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Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression

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Abstract

Intolerance of uncertainty (IU) - a dispositional characteristic resulting from negative beliefs about uncertainty and its implications - may be an important construct in anxiety disorders and depression. Despite the potential importance of IU, clinical data on the construct remains relatively scant and focused on generalized anxiety disorder and obsessive-compulsive disorder. The present study systematically investigated IU, as measured by the Intolerance of Uncertainty Scale-12 (IUS-12), across groups diagnosed with anxiety disorders (i.e., social anxiety disorder, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder) or depression (clinical sample: n=376; 61% women), as well as undergraduate (n=428; 76% women) and community samples (n=571; 67% women). Analysis of variance revealed only one statistically significant difference in IUS-12 scores across diagnostic groups in the clinical sample; specifically, people with social anxiety disorder reported higher scores (p<.01; η(2)=.03) than people with panic disorder. People diagnosed with an anxiety disorder or depression reported significantly and substantially higher IUS-12 scores relative to community and undergraduate samples. Furthermore, IUS-12 score distributions were similar across diagnostic groups as demonstrated by Kernel density estimations, with the exception of panic disorder, which may have a relatively flat distribution of IU. Response patterns were invariant across diagnostic groups as demonstrated by multi-group confirmatory factor analyses, but varied between clinical and nonclinical samples. Overall, the findings suggest IU may serve as an important transdiagnostic feature across anxiety disorders and depression. In addition, robust support was found for the proposed 2-factor model of the IUS-12. Comprehensive findings, implications, and future research directions are discussed.

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... In fact, IU was found to mediate the link between negative affect and worry, and between negative affect and social anxiety. Carleton et al. (2012) conducted one of the few studies on social anxiety and IU using a clinical population. Their results support that patients with diagnosed depression, SAD, OCD, and GAD all experience higher levels of IU compared to a nonclinical community sample and undergraduates. ...
... This becomes particularly relevant as a large proportion of our sample included participants with comorbidities rather than a single diagnosis (e.g., SAD only), and IU in our clinical sample was generally high regardless of diagnostic category. In fact, some research suggests that IU may play a nonspecific cognitive role cutting across the anxiety disorders (Carleton et al., 2012;Holaway et al., 2006). If IU plays an etiological role in other anxiety disorders, treatment focusing on fostering tolerance of uncertainty would be highly beneficial for other clinical populations aside from those with GAD. ...
... For example, it is possible that behavioural inhibition, neuroticism, or negative affect is implicated with IU, and may be a mediator or moderator in its relationship with social anxiety. However, previous research demonstrated that IU accounts for a significant amount of variability in social anxiety even after controlling for some of these traits (e.g., Boelen & Reijntjes, 2009;Boelen et al., 2010;Carleton et al., 2010Carleton et al., , 2012. ...
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p>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.</p
... However, subsequent works have not found specific differences in the UI dimensions in different clinical groups. In fact, similar scores have been reported between groups of university students and community groups (Carleton et al., 2012). ...
... Although initially the study of uncertainty intolerance focused on its role in the etiology of generalized anxiety disorder, it was subsequently recognized as a transdiagnostic characteristic (Carleton et al., 2012;McEvoy et al., 2019). It is currently assumed to be an influential factor in the development and maintenance of anxiety in different groups of people (Carleton et al., 2012;Osman-agaoglu et al., 2018), even its role in statistical anxiety has been shown (Williams, 2013). ...
... Although initially the study of uncertainty intolerance focused on its role in the etiology of generalized anxiety disorder, it was subsequently recognized as a transdiagnostic characteristic (Carleton et al., 2012;McEvoy et al., 2019). It is currently assumed to be an influential factor in the development and maintenance of anxiety in different groups of people (Carleton et al., 2012;Osman-agaoglu et al., 2018), even its role in statistical anxiety has been shown (Williams, 2013). ...
Article
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Este estudio analiza el efecto de la intolerancia a la incertidumbre sobre la ansiedad estadística bajo la mediación de la orientación negativa al problema y la preocupación en una muestra de universitarios. Se analizó 437 estudiantes colombianos (285 mujeres) de entre 18 y 30 años (M = 21,28, DT = 2,43) mediante modelos de mediación serial entre la intolerancia a la incertidumbre inhibitoria y prospectiva y tres dimensiones de ansiedad estadística (ansiedad de pedir ayuda, ansiedad ante exámenes, ansiedad interpretativa). La intolerancia a la incertidumbre influye en la aparición de ansiedad estadística gracias a la mediación de las variables disposicionales. Los resultados ponen de relieve el papel mediador de la orientación negativa al problema sobre todos los síntomas ansiosos, mientras que la preocupación opera como mediador serial frente a la ansiedad ante exámenes estadísticos. Este estudio demuestra que la baja tolerancia a la incertidumbre conduce a la experiencia de ansiedad estadística cuando los estudiantes asumen los problemas como una amenaza.
... Intolerance of uncertainty (IU) is defined as a tendency toward negative cognitive, emotional, and behavioral responses to situations characterized by ambiguity and a lack of information concerning future outcomes of the current situation (Carleton et al., 2012(Carleton et al., , 2007. IU has been previously linked to anxiety, depression, and maladaptive coping (Buhr & Dugas, 2009;Sbrilli et al., 2021). ...
... This aligns with research demonstrating the link between insecure attachment and maladaptive coping strategies, exacerbating stress and negatively impacting mental health-e.g., (Mikulincer & Shaver, 2023;Shaver & Mikulincer, 2007). Additionally, intolerance of uncertainty significantly mediated the association between attachment anxiety and poorer mental health (supporting H3), consistent with research showing that individuals with high intolerance of uncertainty experience increased anxiety and struggle to cope effectively with ambiguous situations (e.g., Carleton et al., 2012;Bomyea et al., 2015). The heightened uncertainty inherent in raising a child with special needs, exacerbated by the acute stress of a major stressful event like the October 7th attacks, likely contributed significantly to this effect. ...
Article
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The October 7th events precipitated an unprecedented psychological crisis for Israeli families, particularly affecting parents of children with special needs. This empirical study aimed to investigate the psychological factors contributing to parental stress and mental health outcomes in a community sample of 2097 parents, comparing those with children with special needs (n = 540) to those with typically developing children (n = 1557). Findings revealed that parents of children with special needs exhibited significantly higher levels of attachment anxiety and avoidance, parental stress, and intolerance of uncertainty, while reporting lower levels of parental competence, perceived social support, and mental health. Notably, meaning in life did not significantly differ between the groups. Correlational analyses indicated that attachment anxiety and avoidance were negatively correlated with parental competence, social support, meaning in life, and mental health while positively correlating with parental stress and intolerance of uncertainty. Mediation analyses showed that attachment anxiety and avoidance significantly predicted increased parental stress and reduced mental health, with these effects mediated by lower parental competence and diminished meaning in life. Moreover, intolerance of uncertainty mediated the effect of attachment anxiety on mental health. However, the mediating role of perceived social support on parental stress was absent among parents of children with special needs. These findings underscore the need for targeted interventions that bolster parental resilience, particularly for families of children with special needs during times of crisis.
... According to the HiTOP classification (Kotov et al., 2017;Watson et al., 2022), emotional dysfunction (modeling the commonality between internalizing and somatoform) is conceptualized as one of three superspectra, alongside psychosis (combining thought disorder and detachment) and externalizing (subsuming antagonistic and disinhibited forms of psychopathology). Although most studies suggest that a higher need for control plays a substantial part within emotional dysfunction disorders (Bagcioglu et al., 2012;Boswell et al., 2013;Brown et al., 2017;Burger & Arkin, 1980;Cano-López et al., 2022;Carleton et al., 2012Carleton et al., , 2014Keen et al., 2022;Laghi et al., 2018;Lawless et al., 2021;Moulding et al., 2008;Moulding & Kyrios, 2007;Oguz et al., 2019;Sarawgi et al., 2013;Saulnier et al., 2019), some studies did not confirm this (Froreich et al., 2016) or obtained opposite results (Kleftaras & Georgiou, 2014;Myles et al., 2020Myles et al., , 2021Tiggemann & Raven, 1998). The discrepancy among these findings may, in part, be due to the fact that the used questionnaires do not measure identical constructs of control. ...
... All participants provided signed informed consent (in accordance with the Helsinki Declaration) beforehand and completed a series of 11 self-report questionnaires, including our primary questionnaire of interest, the NCP-q. Considering that intolerance of uncertainty is a construct conceptually related to the NCP-q, is associated with higher worry, anxiety, and depression (Boswell et al., 2013;Carleton et al., 2012Carleton et al., , 2014Dugas et al., 2001;Saulnier et al., 2019;Wilson et al., 2020), and given the role that a higher need for control plays in both anxiety and depression (Burger & Arkin, 1980;Cano-López et al., 2022;Keen et al., 2022;Moulding et al., 2008;Moulding & Kyrios, 2007;Oguz et al., 2019), we used the Intolerance of Uncertainty Scale (IUS), the Penn State Worry Questionnaire (PSWQ), the State-Trait Anxiety Inventory-Trait Form (STAI-T), and the Beck Depression Inventory II (BDI-II), to examine convergent validity. A subsample of 38 participants (94.74% women; mean age = 18.21 years; SD age = 0.99) filled out the NCP-q twice, one month apart, to investigate test-retest reliability. ...
Article
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Background Given the importance of the need for controllability and predictability in the broad field of health psychology, a high-quality measurement tool for these constructs is required. Participants and procedure The objective of our study was to validate the Need for Controllability and Predictability questionnaire (NCP-q), which is a 15-item self-report measure that assesses an individual’s need for controllability and predictability. In study 1, an explora-tory (n = 464) and confirmatory (n = 304) factor analysis was performed in two student convenience samples. In study 2, NCP-q data of patients with panic disorder (n = 34), stress related syndromes (overstrain, n = 33; burnout, n = 39), func-tional somatic syndromes (fibromyalgia and/or chronic fatigue syndrome, n = 34), and healthy controls (n = 30) were com-pared. Results The results from study 1 suggest that the NCP-q should be used as a one-dimensional instrument. The NCP-q has excellent internal consistency and an acceptable four-week test-retest reliability. Convergent validity was demonstrated. Study 2 re-vealed significantly higher NCP-q scores for all patient groups compared to healthy controls, but no differences between patient groups. Conclusions A higher self-reported need for controllability and predictability can be seen as a transdiagnostic underlying mechanism of different patient groups characterized by experiencing physical symptoms in daily life. The NCP-q can be used as a reliable, concise, and clinically relevant research tool and may contribute to identifying relevant underlying mechanisms in different patient samples.
... A wealth of research has shown that individuals with higher levels of IU perceive uncertain situations as more threatening and unsafe (Cupid et al., 2021;Pepperdine et al., 2018), and under such conditions, they tend to experience heightened negative emotions (Morriss, Goh, et al., 2023) and increased physiological arousal (Morriss, Abend, et al., 2023;Tanovic et al., 2018). IU is normally distributed across community samples (Carleton et al., 2012;Hong & Lee, 2015). Moreover, IU is a transdiagnostic dimension, as the IU total score is higher across a variety of mental health conditions, including anxiety, mood, eating, and schizophrenia-spectrum disorders (McEvoy et al., 2019;. ...
