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

In the paper

“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).”

What the sources say

• Supported

  The Abstract reports extensive comorbidity among anxiety and mood disorders and says common higher-order dimensions account for their covariation. The proposal that intolerance of uncertainty might be one such factor is the citing authors’ conditional inference, not a finding attributed to Brown and Barlow. (LLM, conf=0.90)

  cites Brown & Barlow, 2009 source

In the paper

“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.”

What the sources say

• ?Not matched

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

  cites Borkovec, 1994
• Supported

  The Summary and Conclusion (p. 16) says worry functions as cognitive avoidance of threat and can be negatively reinforced and maintained, in part because it attenuates somatic reactions to aversive images. “Worry Suppresses Somatic Anxiety” (p. 6) also describes demonstrated suppressive effects on somatic anxiety. (LLM, conf=0.92)

  cites Borkovec, Ray, & Stober, 1998 source

In the paper

“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”

What the sources say

• ?Could not verify

  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)

  cites Farchione et al., 2012 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Supported

  The Reliability section reports good test-retest and interrater reliability for the traditional HAM-A (HARS). The Validity section reports correlations with the clinician-rated SIGH-A and the self-report Beck Anxiety Inventory, which it describes as evidence of convergent validity. (LLM, conf=0.92)

  cites Shear et al., 2001 source

In the paper

“The lack of association with OCD symptoms was somewhat surprising, given results from previous studies (Gentes & Ruscio, 2011; Steketee et al., 1998).”

What the sources say

• ?Not checked — no full text of the sourcecites Gentes & Ruscio, 2011 source
• Supported

  The Correlation and Regression Analyses section reports that uncertainty beliefs were associated with OCD symptom measures, including a stronger correlation with Padua scores than with depression or anxiety sensitivity. This supports citing the study as a reason a later lack of association was surprising; the paper does not itself assess the later study’s baseline IUS result. (LLM, conf=0.88)

  cites Steketee et al., 1998 source

In the paper

“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.”

In the paper

“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”

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites Greco & Roger, 2003 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Borkovec, Hazlett-Stevens, & Diaz, 1999 source
• ?Not checked — no full text of the sourcecites Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994 source

In the paper

“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.”

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites Dugas et al., 2001 source
• ?Not checked — no full text of the sourcecites Garber & Hollon, 1991 source

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites Greco & Roger, 2003 source

In the paper

“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.”

In the paper

“The cardinal feature of GAD is excessive and uncontrollable worry regarding future events and outcomes (Borkovec, 2002).”

What the sources say

• ?Not checked — no full text of the sourcecites Borkovec, 2002 source

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites American Psychiatric Association, 2000

In the paper

“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.”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites McLaughlin, Borkovec, & Sibrava, 2007 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Liao & Wei, 2011 source

In the paper

“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.”

In the paper

“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).”

In the paper

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

In the paper

“As noted, patients were randomized to two conditions, immediate or delayed treatment.”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Gentes & Ruscio, 2011 source

In the paper

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

In the paper

“Ongoing adherence ratings were not conducted in this trial.”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Williams, 1988 source
• ?Not checked — no full text of the sourcecites Bech et al., 1992 source

In the paper

“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.”

In the paper

“Adherence was monitored during weekly supervision and by reading required session notes.”

In the paper

“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).”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites McHugh& Barlow, 2010 source
• ?Not checked — no full text of the sourcecites Norton & Philipp, 2008 source

In the paper

“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.”

In the paper

“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).”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Freeston et al., 1994 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Brown et al., 2001 source

In the paper

“All therapists underwent extensive training and certification prior to treating study patients, and therapists produced statistically equivalent outcomes across their patients.”

In the paper

“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.”

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites Brown, Campbell, Lehman, Grisham, & Mancill, 2001
• ?Not checked — no full text of the sourcecites Barlow, Allen, & Choate, 2004 source
• ?Not checked — no full text of the sourcecites Moses & Barlow, 2006 source

In the paper

“All treatment completers received all treatment modules.”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Dugas et al., 1997 source

In the paper

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

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites Derogatis, Lipman, Ulenhuth, & Covi, 1976

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites Barlow, 2002
• ?Not checked — no full text of the sourcecites Rachman, 1984 source

In the paper

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

In the paper

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

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Brown et al., 2001 source

In the paper

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

In the paper

“A sample of treatment sessions were recorded and reviewed as part of this supervision process.”

In the paper

“In the validation sample, internal consistency and test-retest reliability were high (α = .90; r = .71).”

What the sources say

• ?Not checked — no full text of the sourcecites Watson, Clark, & Tellegen, 1988 source

In the paper

“The significant correlation between baseline IU and baseline worry scores is consistent with previous research findings (e.g., Buhr & Dugas, 2002)”

What the sources say

• ?Not checked — no full text of the sourcecites Buhr & Dugas, 2002 source

In the paper

“All therapists underwent extensive training and certification prior to treating study patients, and therapists produced statistically equivalent outcomes across their patients.”

In the paper

“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.”

In the paper

“interpretation of the results was enhanced by the inclusion of effect sizes.”

In the paper

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

In the paper

“the small sample size”

In the paper

“and the high degree of ethnic homogeneity.”

In the paper

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

In the paper

“However, IU may also have particular relevance to GAD because it represents a “slice” of a broader construct, such as perceived control (Barlow, 2002).”

What the sources say

• ?Not matched

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

  cites Barlow, 2002