Adaptation of the State Desperation Scale: Its Association with Intolerance of Uncertainty, Entrapment and Resilience

An examination of the role of intolerance of distress and uncertainty in hoarding symptoms

A preliminary investigation of impulsivity in generalized anxiety disorder

BackgroundA key feature of anorexia nervosa is body image disturbances and is often expressed by dysfunctional body-related behaviours such as body checking and body avoiding. These behaviours are thought to contribute to both the maintenance and relapse of AN, yet empirical evidence is scarce. One variable that may contribute to the need for engaging in these behaviours is intolerance of uncertainty. This study aims to investigate body checking and body avoiding and its relations with intolerance of uncertainty in women with anorexia nervosa (AN-ill; 70), women recovered from AN (AN-rec; 85) and control group (127).MethodsThree questionnaires were completed, measuring eating pathology, intolerance of uncertainty and body checking and body avoiding. One-way ANOVAS were used to test group differences. Moderation analyses were used to investigate associations between variables.ResultsLevels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill followed by AN-rec and, lastly, the control group, confirming group differences. Intolerance of uncertainty was associated with body checking in the AN-rec group and the control group but not in the AN-ill group. The association between intolerance of uncertainty and body avoiding was reported in the AN-rec group and only marginally in the control group.ConclusionLevels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill, however still elevated in AN-rec, confirming the presence of body image disturbances, even after recovery. The unique associations between intolerance of uncertainty and body checking and body avoiding within the studied groups may represent different stages of the illness. In the AN-rec group, the relation between intolerance of uncertainty, body checking and body avoiding may be driven by trait anxiety. For AN-ill group, body checking and body avoiding may eventually have grown into habitual patterns, rather than a strategy to ameliorate anxiety and uncertainty.Plain English summaryWomen with anorexia nervosa often experience disturbances in their body image and are expressed in body-related behaviours such as body checking and body avoiding. These behaviours are thought to contribute to both the maintenance and relapse of anorexia nervosa. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and may contribute to the need for engaging in these behaviours. This study aims to investigate body checking and body avoiding and its relations with intolerance of uncertainty in women with anorexia nervosa (AN-ill; 70), women recovered from AN (AN-rec; 85) and control group (127). Three questionnaires were completed, measuring eating pathology, intolerance of uncertainty and body checking and body avoiding. Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill and still elevated in AN-rec, even after recovery. The associations between intolerance of uncertainty and body checking and body avoiding within the studied groups may represent different stages of the illness. In the AN-rec group, the relation between intolerance of uncertainty, body checking and body avoiding may be driven by trait anxiety. For AN-ill group, body checking and body avoiding may have grown into habitual patterns, rather than a strategy to ameliorate anxiety and uncertainty.

Are we still uncertain about the latent structure of intolerance of uncertainty: Results from factor mixture modeling in a Serbian sample

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.

Targeting intolerance of uncertainty in treatment: A meta-analysis of therapeutic effects, treatment moderators, and underlying mechanisms

Intolerance of Uncertainty (IU) is a transdiagnostic vulnerability factor involved in depression and anxiety symptoms and disorders. IU encompasses Prospective IU ("Unforeseen events upset me greatly") and Inhibitory IU ("The smallest doubt can stop me from acting"). Research has yet to explore whether subgroups or classes of people exist characterized by different profiles of IU. This study used latent class analysis to identify such subgroups and examined if different classes of IU were distinct in terms of several cognitive vulnerabilities and psychological symptoms. Data were obtained from 519 students completing a 12-item measure of IU. Four subgroups were identified, characterized by low IU, predominantly Prospective IU, predominantly Inhibitory IU, and high IU, respectively. People in the high IU class reported cognitive vulnerabilities and depression and anxiety more than people in the low IU class. Inhibitory IU was more strongly associated with poor outcomes than was Prospective IU.