... The findings provide important evidence that high levels of IU are observed in both SSDs and anxiety disorders, compared to non-clinical controls. While elevated IU has been observed separately in SSDs (Morriss, Butler et al., 2024) and anxiety disorders (Carleton et al., 2012), to our knowledge, this study is the first to directly compare IU levels across these two populations. ...
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Background. Greater Intolerance of Uncertainty (IU: the tendency to find uncertainty negative) is associated with greater paranoia (mistrust of others) in clinical samples with schizophrenia-spectrum disorders (SSDs). Questions remain on whether the relationship between IU and paranoia / prodromal symptoms is: (1) specific over other related negative affective traits and cognitive biases, and (2) specific to SSDs or is transdiagnostic. Method. To examine these research questions, we conducted a survey in those with SSDs (n = 103), anxiety disorders (n = 102) a non-clinical sample (n = 102). Questionnaires included: IU, paranoia, prodromal symptoms of schizophrenia, neuroticism, and jumping to conclusions bias. Results. IU, neuroticism, and jumping to conclusion bias was elevated in those with SSDs and anxiety disorders, compared to the non-clinical group. Both paranoia and prodromal symptoms were highest in those with SSDs, then anxiety disorders, and lowest in the non-clinical group. Greater IU was associated with greater paranoia and prodromal symptoms across SSDs, anxiety disorders, and a non-clinical sample. The majority of the relationships between IU and paranoia /prodromal symptoms remained significant when controlling for neuroticism and the jumping to conclusions bias. However, the relationship between IU and paranoia in the SSD group was not specific over the jumping to conclusions bias. Conclusions. These findings highlight the potentially transdiagnostic role of IU in paranoia / prodromal symptoms across SSDs and anxiety disorders, which has implications for the development of transdiagnostic treatment interventions for SSDs and anxiety disorders.
... The inhibitory IU subscale measures action paralysis in the face of uncertainty and the prospective IU subscale measures the desire for predictability (Carleton et al., 2007). Both the total IU score and the inhibitory/prospective subscales evidence robust psychometrics and are reliably normally distributed across community samples (Carleton et al., 2012;Hong & Lee, 2015). Importantly, a wealth of recent evidence has demonstrated that higher IU is common across a variety of mental health conditions such as anxiety, depression, schizophrenia and eating disorders (Carleton et al., 2012;McEvoy et al., 2019;Morriss & Ellett, under review). ...
... Both the total IU score and the inhibitory/prospective subscales evidence robust psychometrics and are reliably normally distributed across community samples (Carleton et al., 2012;Hong & Lee, 2015). Importantly, a wealth of recent evidence has demonstrated that higher IU is common across a variety of mental health conditions such as anxiety, depression, schizophrenia and eating disorders (Carleton et al., 2012;McEvoy et al., 2019;Morriss & Ellett, under review). Because of this, there has been a surge of interest in characterising how IU maps onto psychological processes, in order to determine how to effectively target IU in mental health treatment and support (Einstein, 2014;Shihata et al., 2016). ...
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Identifying and responding adaptively to a change in our environment is an essential skill. However, differences in our ability to detect and our disposition to react to these changes mean that some individuals are better equipped to deal with change than others. Here, we investigate whether intolerance of uncertainty, a transdiagnostic dimension of psychopathology, is associated with performance during a reversal learning task. We assessed task performance of 145 subjects using behavioural measures and computational modelling across two time points (approximately 12 days apart). Intolerance of uncertainty and its prospective and inhibitory subscales were associated with task performance, irrespective of self-reported levels of trait anxiety. Intolerance of uncertainty and its inhibitory subscale were positively associated with increased sensitivity to reinforcement from positive, but not negative, feedback. Furthermore, the inhibitory subscale was positively associated with better performance, both overall (as indexed by accuracy) and immediately following a change in reward contingencies (as indexed by perseveration). Lastly, the prospective subscale interacted with the extent to which choice was driven by expected value across time points. These findings provide novel evidence for how trait intolerance of uncertainty may modulate behavioural flexibility in changeable environments. The study points towards exciting avenues for further research into the development of IU-related behaviours across the lifespan and their implications for mental health.
... However, IU is not unique to GAD and worry. Evidence demonstrates that IU is a risk and maintenance factor for other disorders characterized by RNT (Mahoney & McEvoy, 2012b), including MDD, anxiety disorders, and PTSD (Carleton et al., 2012;Hunt et al., 2022;McEvoy et al., 2019;White & Gumley, 2009). Accumulating findings show that IU predicts rumination (e.g., de Jong-Meyer et al., 2009;Liao & Wei, 2011;Yook et al., 2010) and other forms of RNT such as catastrophizing and post-event processing (Rondung et al., 2019;Shikatani et al., 2016). ...
... IU predicts symptom severity among veterans with emotional disorders (Hunt et al., 2022) and they report smaller reductions in RNT following treatment relative to civilians (Barrera et al., 2015;Hundt et al., 2014). Since veterans are more likely to have comorbid mental health problems (Black et al., 2004;Kessler et al., 2005), they may that indicate IU (Carleton et al., 2012;McEvoy et al., 2019;White & Gumley, 2009) and RNT (Arditte- Hall et al., 2019;Bakhshian et al., 2013;Olatunji et al., 2010) contribute to symptom severity in individuals with MDD and PTSD. Given that these findings extended to stress and impairment in the full mixed clinical sample and specific symptoms in two of the three clinical subsamples, this further supports IU and RNT as transdiagnostic factors. ...
Article
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Repetitive negative thinking and intolerance of uncertainty are risk and maintenance factors for emotional disorders. Although emerging evidence suggests that intolerance of uncertainty predicts increases in distress through repetitive negative thinking, these relationships have yet to be investigated among veterans. The present study examines if repetitive negative thinking mediates the relationships of intolerance of uncertainty with stress, disordered symptoms and impairment among a mixed clinical sample of veterans. Two hundred and forty-four treatment-seeking veterans with diagnoses of major depressive disorder, panic disorder, or posttraumatic stress disorder completed measures of intolerance of uncertainty, repetitive negative thinking, stress, impairment, depression, panic, and posttraumatic stress prior to receiving treatment. Mediation models revealed indirect effects of intolerance of uncertainty through repetitive negative thinking on stress and impairment in the full sample, and on disordered symptoms in subsamples with major depressive disorder and posttraumatic stress disorder. Conversely, intolerance of uncertainty did not have direct or indirect effects on disordered symptoms in a panic disorder subsample. Findings suggest that repetitive negative thinking and intolerance of uncertainty uniquely contribute to stress, impairment, and disordered symptoms, but repetitive negative thinking, may, in part, drive intolerance of uncertainty’s contribution to emotional disorders. Interventions for repetitive negative thinking might improve the efficacy of existing transdiagnostic treatment protocols. Cross-sectional data is a limitation of the present study. Prospective designs in civilian samples can better establish the temporality of these relationships and if they are generalizable to the larger population.
... Inhibitory IU subscale captures paralysis of cognition and action during uncertainty and the prospective IU subscale captures the desire for predictability (Carleton et al., 2007). The total IU score and subscales are reliably normally distributed across the general population (Carleton et al., 2012;Hong & Lee, 2015). ...
... The total IU score and its subscales are noticeably higher in individuals with clinical anxiety (e.g., generalized anxiety, obsessivecompulsive, and posttraumatic stress disorders) and depression (Carleton et al., 2012;McEvoy et al., 2019), relative to the general population. Further recent evidence suggests that self-reported IU is also higher in individuals with schizophrenia spectrum conditions as well, compared to the general population (Morriss et al., under review). ...
Article
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Intolerance of uncertainty (IU; the tendency to find uncertainty aversive) and paranoia (e.g., excessive mistrust of others), are both associated with anxiety and depression symptoms. While previous research has primarily focused on IU and paranoia separately, there is recent evidence to suggest that IU and paranoia are linked and may interact to increase risk for anxiety, depression, and schizophrenia‐spectrum conditions. The aims of the current study were to assess: (1) the extent to which IU (total score and subscales), paranoia, anxiety, and depression are associated and (2) whether the interaction between IU and paranoia is associated with greater anxiety and depression symptoms. To examine these aims, we conducted a survey in an international multisite sample (n = 2510). Questionnaires included: IU (total score and subscales), paranoia (RGPTS persecution subscale), anxiety, and depression. The findings revealed that: (1) IU was positively associated with paranoia (r = 0.43), anxiety (r = 0.48), and depression (r = 0.49), and (2) People with high scores on IU and paranoia showed higher anxiety and depression symptoms. Importantly, these effects remained when controlling for negative beliefs about the self and others and demographic factors. Additionally, the inhibitory IU subscale (uncertainty paralysis) was related to paranoia, anxiety, and depression. However, the prospective IU subscale (desire for predictability) was only related to depression, but not paranoia and anxiety. Overall, these findings reliably demonstrate that IU and paranoia are linked, and that IU and paranoia interactions may synergistically work to affect current levels of anxiety and depression symptoms.
... Thus, high-state anxiety may also motivate uncertainty reduction when it is maladaptive. This appears consistent with the first study reviewed above (Aberg et al. 2022), and suggests a general intolerance of uncertainty (Carleton et al. 2012). ...
Chapter
The drive to seek information through exploratory behavior is widespread in both humans and other animals. This can be adaptive in reducing uncertainty about the best course of action within novel or changing environments. However, exploratory behaviors can also become maladaptive if subjective uncertainty levels remain too high or too low, as may happen in states of elevated anxiety. In this article, we review recent studies investigating the influence of anxiety on information-seeking behavior. We focus primarily on studies using cognitive computational models and associated behavioral tasks designed to test specific exploratory strategies, which could each be affected by anxiety in distinct ways. Results of current studies remain mixed and highlight the importance of distinguishing potential effects of task, state vs. trait anxiety, somatic vs. cognitive anxiety, and clinical vs. sub-clinical anxiety. There are also a range of different information-seeking strategies that are necessary to consider. At present, many findings could be taken to support a picture in which cognitive anxiety, and/or trait anxiety more broadly, may increase information-seeking, while somatic and/or state anxiety could have opposing effects. However, a number of previous results also appear inconsistent or task-dependent. Future studies are needed to resolve these apparent inconsistencies and more directly disentangle effects of different dimensions of anxiety on the adaptive and maladaptive use of information-seeking.
... Belirsizliğe tahammülsüzlük bireyin belirsizliği nasıl algıladığı ve belirsizlik altındayken bununla nasıl mücadele ettiğini anlatmaktadır. (Krohne, 1989;Carleton 2012) Belirsizliğe tahammülsüzlük başta psikoloji ve davranış bilimleri olmak üzere birçok disiplin tarafından incelenen disiplinler arası bir kavramdır. Yaşamın içinde yer alan belirsizliğin bireylerce algılanma şekli ve belirsizlikle mücadele biçimi birçok disiplinin ilgi alanına girmekte ve bu konudaki çalışmalar her geçen gün biraz daha artmaktadır. ...
... dispositional challenges concerning the perceived absence of key, sufficient, or salient information; Carleton et al., 2007), pain anxiety (i.e. the dispositional tendency to experience anxiety or fear in relation to actual or potential pain, viewed as a mechanism that can underly and maintain chronic pain; Asmundson et al., 1999;McCracken et al., 1992), and state anger (i.e. anger precipitated by exposure to a potentially psychologically traumatic event (PPTE)); Meffert et al. (2008) are associated with diverse mental health challenges in the general population (Capron et al., 2012;Carleton, 2016;Carleton et al., 2009Carleton et al., , 2012de Bles et al., 2019;Feeny et al., 2000;O'Connor et al., 2002;Schmidt & Lerew, 1998;Schmidt et al., 1999). Research indicates that these modifiable individual difference variables are also associated with greater mental health challenges among public safety personnel (PSP; e.g. ...
