To Be Sure, To Be Sure: Intolerance of Uncertainty Mediates Symptoms of Various Anxiety Disorders and Depression

McEvoy, Peter M.; Mahoney, Alison E.J.

doi:10.1016/j.beth.2011.02.007

Cited by 468Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional DevelopmentMental Health Research Topics

To Be Sure, To Be Sure: Intolerance of Uncertainty Mediates Symptoms of Various Anxiety Disorders and Depression

McEvoy, Peter M., Mahoney, Alison E.J.·2012·Behavior Therapy

DOI 10.1016/j.beth.2011.02.007

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Abstract

The Intolerance of Uncertainty Model was initially developed as an explanation for worry within the context of generalized anxiety disorder. However, recent research has identified intolerance of uncertainty (IU) as a possible transdiagnostic maintaining factor across the anxiety disorders and depression. The aim of this study was to determine whether IU mediated the relationship between neuroticism and symptoms related to various anxiety disorders and depression in a treatment-seeking sample (N=328). Consistent with previous research, IU was significantly associated with neuroticism as well as with symptoms of social phobia, panic disorder and agoraphobia, obsessive-compulsive disorder, generalized anxiety disorder, and depression. Moreover, IU explained unique variance in these symptom measures when controlling for neuroticism. Mediational analyses showed that IU was a significant partial mediator between neuroticism and all symptom measures, even when controlling for symptoms of other disorders. More specifically, anxiety in anticipation of future uncertainty (prospective anxiety) partially mediated the relationship between neuroticism and symptoms of generalized anxiety disorder (i.e. worry) and obsessive-compulsive disorder, whereas inaction in the face of uncertainty (inhibitory anxiety) partially mediated the relationship between neuroticism and symptoms of social anxiety, panic disorder and agoraphobia, and depression. Sobel's test demonstrated that all hypothesized meditational pathways were associated with significant indirect effects, although the mediation effect was stronger for worry than other symptoms. Potential implications of these findings for the treatment of anxiety disorders and depression are discussed.

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This finding is consistent with previous evidence that Prospective but not Inhibitory IU mediates the relationship between neuroticism and worry in mixed anxiety disorder samples.
“This finding is consistent with previous evidence that Prospective but not Inhibitory IU mediates the relationship between neuroticism and worry in mixed anxiety disorder samples (McEvoy & Mahoney, 2012).”
From The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty (2016) · cites this paper as McEvoy & Mahoney, 2012
There has been considerable support for a two-factor IUS-12 structure: a 7-item prospective IU scale and a 5-item inhibitory IU scale.
“there has been considerable support for a two-factor IUS-12 structure: (1) a 7-item prospective IU scale related to action/approach-oriented strategies in order to increase certainty (e.g. seeking more information), and (2) a 5-item inhibitory IU associated with inaction/avoidance-oriented thoughts and behaviours (e.g. delayed decision-making) [251, 259, 264–271].”
From Infraslow closed-loop brain training for anxiety and depression (ISAD): a protocol for a randomized, double-blind, sham-controlled pilot trial in adult females with internalizing disorders (2022) · cites this paper as [268]
IU is a transdiagnostic dimension, with high levels of self-reported IU observed in a number of mental health disorders.
“Notably, IU is a transdiagnostic dimension, with high levels of self-reported IU observed in a number of mental health disorders, such as anxiety, obsessive-compulsive, trauma, and stress disorders (20,21).”
From I Doubt It Is Safe: A Meta-analysis of Self-reported Intolerance of Uncertainty and Threat Extinction Training (2021) · cites this paper as [20]
Several studies have demonstrated the stability of a two-factor structure for the IUS-12 and associations between these factors and different anxiety disorders.
“Several studies have demonstrated the stability of a two-factor structure for the IUS-12 and associations between these factors and different anxiety disorders. 11-13”
From Psychometric properties of the brazilian intolerance of uncertainty scale – short version (Ius-12) (2020) · cites this paper as [11]
A predominance of female participants appears to be a common occurrence in scientific studies of IU.
“This, however, appears to be a common occurrence in scientific studies of IU. 10,11,38”
From Psychometric properties of the brazilian intolerance of uncertainty scale – short version (Ius-12) (2020) · cites this paper as [11]