Objectives: Intolerance of uncertainty (IU) describes a dispositional aversion to uncertainty. Recent research has identified IU as a causal contributor to pervasive decision difficulties (indecisiveness). Given that IU and indecisiveness occur across mental disorders, understanding whether IU's causal role in indecisiveness extends to clinical populations is critical. This study therefore tested the effect of IU on indecisiveness in a clinical sample.Methods: In this pre-registered experiment, N = 154 individuals with formally diagnosed obsessive-compulsive and/or anxiety disorders were randomly assigned to a condition aimed at either increasing or decreasing IU. Subsequently, participants reported their current levels of (situational) IU and, critically, their indecisiveness regarding two personally relevant decisions.Results: The experimental manipulation successfully altered IU levels. Participants with heightened IU exhibited more indecisiveness compared to those with reduced IU, but this effect occurred only indirectly through situational IU. The observed effect sizes were small.Limitations: Compared to preceding research, effect sizes were small and the effect of IU on indecisiveness only manifested itself indirectly. More robust interventions may be necessary to induce more pronounced changes in IU within clinical populations. The reliance on a heterogeneous sample with various diagnoses limits the disorder-specificity of the findings.Conclusions: These results extend the causal role of IU in indecisiveness to mental disorders. The findings suggest IU as a potential approach for addressing problematic indecisiveness.

Intolerance of uncertainty (IU) has often been studied in the context of internalizing disorders, but no studies to our knowledge have explored the relation between IU and externalizing disorders. Given the proposed link between IU and emotion regulation, the current study sought to examine levels of IU in an externalizing clinical population with known emotion regulation difficulties-attention-deficit/hyperactivity disorder (ADHD). IU levels in this population were compared to a clinical population known to experience elevated levels of IU. Participants in present study were ninety-three children (36 anxiety disorder, 28 ADHD, 29 unaffected children) ages 7-13, who completed the Intolerance of Uncertainty Scale-Short Version (IUS). Responses on the IUS were converted to total IU, prospective IU, and inhibitory IU. A linear mixed model analysis of covariance was conducted while controlling for age, sex, and ADHD medications. A significant interaction was observed between diagnostic status and IU scale. Planned contrasts indicated that children with anxiety disorders and ADHD reported significantly higher levels of IU relative to unaffected children, and children with ADHD reported comparable levels of inhibitory IU relative to children with anxiety disorders. The current results contribute to a growing literature on the link between IU and psychopathology. IU appears to be a transdiagnostic construct present among children with internalizing and externalizing disorders, and may be broadly associated with emotion regulation deficits rather than specific disorder symptoms.

Intolerance of uncertainty (IU) is a cognitive vulnerability factor that plays a role in obsessive compulsive disorder (OCD). Most research has looked at IU at an omnibus level. This paper aimed to investigate the two dimensions of IU, prospective and inhibitory IU, and their relation to overall OCD symptom severity, as well as the severity of obsessions and compulsions. Fifty-nine individuals with OCD completed measures of OCD symptom severity and IU at pre- and post- group cognitive behavioral therapy (CBT). IU and OCD symptoms, and their dimensions, all reduced over the CBT treatment. At the start of treatment, only prospective IU was associated with compulsion symptom severity. In contrast, at the end of treatment, prospective and inhibitory IU were associated with compulsion symptom severity, and inhibitory IU was associated with obsession symptom severity. Baseline IU, prospective and inhibitory IU were not associated with post OCD symptom severity scores, when controlling for pre-treatment OCD severity levels. Change in prospective IU was associated with changes in OCD symptom severity, and change in compulsions, but not change in obsessions. The results cannot speak to causal or temporal predictions, or directionality of the relationship between IU and OCD. These findings underscore the dynamic relationship between the IU dimensions and OCD symptoms, and highlights prospective IU as a potential important target in CBT for OCD to achieve reductions in compulsions and overall OCD symptom severity.