Article
Mental health disorders are particularly prevalent among public safety personnel (PSP). Emotional Resilience Skills Training (ERST) is a cognitive behavioural training program for PSP based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (i.e. Unified Protocol). The current study was designed to assess whether ERST is associated with reduced putative risk factors for mental disorders and increased individual resilience. The PSP-PTSI Study used a longitudinal prospective sequential experimental cohort design that engaged each participant for approximately 16 months. PSP from diverse sectors (i.e. firefighters, municipal police, paramedics, public safety communicators) completed self-report measures of several putative risk variables (i.e. anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, state anger) and resilience at three time points: pre-training (n = 191), post-training (n = 103), and 1-year follow-up (n = 41). Participant scores were statistically compared across time points. Participants reported statistically significantly lower scores on all putative risk variables except pain anxiety, and statistically significantly higher resilience from pre- to post-training. Changes were sustained at 1-year follow-up. The results indicate that ERST is associated with reductions in several putative risk variables and improvement in resilience among PSP.
... That is, reduced directed exploration with high anxiety was partially explained by greater information-seeking when it was not useful (i.e., not solely due to less information-seeking when it would have been useful in H6). Thus, these findings are somewhat consistent with the first study (Aberg et al., 2022), and suggest a general intolerance of uncertainty (Carleton et al., 2012). Notably, this study also found a similar pattern of relationships between directed exploration and depression scores, which were positively correlated with anxiety. ...
... Perhaps the most obvious psychological mechanism associated with the COVID-19 pandemic is the uncertainty that defines the extent and timescale of the lifestyle restrictions. In general, high intolerance of uncertainty is associated with higher levels of mental distress, particularly anxiety (16). The intolerance of uncertainty model suggests that individuals whose tolerance for uncertainty is low have the tendency to respond negatively to situations that are uncertain (17). ...
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Introduction Public concern for the mental health of university students has been rising over recent years. Newly arising stressors associated with the COVID-19 pandemic could contribute to further mental health burden for students. This study aimed to understand the mental health status of university students at an early stage in the pandemic and to identify academic, non-academic, and COVID-19-related predictors of common mental health difficulties at this time. Methods This study examined how academic and non-academic predictors relate to common mental health difficulties using a cross-sectional sample of university students (n = 3817). Results There were high levels of depression and anxiety during the pandemic, with more than 50% experiencing levels above the clinical cut offs. Academic stress, social isolation, intolerance of uncertainty, and more negative attitudes towards remote teaching and learning predicted higher levels of depression and anxiety. University identification predicted lower levels of depression whereas receiving a diagnosis of COVID-19 was associated with higher levels of depression. Discussion This study identified COVID-19-related factors that uniquely contributed to students’ distress during the pandemic, over and above social connectivity variables. As COVID-19 factors, such as the uncertainty surrounding the pandemic, may have driven an increase in distress levels among students, these findings provide insights that could help universities and policymakers develop targeted interventions to support the mental health and well-being of university students during future crises.
... Many psychopathologies are linked to difficulties in resolving uncertainty (Andersen & Schwartz, 1992;Carleton et al., 2012;Gillett et al., 2018;Raines et al., 2019), and many of these disorders are associated with abnormalities in the inhibition system (Enright & Beech, 1993;Hallion et al., 2017;Joormann et al., 2007;Mar et al., 2022). The anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (dlPFC) are activated when resolving uncertainty and when inhibiting responses (Blasi et al., 2006;Keri et al., 2004;Schienle et al., 2010;Schulreich & Schwabe, 2021;Yu et al., 2011). ...
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Difficulty tolerating uncertainty is a central deficit across psychopathologies, and checking behavior is a common response to uncertainty. Inducing inhibition improves resolution of uncertainty. However, it is unclear whether inducing inhibition improves decision-making under conditions of uncertainty or whether it reduces checking. This study evaluated how inducing inhibition affects resolution of uncertainty and checking separately. Healthy adults (N = 34) completed three experiments combining an inhibition-induction task with a novel visual-matching task, which dissociated resolving uncertainty from checking. In Experiment 1, the visual-matching task included only “certainty” trials with unlimited checking. In Experiment 2, the task featured “certainty” and “uncertainty” trials, without checking. In Experiment 3, the task featured “certainty” trials, without checking. All participants completed self-report assessments of relevant clinical constructs including obsessive-compulsive symptoms and depressive symptoms. Our results indicate that inducing inhibition reduces unnecessary checking in “certainty” trials. Inducing inhibition also improves accuracy in “uncertainty” trials when checking is impossible, by limiting the harmful propagation of uncertainty. The propagation of uncertainty correlated with depressive symptoms and checking correlated with obsessive-compulsive symptoms. Our results offer a novel measure of different uncertainty facets and demonstrate the interactions between inhibition, uncertainty, and checking. We also outline implications for understanding specific uncertainty facets in psychopathologies and suggest that inducing inhibition may play a role in alleviating certain mental health symptoms.
... Additionally, Journault et al. (2022) delineated four distinct anxiety susceptibility profiles based on anxiety sensitivity and test anxiety levels: 1) Double-susceptibility, with high scores in both dimensions, 2) Test anxiety-specific susceptibility, with high test anxiety but low anxiety sensitivity, 3) Anxiety sensitivity-specific susceptibility, with the opposite pattern, and 4) No-susceptibility, where both scores are low. These processes are also present in anxiety and depressive disorders (Carleton et al., 2012;Hovenkamp-Hermelink et al. 2021). The findings of these studies illustrate the complexity of the relationship between test anxiety, anxiety, and depressive symptoms. ...
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Test anxiety is a problem affecting more and more adolescents and leading to significant negative consequences (Putwain & Daly, Educational Studies, 40(5), 554–570, 2014; von der Embse et al., Journal of Affective Disorders, 227, 483–493, 2018; von der Embse et al., School Psychology, 36(2), 86–96, 2021). However, few programs have been developed to target test anxiety in school settings among adolescents (Ergene, School Psychology International, 24(3), 313–328, 2003; von der Embse et al., Psychology in the Schools, 50(1), 57–71, 2013a). Thus, this study aims to evaluate the effectiveness of the Pastel intervention program in a randomized control trial, based on a cognitive-behavioral based approach combined with study skills to reduce test anxiety in adolescents. The pretest, posttest, and six-month follow-up effects of the program on test anxiety (primary outcome), as well as on secondary outcomes (social anxiety, generalized anxiety, depressive symptoms, and academic self-efficacy) were assessed. This study was carried out with 48 adolescents aged 14 to 17 years, from five private or public schools. The results indicated a medium effect on test anxiety between the pretest and posttest, and a low effect between the pretest and the six-month follow-up. The program also appeared to have an impact on some short-term and long-term secondary outcomes, such as social anxiety and depression symptoms. This study adds to the literature on test anxiety in adolescents by proposing an innovative and promising program to reduce symptoms associated with test anxiety and related issues.
... Greater intolerance of uncertainty significantly predicted greater anxiety but not depression 12 weeks later. The predictive role of intolerance of uncertainty in anxiety is in line with existing literature which finds higher levels of intolerance of uncertainty in individuals with clinical levels of generalised anxiety disorder than the general population (Carleton et al., 2012;Gu et al., 2020;Wilson et al., 2023). Our results extend the literature by showing this relationship with longitudinal data. ...
... The RTQ-10 has been demonstrated to be a reliable and valid transdiagnostic measure of RNT in adolescents [86]; (4) the Difficulties in Emotion Regulation Scale (DERS-16 [159]), a 16-item questionnaire measuring emotion regulation on a 5-point Likert-type scale from Almost never (1) to Almost always (5). The DERS-16 has good psychometric properties in adolescents [159] and has been used in adolescent clinical as well as in nonclinical samples before [160,161]; (5) the Intolerance of Uncertainty Scale (IUS-12 [162]), a 12-item questionnaire measuring reactions to uncertainty, ambiguous situations, and the future on a 5-point Likert scale from Not at all characteristic of me (1) to Entirely characteristic of me (5). The IUS-12 demonstrated very good psychometric properties [163,164] which have been replicated in clinical as well as nonclinical samples [164][165][166]; (6) the Children's Rejection Sensitivity Questionnaire (C-RSQ [167,168]) assesses rejection sensitivity through six hypothetical interpersonal situations with ambiguous outcomes. ...
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Background Most mental disorders have their onset in adolescence. Preventive interventions during this period are important; however, help-seeking behavior is generally poor in this age group resulting in low treatment rates. Internet interventions are expected to be an effective, low-threshold, and scalable approach to overcome barriers to help-seeking, particularly for individuals experiencing subclinical symptoms. Internet-delivered indicated prevention seems promising as it targets individuals with minimal symptoms of mental disorders who might need care but are not help-seeking yet. Previous indicated prevention-approaches have mainly targeted specific risk-syndromes. However, this contradicts the increasing recognition of emerging psychopathology as a complex system characterized by co-occurrence and rapid shifts of subclinical symptoms cutting across diagnostic categories. Therefore, this study will investigate the efficacy, mediators, moderators, and core symptomatic changes of a transdiagnostic Internet-delivered indicated prevention program (EMPATIA program) for adolescents. Methods This randomized controlled trial (RCT) will be conducted in a general population sample (planned n = 152) of adolescents aged 12–18 years with subclinical symptoms but without any current or past mental disorder. Participants will be randomly assigned to the EMPATIA program or a care as usual (CAU) control condition. The 8-week guided EMPATIA program encompasses 8 modules targeting the following transdiagnostic mechanisms: repetitive negative thinking, self-perfectionism, emotion regulation, intolerance of uncertainty, rejection sensitivity, and behavioral avoidance. Participants will be asked to answer online self-report questionnaires at baseline, after 8 weeks, and at 6-, 9-, and 12-month follow-up. Diagnostic telephone interviews will be conducted at baseline and at 12-month follow-up. Additionally, intervention-specific constructs (motivation, alliance, negative effects, satisfaction, adherence) will be assessed during and after the EMPATIA program. The level of self-reported general psychopathology post-intervention is the primary outcome. Discussion Results will be discussed considering the potential of Internet interventions as a scalable, low-threshold option for indicated prevention in adolescents experiencing subclinical symptoms. The EMPATIA program introduces a novel Internet prevention program targeting six transdiagnostic mechanisms associated with various mental health outcomes. Thereby, this trial pursues a very timely and important topic because it may contribute to narrow the current care gap for adolescents, to prevent mental health problems and related negative consequences, and to promote mental health in the long-term. Trial registration The trial was approved by Swissmedic (Registration Number: 10001035, 08/22/2022) and the Ethics Committee of Bern (Registration Number: 2022-D0036, 08/22/2022). The trial was registered at ClinicalTrials.gov NCT05934019 on 07–03-2023.
