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Cited by 50Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional DevelopmentPsychological Treatments and Assessments

Intolerance of Uncertainty and Parental Accommodation: Promising Targets for Personalized Intervention for Youth Anxiety.

Open access
Kendall, Philip C., Norris, Lesley A., Rabner, Jonathan C., Crane, Margaret E., Rifkin, Lara S.·2020·Current Psychiatry Reports
DOI 10.1007/s11920-020-01170-3PMC PMC8098646
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Abstract

Purpose Of Review: After reviewing predictors of differential outcomes of cognitive behavioral therapy (CBT) for pediatric anxiety, we identify and discuss recent evidence for the role of (a) intolerance of uncertainty (IU) and (b) parental accommodation as meaningful targets for personalized intervention.Recent Findings: Few studies to date have identified promising, theory-driven predictors of differential CBT outcomes. Recent findings suggest that increased IU and high levels of parental accommodation are associated with a poorer response to CBT. Several adaptations of CBT and new interventions targeting either IU or parental accommodation have been developed and found to be efficacious in preliminary studies. IU and parental accommodation are promising constructs for personalizing intervention, both in the identification of who will respond to treatment and in the development of targeted intervention. We recommend that future work test if individuals high in IU and/or parental accommodation will respond more optimally to treatments that specifically target these constructs. The results of this future work may help to move the field closer to personalized intervention.

Integrity signals

Registry

Crossref · 10.1007/s11920-020-01170-3

Cites

93 of 93 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

28 of 107 cited sources checked · 20 supported · 0 flagged · accuracy not yet measured

  • Interpretationcitation

    IU can be viewed as a transdiagnostic construct underlying a diverse range of anxiety disorders.

    “As a result, IU can be viewed as a transdiagnostic construct underlying a diverse range of anxiety disorders [29].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [29] Carleton RN. Fear of the unknown: one fear to rule them all? J Anxiety Disord. 2016;41:5–21. source
  • Findingcitation

    Only 28.6% of randomized clinical trials for youth anxiety treatments have reported formal predictor analyses.

    “A small percentage (28.6%) [17] of RCTs for youth anxiety treatments have reported formal predictor analyses”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [17] Compton SN, Peris TS, Almirall D, Birmaher B, Sherrill J, Kendall PC, et al. Predictors and moderators of treatment response in childhood anxiety disorders: results from the CAMS trial. J Consult Clin Psychol. 2014;82(2):212–24. source
  • Premisecitation

    IU and parental accommodation are central to the etiology and maintenance of youth anxiety disorders.

    “IU and parental accommodation, both of which are central to the etiology and maintenance of youth anxiety disorders, are promising targets for the identification of meaningful subgroups and development of personalized intervention.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [21] Carleton RN. Into the unknown: a review and synthesis of contemporary models involving uncertainty. J Anxiety Disord. 2016;39:30–43. source

      Section 7 describes intolerance of uncertainty (IU) as a transdiagnostic factor in anxiety, and Section 4 discusses fear of the unknown and parent-child attachment in relation to children’s anxiety. Neither section identifies parental accommodation as a factor in the etiology or maintenance of youth anxiety disorders; attachment is not the same as accommodation. The source therefore supports the IU component broadly, but not the full claim. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [63••]

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

  • Premisecitation

    Accommodation is very common in samples of anxious youth, with as many as 95-97% of caregivers engaging in some form of accommodation.

    “Studies have shown that accommodation is very common in samples of anxious youth, with as many as 95–97% of caregivers engaging in some form of accommodation [63, 64, 66, 67]”
    Quote in the paperNot a substantial claim2 of 4 sources checked
    • cites [63] •• Kagan ER, Frank HE, Kendall PC. Accommodation in youth with OCD and anxiety. Clin Psychol. 2017;24(1):78–98. This manuscript reviews theory and recent literature on parental accommodation. source
    • cites [64] Benito KG, Caporino NE, Frank HE, Ramanujam K, Garcia A, Freeman J, et al. Development of the pediatric accommodation scale: reliability and validity of clinician-and parent-report measures. J Anxiety Disord. 2015;29:14–24. source
    • cites [66] Thompson-Hollands J, Kerns CE, Pincus DB, Comer JS. Parental accommodation of child anxiety and related symptoms: range, impact, and correlates. J Anxiety Disord. 2014;28(8):765–73. source
    • cites [67] Lebowitz ER, Scharfstein LA, Jones J. Comparing family accommodation in pediatric obsessive-compulsive disorder, anxiety disorders, and nonanxious children. Depress Anxiety. 2014;31(12):1018–25. source
  • Premisecitation

    Several studies suggest that accommodation may be more prevalent among youth with a primary diagnosis of SAD.

