Revising the Intolerance of Uncertainty Model of Generalized Anxiety Disorder: Evidence from UK and Italian Undergraduate Samples.

Gioia Bottesi,Nicola Barclay,Rebecca Payne,Eleonora Carraro,Mark H Freeston,Marta Ghisi

doi:10.3389/fpsyg.2016.01723

Abstract

The Intolerance of Uncertainty Model (IUM) of Generalized Anxiety Disorder (GAD) attributes a key role to Intolerance of Uncertainty (IU), and additional roles to Positive Beliefs about Worry (PBW), Negative Problem Orientation (NPO), and Cognitive Avoidance (CA), in the development and maintenance of worry, the core feature of GAD. Despite the role of the IUM components in worry and GAD has been considerably demonstrated, to date no studies have explicitly assessed whether and how PBW, NPO, and CA might turn IU into worry and somatic anxiety. The current studies sought to re-examine the IUM by assessing the relationships between the model’s components on two different non-clinical samples made up of UK and Italian undergraduate students. One-hundred and seventy UK undergraduates and 488 Italian undergraduates completed measures assessing IU, worry, somatic anxiety, depression, and refined measures of PBW, NPO, and CA. In each sample, two mediation models were conducted in order to test whether PBW, NPO, and CA differentially mediate the path from IU to worry and the path from IU to somatic anxiety. Secondly, it was tested whether IU also moderates the mediations. Main findings showed that, in the UK sample, only NPO mediated the path from IU to worry; as far as concern the path to anxiety, none of the putative mediators was significant. Differently, in the Italian sample PBW and NPO were mediators in the path from IU to worry, whereas only CA played a mediational role in the path from IU to somatic anxiety. Lastly, IU was observed to moderate only the association between NPO and worry, and only in the Italian sample. Some important cross-cultural, conceptual, and methodological issues raised from main results are discussed.

Highlights

Mediation Models The first mediation analysis examined the indirect effects of IUS12 scores on Penn State Worry Questionnaire (PSWQ) scores through WW-III, NPOQ, and Revised Cognitive Avoidance Questionnaire (R-CAQ), controlling for Depression Anxiety Stress Scales -21 (DASS-21) Depression
Results from the first mediation model suggest that only Negative Problem Orientation (NPO) has a mediational role in the path from Intolerance of Uncertainty (IU) and worry in UK undergraduates
This finding provides only partial support to the original hypotheses, since neither Positive Beliefs about Worry (PBW) nor Cognitive Avoidance (CA) emerged to mediate the relationship between IU and worry

Summary

Introduction

Intolerance of Uncertainty (IU) can be defined as the “individual’s dispositional incapacity to endure the aversive response triggered by the perceived absence of salient, key, or sufficient information, and sustained by the associated perception of uncertainty” (Carleton, 2016, p. 31); individuals high in IU find situations that are uncertain threatening, upsetting, and undesirable, The Intolerance of Uncertainty Model of Gad Revised regardless of the actual probability of a negative event to occur (Dugas et al, 1998). Individuals endorsing PBW believe that worry is a positive personality feature (i.e., “being a worrier means being thoughtful”), and that worrying is an effective problem solving strategy, capable of preventing negative situations to occur, avoiding unpleasant emotions associated with negative events, and motivating to act in life (Freeston et al, 1994). NPO refers to a negative attitude toward problems and consists of a set of negative cognitive and emotional reactions that are activated when a problem situation occurs It is associated with low levels of confidence about the ability to solve problems successfully, low personal control over the problem solving process, and pessimism about problem-solving outcomes (D’Zurilla and Nezu, 1999, 2006). The clinical efficacy of the IUM-based treatments for GAD relative to wait-list control conditions (Dugas and Ladouceur, 2000; Ladouceur et al, 2000; Dugas et al, 2003, 2010; Dugas and Robichaud, 2007) has been supported in multiple studies

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