CoChat
Sign Up
Cited by 495Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsPersonality Disorders and Psychopathology

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

Open access
Boswell, James F., Thompson-Hollands, Johanna, Farchione, Todd J., Barlow, David H.·2013·Journal of Clinical Psychology
DOI 10.1002/jclp.21965PMC PMC3712497
Open this paper in CoChat — free account

Abstract

Intolerance of uncertainty (IU) is a characteristic predominantly associated with generalized anxiety disorder (GAD); however, emerging evidence indicates that IU may be a shared element of emotional disorders. Aims: This study aimed to examine IU across diagnostic categories, change in IU during transdiagnostic treatment, and the relationship between change in IU and treatment outcome. Method: Patients diagnosed with heterogeneous anxiety and depressive disorders received up to 18 weeks of a transdiagnostic cognitive-behavioral therapy intervention. Patient self-reported IU and self-report and clinician-rated symptom/functioning measures were administered at pretreatment and posttreatment. Results: When controlling for negative affectivity, IU correlated with measures of depressive symptoms and worry severity at pretreatment. Patients with GAD and panic disorder exhibited the highest pretreatment IU scores, yet IU scores did not differ significantly based on the presence or absence of a specific diagnosis. A significant decrease in IU was observed, and change in IU was related to reduced anxiety and depressive symptom levels at posttreatment across diagnostic categories. Discussion: Change in IU can be observed across problem areas in transdiagnostic treatment and such change is correlated with treatment outcome. © 2013 Wiley Periodicals, Inc.

Integrity signals

Registry

Crossref · 10.1002/jclp.21965

Cites

59 of 59 references verified0 citation errors · 0 not checkable

Statistics

7 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

10 of 67 cited sources checked · 7 supported · 1 flagged · accuracy not yet measured

  • Study design and conductcitation

    No posttreatment symptom differences were found between the immediate-treatment and delayed-treatment groups.

    “Furthermore, no posttreatment symptom differences were observed between the immediate and delayed treatment groups (see Farchione et al., 2012).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Farchione et al., 2012 source

      The Results section (‘Efficacy at Posttreatment’; page unavailable) reports significant differences between the immediate-treatment group and the wait-list/delayed-treatment group in depression and anxiety symptoms, rather than no differences. The Study Design section clarifies that the delayed group received treatment only after its wait-list assessment. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    In the conceptual and empirical literature, intolerance of uncertainty has been linked mainly to generalized anxiety disorder and obsessive-compulsive disorder.

    “The IU construct has been associated predominantly (conceptually and empirically) with generalized anxiety disorder (GAD; Dugas, Freeston, & Ladouceur, 1997) and obsessive-compulsive disorder (OCD; Lind & Boschen, 2009; Steketee, Frost, & Cohen, 1998).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Dugas, Freeston, & Ladouceur, 1997 source
    • cites Lind & Boschen, 2009 source
    • cites Steketee, Frost, & Cohen, 1998 source
  • Study design and conductown data

    Baseline evaluation found no significant differences in type or severity of psychopathology between eligible participants and those excluded from the trial.

    “No statistical differences in initial severity or demographic variables were observed between treatment completers and noncompleters, and baseline evaluation indicated that no significant differences in the type or severity of psy-chopathology existed between eligible participants and those excluded from the trial (e.g., refused potential randomization to waitlist/delayed treatment condition; see”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Farchione et al., 2012 source

      The Method > Participants passage says that, based on the initial diagnostic evaluation, excluded individuals did not appear to have more severe psychopathology than enrolled and randomized patients. It does not report a statistical comparison or establish that the groups did not differ in type of psychopathology. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Premisecitation

    Lack of perceived control may represent a generalized psychological vulnerability to develop emotional disorders.

    “Lack of perceived control may represent a generalized psychological vulnerability to develop emotional disorders (Chorpita, Brown, & Barlow, 1998)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Chorpita, Brown, & Barlow, 1998 source
  • Findingown data

    The mean pre-post treatment difference exceeded the reliable change index criterion of 13.82 IUS points.

    “Utilizing Jacobson and Truax's (1991) formula for calculating a reliable change index (RCI), the mean pre-post treatment difference exceeded the RCI criterion (13.82 IUS points).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Jacobson and Truax's (1991)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. 37
  • May combine two claims. 29
  • The quote only partly states this claim. 1

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    If intolerance of uncertainty is a shared factor, it should appear in emotional disorders beyond generalized anxiety disorder and obsessive-compulsive disorder, which may help explain comorbidity.