    “several studies suggest that accommodation may be more prevalent among youth with a primary diagnosis of SAD [64, 72, 73].”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [64] Benito KG, Caporino NE, Frank HE, Ramanujam K, Garcia A, Freeman J, et al. Development of the pediatric accommodation scale: reliability and validity of clinician-and parent-report measures. J Anxiety Disord. 2015;29:14–24. source
    • cites [72] Lebowitz ER, Woolston J, Bar-Haim Y, Calvocoressi L, Dauser C, Warnick E, et al. Family accommodation in pediatric anxiety disorders. Depress Anxiety. 2013;30(1):47–54. source

      In Results > Prevalence of Family Accommodation (page unavailable), separation anxiety disorder was the only diagnosis significantly associated with the degree of accommodation in the specialty-clinic sample. The analysis tested whether each diagnosis was present, not whether SAD was the primary diagnosis, so the paper does not establish that qualifier. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [73] Phillips KE, Norris LA, Kendall PC. Separation anxiety symptom profiles and parental accommodation across pediatric anxiety disorders. Child Psychiatry Hum Dev. 2020:1–13. This study found that high levels of parental accommodation was associated with more interfering youth separation anxiety disorder symptoms. source
  • May combine two claims. 30
  • Classified as probably not a substantial claim. 8

  • May combine two claims.

    Premisecitation

    IU is associated with global anxiety severity, but not with GAD symptom severity specifically.

    “several studies have found that IU is associated with global anxiety severity, but not with GAD symptom severity specifically [30, 31].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [30] Cowie J, Clementi MA, Alfano CA. Examination of the intolerance of uncertainty construct in youth with generalized anxiety disorder. J Clin Child Adolesc Psychol. 2018;47(6):1014–22. source

      The Results (page not provided) report that IU correlated with general anxiety severity and was also associated with GAD severity in the GAD groups. IU did not independently predict GAD severity after accounting for anxiety, so the claim is supported only if “not with GAD symptom severity specifically” means no unique association—not no association at all. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [31] • Rifkin LS, Kendall PC. Intolerance of uncertainty in youth: psychometrics of the intolerance of uncertainty index-A for children. J Anxiety Disord. 2020;71:102197. This study supports findings that intolerance of uncertainty is a transdiagnostic construct underlying all anxiety disorders and presents psychometrics of a self-report and clinician-report measure of intolerance of uncertainty. source

  • May combine two claims.

    Findingcitation

    Few statistically significant and no consistent predictors of CBT response have been identified across studies.

    “Few statistically significant and no consistent predictors have been identified across studies [17–19].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [17] Compton SN, Peris TS, Almirall D, Birmaher B, Sherrill J, Kendall PC, et al. Predictors and moderators of treatment response in childhood anxiety disorders: results from the CAMS trial. J Consult Clin Psychol. 2014;82(2):212–24. source

      The section on predictors and moderators of child and adolescent anxiety treatment reports relatively few significant predictor findings across the 98 trials reviewed and says findings were generally mixed. But it identifies higher baseline symptom severity and poorer family functioning as consistent predictors of poorer outcome, so the claim that no consistent predictors have been identified overstates the source. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [18] Nilsen TS, Eisemann M, Kvernmo S. Predictors and moderators of outcome in child and adolescent anxiety and depression: a systematic review of psychological treatment studies. Eur Child Adolesc Psychiatry. 2013;22(2):69–87. source
    • cites [19] Knight A, McLellan L, Jones M, Hudson J. Pre-treatment predictors of outcome in childhood anxiety disorders: a systematic review. Psychopathol Rev. 2014;1(1):77–129. source

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

    Premisecitation

    A third review pointed to increased baseline symptom severity and family dysfunction as predictors of poorer outcome.

    “a third review of psychotherapy and medication treatments for youth anxiety, which pointed to increased baseline symptom severity and family dysfunction as predictors of poorer outcome [17].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] Compton SN, Peris TS, Almirall D, Birmaher B, Sherrill J, Kendall PC, et al. Predictors and moderators of treatment response in childhood anxiety disorders: results from the CAMS trial. J Consult Clin Psychol. 2014;82(2):212–24. source

  • May combine two claims.

    Premisecitation

    Research has offered some support for the intolerance of uncertainty model in adult samples and in youth as young as 7 years old.

    “Research has offered some support for IUM in both adult samples [32–37] and samples of youth as young as 7 years old [14, 38–42].”
    Quote in the paperSubstantial claim3 of 10 sources checked
    • cites [32] Dugas MJ, Gagnon F, Ladouceur R, Freeston MH. Generalized anxiety disorder: a preliminary test of a conceptual model. Behav Res Ther. 1998;36(2):215–26. source
    • cites [33] Dugas MJ, Brillon P, Savard P, Turcotte J, Gaudet A, Ladouceur R, et al. A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Behav Ther. 2010;41(1):46–58. source
    • cites [34] Dugas MJ, Hedayati M, Karavidas A, Buhr K, Francis K, Phillips NA. Intolerance of uncertainty and information processing: evidence of biased recall and interpretations. Cogn Ther Res. 2005;29(1):57–70. source
    • cites [35] Dugas MJ, Savard P, Gaudet A, Turcotte J, Laugesen N, Robichaud M, et al. Can the components of a cognitive model predict the severity of generalized anxiety disorder? Behav Ther. 2007;38(2):169–78. source
    • cites [36] Gana K, Martin B, Canouet M-D. Worry and anxiety: is there a causal relationship? Psychopathology. 2001;34(5):221–9. source
    • cites [37] Ladouceur R, Gosselin P, Dugas MJ. Experimental manipulation of intolerance of uncertainty: a study of a theoretical model of worry. Behav Res Ther. 2000;38(9):933–41. source
    • cites [14] Cartwright-Hatton S, Roberts C, Chitsabesan P, Fothergill C, Harrington R. Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders. Br J Clin Psychol. 2004;43(4):421–36. source
    • cites [38] Bacow TL, Pincus DB, Ehrenreich JT, Brody LR. The metacognitions questionnaire for children: development and validation in a clinical sample of children and adolescents with anxiety disorders. J Anxiety Disord. 2009;23(6):727–36. source
    • cites [39] Comer JS, Roy AK, Furr JM, Gotimer K, Beidas RS, Dugas MJ, et al. The intolerance of uncertainty scale for children: a psychometric evaluation. Psychol Assess. 2009;21(3):402–11. source
    • cites [40] Gosselin P, Langlois F, Freeston MH, Ladouceur R, Laberge M, Lemay D. Cognitive variables related to worry among adolescents: avoidance strategies and faulty beliefs about worry. Behav Res Ther. 2007;45(2):225–33. source

  • May combine two claims.

    Premisecitation

    In adults, IU decreased over typical CBT and greater changes in IU were associated with greater reduction in symptom severity from pre- to post-treatment.

    “Results of multiple studies in adults have found that IU decreased over the course of typical CBT and that greater changes in IU were associated with greater reduction in symptom severity from pre- to post-treatment [49–51].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [49] Boswell JF, Thompson-Hollands J, Farchione TJ, Barlow DH. Intolerance of uncertainty: a common factor in the treatment of emotional disorders. J Clin Psychol. 2013;69(6):630–45. source
    • cites [50] Stevens K, Rogers T, Campbell M, Björgvinsson T, Kertz S. A transdiagnostic examination of decreased intolerance of uncertainty and treatment outcome. Cogn Behav Ther. 2018;47(1):19–33. source
    • cites [51] Talkovsky AM, Norton PJ. Intolerance of uncertainty and transdiagnostic group cognitive behavioral therapy for anxiety. J Anxiety Disord. 2016;41:108–14. source

  • May combine two claims.

    Premisecitation

    Elements targeting IU have been incorporated into group CBT for social anxiety disorder and via behavioral experiments in adults, with promising preliminary findings.

    “Elements targeting IU have also been incorporated into group CBT for social anxiety disorder [58] and via behavioral experiments in adults [33], with promising preliminary findings for both approaches.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [58] Mahoney AE, McEvoy PM. Changes in intolerance of uncertainty during cognitive behavior group therapy for social phobia. J Behav Ther Exp Psychiatry. 2012;43(2):849–54. source
    • cites [33] Dugas MJ, Brillon P, Savard P, Turcotte J, Gaudet A, Ladouceur R, et al. A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Behav Ther. 2010;41(1):46–58. source

      The Cognitive-Behavioral Therapy section (page unavailable) describes an intolerance-of-uncertainty component in which adults with GAD sought out uncertainty-inducing situations, and the Short-Term Outcomes section reports favorable results for CBT. The paper calls this component behavioral exposure, not behavioral experiments, and evaluates the full CBT program rather than that component separately. Citation [33] is attached to the adults portion of the sentence, not the separate social-anxiety citation. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Some studies show that parents accommodate more during times of increased child distress and that maternal anxiety and distress are associated with increased accommodation.

    “Some studies have shown that parents accommodate more during times of increased child distress [79] and that maternal anxiety and distress are associated with increased accommodation [66, 80].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [79] Settipani CA, Kendall PC. The effect of child distress on accommodation of anxiety: relations with maternal beliefs, empathy, and anxiety. J Clin Child Adolesc Psychol. 2017;46(6):810–23. source
    • cites [66] Thompson-Hollands J, Kerns CE, Pincus DB, Comer JS. Parental accommodation of child anxiety and related symptoms: range, impact, and correlates. J Anxiety Disord. 2014;28(8):765–73. source
    • cites [80] Kerns CE, Pincus DB, McLaughlin KA, Comer JS. Maternal emotion regulation during child distress, child anxiety accommodation, and links between maternal and child anxiety. J Anxiety Disord. 2017;50:52–9. source

  • May combine two claims.

    Premisecitation

    One study found that reductions in IU mediated and preceded reductions in worry, but the reverse pattern was not found.

    “one study found that reductions in IU mediated (and preceded) reductions in worry, but the reverse pattern was not found”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [54] Bomyea J, Ramsawh H, Ball T, et al. Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder. J Anxiety Disord. 2015;33:90–4. source

  • May combine two claims.

    Premisecitation

    Baseline parental accommodation was significantly associated with post-treatment anxiety following 16 weeks of CBT; marginally significant associations with responder status were also reported.

    “One study found that baseline levels of parental accommodation were significantly associated with post-treatment anxiety following 16 weeks of CBT; marginally significant associations with responder status also were reported [74].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [74] Kagan ER, Peterman JS, Carper MM, Kendall PC. Accommodation and treatment of anxious youth. Depress Anxiety. 2016;33(9):840–7. source

      The Relation Between Accommodation and Anxiety section reports a significant association between pretreatment accommodation and posttreatment anxiety ratings, plus a marginally significant association with responder status (P = .057). However, the Procedure section says only 65% completed 16 weeks of treatment; the others received 10–15 sessions, so the 16-week description does not apply to the full sample. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Accommodation was originally examined in OCD, but researchers have increasingly recognized its importance in SAD and youth anxiety disorders more broadly.

    “although originally examined in the context of obsessive compulsive disorder (OCD) [70, 71], researchers have increasingly recognized the importance of accommodation in the maintenance of separation anxiety disorder (SAD) [64, 72, 73] and youth anxiety disorders more broadly [63, 74]”
    Quote in the paperNot a substantial claim3 of 7 sources checked
    • cites [70] Calvocoressi L, Lewis B, Harris M, et al. Family accommodation in obsessive-compulsive disorder. Am J Psychiatry. 1995. source
    • cites [71] Calvocoressi L, Mazure CM, Kasl SV, et al. Family accommodation of obsessive-compulsive symptoms: instrument development and assessment of family behavior. J Nerv Ment Dis. 1999;187(10):636–42. source
    • cites [64] Benito KG, Caporino NE, Frank HE, Ramanujam K, Garcia A, Freeman J, et al. Development of the pediatric accommodation scale: reliability and validity of clinician-and parent-report measures. J Anxiety Disord. 2015;29:14–24. source
    • cites [72] Lebowitz ER, Woolston J, Bar-Haim Y, Calvocoressi L, Dauser C, Warnick E, et al. Family accommodation in pediatric anxiety disorders. Depress Anxiety. 2013;30(1):47–54. source
    • cites [73] Phillips KE, Norris LA, Kendall PC. Separation anxiety symptom profiles and parental accommodation across pediatric anxiety disorders. Child Psychiatry Hum Dev. 2020:1–13. This study found that high levels of parental accommodation was associated with more interfering youth separation anxiety disorder symptoms. source
    • cites [63] •• Kagan ER, Frank HE, Kendall PC. Accommodation in youth with OCD and anxiety. Clin Psychol. 2017;24(1):78–98. This manuscript reviews theory and recent literature on parental accommodation. source
    • cites [74] Kagan ER, Peterman JS, Carper MM, Kendall PC. Accommodation and treatment of anxious youth. Depress Anxiety. 2016;33(9):840–7. source

  • May combine two claims.

    Premisecitation

    Alternative treatments in youth with GAD, including behavioral experiments and an IU-CBT protocol, reported significant reductions in GAD symptom severity across most outcome measures; sample sizes were small (N=16 and 12) and no control condition was included.

    “Both studies reported significant reductions in GAD symptom severity across most outcome measures; however, consistent with other trials, sample sizes were small (N = 16 and 12, respectively) and studies did not include a control condition for comparison.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [47•]

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

    • cites [61] Wahlund T, Andersson E, Jolstedt M, Perrin S, Vigerland S, Serlachius E. Intolerance of uncertainty–focused treatment for adolescents with excessive worry: a pilot feasibility study. Cogn Behav Pract. 2019. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [55] Ladouceur R, Dugas MJ, Freeston MH, Léger E, Gagnon F, Thibodeau N. Efficacy of a cognitive–behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. J Consult Clin Psychol. 2000;68(6):957–64. source

  • May combine two claims.

    Findingcitation

    The majority of studies examining IU in treatment outcome have been in adults and focused on within-treatment IU change rather than baseline IU predicting post-treatment response.

    “The majority of studies conducted to date examining the role of IU in treatment outcome have been conducted in adult samples and have focused primarily on within-treatment IU change, rather than looking at the association between baseline IU and post-treatment response in line with convention for defining predictors [20, 48].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [20] Kraemer HC, Frank E, Kupfer DJ. Moderators of treatment outcomes: clinical, research, and policy importance. JAMA. 2006;296(10):1286–9. source
    • cites [48] Kraemer HC, Wilson GT, Fairburn CG, Agras WS. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry. 2002;59(10):877–83. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Predictor selection based on theoretical models may yield more favorable results.

    “predictor selection based on theoretical models may yield more favorable results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    IU is associated with symptoms or diagnosis of GAD and with social anxiety disorder, separation anxiety disorder, panic disorder, obsessive compulsive disorder, and health anxiety.

