Behavioral Experiments for Intolerance of Uncertainty: Challenging the Unknown in the Treatment of Generalized Anxiety Disorder

Abstract

Intolerance of uncertainty (IU) is implicated in the development and maintenance of generalized anxiety disorder (GAD). Although an efficacious cognitive-behavioral treatment (CBT) targeting IU and associated factors has been established, approximately 20–30% of participants do not achieve full remission by posttreatment. IU remains elevated in these individuals. In addition, GAD treatments need greater parsimony and efficiency. To that end, we developed a novel, focused CBT protocol exclusively targeting IU via behavioral experiments. Treatment consists of three modules applied over 12 sessions: (a) psychoeducation and uncertainty awareness training, (b) behavioral experiments targeting IU, and (c) relapse prevention. The present article describes each treatment component, as well as additional considerations for therapists. We conducted a preliminary investigation of efficacy with seven (N = 7) participants with a primary diagnosis of GAD. Results indicated substantial decreases in GAD symptoms, general psychopathology, and IU by posttreatment that were generally maintained at 6-month follow-up. Six of seven participants demonstrated moderate to high end-state functioning at posttreatment and 6-month follow-up. Research and clinical implications are discussed.