    “If this is the case for IU, then it should be present as a shared factor in not just GAD and OCD, but other emotional disorders as well, which may help to explain the high degree of comorbidity observed across different emotional disorders (Brown & Barlow, 2009).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Brown & Barlow, 2009 source

  • May combine two claims.

    Premisecitation

    Worry can act as experiential avoidance by lowering anxious arousal about feared outcomes, and it is at least partly maintained through negative reinforcement.

    “Worry can serve an experiential avoidance function (Borkovec, 1994; Borkovec, Ray, & Stober, 1998) insofar as engaging in worry reduces anxious arousal related to feared potential outcomes; thus, worry is at least partially maintained through negative reinforcement.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Borkovec, 1994

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Borkovec, Ray, & Stober, 1998 source

  • May combine two claims.

    Study design and conductown data

    No statistical differences in initial severity or demographic variables were found between treatment completers and noncompleters.

    “No statistical differences in initial severity or demographic variables were observed between treatment completers and noncompleters, and baseline evaluation indicated that no significant differences in the type or severity of psy-chopathology existed between eligible participants and those excluded from the trial (e.g., refused potential randomization to waitlist/delayed treatment condition; see”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Farchione et al., 2012 source

      The Method (Participants; page unavailable) reports how many patients did not complete treatment, but does not compare their initial severity or demographics with those of completers. I searched for completer–noncompleter baseline and dropout comparisons; the reported demographic comparison is between treatment arms, not between completers and noncompleters. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The HARS has shown good interrater and test-retest reliability and convergent validity with similar clinician-rated and self-report anxiety measures.

    “This commonly used measure has demonstrated good levels of interrater and test-retest reliability, as well as convergent validity with similar clinician rated and self-report measures of anxiety symptoms (Shear et al., 2001).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Shear et al., 2001 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The lack of association between baseline IUS and OCD symptoms was surprising given previous studies.

    “The lack of association with OCD symptoms was somewhat surprising, given results from previous studies (Gentes & Ruscio, 2011; Steketee et al., 1998).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Gentes & Ruscio, 2011 source
    • cites Steketee et al., 1998 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Descriptively, more people with principal panic disorder demonstrated reliable change than any other principal diagnosis.

    “yet, descriptively, more people with principal panic disorder demonstrated reliable change than any other principal diagnosis (see Table 4).”
    • Also stated in: § Discussion · hedged
      “and were more likely to demonstrate reliable change in IUS scores.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    The presence or absence of any principal or comorbid diagnosis did not affect baseline IUS scores, F(5, 35) = 0.57, p = .83, ηp2 = .31.

    “Univariate ANOVA results indicated that the presence or absence of any particular diagnosis did not have an effect on baseline IUS scores, univariate F (5, 35) = 0.57, p = .83, ηp2 = .31”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The heightened arousal tied to uncertainty may itself trigger panic attacks and lead to further avoidance.

    “The heightened arousal associated with this uncertainty (Greco & Roger, 2003) may itself become a trigger for experiencing a panic attack and lead to further avoidance.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Greco & Roger, 2003 source

  • May combine two claims.

    Premisecitation

    People who worry excessively report that worrying helps them solve problems, prepare for outcomes, prevent negative outcomes, and reduce emotional reactions to negative outcomes.

    “Furthermore, excessive worriers report that worrying helps them to problem solve, prepare for potential outcomes, prevent negative outcomes from occurring, and minimize emotional reactions to negative outcomes (Borkovec, Hazlett-Stevens, & Diaz, 1999; Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Borkovec, Hazlett-Stevens, & Diaz, 1999 source
    • cites Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994 source

  • May combine two claims.

    Interpretationreasoning

    Distress about uncertainty and the use of cognitive and behavioral strategies to manage anxious arousal and increase certainty and control are core features of generalized anxiety disorder and obsessive-compulsive disorder that help maintain both disorders.

