Several studies have been conducted to examine whether the construct of intolerance of uncertainty (IU) (Dugas, Gagnon, Ladouceur, & Freeston, Behaviour Research and Therapy, 36, 215-226, 1998b) meets formal criteria as a cognitive vulnerability for excessive and uncontrollable worry. Cognitive models of anxiety suggest that vulnerability is manifest in the manner in which individuals process information. As such, cognitive bias is expected to be observed in individuals characterized by high levels of a putative cognitive vulnerability. In this study, individuals low (n = 110) and high (n = 89) on IU were compared on their appraisals of ambiguous, negative, and positive situations. Individuals high on IU appraised all situation types as more disconcerting relative to the comparison group. However, when controlling for demographics, generalized anxiety disorder (GAD) symptoms, and mood variables, the groups differed only in their appraisals of ambiguous situations. Further, in the high-vulnerability group, degree of IU was a stronger predictor of appraisals of ambiguous situations than were GAD symptoms and mood variables. Tests of mediation showed that appraisals of ambiguous situations partly mediated the relationship of IU to worry, the main symptom of GAD; however, worry also emerged as a partial mediator of the relation of IU to appraisals of ambiguous situations. An exploratory analysis revealed that in individuals high on IU, appraisals were not specific to the content of current worries, whereas they were to some extent in individuals low on IU. The results are discussed within the context of findings emerging from cognitive models of GAD, in particular the model proposed by Dugas et al. (1998b).

No abstract

Over the past decade, a number of well-controlled studies have supported the validity of a cognitive model of generalized anxiety disorder (GAD) that has four main components: intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Although these studies have shown that the model components are associated with high levels of worry in nonclinical samples and with a diagnosis of GAD in clinical samples, they have not addressed the question of whether the model components can predict the severity of GAD. Accordingly, the present study sought to determine if the model components are related to diagnostic severity, worry severity, and somatic symptom severity in a sample of 84 patients with a primary diagnosis of GAD. All model components were related to GAD severity, although positive beliefs about worry and cognitive avoidance were only modestly associated with the severity of the disorder. Intolerance of uncertainty and negative problem orientation had more robust relationships with the severity of GAD (and with worry severity, in particular). When participants were divided into Mild, Moderate, and Severe GAD groups, intolerance of uncertainty and negative problem orientation distinguished the Moderate and Severe GAD groups from the Mild GAD group, even when age, gender, and depressive symptoms were statistically controlled. Overall, the results lend further support to the validity of the model and suggest that intolerance of uncertainty and negative problem orientation are related to the severity of GAD, independently of sociodemographic and associated clinical factors. The theoretical and clinical implications of the findings are discussed.

No abstract

In this article, we present a cognitive-behavioral model and treatment of generalized anxiety disorder (GAD). In the first section, we review a model of GAD that includes four main components: intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Next we present the GAD assessment tools used at our clinic, which include standardized interviews and self-report questionnaires of GAD symptoms and underlying cognitive-behavioral processes. We then provide a step-by-step description of a treatment that is based on the aforementioned model of GAD, and that has six core components: presentation of treatment rationale (learning to cope with uncertainty); worry awareness training; reevaluation of the usefulness of worrying; problem-solving training; cognitive exposure; and relapse prevention. Following the treatment description, we summarize the efficacy data from our completed randomized clinical trials, and present some preliminary findings from our ongoing trial comparing our treatment to applied relaxation and wait-list control. In the final section, we present an in-depth discussion of future directions for the study and treatment of GAD, with a focus on the approach-avoidance nature of GAD. Given the movement in the field favoring the expansion of cognitive-behavioral treatments, we also comment on the possible implications of the newest integrative therapies for our existing treatment.