Intolerance of Uncertainty: A Common Factor in the Treatment of Emotional Disorders

Boswell, James F.; Thompson‐Hollands, Johanna; Farchione, Todd J.; Barlow, David H.

doi:10.1002/jclp.21965

Cited by 351 publications

(233 citation statements)

References 52 publications

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“…For example, uncertainty about catastrophic consequences of physical symptoms in panic disorder may differ from uncertainty about social evaluative cues in social anxiety disorder. Thus, the nature of uncertainty may differ between emotional disorders and IU may manifest differently based on contextual factors (Boswell, Thompson-Hollands, Farchione, & Barlow, 2013;Carleton, 2016;Mahoney & McEvoy, 2012c). State IU can be considered as any instance of heightened negative affect in response to an uncertain stimulus, which may or may not co-occur with high trait IU or occur within the context of emotional disorders.…”

Section: What Uncertainties Remain?mentioning

confidence: 99%

“…Research has also examined other cognitive-behavioral interventions that do not specifically target IU, but nonetheless have shown a reduction in IU and symptoms of social anxiety (Hewitt, Egan, & Rees, 2009;Mahoney & McEvoy, 2012b), health anxiety (Langlois & Ladouceur, 2004), anxiety and depressive disorders (Bomyea et al, 2015), delivered as individual and group transdiagnostic interventions (Boswell et al, 2013; Abramowitz and Arch (2014) made a compelling argument that exposure-driven cognitive-behavioral treatment for obsessive-compulsive disorder may benefit from strengthening inhibitory learning of nonthreatening associations (e.g., uncertainty is intolerable), such that uncertainty becomes increasingly acceptable as normal across contexts. Abramowitz and Arch (2014) suggest treatment should emphasize tolerating uncertainty through exposure, which may strengthen inhibitory associations.…”

Section: What Is Known?mentioning

confidence: 99%

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Intolerance of uncertainty in emotional disorders: What uncertainties remain?

Shihata

McEvoy

Mullan

et al. 2016

Journal of Anxiety Disorders

220

189

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The current paper presents a future research agenda for intolerance of uncertainty (IU), which is a transdiagnostic risk and maintaining factor for emotional disorders. In light of the accumulating interest and promising research on IU, it is timely to emphasize the theoretical and therapeutic significance of IU, as well as to highlight what remains unknown about IU across areas such as development, assessment, behavior, and relationships to emotional disorders. The present paper was designed to provide a synthesis of what is known and unknown about IU, and, in doing so, proposes broad and novel directions for future research to address the remaining uncertainties in the literature.Keywords: intolerance of uncertainty, review, emotional disorders, transdiagnostic, disorder-specific, research agenda WHAT UNCERTAINTIES REMAIN? 3 Intolerance of Uncertainty in Emotional Disorders: What Uncertainties Remain?The current paper briefly reviews what is known about intolerance of uncertainty (IU) before highlighting what remains unknown. Due to rapidly increasing interest and research focus on IU, culminating in the current special issue, a review is both timely and necessary to set a future research agenda. This paper will review IU with respect to conceptual foundations and definitional issues, development, assessment, behavioral consequences, associations to threat and risk, other cognitive vulnerability factors, emotional disorders, as well as clinical applications.Within each of these domains, what is currently known will first be briefly reviewed followed by what remains unknown. The major contribution of the current paper is the description of future research avenues to address the known unknowns. Conceptual Foundations of Intolerance of Uncertainty What is known?Models of psychopathology posit that uncertainty is a central feature in anxiety-related experience (Carleton, 2016) and the incapacity to endure unknowns appears to be a robust vulnerability factor associated with a range of psychological disorders (Grupe & Nitschke, 2013;Hong & Cheung, 2015). IU was originally defined as a broad construct that reflects "cognitive, emotional, and behavioral reactions to uncertainty in everyday life situations" (Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994, p. 792). Freeston and colleagues (1994) speculated that people with IU may engage in worry to increase their sense of certainty and control when faced with ambiguity. The definition of IU evolved as research on IU shifted from an initial focus on generalized anxiety disorder (GAD) to other disorders. A revised and broader definition described IU as a predisposition to negatively perceive and respond to uncertain information and situations irrespective of its probability and outcomes (Ladouceur, Blais, WHAT UNCERTAINTIES REMAIN? 4 Freeston, & Dugas, 1998;Ladouceur, Gosselin, & Dugas, 2000). IU has also been conceptualized as a cognitive filter and as the excessive tendency to perceive and interpret negative events as unacceptable (Buhr & Dugas...

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Section: What Uncertainties Remain?mentioning

confidence: 99%

Section: What Is Known?mentioning

confidence: 99%

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

Shihata

McEvoy

Mullan

et al. 2016

Journal of Anxiety Disorders

220

189

View full text Add to dashboard Cite

show abstract

“…Uncertainty occurs when some aspect of a threat is poorly defined. While anxiety can be described in numerous ways, exacerbated responses to low probability or otherwise uncertain negative events is a distinguishing clinical symptom in anxiety disorders 1,2 . Furthermore, increased anxiety related physiological responding during uncertain threat of shock versus fear related physiological responding during certain threat of shock in laboratory tasks may provide a physiological marker for anxiety disorders 3 .…”

Section: Introductionmentioning

confidence: 99%

Using the Threat Probability Task to Assess Anxiety and Fear During Uncertain and Certain Threat

Bradford

Magruder

Korhumel

et al. 2014

JoVE

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Fear of certain threat and anxiety about uncertain threat are distinct emotions with unique behavioral, cognitive-attentional, and neuroanatomical components. Both anxiety and fear can be studied in the laboratory by measuring the potentiation of the startle reflex. The startle reflex is a defensive reflex that is potentiated when an organism is threatened and the need for defense is high. The startle reflex is assessed via electromyography (EMG) in the orbicularis oculi muscle elicited by brief, intense, bursts of acoustic white noise (i.e., "startle probes"). Startle potentiation is calculated as the increase in startle response magnitude during presentation of sets of visual threat cues that signal delivery of mild electric shock relative to sets of matched cues that signal the absence of shock (no-threat cues). In the Threat Probability Task, fear is measured via startle potentiation to high probability (100% cue-contingent shock; certain) threat cues whereas anxiety is measured via startle potentiation to low probability (20% cue-contingent shock; uncertain) threat cues. Measurement of startle potentiation during the Threat Probability Task provides an objective and easily implemented alternative to assessment of negative affect via self-report or other methods (e.g., neuroimaging) that may be inappropriate or impractical for some researchers. Startle potentiation has been studied rigorously in both animals (e.g., rodents, non-human primates) and humans which facilitates animal-to-human translational research. Startle potentiation during certain and uncertain threat provides an objective measure of negative affective and distinct emotional states (fear, anxiety) to use in research on psychopathology, substance use/abuse and broadly in affective science. As such, it has been used extensively by clinical scientists interested in psychopathology etiology and by affective scientists interested in individual differences in emotion. Video LinkThe video component of this article can be found at

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“…IU has been associated with several anxiety disorders (e.g., generalized anxiety disorder [GAD], obsessive-compulsive disorder [OCD]; Dugas, Gagnon, Ladouceur, & Freeston, 1998;Tolin, Abramowitz, Brigidi, & Foa, 2003) and depression (Carleton et al, 2012), and treatments targeting IU reduce symptoms of anxiety and depression (Robichaud, 2013;van der Heiden, Muris, & van der Molen, 2012). These findings have led several researchers to suggest that IU constitutes a transdiagnostic mechanism of emotional disorders (Boswell, Thompson-Hollands, Farchione, & Barlow, 2013;. The present study also examined whether individual differences in IU were associated with the RewP and behavioral adjustment during the unpredictable and predictable contexts.…”

mentioning

confidence: 99%

The impact of an unpredictable context and intolerance of uncertainty on the electrocortical response to monetary gains and losses

Nelson

Kessel

Jackson

et al. 2015

Cogn Affect Behav Neurosci

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There is growing evidence that unpredictability and uncertainty can alter reward system functioning. The present study examined the impact of (1) a task-irrelevant unpredictable relative to predictable context and (2) individual differences in intolerance of uncertainty (IU) on the reward-related positivity (RewP), an event-related potential (ERP) response to monetary gains relative to losses. Specifically, 64 participants listened to predictable and unpredictable tone sequences while electroencephalography was recorded during a monetary gambling task. Participants also completed the Intolerance of Uncertainty Scale, which measures both cognitive distress (prospective IU) and behavioral inhibition (inhibitory IU) elicited by uncertainty, in addition to the Depression Anxiety Stress Scale-21 and Penn State Worry Questionnaire. Results indicated that the RewP was reduced during the unpredictable relative to the predictable context. Greater selfreported anxiety elicited by the unpredictable context was associated with a decreased RewP, and a decreased RewP was associated with poorer lose-shift behavioral adjustment. Furthermore, the RewP mediated the relationship between selfreported anxiety elicited by the unpredictable context and lose-shift behavioral adjustment. The IU subscales demonstrated the opposite relationship with the RewP across both contexts-inhibitory IU was associated with an attenuated RewP and prospective IU was associated with an enhanced RewP. In contrast, anxiety, depression, stress, and worry symptomatology were not associated with the RewP. This is the first study to demonstrate that an unpredictable context and individual differences in the degree to which people cannot tolerate uncertainty impact an ERP measure of reward system functioning.

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Intolerance of Uncertainty: A Common Factor in the Treatment of Emotional Disorders

Cited by 351 publications

References 52 publications

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

Using the Threat Probability Task to Assess Anxiety and Fear During Uncertain and Certain Threat

The impact of an unpredictable context and intolerance of uncertainty on the electrocortical response to monetary gains and losses

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