    “Distress related to uncertainty and the use of cognitive and behavioral strategies to reduce or manage anxious arousal related to feared potential outcomes and increase one's perception of certainty and control are core elements of GAD and OCD that are implicated in the development and maintenance of both disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Although intolerance of uncertainty is more strongly associated with generalized anxiety disorder severity than with other anxiety disorders, accumulating evidence questions its narrow specificity to generalized anxiety disorder.

    “Although there is evidence that IU is more strongly associated with GAD severity compared with other anxiety disorders (Dugas et al., 2001), accumulating evidence brings into question IU's narrow specificity (Garber & Hollon, 1991) to GAD.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Dugas et al., 2001 source
    • cites Garber & Hollon, 1991 source

  • May combine two claims.

    Premisecitation

    Worry is thought to lessen distress about uncertainty and to increase at least the perception of control over future outcomes.

    “Worry, therefore, is thought to reduce distress over uncertainty and its associated affects (Greco & Roger, 2003) and increase, at least the perception of, control over future outcomes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Greco & Roger, 2003 source

  • May combine two claims.

    Interpretationreasoning

    As with worry in generalized anxiety disorder, obsessions and compulsions in obsessive-compulsive disorder reduce uncertainty and increase perceived control, while opportunities for disconfirmation and new learning are missed.

    “Similar to worry in GAD, obsessions and compulsions in OCD reduce experiences of uncertainty and increase perceptions of control, and, similarly, opportunities for disconfirmation and new learning are missed.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Generalized anxiety disorder is characterized by excessive and uncontrollable worry about future events and outcomes.

    “The cardinal feature of GAD is excessive and uncontrollable worry regarding future events and outcomes (Borkovec, 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Borkovec, 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A diagnosis of panic disorder requires excessive worry about future panic attacks or about changing behavior to prevent future panic attacks and related symptoms.

    “Additionally, a diagnosis of panic disorder requires the presence of excessive worry regarding future panic attacks or changes in behavior to prevent future panic attacks and related symptoms (American Psychiatric Association, 2000).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites American Psychiatric Association, 2000

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Because catastrophic outcomes are low base-rate events, people often credit preventative worry for their nonoccurrence, so uncertainty persists and worry is strengthened when disconfirmation opportunities are missed.

    “Because the potential catastrophic outcomes are relatively low base-rate events, individuals often attribute their nonoccurrence to preventative worry, yet uncertainty remains and worry processes are strengthened as opportunities for disconfirmation are missed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Major depressive disorder is characterized by rumination, which is hypothesized to serve an experiential avoidance function similar to worry.

    “MDD is characterized by rumination, which is hypothesized to serve a similar function to that of worry (i.e., experiential avoidance; McLaughlin, Borkovec, & Sibrava, 2007).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites McLaughlin, Borkovec, & Sibrava, 2007 source

  • May combine two claims.

    Premisecitation

    Rumination involves repeated attempts to understand past outcomes and has been found to mediate the relationship between intolerance of uncertainty and depressive symptoms.

    “Although often past rather than future oriented, rumination involves repeated attempts to better understand the nature of past outcomes (e.g., guilt over things that one should have done, should not have done, or could have done differently) and has been found to mediate the relationship between IU and depressive symptoms (Liao & Wei, 2011).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Liao & Wei, 2011 source

  • Probably not a substantial claim: may not pass S1 (asserted). May combine two claims.

    Interpretationreasoning

    If intolerance of uncertainty is a common mechanism in emotional disorders, then changes in it should be associated with positive outcomes across disorders, making it a common change factor.

    “If IU represents a common mechanism of psychopathology in emotional disorders, then changes in this factor should be associated with positive outcomes across different disorders, thus, representing a common change factor.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the present sample, the self-report Y-BOCS had an internal consistency alpha of .93.

    “OCD symptom severity was assessed using the self-report version of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS; Baer, 1991; Goodman et al., 1989; alpha = .93 in the present sample).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the present sample, the SIAS had an internal consistency alpha of .94.

    “Social anxiety symptoms were assessed using the Social Interaction Anxiety Scale (SIAS; Mattick & Clarke, 1998; alpha = .94 in the present sample).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Patients were randomized to immediate or delayed treatment.

    “As noted, patients were randomized to two conditions, immediate or delayed treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The IUS was initially created to assess the hypothesized construct in GAD, so the scale may be particularly sensitive to worry-related phenomena.

