Intolerance of Uncertainty as a Transdiagnostic Mechanism of Psychological Difficulties: A Systematic Review of Evidence Pertaining to Causality and Temporal Precedence
Open accessAbstract
Intolerance of uncertainty (IU) is proposed to be a transdiagnostic causal mechanism of psychological difficulties. The systematic review sought to evaluate the status of evidence pertaining to IU’s proposed causal influence upon symptoms of psychological conditions. The review collated evidence from studies involving experimental manipulation and assessment of temporal precedence to ensure direct assessment of causality. The search strategy and eligibility screening identified 12 articles, detailing 15 eligible studies (experimental manipulations: n = 10; temporal precedence studies: n = 5). Available evidence comprised symptoms of anxiety- and mood-related conditions, including obsessive–compulsive disorder (OCD). The greatest support for IU as a causal mechanism was evident for anxiety-related difficulties and, to a lesser extent, negative affect; limited support was found for OCD-related difficulties. However, notable inconsistency across study findings for all difficulty types precludes absolute conclusions. Implications and recommendations are discussed.
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IU has been identified as a critical transdiagnostic risk factor and component of internalizing psychopathology across a range of mental disorders.
“IU has been identified as a critical transdiagnostic risk factor and component of internalizing psychopathology across a range of mental disorders, such as generalized panic and social anxiety disorders, obsessive-compulsive disorder, depression, eating disorders, and others [87-89].”
From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [89]
The Introduction associates IU with generalized anxiety, social anxiety, panic, obsessive-compulsive difficulties, depression, and eating disorders, and proposes it as a transdiagnostic vulnerability. But the Summary of Evidence says the findings are too limited to establish its transdiagnostic status, so calling it an identified critical risk factor overstates the review's conclusion. (LLM, conf=0.87)
Experimental — accuracy not yet measuredHigher levels of intolerance of uncertainty are associated with anxiety-related disorders.
“Higher levels of intolerance of uncertainty have been associated with anxiety-related disorders [16].”
From The Role of Pre-Pandemic Mental Health Status and Personality Traits on Psychological Distress during the COVID-19 Lockdown among Italian Young Adults (2023) · cites this paper as [16]
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- Authors
- Rosser, B. A.
- Affiliations
- Liverpool John Moores University (GB)
- Corresponding author
- Rosser, Benjamin A.
- ORCID
- Rosser, Benjamin A.
- Venue
- Cognitive Therapy and Research
- Published
- 2018-09-22
- Volume
- 43
- Issue
- 2
- Pages
- 438-463
- ISSN
- 0147-5916 (ISSN-L)
- 1573-2819
- OpenAlex
- W2892588052
- Cited by
- 157
- References
- 88
- Citations by year
- 2026: 12 · 2025: 27 · 2024: 21 · 2023: 32 · 2022: 25 · 2021: 25 · 2020: 13 · 2019: 2
- FWCI
- 1.59
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Cognitive Therapy and Research (publishedVersion, cc-by)
- Liverpool John Moores University (acceptedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- intolerance of uncertainty, transdiagnostic mechanisms, temporal precedence, experimental manipulation, anxiety, mood disorders, obsessive-compulsive disorder, negative affect
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