    “there is strong support not only for the association between IU and symptoms or a diagnosis of GAD [22, 23] but also for the association between IU and social anxiety disorder, separation anxiety disorder (SAD), panic disorder, obsessive compulsive disorder, and health anxiety [24–28].”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [22] Donovan CL, Holmes MC, Farrell LJ. Investigation of the cognitive variables associated with worry in children with Generalised Anxiety Disorder and their parents. J Affect Disord. 2016;192:1–7. source
    • cites [23] • Read KL, Comer JS, Kendall PC. The Intolerance of Uncertainty Scale for Children (IUSC): discriminating principal anxiety diagnoses and severity. Psychol Assess. 2013;25(3):722. This paper proposed the current definition of intolerance of uncertainty. source
    • cites [24] Boelen PA, Vrinssen I, van Tulder F. Intolerance of uncertainty in adolescents: correlations with worry, social anxiety, and depression. J Nerv Ment Dis. 2010;198(3):194–200. source
    • cites [25] Cornacchio D, Sanchez AL, Coxe S, Roy A, Pincus DB, Read KL, et al. Factor structure of the intolerance of uncertainty scale for children. J Anxiety Disord. 2018;53:100–7. source
    • cites [26] Hearn CS, Donovan CL, Spence SH, March S. A worrying trend in social anxiety: to what degree are worry and its cognitive factors associated with youth social anxiety disorder? J Affect Disord. 2017;208:33–40. source
    • cites [27] Hearn CS, Donovan CL, Spence SH, March S, Holmes MC. What’s the worry with social anxiety? Comparing cognitive processes in children with generalized anxiety disorder and social anxiety disorder. Child Psychiatry Hum Dev. 2017;48(5):786–95. source
    • cites [28] Wright KD, Lebell MAA, Carleton RN. Intolerance of uncertainty, anxiety sensitivity, health anxiety, and anxiety disorder symptoms in youth. J Anxiety Disord. 2016;41:35–42. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Current non-significant findings may be due in part to analyses not grounded in a strong theory of youth anxiety development, maintenance, and treatment.

    “Current non-significant findings may be due, in part, to the preponderance of analyses that are not grounded in a strong theory of youth anxiety development, maintenance, and treatment.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    CBT is a well-established first-line treatment for youth anxiety.

    “cognitive behavioral therapy (CBT) is a well-established treatment that has been designated as a first-line intervention [8•].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8•]

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

  • May combine two claims.

    Premisecitation

    The intolerance of uncertainty model proposes that individuals with GAD have a lower threshold for tolerating uncertain or ambiguous situations, leading to reassurance-seeking and worries exacerbated by cognitive processes.

    “In the first of four main model features, it was proposed that individuals with GAD have a lower threshold for tolerating uncertain or ambiguous situations (i.e., high IU), which leads to either the increase in or onset of reassurance-seeking “what if?” questions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Dugas MJ, Gagnon F, Ladouceur R, Freeston MH. Generalized anxiety disorder: a preliminary test of a conceptual model. Behav Res Ther. 1998;36(2):215–26. source

  • May combine two claims.

    Interpretationreasoning

    Accommodation can be conceptualized as an avoidance behavior that facilitates youth avoidance of feared stimuli, temporarily reducing distress but maintaining the anxiety cycle over time.

    “Accommodation can be conceptualized as one of several avoidance behaviors that facilitate youth avoidance of the feared stimuli during the maintenance phase, temporarily reducing youth distress but ultimately maintaining the anxiety cycle over time.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    At 3-month follow-up, 100% of participants who completed treatment no longer met criteria for GAD and 50% no longer met criteria for any diagnoses.

    “At 3-month follow-up, 100% of participants who completed treatment no longer met criteria for GAD and 50% no longer met criteria for any diagnoses.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [62••]

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

  • May combine two claims.

    Premisecitation

    The two-stage theory of fear development and maintenance proposes that interfering anxiety is acquired when a neutral stimulus is paired with a fear response and generalized via classical conditioning; anxiety is maintained by negative reinforcement of avoidance behaviors.

    “According to this theory, interfering anxiety is acquired when a neutral stimulus is paired with a fear response and generalized via classical conditioning; anxiety is then maintained over time by the negative reinforcement of avoidance behaviors that decrease anxiety in the short-term but interfere with natural extinction of the conditioned fear [76, 77].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [75] Mowrer O. Learning theory and behavior. 1960. source
    • cites [76] Foa EB, Kozak MJ. Emotional processing of fear: exposure to corrective information. Psychol Bull. 1986;99(1):20–35. source
    • cites [77] Bouton ME, Mineka S, Barlow DH. A modern learning theory perspective on the etiology of panic disorder. Psychol Rev. 2001;108(1):4–32. source

  • Classified as probably not a substantial claim.

    Premisecitation

    Family accommodation refers to ways parents or family members act to alleviate symptoms, such that youth distress is minimized in the short-term but maintained in the long-term.

    “Family accommodation “refers to the ways in which parents or other family members act to alleviate the accompanying symptoms,” [63••] such that youth distress is minimized in the short-term but maintained in the long-term”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [63••]

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

  • May combine two claims.