    “The IUS was initially created to assess this hypothesized construct in GAD; thus, the scale may be particularly sensitive to worry-related phenomena (Gentes & Ruscio, 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gentes & Ruscio, 2011 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Clinical raters were trained extensively on the SIGH-D and had to show acceptable reliability before taking part in the trial.

    “Clinical raters received extensive training on the SIGH-D and had to demonstrate acceptable levels of reliability prior to their participation in the trial.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Ongoing adherence ratings were not conducted in this trial.

    “Ongoing adherence ratings were not conducted in this trial.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The HDRS has shown good interrater and test-retest reliability and concurrent validity with similar clinician-rated and self-report depression measures.

    “This commonly used measure has demonstrated good levels of interrater and test-retest reliability (Williams, 1988), as well as concurrent validity with similar clinician rated and self-report measures of depression symptoms (Bech et al., 1992).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Williams, 1988 source
    • cites Bech et al., 1992 source

  • May combine two claims.

    Interpretationreasoning

    Because uncertainty distress is associated with symptom severity in several emotional disorders and avoidance strategies help maintain psychopathology, intolerance of uncertainty may be an important treatment factor.

    “Given that distress related to experiences of uncertainty has been associated with levels of symptom severity in several emotional disorders, and strategies utilized to avoid uncertainty and increase perceived control are closely tied with diagnostic factors and sequelae that are hypothesized to strengthen and maintain psychopathology, IU may represent an important factor in treatment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Adherence was monitored through weekly supervision and by reading required session notes.

    “Adherence was monitored during weekly supervision and by reading required session notes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the present sample, the BDI-II had an internal consistency alpha of .88.

    “The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) was also used as a self-report of depressive symptoms (alpha = .88 in the present sample).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Transdiagnostic cognitive-behavioral treatments are being developed because single-diagnosis protocols may hinder dissemination and adoption, and to address shared features and mechanisms of change in emotional disorders.

    “Transdiagnostic cognitive-behavioral therapy (CBT) treatments are being developed in response to the proliferation of single-diagnosis treatment protocols that may actually hinder the dissemination and adoption of evidence-based psychological treatments (see McHugh& Barlow, 2010), and to address shared features and mechanisms of change in emotional disorders (Norton & Philipp, 2008).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites McHugh& Barlow, 2010 source
    • cites Norton & Philipp, 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    There was no difference in baseline Intolerance of Uncertainty Scale score between treatment completers and noncompleters.

    “In addition, there was no difference in baseline Intolerance of Uncertainty Scale (IUS) score between treatment completers and noncompleters, F (1, 34) = 0.36, p = .55.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the present sample, the PDSS-SR had an internal consistency alpha of .91.

    “Symptoms related to panic were assessed using the Panic Disorder Severity Scale – Self-Report Version (PDSS-SR; Houck, Spiegel, Shear, & Rucci, 2002) (alpha = .91 in the present sample).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The Intolerance of Uncertainty Scale has excellent internal consistency, including in the present sample.

    “The IUS has excellent internal consistency (α = .91; Freeston et al., 1994; alpha = .95 in the present sample) and good test-retest reliability (r = .78; Dugas et al., 1997).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Freeston et al., 1994 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Anxiety Disorders Interview Schedule for DSM-IV Lifetime Version has demonstrated good to excellent interrater reliability for anxiety and mood disorders.

    “The ADIS-IV-L has demonstrated good (e.g., GAD κ = 0.67; MDD and dysthymia κ = 0.72) to excellent (e.g., panic disorder with agoraphobia and social anxiety disorder κ = 0.77; OCD κ = 0.85) interrater reliability for the anxiety and mood disorders (Brown et al., 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Brown et al., 2001 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Therapists produced statistically equivalent outcomes across their patients.

    “All therapists underwent extensive training and certification prior to treating study patients, and therapists produced statistically equivalent outcomes across their patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Independent clinical evaluators were trained extensively on the SIGH-A and had to show acceptable reliability before taking part in the trial.

    “Independent clinical evaluators received extensive training on the SIGH-A and had to demonstrate acceptable levels of reliability prior to their participation in the trial.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Decades of research show considerable comorbidity and overlap among anxiety and mood disorders, and interest has grown in identifying underlying factors for conceptualization and treatment.

    “Decades of research has shown considerable comorbidity (Brown, Campbell, Lehman, Grisham, & Mancill, 2001) and overlap among anxiety and mood disorders (Barlow, Allen, & Choate, 2004; Moses & Barlow, 2006), and interest in the identification of relevant, underlying factors to aid in conceptualization and treatment has grown (Brown & Barlow, 2009).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Brown, Campbell, Lehman, Grisham, & Mancill, 2001

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Barlow, Allen, & Choate, 2004 source
    • cites Moses & Barlow, 2006 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    All treatment completers received every treatment module.

    “All treatment completers received all treatment modules.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Intolerance of Uncertainty Scale has good test-retest reliability.

    “The IUS has excellent internal consistency (α = .91; Freeston et al., 1994; alpha = .95 in the present sample) and good test-retest reliability (r = .78; Dugas et al., 1997).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dugas et al., 1997 source

  • May combine two claims.

    Study design and conductown data

    No significant differences in initial severity, motivation, or intolerance-of-uncertainty scores were found between the immediate-treatment and delayed-treatment groups.

    “No significant differences in initial severity, motivation, or IU scores were observed between the immediate and delayed treatment groups.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The PANAS negative affect scale correlated significantly with the Hopkins Symptoms Checklist, a general distress measure, at r .74.

    “Additionally, the PANAS-NA was significantly correlated with the Hopkins Symptoms Checklist (Derogatis, Lipman, Ulenhuth, & Covi, 1976), which has been shown to measure general distress (r = .74).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Derogatis, Lipman, Ulenhuth, & Covi, 1976

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Patients with panic disorder spend much energy planning ahead to avoid potential panic and using safety signals to gain a sense of control over feared physical sensations.

    “it is recognized that patients with panic disorder spend a great deal of energy planning ahead to avoid potential panic and using safety signals to provide a sense of control over their feared physical sensations (Barlow, 2002; Rachman, 1984).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Barlow, 2002

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Rachman, 1984 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the present sample, the PSWQ had an internal consistency alpha of .93.

    “GAD symptom severity was assessed using the Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990; alpha = .93 in the present sample).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All study cases were closely supervised by a senior treatment developer.

    “All study cases were closely supervised by a senior treatment developer.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    All independent evaluators in the trial were trained to a high level of reliability and underwent a rigorous certification process.

    “All independent evaluators in the trial were trained to a high level of reliability and underwent a rigorous certification process (see Brown et al., 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Brown et al., 2001 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Staff held weekly meetings in which all initial diagnostic interviews were discussed and a consensus diagnosis was reached.

    “In addition to the training procedures, staff held weekly meetings during which all initial diagnostic interviews were discussed and a consensus diagnosis was reached.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A sample of treatment sessions was recorded and reviewed as part of supervision.

    “A sample of treatment sessions were recorded and reviewed as part of this supervision process.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the PANAS validation sample, internal consistency and test-retest reliability were high, with alpha .90 and r .71.

    “In the validation sample, internal consistency and test-retest reliability were high (α = .90; r = .71).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Watson, Clark, & Tellegen, 1988 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The significant correlation between baseline IU and baseline worry scores is consistent with previous research.

    “The significant correlation between baseline IU and baseline worry scores is consistent with previous research findings (e.g., Buhr & Dugas, 2002)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Buhr & Dugas, 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All therapists received extensive training and certification before treating study patients.

    “All therapists underwent extensive training and certification prior to treating study patients, and therapists produced statistically equivalent outcomes across their patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    The UP is not exclusively focused on GAD or IU; it targets emotion regulation and avoidance/control processes more broadly.

    “Unlike the treatments examined in these studies (e.g., IUT), the UP is not exclusively focused on GAD or IU; rather, the target is emotion regulation and avoidance/control processes more broadly.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Interpretation of the results was enhanced by including effect sizes.

    “interpretation of the results was enhanced by the inclusion of effect sizes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Causal relationships regarding the direct effects of the UP on IU or of IU on symptom change cannot be determined.

    “Consequently, causal relationships regarding the direct effects of the UP on IU or IU on symptom change cannot be determined”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The study had a small sample size.

    “the small sample size”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study sample had a high degree of ethnic homogeneity.

    “and the high degree of ethnic homogeneity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Change in IU was significantly related to posttreatment symptom levels across diagnoses, demonstrating a potential transdiagnostic change factor.

    “Change in IU was significantly related to posttreatment symptom levels across diagnoses, demonstrating a potential transdiagnostic change factor.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    IU may have particular relevance to GAD because it represents a slice of a broader construct such as perceived control.

    “However, IU may also have particular relevance to GAD because it represents a “slice” of a broader construct, such as perceived control (Barlow, 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barlow, 2002

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

57 of 57

  • The paper relies on this without support.

    Except for obsessive-compulsive disorder, intolerance of uncertainty has not been examined in the treatment of many anxiety and mood disorders or across multiple emotional disorders in a single treatment study.

    “However, with the exception of OCD (see Grayson, 2004, and Wilhelm & Steketee, 2006), IU has yetto be examined in the treatment of many anxiety and mood disorders, or across multiple emotional disorders in the context of a single treatment study.”

  • The paper relies on this without support.

    No previous research has examined intolerance of uncertainty in a single transdiagnostic treatment for heterogeneous disorders.

    “However, we are unaware of previous research that has examined IU in the context of a single transdiagnostic treatment for heterogeneous disorders.”

  • The paper relies on this without support.

    The question of whether change in intolerance of uncertainty during treatment differs by diagnosis has not been addressed empirically within a single treatment.

    “To our knowledge, this question has not been addressed empirically within the context of a single treatment.”

  • The paper relies on this without support.

    Panic disorder has not typically been associated with intolerance of uncertainty in the literature.

    “Panic disorder has not typically been associated with IU in the literature”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • IU is strongly implicated in the etiology of generalized anxiety disorder and is a transdiagnostic risk and maintenance factor across mental health concerns and an intervention target.

    “IU is strongly implicated in the etiology of generalized anxiety disorder (GAD; Dugas et al., 1998), but more recently has been included in transdiagnostic models as a central risk and maintenance factor across mental health concerns and an important transdiagnostic intervention target (Boswell et al., 2013; Carleton, 2016; Einstein, 2014; McEvoy & Mahoney, 2012) in COVID-19 (Freeston et al., 2020”

    From The Indirect Effect of Parental Intolerance of Uncertainty on Perinatal Mental Health via Mindfulness During COVID-19 (2021) · cites this paper as Boswell et al., 2013

    The Abstract Results and Discussion (page not provided) report that IU was associated with symptoms across diagnostic categories, decreased during transdiagnostic treatment, and may be a shared factor in emotional disorders. The paper does not establish IU as a central risk and maintenance factor across mental health concerns generally; its Discussion calls for further research on IU’s role in etiology and maintenance. The GAD-etiology clause is attributed to Dugas et al., not Boswell et al. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Individuals with higher intolerance of uncertainty and tendency to worry are more prone to anxiety.

    “That is particularly the case for individuals with higher IU and tendency to worry which, in the cognitive behavioral literature, represent some of the most important factors that make a person prone to anxiety (Carleton et al., 2007, 2012; Boswell et al., 2013).”

    From Intolerance of Uncertainty and Tendency to Worry as Mediators Between Trust in Institutions and Social Support and Fear of Coronavirus and Consequences of the Pandemic (2021) · cites this paper as Boswell et al., 2013

    The paper’s Discussion (page not available) associates intolerance of uncertainty with anxiety disorders and describes excessive worry as a cardinal feature of generalized anxiety disorder. It does not establish that higher intolerance of uncertainty and worry make individuals more prone to anxiety, or rank them among the most important factors that do so. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • In neurotypical individuals, a reduction in intolerance of uncertainty is associated with a reduction in anxiety and improvements in everyday functioning.

    “intervention studies with neurotypical individuals suggest that a reduction in IU is associated with a reduction in anxiety and improvements in everyday functioning (see, for example, [14]).”

    From Coping with Uncertainty in Everyday Situations (CUES©) to address intolerance of uncertainty in autistic children: Study protocol for an intervention feasibility trial (2019) · cites this paper as [14]

    The Results (Change in IU and Posttreatment Symptom Severity; page not indicated) associate greater reductions in IU with lower anxiety symptom severity. But the Method (Participants; page not indicated) describes patients diagnosed with anxiety disorders, not a neurotypical sample. Although the Abstract (Method) mentions functioning measures, the reported IU-change analysis addresses symptom severity, not improvements in everyday functioning. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Several prominent models posit a direct causal link between uncertainty and anxiety.