... Individuals with higher levels of IU are expected to report more negative experiences (Morriss et al., 2023), greater psychological adjustment difficulties (Kestler-Peleg et al., 2023), and increased feelings of loneliness (Parlapani et al., 2020) compared to those with lower levels of intolerance of uncertainty. This hypothesis is grounded in prior research that has consistently identified IU as a contributing factor to adverse mental health outcomes such as depression and anxiety (Carleton et al., 2012a;Gentes & Ruscio, 2011;Hong & Cheung, 2015). Also, according to the research findings, IU is a potentially essential transdiagnostic fragility factor (Carleton, 2012). ...
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This study examined whether positive and negative experiences mediatethe association of intolerance of uncertainty with psychologicaladjustment problems as well as loneliness. A total of 366undergraduate students (50.3% females; mean age = 21.24 ± 2.96 years)completed an online survey that included measures of intolerance ofuncertainty, positive experiences, negative experiences, psychologicaladjustment problems, and loneliness. The findings indicated that therelationship between intolerance of uncertainty and psychologicaladjustment problems was mediated by positive and negativeexperiences. Similarly, the association between intolerance ofuncertainty and loneliness was also mediated by positive and negativeexperiences. These findings suggest that emotional experiences areimportant in mitigating the negative effects of intolerance ofuncertainty on mental health outcomes. Theoretical contributions andpractical implications of the results are also discussed
... IU is a unique construct, related to, but distinct from fear or the unknown (Carleton, 2016). In the clinical literature, IU accounts for a significant amount of variance in anxiety severity in generalized anxiety disorder (GAD), depression, obsessive compulsive disorder, and social anxiety disorder (Boelen & Carleton, 2012;Boelen & Reijntjes, 2009;Carleton et al., 2012;Prousky, 2015). Targeting IU through cognitive behavioral therapy significantly reduces symptom severity in anxiety and mood-related disorders (Boswell et al., 2013). ...
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Study Intolerance of uncertainty (IU), a disposition to see uncertainty as negative, is a unique construct associated with a number of internalizing disorders and has been a target in cognitive behavioral interventions. Given the overlap between internalizing disorders and alcohol use, exploring IU in the context of drinking behavior provides a promising area of inquiry. Past work identified associations between IU and drinking motives, important predictors of alcohol-related outcomes, with less work examining drinking behavior. Objective We explored the role of IU and drinking motives on drinking patterns and potentially problematic drinking in a community sample of emerging adults (18–25 years). Method Survey data was collected from 551 emerging adults (Mage = 22.26, SD = 2.25; 42.50% cisgender women, 42.28% cisgender men, 9.44% gender diverse; 37.93% white; 16.18% Hispanic/Latine) using an online participant recruitment tool. Participants completed demographic questions, motivations for drinking (DMQ-R), quantity and frequency of alcohol use (DDQ-R), potentially problematic drinking behavior (AUDIT), and attitudes towards uncertainty with a two-factor and single factor operationalization (IUS-27 and IUS-12). Results Across models, statistically significant indirect effects were found, such that greater IU was associated with higher coping and enhancement motives and increased average and maximum drinks per week and AUDIT scores. Conclusion While consistent with the prior literature, novel relations were found between IU and drinking indices via drinking motives. Future work should explore relations between IU and drinking outcomes longitudinally and whether interventions targeting IU have benefit in the prevention of maladaptive alcohol use.
... This finding may seem counter intuitive at first glance as anxiety has often been associated with avoidance of threat (i.e., avoiding signs of recurrence). However, intolerance of uncertainty features largely in high anxious individuals leading to catastrophising and clinical levels of worry and depression (Carleton et al., 2012). Our findings suggest that the Infographics can help manage the uncertainties surrounding metastatic breast cancer by providing the knowledge and power to increase certainty around decision making more effectively. ...
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We investigated the usefulness of a metastatic (secondary) breast cancer Infographics designed to enhance knowledge about symptoms of metastatic breast cancer in women diagnosed with breast cancer. Women with a primary or metastatic diagnosis of breast cancer who had not been in receipt of the Infographics previously, were sent the Infographics and asked to complete a questionnaire measuring their views of the usefulness of the Infographics in a number of domains. They were also asked to complete questionnaires on, anxiety and depression, coping, emotion regulation strategies and perceived cognitive functioning. Results showed that women advocated the use of the Infographics in medical and health care settings, as well as its ability in equipping themwith the relevant knowledge on signs of recurrence, its benefits in empowering control and reducing fears and uncertainties regarding metastatic breast cancer. Exploratory analysis showed that individual differences in trait vulnerability to anxiety and in emotion regulation strategies modulated women’s responses suggesting the use of tailored approaches in the communication of the Infographics with patients. Our results point to the overall benefits of the Infographics in a number of domains. Implications for applications in healthcare settings are discussed.
... Unadjusted reactions to uncertain future relevant events have been claimed to be crucial to understand the relationship between IU and pathological anxiety, as this condition has been related to maladaptive anticipatory reactions to unpredictable future threats [3]. Consequently, it is not surprising that IU has been found to play a crucial role in several anxiety-related disorders [4][5][6][7][8], as well as a transdiagnostic vulnerability factor for the development and maintenance of anxiety and depression symptoms [7,9,10]. Studies about IU have greatly improved our knowledge about the concept itself, its assessment, its relationship with different mental disorders as well as with other dispositional factors [11]. ...
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Intolerance of Uncertainty (IU) is thought to lead to maladaptive behaviours and dysfunctional decision making, both in the clinical and healthy population. The seminal study reported by Luhmann and collaborators in 2011 showed that IU was negatively associated with choosing a delayed, but more certain and valuable, reward over choosing an immediate, but less certain and valuable, reward. These findings have been widely disseminated across the field of personality and individual differences because of their relevance to understand the role of IU in maladaptive behaviours in anxiety-related disorders. We conducted a study to replicate and extend Luhmann et al.’s results with a sample of 313 participants, which exceeded the size necessary (N = 266) to largely improve the statistical power of the original study by using the small telescopes approach. The results of our well powered study strongly suggest that the relationship between IU and the tendency to prefer an immediate, but less certain and less valuable reward is virtually negligible. Consequently, although this relationship cannot be definitely discarded, we conclude that it cannot be detected with Luhmann et al.’s (2011) decision-making task.
... That is, reduced directed exploration with high anxiety was partially explained by greater information-seeking when it was not useful (i.e., not solely due to less informationseeking when it would have been useful in H6). Thus, these findings are somewhat consistent with the first study (Aberg et al., 2022), and suggest a general intolerance of uncertainty (Carleton et al., 2012). Notably, this study also found a similar pattern of relationships between directed exploration and depression scores, which were positively correlated with anxiety. ...
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Exploratory behaviors can serve an adaptive role within novel or changing environments. Namely, they facilitate information gain, allowing an organism to maintain accurate beliefs about the environment and select actions that better maximize reward. However, finding the optimal balance between exploration and reward-seeking behavior – the so-called explore-exploit dilemma – can be challenging, as it requires sensitivity to one’s own uncertainty and to the predictability of one’s surroundings. Here, we review computational modeling studies investigating how exploration is influenced by anxiety. While some apparent inconsistencies remain to be resolved, studies using reinforcement learning tasks suggest that directed (but not random) forms of exploration may be elevated by trait and/or cognitive anxiety, but reduced by state and/or somatic anxiety. Anxiety is also consistently associated with less exploration in foraging tasks. Some differences in exploration may further stem from how anxiety modulates changes in uncertainty over time (learning rates). Jointly, these results highlight important directions for future work in refining choice of tasks and anxiety measures and maintaining consistent methodology across studies.
... While closely related to pathological doubts, intolerance of uncertainty emerges as a distinct, widely recognized symptom in OCD. Similar to doubts, intolerance of uncertainty can be defined in several ways [34,35]. In the most prevalent selfreport measures of intolerance to uncertainty-the Intolerance of Uncertainty Scale [36] and the Intolerance of Uncertainty Scale Short Form (IUS-12) [37]-it is characterized as the propensity to react or think negatively toward uncertain events. ...
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OCD has been conceptualized as a disorder arising from dysfunctional beliefs, such as overestimating threats or pathological doubts. Yet, how these beliefs lead to compulsions and obsessions remains unclear. Here, we develop a computational model to examine the specific beliefs that trigger and sustain compulsive behavior in a simple symptom-provoking scenario. Our results demonstrate that a single belief disturbance–a lack of confidence in the effectiveness of one’s preventive (harm-avoiding) actions–can trigger and maintain compulsions and is directly linked to compulsion severity. This distrust can further explain a number of seemingly unrelated phenomena in OCD, including the role of not-just-right feelings, the link to intolerance to uncertainty, perfectionism, and overestimation of threat, and deficits in reversal and state learning. Our simulations shed new light on which underlying beliefs drive compulsive behavior and highlight the important role of perceived ability to exert control for OCD.
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Anxiety is intimately related to the desire for information and, under some accounts, thought to arise from the intolerance of uncertainty. Here, we seek to test this hypothesis by studying the relationship between trait anxiety and the willingness to pay for non-instrumental information (i.e., information that reveals whether an event will happen but cannot be used to change the outcome). We model behavior with a resource-rational model of planning, according to which non-instrumental information is useful for planning ahead, but paying for this information only makes sense if the anticipated benefits of planning outweigh the cognitive and financial costs. We find a bidirectional effect of trait anxiety factors on information seeking behavior: those with high trait somatic anxiety exhibit a stronger preference for non-instrumental information, whereas those with high trait negative affect exhibit a weaker preference. By fitting the resource-rational model, we find that this divergent desire for information arises from the utility of obtaining information for future planning (increased in somatic anxiety, decreased in negative affect). Our findings lend support to the intolerance of uncertainty hypothesis in somatic anxiety and highlight the importance of studying anxiety as a multifactorial construct.
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The intergenerational transmission of anxiety and depression is well-documented, but the specific pathways remain less understood. This study examined the role of intolerance of uncertainty (IU) as a transdiagnostic mechanism in this transmission. We recruited 966 children aged 9–13 and their mothers from two primary schools in China using convenience sampling. Maternal and child IU, anxiety, and depression were assessed, and structural equation modeling was employed to analyze the data. Results indicated that the direct path linking maternal and child IU, rather than maternal or child IU alone, mediated the relationship between maternal and child anxiety and depression. These findings suggest that the intergenerational link between cognitive vulnerabilities, such as IU, is critical in perpetuating anxiety and depression across generations. Future research is needed to confirm these findings and further elucidate the mechanisms involved to develop effective prevention and intervention strategies aimed at breaking the cycle of psychopathology across generations.