Prospective associations between intolerance of uncertainty and psychopathology

Intolerance of uncertainty (IU), the dispositional tendency to fear the unknown, has clinical implications across a variety of disorders. While research has linked IU and OCD, relatively little is known about this association. Previous studies have focused on IU’s association with overall OCD severity and specific symptom dimensions, but we do not yet understand to what degree this cognitive vulnerability is associated with each of the two cardinal symptoms: obsessions and compulsions. Additionally, few studies have examined the established IU subtypes—prospective and inhibitory IU—as unique contributors to OCD severity. Given the ubiquity of uncertainty in daily life and the potential for IU to influence obsessive-compulsive processes, further investigation of this cognitive vulnerability in OCD is warranted. In a sample of patients diagnosed with OCD, partial correlations were conducted to determine the association between OCD severity (separately examining obsessions and compulsions) and IU (separately examining prospective and inhibitory IU). These analyses revealed positive correlations between IU and compulsion severity, specifically. And of the IU subtypes, this link was specifically associated with prospective IU. The results of this correlational study contribute to the literature on IU in OCD, suggesting prospective IU as a cognitive mechanism that may be involved in the maintenance of compulsions.

Divergent neural correlates of intolerance of uncertainty subdimensions: Insights from multimodal analyses of reward processing.

BackgroundTest anxiety has a detrimental effect on test performance but current interventions for test anxiety have limited efficacy. Therefore, examination of newer psychological models of test anxiety is now required. Two transdiagnostic psychological models of emotional disorders that can account for anxiety are the intolerance of uncertainty model (IUM) and the Self-Regulatory Executive Function (S-REF) model. Intolerance of uncertainty, the stable disposition to find uncertainty distressing, is central to the IUM, while beliefs about thinking, metacognition, are central to the S-REF model. We tested for the first time the role of both intolerance of uncertainty and metacognitive beliefs in test anxiety.MethodsA cross-sectional design was used, with college students (n = 675) completing questionnaires assessing their test anxiety, intolerance of uncertainty, and metacognitive beliefs. Hierarchical linear regressions examined if intolerance of uncertainty and metacognitive beliefs were associated with test anxiety, after controlling for age and gender.ResultsFemales reported significantly more test anxiety than males. Partial correlations, controlling for gender, found intolerance of uncertainty and metacognitive beliefs were significantly and positively correlated with test anxiety. Hierarchical linear regressions found metacognitive beliefs explained an additional 13% of variance in test anxiety, after controlling for intolerance of uncertainty. When the order of entry was reversed, intolerance of uncertainty was only able to explain an additional 2% of variance, after controlling for metacognitive beliefs. In the final regression model, gender, intolerance of uncertainty and the metacognitive belief domains of ‘negative beliefs about the uncontrollability and danger of worry’ and ‘cognitive confidence’ were all significantly associated test anxiety, with ‘negative beliefs about the uncontrollability and danger of worry’ having the largest association.ConclusionsBoth intolerance of uncertainty and metacognitive beliefs are linked to test anxiety, but results suggest metacognitive beliefs have more explanatory utility, providing greater support for the S-REF model. Modification of intolerance of uncertainty and metacognitive beliefs could alleviate test anxiety and help students fulfil their academic potential.

BackgroundInherent to anorexia nervosa are repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. The relation between these cognitive processes and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study investigated associations between prospective (desire for predictability) and inhibitory (uncertainty paralysis) intolerance of uncertainty, and weight and shape concerns and the mediating role of worry in these associations.MethodsIn a cross-sectional study, 93 adolescent girls with anorexia nervosa completed questionnaires measuring the variables of interest. A mediation model with worry as a mediator between inhibitory and prospective intolerance of uncertainty and weight and shape concerns was tested.ResultsA total and direct effect of inhibitory intolerance of uncertainty on weight and shape concerns was found. Worry did not mediate this relation.ConclusionsThese results confirm the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls with anorexia nervosa.Plain English summaryAdolescent girls with anorexia nervosa often experience repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and is often divided into two components; prospective intolerance of uncertainty (desire for predictability) and inhibitory intolerance of uncertainty (uncertainty paralysis). The relation between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study aims to investigate study relations between prospective and inhibitory intolerance of uncertainty, worry, and weight and shape concerns. A total of 93 adolescent girls with anorexia nervosa completed three questionnaires, measuring prospective and inhibitory intolerance of uncertainty worry, and weight and shape concerns, respectively. The results of this study confirmed the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls.