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Intolerance of Uncertainty and Social Anxiety: An Experimental Investigation

Published online by Cambridge University Press:  20 February 2023

Pooja Saraff Open the ORCID record for Pooja Saraff [Opens in a new window] ,
Bethany Shikatani ,
Anna Maria Rogic ,
Erin Faith Dodig ,
Snigdha Talluri  and
Heather Murray-Latin
Pooja Saraff*
Affiliation:
Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Bethany Shikatani*
Affiliation:
Center for Anxiety and Related Disorders, Boston University, Boston, Massachusetts, USA
Anna Maria Rogic
Affiliation:
Center for Anxiety and Related Disorders, Boston University, Boston, Massachusetts, USA
Erin Faith Dodig
Affiliation:
Center for Anxiety and Related Disorders, Boston University, Boston, Massachusetts, USA
Snigdha Talluri
Affiliation:
Center for Anxiety and Related Disorders, Boston University, Boston, Massachusetts, USA
Heather Murray-Latin
Affiliation:
Center for Cognitive Behavioral Therapy, Hartford Hospital Institute of Living, Hartford, Connecticut, USA
*
*Corresponding author: Pooja Saraff, Department of Psychiatry, University of Massachusetts Medical School, 100 Century Drive, Worcester, MA 01606, USA. Email: [email protected]
†These authors are indicated as joint first authors
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Abstract

Intolerance of uncertainty (IU) is a cognitive bias that leads to perception and intolerance of uncertainty and has associated negative cognitive, emotional, and behavioural responses. It plays a strong role in social anxiety disorder (SAD; Counsell et al., 2017). Our experimental study examined the impact of uncertainty related to a social stressor on SAD using a speech task. We examined features of SAD including anticipatory anxiety, anxiety during the task, willingness to perform the task, and avoidance of the task. Undergraduate students (N = 110, 88% female) with significant social anxiety completed a series of questionnaires, then were randomised to one of two conditions related to level of uncertainty about an impromptu speech task. The experimental condition (state IU) did not predict any of the outcome variables, while trait IU significantly predicted anxiety levels. Results indicate that increased uncertainty of a social situation does not impact acute anxiety levels in SAD and reinforce the strong role of trait IU as a transdiagnostic cognitive variable. Neither trait nor state IU predicted the willingness and avoidance variables. Results also highlighted the central role of the experience of anxiety on avoidance behaviours, above cognitive factors such as IU.

Keywords

intolerance of uncertaintysocial anxiety disorderexperimentalavoidancewillingness
Type
Standard Paper
Information
Behaviour Change , Volume 40 , Issue 4 , December 2023 , pp. 314 - 327
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Australian Association for Cognitive and Behaviour Therapy