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Cilj je provedenoga istraživanja bio provjeriti prediktore depresivnosti kod pacijenata oboljelih od različitih kardiovaskularnih bolesti. Ispitana je uloga pripadnosti skupini pacijenata (bolničkoj ili ambulantnoj), netolerancije na neizvjesnost te socijalne podrške u objašnjenju izraženosti depresivnih simptoma. Također je provjeren i medijacijski učinak percipirane socijalne podrške u odnosu između skupine ambulantnih i bolničkih pacijenata te depresivnosti. Bolnički je uzorak činilo 74 pacijenata s akutizacijom srčanog zatajenja, od kojih 56 muškaraca i 18 žena u dobi od 39 do 89 godina, a ambulantni je uzorak činilo 74 pacijenata s kardiovaskularnim bolestima bez znakova akutizacije zatajenja srca, od kojih 36 muškaraca i 38 žena u dobi od 27 do 80 godina. Obje su skupine ispunjavale Upitnik o zdravlju pacijenata koji ispituje depresivnost, Upitnik netolerancije na neizvjesnost te ENRICHD upitnik socijalne podrške. Rezultati su pokazali da je bolnička skupina pacijenata imala značajno višu razinu depresivnosti i značajno nižu razinu percipirane socijalne podrške u odnosu na ambulantnu skupinu pacijenata. Skupina bolničkih pacijenata, s povišenom inhibitornom i prospektivnom netolerancijom na neizvjesnost te percepcijom manje socijalne podrške pokazala je više razine depresivnosti. Percipirana socijalna podrška pokazala se djelomičnim medijatorom u odnosu između pripadnosti bolničkoj skupini pacijenata i depresivnosti. Rezultati upućuju na to da se prilikom tretmana srčanih bolesti, posebice sindroma zatajenja srca, treba ispitati i psihičko funkcioniranje pacijenata kako bi im se mogla pružiti sveobuhvatna zdravstvena i psihološka pomoć.
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The fact that mental health has a major impact on individuals’ lives increases the importance of evaluating mental well-being. This longitudinal study investigated interaction between emotional reactivity, intolerance of uncertainty, and mental well-being among Turkish adults. Drawing on a sample of 199 participants, the research utilized measures to assess emotional responses, intolerance of uncertainty, and mental well-being. The findings indicated that emotional reactivity has a significant positive effect on intolerance of uncertainty, suggesting that heightened emotional reactivity is associated with an increase in intolerance of uncertainty. Moreover, intolerance of uncertainty demonstrated a significant negative impact on mental well-being, highlighting its role as a predictor of mental health outcomes. Importantly, intolerance of uncertainty fully mediated in the relationship between emotional reactivity and mental well-being. The study contributed to the literature by employing a longitudinal design, shedding light on the dynamic interactions between emotional processes, intolerance of uncertainty, and mental well-being. The findings emphasized the importance of considering intolerance of uncertainty as a key factor in understanding mental health outcomes and suggested avenues for future research to explore these relationships further.
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Objective: Insomnia, anxiety, and depression are common and co-morbid amongst college students. The mechanisms by which trait factors like intolerance of uncertainty and anxiety sensitivity connect to state anxiety and depression is unclear, but insomnia may mediate that relationship. Participants: College students (N = 439) were recruited from national and local sources. Methods: Participants completed the Sleep Condition Indicator (SCI), Depression, Anxiety and Stress Scale (DASS), Anxiety Sensitivity Index (ASI), and Intolerance of Uncertainty Scales (IUS). Results: All models predicted a significant amount of variability in state anxiety and depression (R2 between 0.24 and 0.32). Mediation analyses revealed that the relationship between anxiogenic and depressogenic traits and state anxiety and depression is significantly mediated by insomnia. Conclusions: Our findings support the role of insomnia in the expression of anxiety and depression in at-risk college students. Clinical sleep intervention, either reactive or prophylactic, may help reduce mental health burden on campus.
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Background and objectives: Morally horrific events can evoke moral pain and may result in a type of psychological distress known as moral injury (MI). Previous research has hypothesized intolerance of uncertainty (IU; the aversive cognitive and behavioural reaction to uncertainty) may predict MI symptomatology due to its influence on perceived responsibility (PR). As such, we examined the influence of IU and PR on moral emotions associated with vignettes depicting morally stressful events. Method: Participants (n = 245) completed the IU-Scale Short-Form, and were randomly assigned to listen and imagine themselves in a series of vignettes depicting grave moral transgressions committed either by the self (self-transgression condition; STC) or others (OTC). Participants provided ratings of moral emotions and PR in response to each vignette. Results: Significant positive associations were observed between PR and moral emotions in the STC and OTC. IU's behavioral subdimension, inhibitory IU, was positively associated with moral emotions in the STC. Inhibitory IU did not moderate the association between PR and moral emotions. Conclusion: Future research should further explore the interplay of inhibitory IU, PR and MI. Understanding the behavioral inaction associated with elevated inhibitory IU may be important in mitigating painful moral emotions following self-transgressed moral violations.
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Checking behaviours are engaged to prevent adverse outcomes and alleviate uncertainty. However, there is still a gap in our understanding as to how factors such as threat level and performance feedback impact the frequency of checking and associated concomitants. To address these questions, we collected data across two lab sites (n = 208) and manipulated threat level (low threat: performance score only; high threat: mild electric shock based on performance score) and performance feedback (no feedback, feedback) during a visual discrimination and checking task. Throughout the task, we recorded checking frequency, ratings of the urge to check and distress, task performance, and corrugator supercilii activity. High threat versus low threat led to increased checking frequency in one testing site, but not the other. No effect of performance feedback was observed on checking frequency. Performance feedback was associated with the urge to check differently across sites. Both, high threat versus low threat, and no feedback versus feedback, were separately associated with improved task accuracy for easier trial types. Lastly, no feedback, compared to feedback, was associated with greater engagement of the corrugator supercilii. These results suggest that: (1) higher threat level increases checking behaviour to some extent and improves task performance, and (2) the absence of feedback improves task performance and is associated with greater distress or effort. Overall, these findings provide insight into how factors such as threat level and performance feedback differently impact checking behaviour and its concomitants.
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Introduction While changes in the prevalence of depressive symptoms during the COVID-19 pandemic have been described across populations, few studies have incorporated multidimensional variables to characterise the varying effects of the pandemic on the population’s mental health. Methods This cohort study included 6423 participants aged ≥18 years from the Icelandic COVID-19 National Resilience Cohort. Data on depressive symptoms and pandemic-related and non-pandemic-related factors were obtained during three pandemic assessment periods (baseline, follow-up wave 1 and follow-up wave 2; April 2020–December 2021), while health outcomes were obtained during the post-pandemic assessment period (follow-up wave 3; September 2022–February 2023). We used latent growth mixture models to identify variation in depressive symptom trajectories during the pandemic. We then used XGBoost models with 37 pandemic-related and non-pandemic-related factors to characterise these trajectories. Moreover, we performed linear regression to assess the association between the identified trajectories and post-pandemic health outcomes. Results Of the included participants, we identified four depressive symptom trajectories, including consistently low (83.7%), consistently high (5.3%), initially high (5.1%) and late-onset high (5.9%) symptom trajectories. Individuals who exercised frequently (≥3 days/week) and enjoyed social and family support were more likely to experience a consistently low symptom trajectory. In contrast, individuals with a history of psychiatric disorders, women and young adults (18–39 years) were less likely to follow the consistently low symptom trajectory. Moreover, compared with the consistently low symptom trajectory, the other trajectories were associated with significantly higher levels of depressive, anxiety and somatic symptoms and cognitive problems during the post-pandemic period. Conclusions Our results underscore the long-lasting impact of the COVID-19 pandemic on population mental health. Interventions focusing on exercise, social support and family support may mitigate the adverse mental health effects of future pandemics.
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This study explores the relationship between “doomscrolling”—the habit of consuming continuous negative news—and trait anxiety, while considering the explanatory role of psychological resilience and intolerance of uncertainty. With constant connectivity and information overload in the digital age, doomscrolling has raised concerns about its potential to heighten anxiety. The study examines 443 participants (79.9 % female, 20.1 % male, average age 23.49 years) using Structural Equation Modeling (SEM) to assess the connections between the variables. Key findings reveal that trait anxiety significantly predicts intolerance of uncertainty (β = 0.50, p < .001) and is negatively linked to psychological resilience (β = − 0.19, p < .001). Intolerance of uncertainty is negatively correlated with psychological resilience (β = − 0.42, p < .001) and positively associated with doomscrolling (β = 0.29, p < .001). Psychological resilience acts as a protective factor, negatively associated with doomscrolling (β = − 0.12, p < .05). Additionally, both psychological resilience and intolerance of uncertainty explain the rela- tionship between trait anxiety and doomscrolling (β = 0.193, p < .05). These results provide insights into how intolerance of uncertainty and psychological resilience influence the connection between anxiety and doomsc- rolling, suggesting intervention opportunities in an anxiety-inducing digital world.
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Objectives There is little research exploring the subthreshold social anxiety (SSA) in culturally diverse young people. This study addresses this gap and provides an insight into the vivid world of this ‘hidden’ population. Design Four participants from England were interviewed using semi‐structured interviews. Four superordinate themes and their corresponding subordinate themes emerged from the transcripts: Excessive self‐consciousness—The inner critic and Feeling judged by others; Influences of social and cultural norms—The impact of dress‐code rules and The pressure of high expectations; Embracing a false reality—Patterns of avoidance and The public self; and Coping strategies—Breaking the wall of cultural norms, Pushing the bubble out and Know that you are not alone. Due to the vastness of the data, this study presents only the first two superordinate themes and their corresponding subordinate themes. Methods The author chose interpretative phenomenological analysis (IPA). This allowed the participants to describe thoroughly their lived experiences and enabled the researcher to adopt a scientific approach. Results The results revealed that the socio‐cultural background of this population played a pivotal role in the prevalence and expression of SSA. Conclusions The participants' experiences were significantly influenced by the social and cultural norms of their country of origin as well as the characteristics of modern society in England. The predominant factors were the pressure of high expectations from family and society, transgenerational trauma, socio‐cultural norms, uncertainty about the future and lack of opportunities to secure employment. Future research could examine the socio‐cultural influences shaping contemporary British society and their impact on youth's mental health.
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Background Emergency medicine (EM) physicians often practice in dynamic, high‐stress, and uncertain settings with limited resources. Although simulation has been shown to enhance various aspects of student development, its impact on medical students' personal growth initiative, resourcefulness, and tolerance of uncertainty—crucial traits for managing future crises as emergency physicians—remain unclear. The purpose of this study, therefore, was to determine a high‐fidelity prehospital simulation's impact on medical students' resourcefulness, personal growth, and tolerance of uncertainty. Methods We surveyed 107 fourth‐year medical students before and after a multiday, high‐fidelity prehospital simulation. The survey included items from the Intolerance of Uncertainty Scale‐12 Item Form, the Personal Growth Initiative Scale, and the Resourcefulness Skills Scale. We compared students' pre‐ and post‐simulation responses to investigate any change in their uncertainty intolerance, personal growth initiative, and resourcefulness following simulation participation. Results Students’ scores significantly increased following the simulation for both resourcefulness ( t (106) = −6.89, p < 0.001, d = −0.67) and personal growth initiative ( t (106) = −6.22, p < 0.001, d = −0.60). Effect size calculations suggest that participating in the simulation had a medium to large effect on participants’ resourcefulness and personal growth initiative. However, participants’ tolerance of uncertainty scores prior to and following the simulation did not significantly differ ( t (106) = 1.66, p = 0.100, d = 0.16), indicating that the simulation had little effect on participants’ tolerance of uncertainty. Conclusions Our results indicate that simulation is a promising educational tool for developing students' resourcefulness and personal growth initiative so they can navigate high‐stress, low‐resource environments. Follow‐on research is needed to determine how to leverage simulation to enhance students’ uncertainty tolerance in high‐stress, low‐resource environments.
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The unfamiliar and unusual stressful conditions due to COVID-19 have motivated employees to excessively use smartphones for non-work-related activities to alleviate the negative feelings associated with these stressful conditions. To conceptualize our research model, we employed the Compensatory Internet Use Theory (CIUT), which is associated with problematic technology usage. The proposed model investigates the influence of the following negative factors that emerged because of COVID-19 as the determinants of problematic smartphone use (PSU): remote work arrangement (RWA), intolerance of uncertainty (IU), COVID-19 anxiety (CA), and social isolation (ISO). In addition, we suggest that, although employees tend to use smartphones excessively to alleviate stressful life conditions, these conditions (RWA, IU, CA, and ISO) will lead to emotional exhaustion (EE), which will consequently result in the excessive use of smartphones. Furthermore, we are investigating the influence of PSU on employee work productivity. Finally, we are also interested in exploring the moderating role of gender in the relationships within our model. The results have shown that all hypotheses are supported, except for the influence of RWA on EE and PSU, and the influence of CA on PSU. We believe that our findings will provide researchers and businesses with a deeper understanding of this critical issue, especially in the context of smartphone usage at work.
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Background: The outdoor industry has experienced a number of problematic issues, one of the most prominent being staffing concerns related to hiring, retention, and burnout. Purpose: This study investigated the relationship between the level of experience, gender, and age on the selected variables of resilience, coping skills, mental toughness, levels of anxiety, job positivity, and burnout. Methods: This study used an electronic self-report instrument to measure the six variables. For simplicity, level of experience was measured as the overall length of time working in the outdoor industry. Findings: Results partially supported the hypothesis that level of experience can be linked to higher job positivity, lower anxiety, and higher levels of burnout. No significant relationship was found between level of experience and resilience, mental toughness, or coping. Gender and age did not moderate the relationships between experience and the outcomes of interest. Implications: The findings of this study suggest that experience in outdoor adventure programs may be associated with higher job positivity, lower anxiety, and lower levels of burnout among more experienced staff. These results highlight the importance of providing opportunities for individuals to gain experience in order to enhance their well-being and job satisfaction within outdoor adventure programs.
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Intolerance of uncertainty (IU) is a transdiagnostic trait associated with Internet Gaming Disorder (IGD), but the mechanisms underlying this relationship remain unclear. Guided by the Interaction of Person-Affect-Cognition-Execution model, this research explored the serial mediation of experiential avoidance and maladaptive cognitions related to Internet gaming. A sample of 1393 Internet gamers (62.5 % male, aged 14–50, with an average weekly game time of 17.05 h) completed self-report measures of IU, experiential avoidance, maladaptive cognitions, and IGD. Structural equation modelling revealed that IU directly predicted IGD, and indirectly predicted IGD through experiential avoidance and maladaptive cognitions. This hypothesized model explained 46 % of the variance in IGD. These findings suggest that IGD may be particularly problematic for individuals who fear uncertainty. Meanwhile, habitual avoidance of negative experiences and distorted gaming cognitions are key mechanisms linking IU to IGD. While IU is a static risk trait for IGD, experiential avoidance and maladaptive cognitions are more proximal and modifiable risk factors. Addressing these factors may offer promising intervention paths. Given the cross-sectional nature of this study, future research should use longitudinal designs to better assess causal relationships.
Article
Importance Fear of cancer recurrence is common among survivors of adult-onset cancer and associated with increased distress, functional impairment, and health care utilization. However, little is known about the prevalence and risk factors of fear of cancer recurrence among adult survivors of childhood cancer who are also at high risk for subsequent malignant neoplasms. Objective To characterize the prevalence of and risk factors for clinically significant fear of cancer recurrence in adult survivors of childhood cancer. Design, Setting, and Participants This cross-sectional investigation included participants recruited from the Childhood Cancer Survivor Study, a retrospective cohort study of long-term childhood cancer survivors treated at 31 institutions between 1970 and 1999 across North America. Participants were recruited and completed psychosocial measures via online survey between October 2018 and April 2019. Cancer and treatment-related variables were abstracted from medical records. Data were analyzed from May 2023 to July 2024. Main Outcomes and Measures Clinically significant fear of cancer recurrence was assessed via the Fear of Cancer Recurrence Inventory-Short Form. Poisson regression models estimated prevalence ratios (PRs) with 95% CIs adjusted for age and sex to examine the associations of demographic, disease, treatment, and psychosocial variables with fear of cancer recurrence. Results The final sample included 229 adult survivors of childhood cancer (115 female [50.2%]; mean [SD] age, 39.6 [9.9] years; mean [SD] time since diagnosis, 31.7 [8.4] years). Among survivors, 38 (16.6%; 95% CI, 11.6%-21.6%) reported clinically significant fear of cancer recurrence, and an additional 36 (15.7%) reported high fear of cancer recurrence. Clinically significant fear of cancer recurrence was associated with unemployment (PR, 2.5; 95% CI, 1.3-4.8), presence of neurologic chronic health conditions (PR, 3.3; 95% CI, 1.8-6.1), treatment with pelvic radiation (PR, 2.9; 95% CI, 1.5-5.6), and amputation or limb sparing surgery (PR, 2.4; 95% CI, 1.2-4.9). Higher risk of clinically significant fear of cancer recurrence was also associated with having either elevated anxiety or depression (PR, 2.6; 95% CI, 1.2-5.9), having both elevated (PR, 3.2; 95% CI, 1.2-8.4), and perceived poor health status (PR, 3.0; 95% CI, 3.1-9.7). Conclusions and Relevance Decades following treatment, one-third of childhood cancer survivors in this study reported elevated fear their cancer will recur or a subsequent malignant neoplasm will develop. Findings suggest that fear of cancer recurrence should be routinely screened, and clinically significant symptoms intervened upon as a part of survivorship care.
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Due to the repeated changes in the COVID-19 pandemic, we live in an era of various uncertainties that raise future anxiety and behavioral addiction problems. According to the Protection Motivation Theory (PMT), the present study attempted to explore the impact of COVID-19 intolerance of uncertainty (COVID-19 IU) on internet addiction (IA) among college students and the mediating role of future anxiety (FA) by constructing a mediating model. A questionnaire survey was conducted on 679 Chinese college students and PROCESS 3.5 was utilized to test the hypotheses. The results indicated that the COVID-19 IU was significantly positively correlated with IA and FA, and FA was significantly positively correlated with IA. COVID-19 IU had a significant positive predictive effect on IA; FA played a complementary partial mediating role between COVID-19 IU and IA. The results supported the PMT, which not only enriched our understanding of FA under uncertain life circumstances, but also deepened our understanding of the potential mechanisms of the effects of IA. Finally, discussions and suggestions were presented based on the results.
Article
Against the background of Job Demands‐Resources and Conservation of Resources theory and research on organizational communication, this prospective study among n = 312 employees explores the significant role of perceived information process quality (PIPQ) in enhancing employees' optimism during the COVID‐19 pandemic. It thereby contributes to a deeper understanding of the factors influencing employee optimism in challenging contexts. In this study, PIPQ is defined by the availability of timely information, clarity, and consistency in the information provided. Results from latent change score modelling revealed that employees who experienced high PIPQ, particularly consistent information, reported feeling more optimistic about work‐related aspects and also experienced spillover effects into their private lives. Notably, both consistency in information prior to the pandemic and increases in consistent information during the pandemic demonstrated this beneficial effect. Moreover, timely available information also positively influenced optimism, especially regarding work‐related aspects. However, the study did not find evidence that clarity in information significantly affected optimism. In summary, the findings underscore the importance of accessible and consistent information as a vital resource for employees' ability to navigate crises.
Article
Background: Efforts to identify risk and resilience factors for anxiety severity and course during the COVID-19 pandemic have focused primarily on demographic rather than psychological variables. Intolerance of uncertainty (IU), a transdiagnostic risk factor for anxiety, may be a particularly relevant vulnerability factor. Method: N = 641 adults with pre-pandemic anxiety data reported their anxiety, IU, and other pandemic and mental health-related variables at least once and up to four times during the COVID-19 pandemic, with assessments beginning in May 2020 through March 2021. Results: In preregistered analyses using latent growth models, higher IU at the first pandemic timepoint predicted more severe anxiety, but also a sharper decline in anxiety, across timepoints. This finding was robust to the addition of pre-pandemic anxiety and demographic predictors as covariates (in the full sample) as well as prepandemic depression severity (in participants for whom pre-pandemic depression data were available). Younger age, lower self/parent education, and self-reported history of COVID-19 illness at the first pandemic timepoint predicted more severe anxiety across timepoints with strong model fit, but did not predict anxiety trajectory. Conclusions: IU prospectively predicted more severe anxiety but a sharper decrease in anxiety over time during the pandemic, including after adjustment for covariates. IU therefore appears to have unique and specific predictive utility with respect to anxiety in the context of the COVID-19 pandemic.
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Child Abuse and Neglect (CAN) is extensively implicated as a risk factor preceding the development of Obsessive–Compulsive Personality Traits (OCPT). Nevertheless, the majority of individuals with a history of CAN do not go on to develop OCPT. To date, little research has investigated potential model networks that may help contribute to explaining why CAN sometimes leads to OCPT and not at other times. Thus, this study aimed to investigate whether attachment-anxiety, intolerance of uncertainty, and metacognition have indirect effects in the association between CAN and OCPT in various network models. Undergraduate psychology students (N = 291) participated in an anonymous 30-min online survey consisting of a series of self-report questionnaires regarding child abuse and neglect, attachment, intolerance of uncertainty, metacognition, OCPT, and depression. Bootstrapped serial mediation revealed attachment-anxiety and intolerance of uncertainty had a serial-mediation effect in the association between CAN and OCPT. Serial mediation was not found for metacognition and attachment-anxiety. However, metacognition alone mediated between child emotional abuse and OCPT. These findings expand our currently limited knowledge regarding the etiology of OCPT and suggest that attachment-anxiety, intolerance of uncertainty, and metacognition may be important contributors for understanding the development of OCPT following CAN exposure. The potential clinical utility for both assessment and treatment are discussed.
Chapter
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This insert introduces some kernel estimators that provide nonparametric density estimates along with ado-files to calculate them. Kernel density estimators are an essential component of many more complicated estimators, such as semiparametric procedures. In this insert, we will stress the use of kernel estimators as tools for the exploratory stage of data analysis. In this context, kernel estimators can be regarded as nonparametric histogram smoothers. Fron an exploratory point of view, density estimates are valuable because they can reveal skewness, heavy or light tails, and multimodality in the data, characteristics that can be investigated further at the confirmatory stage (Silverman 1986).
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Monte Carlo computer simulations were used to investigate the performance of three χ–2 test statistics in confirmatory factor analysis (CFA). Normal theory maximum likelihood χ–2 (ML), Browne's asymptotic distribution free χ–2 (ADF), and the Satorra-Bentler rescaled χ–2 (SB) were examined under varying conditions of sample size, model specification, and multivariate distribution. For properly specified models, ML and SB showed no evidence of bias under normal distributions across all sample sizes, whereas ADF was biased at all but the largest sample sizes. ML was increasingly overestimated with increasing nonnormality, but both SB (at all sample sizes) and ADF (only at large sample sizes) showed no evidence of bias. For misspecified models, ML was again inflated with increasing nonnormality, but both SB and ADF were underestimated with increasing nonnormality. It appears that the power of the SB and ADF test statistics to detect a model misspecification is attenuated given nonnormally distributed data. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This simulation study investigated the robustness of structural equation modeling to different degrees of nonnormality under 2 estimation methods, generalized least squares and maximum likelihood, and 4 sample sizes, 100, 250, 500, and 1,000. Each of the slight and severe nonnormality degrees was comprised of pure skewness, pure kurtosis, and both skewness and kurtosis. Bias and standard errors of parameter estimates were analyzed. In addition, an analysis of variance was conducted to investigate the effects of the 3 factors on several goodness-of-fit indexes. The study found that standard errors of parameter estimates were not significantly affected by estimation methods and nonnormality conditions. As expected, standard errors decreased at larger sample sizes. Parameter estimates were more sensitive to nonnormality than to sample size and estimation method. Chi-square was the least robust model fit index compared with Normed Fit Index, Nonnormed Fit Index, and Comparative Fit Index. Sample sizes of 100 or more are recommended for accurate parameter estimates.
