing of negatively valenced, and particularly threat-related material plays an important role in the development of paranoid thinking. This has been demonstrated by superior memory for threat-related information in patients with persecutory delusions and in non-clinical paranoia-prone participants. This study examined how emotional mat...

Background This study examines Weiner's recent cognitive emotional model which makes a distinction between judgements of control and responsibility and emphasizes the moderation of control by ‘mitigating’ factors.Method In response to four vignettes describing two conditions of control (high or low) and mitigating factors (present or absent), quest...

We examined whether case formulation guides the endorsement of appropriate treatment strategies. We also considered whether experience and training led to more effective treatment decisions. To examine these questions two related studies were conducted both of which used a novel paradigm using clinically relevant decision-making tasks with multiple...

To date, evidence for cognitive reactivity in OCD has been provided through laboratory-based investigations assessing the impact of mood-states on obsessional appraisals and behaviours in experimenter controlled scenarios. In order to better grasp the dynamics of cognitive reactivity in OCD, the current study provides an extensive and intensive ana...

Adults with Generalized Anxiety Disorder (GAD) are reported to display discrepancy between self-reported somatic anxiety symptoms and physiological indices. Whilst physiological indices indicate a reduced physiological response, self-report measures reflect the perception of heightened and aversive somatic symptoms. It is unclear whether the discre...

The main objectives of this study were to compare the perceived utility of two definitions of schema (i.e. a standard Beckian vs. a revised definition). Fifty clinicians with varying degrees of training in cognitive behavioural therapy (CBT) received a presentation on the Beckian definition of schema before completing two questionnaires, one assess...