    Premisecitation

    In a second set of cases (N=16), the same treatment with minor modifications was associated with an 81% remission rate for GAD, although diagnoses were not blindly assessed.

    “In a second set of cases (N = 16), the same treatment with minor modifications was associated with an 81% remission rate for GAD, although it is notable that diagnoses were not blindly assessed [60].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] Payne S, Bolton D, Perrin S. A pilot investigation of cognitive therapy for generalized anxiety disorder in children aged 7–17 years. Cogn Ther Res. 2011;35(2):171–8. source

  • May combine two claims.

    Premisecitation

    In a study of anxious youth ages 7-17 (N=73) completing 16 weeks of child-focused CBT, greater reductions in IU from pre- to post-treatment were significantly associated with increased coping efficacy, decreased symptom severity, and decreased functional impairment.

    “In this study of anxious youth ages 7–17 (N = 73) who completed 16 weeks of child-focused CBT, greater reductions in IU from pre- to post-treatment were significantly associated with the three outcome variables examined, including increased coping efficacy, decreased symptom severity, and decreased functional impairment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53••]

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

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

    Premisecitation

    A new model posits that contextual attributes trigger uncertainty that, when misinterpreted as catastrophic, results in excessive anxiety, worry, and safety behaviors; each phase is compounded by dispositional IU, emotional state, and life circumstances.

    “This model posits that contextual attributes (i.e., ambiguity, novelty, unpredictability) trigger a state of uncertainty that, when misinterpreted as catastrophic, results in excessive anxiety, worry, and engagement in safety behaviors; each phase of this cycle is compounded by dispositional IU, along with emotional state and life circumstances.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47•]

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

  • May combine two claims.

    Premisecitation

    One adult study found higher pretreatment IU associated with higher symptom severity during and post-treatment, but IU did not moderate the rate of symptom change.

    “one study in adults examining the association between change in IU and the rate of symptom change found that higher pretreatment IU was associated with higher symptom severity during treatment and post-treatment, although IU did not moderate the rate of change in symptoms throughout CBT [52].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Katz D, Rector NA, Laposa JM. The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder. Cogn Behav Ther. 2017;46(6):459–77. source

  • May combine two claims.

    Premisecitation

    In that youth study, findings remained significant after controlling for demographics and other variables, and were consistent across child and parent reports.

    “Findings remained significant after controlling for demographics (i.e., age, sex) and other variables hypothesized to impact the relationship between IU and outcome (i.e., pretreatment levels of IU, pretreatment levels of the outcome variables), and results were consistent across both child and parent reports.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53••]

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

  • May combine two claims.

    Premisecitation

    In the Intolerance of Uncertainty Treatment trial, after treatment 77% of participants no longer met diagnostic criteria for GAD and significant reductions in IU and GAD symptoms were reported.

    “Following treatment, 77% of participants no longer met diagnostic criteria for GAD and significant reductions in IU and GAD symptoms were reported.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Ladouceur R, Dugas MJ, Freeston MH, Léger E, Gagnon F, Thibodeau N. Efficacy of a cognitive–behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. J Consult Clin Psychol. 2000;68(6):957–64. source

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationreasoning

    Theory-driven predictors, such as IU and accommodation, may help answer which treatments work for whom and inform the development of targeted interventions.

    “It is possible that theory-driven predictors, such as IU and accommodation, will help to answer these questions and inform the development of targeted interventions.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    The well-established efficacy of CBT for youth anxiety is encouraging, but there is a need for research designed to address which treatments work for whom and why.

    “The well-established efficacy for CBT for youth anxiety is encouraging, but there is need for research designed to address new questions: most pressingly, which treatments work for whom and why?”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Decreases in accommodation are positively associated with parent-reported youth post-treatment anxiety, controlling for pretreatment differences in youth anxiety severity; however, this finding did not hold across all outcome variables and was not replicated in another study examining sleep outcomes.

    “Results from one study suggest that decreases in accommodation are positively associated with parent-reported youth post-treatment anxiety, controlling for pretreatment differences in youth anxiety severity [84]; however, this finding did not hold across all outcome variables that were examined [84] and results were not replicated in another study examining sleep outcomes in CBT [84].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Peterman JS, Carper MM, Elkins RM, Comer JS, Pincus DB, Kendall PC. The effects of cognitive-behavioral therapy for youth anxiety on sleep problems. J Anxiety Disord. 2016;37:78–88. source

  • May combine two claims.

    Interpretationreasoning

    IU and accommodation are involved in the development and maintenance of youth anxiety symptoms, and thus represent potential theory-driven constructs for identifying subgroups of youth who may benefit from targeted intervention.

    “Recent research findings on IU and accommodation indicate that these constructs are involved in the development and maintenance of youth anxiety symptoms, and thus represent potential theory-driven constructs for identifying subgroups of youth who may benefit from targeted intervention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    High IU and increased parental accommodation are each associated with poorer CBT outcomes.

    “results suggesting that high IU and increased parental accommodation are each associated with poorer CBT outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    IU- and accommodation-specific treatments can be efficacious for anxious youth, although additional work is needed.

    “Results suggest that IU- and accommodation-specific treatments can be efficacious for anxious youth, although additional work is needed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Each additional point on an accommodation frequency subscale and an accommodation impact subscale was associated with a 12% and 26% decrease in the odds of remission, respectively, following computer-assisted CBT, although these results did not reach statistical significance.

    “Finally, each additional point on an accommodation frequency subscale and an accommodation impact subscale was associated with a 12% and 26% decrease in the odds of remission, respectively, following computer-assisted CBT, although these results did not reach statistical significance [85].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [85] Salloum A, Andel R, Lewin AB, Johnco C, McBride NM, Storch EA. Family accommodation as a predictor of cognitive-behavioral treatment outcome for childhood anxiety. Fam Soc. 2018;99(1):45–55. source

  • May combine two claims.

    Premisecitation

    A comparison of ARI using Coping Cat as a benchmark suggested that both treatments resulted in significant reductions in youth symptoms and parental accommodation, with no differences reported between treatments.

    “Results from a comparison of ARI using Coping Cat as a benchmark suggested that both treatments resulted in significant reductions in youth symptoms and parental accommodation, with no differences reported between treatments [86••].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [86••]

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

35 of 35

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?

  • Targeting intolerance of uncertainty and parental accommodation may be effective in reducing anxiety.

    “Results also suggest that targeting intolerance of uncertainty (IU) and parental accommodation, known mechanistic and maintaining variables, respectively, of anxiety in neurotypical and ASD populations, may be effective in reducing anxiety [12, 18, 20].”

    From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [20]

Self-check

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

Each contradiction between two passages listed here was confirmed by an independent check.

  • The cited replication uses the same study reference

    Minor

    The text calls the sleep-outcome analysis "another study" that did not replicate the preceding finding, but cites [84] for both. As written, the same reference is presented as both the original study and a separate replication attempt.

1 of 1

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1 of the 94 references couldn’t be matched to a known paper.

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Related

Authors
Kendall, P. C., Norris, L. A., Rabner, J. C., Crane, M. E., & Rifkin, L. S.
Affiliations
Temple University (US)
Corresponding author
Kendall, Philip C.
ORCID
Venue
Current Psychiatry Reports
Publisher
Springer Science and Business Media LLC
Published
2020-07-14
Volume
22
Issue
9
Pages
49-49
ISSN
  • 1523-3812 (ISSN-L)
  • 1535-1645
DOI
10.1007/s11920-020-01170-3
PMC
PMC8098646
OpenAlex
W3043366423
Semantic Scholar
b443cf77801dfa88585de3fd449d95c237d15a27
Cited by
50
References
94
Citations by year
2026: 5 · 2025: 7 · 2024: 9 · 2023: 6 · 2022: 16 · 2021: 5 · 2020: 2
FWCI
1.06
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Psychiatry Reports (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (F31MH123038, F31MH124346)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
intolerance of uncertainty, parental accommodation, childhood anxiety, youth anxiety, cognitive behavioral therapy, predictors of treatment response, personalized interventions, targeted interventions, treatment-resistant anxiety
MeSH terms
Adolescent, Anxiety, Anxiety Disorders, Child, Humans, Parents, Cognitive Behavioral Therapy, Uncertainty

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 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.

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