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The goal of this study was to explore the specificity of the relationship between intolerance of uncertainty and worry in a nonclinical sample. Three hundred and forty-seven university students completed measures of worry, obsessions/compulsions, and panic sensations. They also completed measures of process variables known to be associated with worry (intolerance of uncertainty), obsessions/compulsions (responsibility), and panic sensations (anxiety sensitivity). The results show that intolerance of uncertainty was highly related to worry, moderately related to obsessions/compulsions, and weakly related to panic sensations. Further, the relationship between intolerance of uncertainty and worry remained strong after shared variance with other study variables was removed. The findings are discussed in terms of their implications for understanding worry and preventing generalized anxiety disorder.
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Vulnerability has increasingly become the organizing construct around which much research in psychopathology is organized. This is particularly the case for depression, where researchers have begun to focus considerable attention on the variables that may predispose some individuals to this disorder. Much of this attention has been directed toward understanding the origins of these presumed vulnerability processes. In line with this interest, vulnerability origins stemming from schema models, hopelessness models, and attachment theory are discussed, as is the idea of disrupted parent-child interactions in the creation of vulnerability. Within this latter category the link between abuse, maltreatment, cognitive factors andvulnerability is examined. Possible directions for future theory and research in cognitive vulnerability and depression are then discussed.
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In the model of Generalised Anxiety Disorder (GAD) proposed by Dugas, Gagnon, Ladouceur, and Freeston (1998), Intolerance of Uncertainty (IU) plays a central role in the acquisition and maintenance of worries. A similar concept, Intolerance of Ambiguity (IA) was introduced by Frenkel-Brunswik 50 years ago. For decades, IU has been confused with IA. Researchers have applied them interchangeably. The main goal of this paper is to clarify and differentiate the notions of IU and IA, as well as to suggest new research avenues.
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Transdiagnostic cognitive-behavioral group treatments for anxiety, treatments that are designed to be applicable to diagnostically mixed groups of anxiety disorder clients, have been garnering interest in recent years. At least 7 independent research teams have developed transdiagnostic anxiety treatment protocols and reported preliminary outcomes data. In this review, we outline the basic theoretical rationale underlying transdiagnostic models of anxiety and review each of the treatment protocols that have been reported to date. Finally, the efficacy of these treatments is examined using meta-analytic methods. Results indicated that overall, transdiagnostic treatments are associated with a very large pre- to posttreatment effect size, and stable maintenance of gains through follow-up. Recommendations for transdiagnostic treatment implementation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
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Intolerance of uncertainty (IU) is related to anxiety, depression, worry, and anxiety sensitivity. Precedent IU measures were criticized for psychometric instability and redundancy; alternative measures include the novel 45-item measure (Intolerance of Uncertainty Index; IUI). The IUI was developed in French with 2 parts, assessing general unacceptability of uncertainty (15 items, Part A) and manifestations of uncertainty approximating more common anxiety disorder symptoms (30 items, Part B). The psychometric stability of the back-translated English items of the IUI as well as the incremental variance of Parts A and B remain to be assessed. The current study involved 2 samples of English-speaking community participants (n = 437 and n = 309; 73% women and 27% men) who completed the IUI and several related measures. Exploratory and confirmatory factor analyses suggested a refinement of IUI items as well as a unitary structure for Part A and a 3-factor structure for Part B. Regression results suggested Parts A and B each provide incremental validity in measures of worry, generalized anxiety disorder symptoms, negative problem orientation, and depression. Comprehensive results, implications, and future research directions are discussed.
Article
Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice provides a review of the empirical support for the different models of GAD. It includes a detailed description of the assessment and step-by-step treatment of GAD (including many examples of therapist-client dialogue), data on treatment efficacy in individual and group therapy, and concludes with a description of maintenance and follow-up strategies.
Article
Monte Carlo computer simulations were used to investigate the performance of three χ2 test statistics in confirmatory factor analysis (CFA). Normal theory maximum likelihood χ2 (ML), Browne's asymptotic distribution free χ2 (ADF), and the Satorra-Bentler rescaled χ2 (SB) were examined under varying conditions of sample size, model specification, and multivariate distribution. For properly specified models, ML and SB showed no evidence of bias under normal distributions across all sample sizes, whereas ADF was biased at all but the largest sample sizes. ML was increasingly overestimated with increasing nonnormality, but both SB (at all sample sizes) and ADF (only at large sample sizes) showed no evidence of bias. For misspecified models, ML was again inflated with increasing nonnormality, but both SB and ADF were underestimated with increasing nonnormality. It appears that the power of the SB and ADF test statistics to detect a model misspecification is attenuated given nonnormally distributed data.
Article
Recent theories of obsessive-compulsive disorder (OCD) emphasize the importance of cognitive contents (beliefs and appraisals) and cognitive processes in the etiology and maintenance of OCD. In order to evaluate these theories and to assess the mechanisms of treatment-related change, it is necessary to develop measures of the relevant cognitive contents and processes. Several scales have been developed, although many are unpublished and there is a great deal of overlap among measures. The purpose of the present article is to describe the progress of an international group of investigators who have commenced a coordinated effort to develop a standardized set of cognitive measures. This article describes the theoretical bases and clinical importance of such an endeavor, and the proceedings of the working group meetings are summarized. Several methods of assessment are reviewed, including idiographic methods, information processing paradigms, and self-report measures. The working group is currently developing and evaluating self-report measures of appraisals about intrusions, and self-report measures of OC-related beliefs. Consensus ratings indicated that 6 belief domains are likely to be important in OCD. These are beliefs pertaining to: (1) inflated responsibility; (2) overimportance of thoughts; (3) excessive concern about the importance of controlling one's thoughts; (4) overestimation of threat; (5) intolerance of uncertainty; and (6) perfectionism.
Chapter
This chapter provides a review of research findings on the nature of anxiety and panic, and a summary and update of Barlow's (1988, 2000, 2002) theory of triple vulnerability in the etiology of anxiety and its disorders. A description of the nature of anxiety is followed by an explication of the emotion of fear, and panic. A model of an integrated set of vulnerabilities is summarized, including a generalized biological (heritable) vulnerability, a generalized psychological vulnerability based on early experiences that contributes to the development of a sense of control over salient events, and a more specific psychological vulnerability associated with learning experiences that serve to focus anxiety on specific objects or situations.
Article
This article considers single sample approximations for the cross-validation coefficient in the analysis of covariance structures. An adjustment for predictive validity which may be employed in conjunction with any correctly specified discrepancy function is suggested. In the case of maximum likelihood estimation under normality assumptions the coefficient obtained is a simple linear function of the Akaike Information Criterion. Results of a random sampling experiment are reported.
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In this paper the formula for the optimal histogram bin width is derived which asymptotically minimizes the integrated mean squared error. Monte Carlo methods are used to verify the usefulness of this formula for small samples. A data-based procedure for choosing the bin width parameter is proposed, which assumes a Gaussian reference standard and requires only the sample size and an estimate of the standard deviation. The sensitivity of the procedure is investigated using several probability models which violate the Gaussian assumption.
Article
The purpose of this article is to illustrate the steps involved in testing for multigroup invariance using Amos Graphics. Based on analysis of covariance (ANCOV) structures, 2 applications are demonstrated, each of which represents a different set of circumstances. Application 1 focuses on the equivalence of a measuring instrument and tests for its invariance across 3 teacher panels, given baseline models that are identical across groups. Application 2 centers on the equivalence of a postulated theoretical structure across adolescent boys and girls in light of baseline models that are differentially specified across groups. Taken together, these illustrated examples should be of substantial assistance to researchers interested in testing for multigroup invariance using the Amos program.
Article
Though the common default maximum likelihood estimator used in structural equation modeling is predicated on the assumption of multivariate normality, applied researchers often find themselves with data clearly violating this assumption and without sufficient sample size to utilize distribution-free estimation methods. Fortunately, promising alternatives are being integrated into popular software packages. Bootstrap resampling, which is offered in AMOS (Arbuckle, 1997), is one potential solution for estimating model test statistic p values and parameter standard errors under nonnormal data conditions. This study is an evaluation of the bootstrap method under varied conditions of nonnormality, sample size, model specification, and number of bootstrap samples drawn from the resampling space. Accuracy of the test statistic p values is evaluated in terms of model rejection rates, whereas accuracy of bootstrap standard error estimates takes the form of bias and variability of the standard error estimates themselves.
Article
The 27-item Intolerance of Uncertainty Scale (IUS) has become one of the most frequently used measure of Intolerance of Uncertainty. More recently, an abridged, 12-item version of the IUS has been developed. The current research used clinical (n = 50) and non-clinical (n = 56) samples to examine and compare the psychometric properties of both versions of the IUS. The two scales showed good internal consistency at both the total and subscale level and had satisfactory test-retest reliability. Both versions were correlated with worry and trait anxiety and had satisfactory concurrent validity. Significant differences between the scores of the clinical and non-clinical sample supported discriminant validity. Predictive validity was also supported for the two scales. Total scores, in the case of the clinical sample, and a subscale, in the case of the non-clinical sample, significantly predicted pathological worry and trait anxiety. Overall, the clinicians and researchers can use either version of the IUS with confidence, due to their sound psychometric properties.
Article
This chapter describes the course of our research on intolerance of uncertainty, beginning with the development and validation of the Intolerance of Uncertainty Scale. Following this, our research on the relationship between intolerance of uncertainty and worry in both nonclinical and clinical populations is reviewed. The nature of the relationship between intolerance of uncertainty and generalized anxiety disorder (GAD), and the role of intolerance of uncertainty in the etiology and maintenance of GAD, are then discussed. Finally, the potential developmental origins of intolerance of uncertainty are explored. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Book
Readers who want a less mathematical alternative to the EQS manual will find exactly what they're looking for in this practical text. Written specifically for those with little to no knowledge of structural equation modeling (SEM) or EQS, the author's goal is to provide a non-mathematical introduction to the basic concepts of SEM by applying these principles to EQS, Version 6.1. The book clearly demonstrates a wide variety of SEM/EQS applications that include confirmatory factor analytic and full latent variable models.