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References

Allan, NP, Cooper, D, Oglesby, ME, Short, NA, Saulnier, KG and Schmidt, NB (2018). Lower-order anxiety sensitivity and intolerance of uncertainty dimensions operate as specific vulnerabilities for social anxiety and depression within a hierarchical model. Journal of Anxiety Disorders, 53, 91–99. doi:10.1016/j.janxdis.2017.08.002.CrossRefGoogle ScholarPubMed
Antony, MM and Rowa, K (2008). Social anxiety disorder. Ashland, OH: Hogrefe & Huber Publishers.Google Scholar
Antony, MM, Bieling, PJ, Cox, BJ, Enns, MW and Swinson, RP (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176.10.1037/1040-3590.10.2.176CrossRefGoogle Scholar
Barlow, DH, Farchione, TJ, Fairholme, CP, Ellard, KK, Boisseau, CL, Allen, LB and Ehrenreich-May, J (2011). Treatments that work. Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press.Google Scholar
Boelen, PA and Reijntjes, A (2009). Intolerance of uncertainty and social anxiety. Journal of Anxiety Disorders, 23, 130–135.10.1016/j.janxdis.2008.04.007CrossRefGoogle ScholarPubMed
Boelen, PA, Vrinssen, I and van Tulder, F (2010). Intolerance of uncertainty in adolescents: Correlations with worry, social anxiety, and depression. Journal of Nervous and Mental Disease, 198, 194–200. doi:10.1097/NMD.0b013e3181d143de.CrossRefGoogle ScholarPubMed
Brown, TA and Barlow, DH (2014). Anxiety and related disorders interview schedule for DSM-5: Adult and lifetime version, clinician manual. New York, NY: Oxford University Press.Google Scholar
Buhr, K and Dugas, MJ (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behaviour Research and Therapy, 40, 931–945.10.1016/S0005-7967(01)00092-4CrossRefGoogle ScholarPubMed
Carleton, RN (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43. doi:10.1016/j.janxdis.2016.02.007.CrossRefGoogle ScholarPubMed
Carleton, RN, Collimore, KC and Asmundson, GJ (2010). ‘It's not just the judgements—it's that I don't know’: Intolerance of uncertainty as a predictor of social anxiety. Journal of Anxiety Disorders, 24, 189–195.10.1016/j.janxdis.2009.10.007CrossRefGoogle Scholar
Carleton, RN, Mulvogue, MK, Thibodeau, MA, McCabe, RE, Antony, MM and Asmundson, GJ (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26, 468–479.10.1016/j.janxdis.2012.01.011CrossRefGoogle ScholarPubMed
Chen, S, Yao, N and Qian, M (2018). The influence of uncertainty and intolerance of uncertainty on anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 61, 60–65. doi:10.1016/j.jbtep.2018.06.005.CrossRefGoogle ScholarPubMed
Connor, KM, Davidson, JR, Churchill, LE, Sherwood, A, Foa, EB and Weisler, RH (2000). Psychometric properties of the social phobia inventory (SPIN). The British Journal of Psychiatry, 176, 379–386.10.1192/bjp.176.4.379CrossRefGoogle ScholarPubMed
Counsell, A, Furtado, M, Iorio, C, Anand, L, Canzonieri, A, Fine, A, … Katzman, MA (2017). Intolerance of uncertainty, social anxiety, and generalized anxiety: Differences by diagnosis and symptoms. Psychiatry Research, 252, 63–69. doi:10.1016/j.psychres.2017.02.046.CrossRefGoogle ScholarPubMed
Dugas, MJ and Ladouceur, R (2000). Treatment of GAD: Targeting intolerance of uncertainty in two types of worry. Behavior Modification, 24, 635–657.10.1177/0145445500245002CrossRefGoogle ScholarPubMed
Dugas, MJ, Ladouceur, R, Léger, E, Freeston, MH, Langolis, F, Provencher, MD and Boisvert, J-M (2003). Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up. Journal of Consulting and Clinical Psychology, 71, 821–825. doi:10.1037/0022-006X.71.4.821CrossRefGoogle ScholarPubMed
Enders, CK (2010). Applied missing data analysis. New York: Guilford Press.Google Scholar
Freeston, MH, Rhéaume, J, Letarte, H, Dugas, MJ and Ladouceur, R (1994). Why do people worry? Personality and Individual Differences, 17, 791–802.10.1016/0191-8869(94)90048-5CrossRefGoogle Scholar
Gentes, EL and Ruscio, AM (2011). A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive–compulsive disorder. Clinical Psychology Review, 31, 923–933. doi:10.1016/j.cpr.2011.05.001CrossRefGoogle ScholarPubMed
Hebert, EA and Dugas, MJ (2019). Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice, 26, 421–436. doi:10.1016/j.cbpra.2018.07.007CrossRefGoogle Scholar