    “Several prominent models posit a direct causal link between uncertainty and anxiety [35-37].”

    From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [36]

    The conceptual discussion describes uncertainty as producing distress or arousal in GAD, OCD, and panic disorder, and relates intolerance of uncertainty to a model of emotional disorders. It does not establish that several prominent models posit a direct causal link between uncertainty and anxiety; the Discussion instead calls for more direct testing of explanatory models. Page numbers are unavailable in our copy. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Psychological and neural mechanisms through which uncertainty-inducing stressors elicit negative mental states, particularly anxiety, and may lead to psychopathology have been extensively described in the literature.

    “Psychological and neural mechanisms through which uncertainty-inducing stressors elicit negative mental states, particularly anxiety, and may lead to psychopathology have been extensively described in the literature [31,35,36,57,119,120], and these models are broadly relevant in the present context.”

    From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [36]

    The Discussion (page unavailable) describes psychological pathways linking uncertainty to distress, anxiety, panic attacks, and emotional disorders. It does not describe neural mechanisms, so the source supports only the psychological part of the cited claim. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • Inconsistent p-value: F (5, 28) = 1.11, p = .43

    Minor

    The paper reports p = .43 here; recomputing from the test statistic and its degrees of freedom gives p = .378. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .43 · recomputed p = .378

  • Inconsistent p-value: F (5, 35) = 0.57, p = .83

    Minor

    The paper reports p = .83 here; recomputing from the test statistic and its degrees of freedom gives p = .722. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .83 · recomputed p = .722

2 of 2

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upF(5, 35) = 0.57reported p = .83 · recomputed p = .722

    “F (5, 35) = 0.57, p = .83”

  • Doesn’t add upF(5, 28) = 1.11reported p = .43 · recomputed p = .378

    “F (5, 28) = 1.11, p = .43”

  • Not confirmedχ²(4) = 6.84reported p = .15 · recomputed p = .145

    “χ2 (4) = 6.84, p = .15”

  • ConsistentF(1, 34) = 0.36reported p = .55 · recomputed p = .552

    “F (1, 34) = 0.36, p = .55”

  • ConsistentF(4, 35) = 1.11reported p = .37 · recomputed p = .367

    “F (4, 35) = 1.11, p = .37”

  • Consistentt(28) = 3.49reported p < .01 · recomputed p = .002

    “t (28) = 3.49, p < .01”

  • Consistentt(9) = -0.43reported p = .68 · recomputed p = .677

    “t (9) = −0.43, p = .68”

7 of 7

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Baer, 1991, Getting control: Overcoming your obsessions and compulsions
  2. Di Nardo, 1994, Anxiety Disorders Interview Schedule for DSM-IV: Lifetime Version (ADIS-IV-L)
  3. Grayson, 2004, Freedom from obsessive compulsive disorder: A personalized recovery program for living with uncertainty

Cited by

Sorted by citations

Related

Authors
Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H.
Affiliations
  • Boston University (US)
  • Boston University
Corresponding author
Boswell, James F.
ORCID
Venue
Journal of Clinical Psychology
Publisher
Wiley
Published
2013-02-04
Volume
69
Issue
6
Pages
630-645
ISSN
0021-9762 (ISSN-L)
DOI
10.1002/jclp.21965
PMC
PMC3712497
OpenAlex
W2170358517
Semantic Scholar
3e13127f4cf99c5e0f3661144ac2abd9cf3b33eb
Cited by
495
References
59
Citations by year
2026: 23 · 2025: 54 · 2024: 39 · 2023: 61 · 2022: 57 · 2021: 64 · 2020: 42 · 2019: 32 · 2018: 27 · 2017: 26 · 2016: 34 · 2015: 21 · 2014: 8 · 2013: 5
FWCI
30.63
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 939 d)
Locations
  • Journal of Clinical Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R34MH070693, R01MH090053)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
intolerance of uncertainty, generalized anxiety disorder, panic disorder, transdiagnostic cognitive behavioral therapy, anxiety disorders, depressive disorders, treatment outcomes, worry, negative affectivity, depressive symptoms
MeSH terms
Adaptation, Psychological, Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Severity of Illness Index, Cognitive Behavioral Therapy, Uncertainty, Young Adult, Self Report

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review