Article
This study evaluated the sensitivity of maximum likelihood (ML)-, generalized least squares (GLS)-, and asymptotic distribution-free (ADF)-based fit indices to model misspecification, under conditions that varied sample size and distribution. The effect of violating assumptions of asymptotic robustness theory also was examined. Standardized root-mean-square residual (SRMR) was the most sensitive index to models with misspecified factor covariance(s), and Tucker-Lewis Index (1973; TLI), Bollen's fit index (1989; BL89), relative noncentrality index (RNI), comparative fit index (CFI), and the ML- and GLS-based gamma hat, McDonald's centrality index (1989; Mc), and root-mean-square error of approximation (RMSEA) were the most sensitive indices to models with misspecified factor loadings. With ML and GLS methods, we recommend the use of SRMR, supplemented by TLI, BL89, RNI, CFI, gamma hat, Mc, or RMSEA (TLI, Mc, and RMSEA are less preferable at small sample sizes). With the ADF method, we recommend the use of SRMR, supplemented by TLI, BL89, RNI, or CH. Finally, most of the ML-based fit indices outperformed those obtained from GLS and ADF and are preferable for evaluating model fit. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Chapter
Intolerance of Uncertainty: a Key Process Involved in WorryIntolerance of Uncertainty: Direct Links with WorryIntolerance of Uncertainty: Indirect Links with WorryThe Role of Competing Cognitive-Motivational States in the Maintenance of WorryConclusion References
Article
Cognitive models of anxiety disorders propose that certain cognitive constructs, that is, underlying beliefs and cognitive processes, may be specific for particular disorders. In this article, we review the specificity of four representative cognitive constructs—anxiety sensitivity, pathological worry, intolerance of uncertainty, and thought–action fusion—for particular disorders. Conceptual overlap, inconsistent definitions, and insufficient consideration of the components of these constructs are limitations of the existing literature. We suggest that the constructs are unlikely to be pathognomonic for any given disorder or to occur in isolation. Rather, the association of each cognitive construct is evident, to varying degrees, with different disorders. Relative to other disorders, anxiety sensitivity is to a certain extent specific for panic disorder, as are pathological worry for generalized anxiety disorder, intolerance of uncertainty for generalized anxiety disorder and obsessive–compulsive disorder, and thought–action fusion for obsessive–compulsive disorder. We discuss the implications of these findings for diagnostic systems and treatment, and suggest areas for further research. Depression and Anxiety 23:51–61, 2006. © 2006 Wiley-Liss, Inc.
Article
Research suggests that intolerance of uncertainty is a cognitive process involved in excessive worry and generalized anxiety disorder (GAD). Although previous studies indicate that intolerance of uncertainty and excessive worry are highly and specifically related, the question of how intolerance of uncertainty might lead to worry has yet to be empirically examined. This paper presents two studies investigating intolerance of uncertainty and information processing. Study 1 used an incidental learning task to examine the relationship between intolerance of uncertainty and the recall of stimuli denoting uncertainty. The results showed that participants high in intolerance of uncertainty, relative to those low in intolerance of uncertainty, recalled a higher proportion of words denoting uncertainty. Study 2 investigated whether intolerance of uncertainty would be associated with threatening interpretations of ambiguous information. The results showed that participants high in intolerance of uncertainty reported more concern about ambiguous situations than did participants with low levels of intolerance of uncertainty. In addition, the tendency to make threatening interpretations of ambiguous situations was more highly related to intolerance of uncertainty than to worry, anxiety, or depression. Taken together, these findings suggest that intolerance of uncertainty is associated with information processing biases that may be involved in the etiology of excessive worry and GAD.
Article
The present study investigated the relation between intolerance of uncertainty (IU), meta-worry, and neuroticism on the one hand, and worry on the other hand, in a sample of 105 university students. Two different operationalizations of worry were used: trait worry and idiosyncratic worry. Results showed that IU, meta-worry, and neuroticism correlated significantly with trait worry. Further, IU and meta-worry were strongly related but made a unique and independent contribution to trait worry. Finally, IU and meta-worry could be considered as partial mediators of the relation between neuroticism and trait-like worry. Relations of IU, meta-worry, and neuroticism with idiosyncratic worry were weak or even absent, although neuroticism was associated with idiosyncratic worry when the stressful event was more imminent. In conclusion, not IU and meta-worry, but the general vulnerability factor of neuroticism appeared to possess the most declarative value in relation to both trait and idiosyncratic worry.
Article
This study's main goal is to test the broad specificity of generalized anxiety disorder (GAD) symptom and process variables. These variables were compared in four groups of participants: (1) 24 patients with primary GAD, (2) 24 patients with secondary GAD, (3) 38 other anxiety disorder patients, and (4) 20 nonclinical control subjects. Each participant received a structured diagnostic interview and a series of standardized questionnaires. The results show that DSM-IV GAD symptoms (worry, GAD physical symptoms, and interference due to worry and anxiety) distinguish GAD patients from those with other anxiety disorders. Two process variables, problem orientation and intolerance of uncertainty, also differentiated GAD patients from other anxiety disorder patients. Overall, these results support the DSM-IV definition of GAD and the broad specificity of problem orientation and intolerance of uncertainty as GAD process variables.
Article
Previous work has highlighted the importance of uncertainty in motivating social comparison. We extended this approach by focusing on the frequency of social comparisons and four uncertainty-related constructs, namely, self-concept clarity, intolerance of uncertainty, anxiety, and depression. Participants were 166 undergraduates who completed measures for each construct, as well as measures of their own frequency of general, upward, and downward social comparisons. Initial correlational analyses indicated that higher self-concept clarity was related to a lower frequency of general and upward social comparisons; whereas higher intolerance of uncertainty was related to a higher frequency of general, upward, and downward social comparisons. Depression and anxiety were also related to increased general and upward comparisons. Of particular interest, however, were the findings associated with two path analyses. The first analysis indicated that when all four uncertainty-related constructs were considered together, intolerance of uncertainty emerged as the most important predictor of general, upward, and downward comparisons. In contrast, lower self-concept clarity and increased depression played a much more limited role, and anxiety was not a significant predictor. In turn, the second analysis showed that self-concept clarity and intolerance of uncertainty fully mediated the relationships between depression, anxiety, and general and upward social comparison.
Article
Over the last few years there has been increased interest in worry. Most assessment up until now has been concerned with what people worry about and how much they worry rather than exploring reasons for worrying. Two questionnaires were developed to go beyond the content and intensity of worry. The first questionnaire, Why Worry?, contains 20 items and assesses reasons why people say they worry. Two types of reasons were found. First, subjects believe that worrying can prevent negative outcomes from happening, minimize the effects of negative events by decreasing guilt, avoiding disappointment, or provide distraction from thinking about things that are even worse. Second, people believe worrying has positive effects such as finding a better way of doing things, increasing control, and finding solutions. The second questionnaire, Intolerance of Uncertainty, consists of 27 items that assesses emotional, cognitive and behavioral reactions to ambiguous situations, implications of being uncertain, and attempts to control the future. The second study demonstrates the instruments' properties by distinguishing between levels of worry, by factor analysis describing the dimensions underlying the constructs, and by establishing appropriate relationships with measures of worry and emotional distress. The implications for current models of worry are discussed.
Article
Researchers have increasingly suggested that people with anxiety disorders share a common fear that the uncertain future will be catastrophic. Intolerance of uncertainty (IU) - the tendency to consider possible negative events as unacceptable and threatening, irrespective of probabilities - is representative of such fears. A key role has been indicated for IU in several anxiety and mood disorders; however, the present study appears to be the first latent structure examination of IU. Responses were obtained from a large sample (n=977; 65% women) unselected with regard to IU level, comprising anxiety disorder outpatients (i.e., putative taxon members), and community residents (i.e., putative complement class members). MAXEIG, MAMBAC, and L-Mode were performed with indicator sets drawn from the Intolerance of Uncertainty Scale-12. Assessments also included objective Comparison Curve Fit Indices. Results yielded converging evidence that IU symptoms have a dimensional latent structure. Comprehensive findings, implications, and future research directions are discussed.
Article
Intolerance of uncertainty (IU) has been suggested to reflect a specific risk factor for generalized anxiety disorder (GAD), but there have been no systematic attempts to evaluate the specificity of IU to GAD. This meta-analysis examined the cross-sectional association of IU with symptoms of GAD, major depressive disorder (MDD), and obsessive-compulsive disorder (OCD). Random effects analyses were conducted for two common definitions of IU, one that has predominated in studies of GAD (56 effect sizes) and another that has been favored in studies of OCD (29 effect sizes). Using the definition of IU developed for GAD, IU shared a mean correlation of .57 with GAD, .53 with MDD, and .50 with OCD. Using the alternate definition developed for OCD, IU shared a mean correlation of .46 with MDD and .42 with OCD, with no studies available for GAD. Post-hoc significance tests revealed that IU was more strongly related to GAD than to OCD when the GAD-specific definition of IU was used. No other differences were found in the magnitude of associations between IU and the three syndromes. We discuss implications of these findings for models of shared and specific features of emotional disorders and for future research efforts.
Article
Generalized anxiety disorder (GAD) is one of the most common comorbid disorders found in individuals with eating disorders. Despite this, little is known of shared vulnerability factors between the two disorders. The aim of the present study was to examine the four main components of a cognitive model for GAD in the eating disorders. One hundred and sixty-two females took part. Three groups were formed comprising of 19 participants with an eating disorder and GAD, 70 with an eating disorder without GAD and 73 healthy controls. All completed self-report questionnaires that measured eating attitudes, levels of GAD, intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Participants with an eating disorder and GAD scored the highest on all four components when compared to healthy individuals and on most components when compared to those with an eating disorder. Participants with an eating disorder without GAD scored higher on all components compared to healthy controls. Findings extend our understanding of shared vulnerability factors between the eating disorders and GAD.
Article
Intolerance of uncertainty (IU) is an important concept in eating disorders (ED). Cognitive, emotional, and behavioral features of IU amongst individuals with and without ED were investigated. Participants completed the intolerance of uncertainty scale (IUS) and four versions of a data-gathering task varying in difficulty/uncertainty, and rated their Beads task experience. ED groups had significantly higher IUS scores than healthy controls (HC). Bulimia Nervosa (BN) participants requested more cues than HC and Anorexia Nervosa (AN) participants before making decisions. ED groups found the task more distressing than HC participants, with those with BN feeling more uncertain and less confident in their decisions, and those with AN attributing greater importance in making the correct decision. While both ED groups reported raised IUS scores only BN participants engaged in an elevated evidence requirement data gathering style. Future research might benefit from further exploration of the role of perseverative processes in BN.
Article
Anxiety and mood disorders are common, chronic, costly, and characterized by high comorbidity. The development of cognitive behavioral approaches to treating anxiety and mood disorders has left us with highly efficacious treatments that are increasingly widely accepted. The proliferation of treatment manuals targeting single disorders, sometimes with trivial differences among them, leaves the mental health professional with no clear way to choose one manual over another and little chance of ever becoming familiar with most of them, let alone trained to competence in their delivery. Deepening understanding of the nature of emotional disorders reveals that commonalities in etiology and latent structures among these disorders supersedes differences. Based on empirical evidence from the domains of learning, emotional development and regulation, and cognitive science, we have distilled a set of psychological procedures that comprise a unified intervention for emotional disorders. The Unified Protocol (UP) is a transdiagnostic, emotion-focused cognitive behavioral treatment, which emphasizes the adaptive, functional nature of emotions, and seeks to identify and correct maladaptive attempts to regulate emotional experiences, thereby facilitating appropriate processing and extinction of excessive emotional responding to both internal (somatic) and external cues. The treatment components of the UP are briefly outlined. Theory and rationale supporting this new approach are described along with some preliminary evidence supporting its efficacy. Implications for the treatment of emotional disorders using the UP are discussed.