Heimberg, RG, Horner, KJ, Juster, HR, Safren, SA, Brown, EJ, Schneier, FR and Liebowitz, MR (1999). Psychometric properties of the Liebowitz social anxiety scale. Psychological Medicine, 29, 199–212.10.1017/S0033291798007879CrossRefGoogle ScholarPubMed
Hezel, DM, Stewart, SE, Riemann, BC and McNally, RJ (2019). Standard of proof and intolerance of uncertainty in obsessive-compulsive disorder and social anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 64, 36–44. doi:10.1016/j.jbtep.2019.02.002CrossRefGoogle ScholarPubMed
Holaway, RM, Heimberg, RG and Coles, ME (2006). A comparison of intolerance of uncertainty in analogue obsessive-compulsive disorder and generalized anxiety disorder. Journal of Anxiety Disorders, 20, 158–174.10.1016/j.janxdis.2005.01.002CrossRefGoogle ScholarPubMed
International Business Machines. (n.d.). Retrieved from https://www.ibm.com/support/knowledgecenter/en/SSLVMB_27.0.0/statistics_mainhelp_ddita/spss/mva/mi_analysis.html.Google Scholar
Khawaja, NG and Yu, LNH (2010). A comparison of the 27-item and 12-item intolerance of uncertainty scales. Clinical Psychologist, 14, 97–106. doi: 10.1080/13284207.2010.502542.CrossRefGoogle Scholar
Ladouceur, R, Gosselin, P and Dugas, MJ (2000). Experimental manipulation of intolerance of uncertainty: A study of a theoretical model of worry. Behaviour Research and Therapy, 38, 933–941.10.1016/S0005-7967(99)00133-3CrossRefGoogle ScholarPubMed
Lovibond, PF and Lovibond, SH (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–343.10.1016/0005-7967(94)00075-UCrossRefGoogle ScholarPubMed
Mahoney, AEJ and McEvoy, PM (2012). Changes in intolerance of uncertainty during cognitive behavior group therapy for social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 43, 849–854.10.1016/j.jbtep.2011.12.004CrossRefGoogle ScholarPubMed
Oglesby, ME and Schmidt, NB (2017). The role of threat level and intolerance of uncertainty (IU) in anxiety: An experimental test of IU theory. Behavior Therapy, 48, 427–434. doi:10.1016/j.beth.2017.01.005.CrossRefGoogle ScholarPubMed
Pedersen, AB, Mikkelsen, EM, Cronin-Fenton, D, Kristensen, NR, Pham, TM, Pedersen, L and Petersen, I (2017). Missing data and multiple imputation in clinical epidemiological research. Clinical Epidemiology, 9, 157–166. doi:10.2147/CLEP.S129785.CrossRefGoogle ScholarPubMed
Reuman, L, Jacoby, RJ, Fabricant, LE, Herring, B and Abramowitz, JS (2015). Uncertainty as an anxiety cue at high and low levels of threat. Journal of Behavior Therapy and Experimental Psychiatry, 47, 111–119. doi:10.1016/j.jbtep.2014.12.002.CrossRefGoogle ScholarPubMed
Shihata, S, McEvoy, PM, Mullan, BA and Carleton, RN (2016). Intolerance of uncertainty in emotional disorders: What uncertainties remain? Journal of Anxiety Disorders, 41, 115–124. doi:10.1016/j.janxdis.2016.05.001.CrossRefGoogle ScholarPubMed
Shihata, S, McEvoy, PM and Mullan, BA (2017). Pathways from uncertainty to anxiety: An evaluation of a hierarchical model of trait and disorder-specific intolerance of uncertainty on anxiety disorder symptoms. Journal of Anxiety Disorders, 45, 72–79. doi:10.1016/j.janxdis.2016.12.001.CrossRefGoogle ScholarPubMed
Shikatani, B, Antony, MM, Cassin, SE and Kuo, JR (2016). Examining the role of perfectionism and intolerance of uncertainty in postevent processing in social anxiety disorder. Journal of Psychopathology and Behavioral Assessment, 38, 297–306.10.1007/s10862-015-9516-8CrossRefGoogle Scholar
Stein, DJ, Lim, CCW, Roest, AM, de Jonge, P, Aguilar-Gaxiola, S, Al-Hamzawi, A, …, Collaborators, W. H. O. W. M. H. S. (2017). The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC Medicine, 15, 143. doi: 10.1186/s12916-017-0889-2.CrossRefGoogle ScholarPubMed
van der Heiden, C, Muris, P and van der Molen, HT (2012). Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behaviour Research and Therapy, 50, 100–109. doi:10.1016/j.brat.2011.12.005.CrossRefGoogle ScholarPubMed
Watson, D, Clark, LA and Tellegen, A (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063.10.1037/0022-3514.54.6.1063CrossRefGoogle ScholarPubMed