Intolerance of uncertainty is postulated as a central feature in development and maintenance of GAD.
“Intolerance of uncertainty is postulated as a central feature in development and maintenance of GAD”
From Psychometric properties of the brazilian intolerance of uncertainty scale – short version (Ius-12) (2020) · cites this paper as [11]
The Prospective IU subscale seems to be more related to GAD and OCD symptoms, while Inhibitory IU is more associated with symptoms of social phobia, panic disorder, PTSD, and depression.
“For example, the Prospective IU subscale seems to be more related to GAD and obsessive-compulsive disorder (OCD) symptoms, while Inhibitory IU is more associated with symptoms of social phobia, panic disorder, post-traumatic stress disorder (PTSD), and depression. 10,11,14,15”
From Psychometric properties of the brazilian intolerance of uncertainty scale – short version (Ius-12) (2020) · cites this paper as [11]
Negative affect associated with IU is seen in generalized anxiety disorder, other anxiety disorders, depression and autism.
“The negative affect associated with IU is seen in generalized anxiety disorder but also other anxiety disorders, depression and autism (McEvoy and Mahoney, 2012; Einstein, 2014).”
From Sensory, emotional and cognitive contributions to anxiety in autism spectrum disorders (2017) · cites this paper as McEvoy and Mahoney, 2012
The finding that there was not a direct association between IU and depression in non-autistic young people does not mirror previous research with general population samples.
“In addition, our finding that there was not a direct association between IU and depression in non-autistic young people does not mirror previous research with general population samples (Carleton et al., 2012; McEvoy & Mahoney, 2012).”
From Investigating the Effects of Transdiagnostic Processes on Anxiety and Depression Symptoms in Autistic Young People: the Mediating Role of Emotion Dysregulation. (2025) · cites this paper as McEvoy & Mahoney, 2012

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The intolerance of uncertainty construct in the context of anxiety disorders: Theoretical and practical perspectives
Carleton, R. N. (2012) · Expert Review of Neurotherapeutics · doi:10.1586/ern.12.82 · Cited by 599 · see citing works
Intolerance of uncertainty as a framework for understanding anxiety in children and adolescents with autism spectrum disorders
Boulter, C., Freeston, M., South, M., & Rodgers, J. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-013-2001-x · Cited by 401 · see citing works
The interplay between sensory processing abnormalities, intolerance of uncertainty, anxiety and restricted and repetitive behaviours in autism spectrum disorder
Wigham, S., Rodgers, J., South, M., McConachie, H., & Freeston, M. (2015) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2248-x · Cited by 373 · see citing works
Intolerance of uncertainty in emotional disorders: what uncertainties remain?
Shihata, S., McEvoy, P. M., Mullan, B. A., & Carleton, R. N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.05.001 · Cited by 301 · see citing works
Self-citation
The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: a meta-analysis
McEvoy, P. M., Hyett, M. P., Shihata, S., Price, J. E., & Strachan, L. (2019) · Clinical Psychology Review · doi:10.1016/j.cpr.2019.101778 · Cited by 271 · see citing works
Self-citation
Sensory, emotional and cognitive contributions to anxiety in autism spectrum disorders
South, M., & Rodgers, J. (2017) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2017.00020 · Cited by 270 · see citing works
“The negative affect associated with IU is seen in generalized anxiety disorder but also other anxiety disorders, depression and autism (McEvoy and Mahoney, 2012; Einstein, 2014).”
Background
A Transdiagnostic Examination of Intolerance of Uncertainty Across Anxiety and Depressive Disorders
Mahoney, A. E. J., & McEvoy, P. M. (2012) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.622130 · Cited by 237 · see citing works
Self-citation
Extension of the Transdiagnostic Model to Focus on Intolerance of Uncertainty: A Review of the Literature and Implications for Treatment
Einstein, D. A. (2014) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12077 · Cited by 223 · see citing works
Intolerance of uncertainty: Neural and psychophysiological correlates of the perception of uncertainty as threatening
Tanovic, E., Gee, D. G., & Joormann, J. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.01.001 · Cited by 214 · see citing works
The Structure of Cognitive Vulnerabilities to Depression and Anxiety: Evidence for a Common Core Etiologic Process Based on a Meta-Analytic Review
Hong, R. Y., & Cheung, M. W.-L. (2015) · Clinical Psychological Science · doi:10.1177/2167702614553789 · Cited by 201 · see citing works
The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis
Jenkinson, R., Milne, E., & Thompson, A. (2020) · Autism · doi:10.1177/1362361320932437 · Cited by 205 · see citing works
“…a substantial role in social anxiety (Boelen & Reijntjes, 2009; Teale Sapach et al., 2015), obsessivecompulsive disorder (Holaway et al., 2006; Lind & Boschen, 2009; Tolin et al., 2003) and depression (Carleton et al., 2012; de Jong-Meyer et al., 2009; McEvoy & Mahoney, 2012; Nelson et al., 2014).”
Background
Intolerance of Uncertainty and PTSD Symptoms: Exploring the Construct Relationship in a Community Sample with a Heterogeneous Trauma History
Fetzner, M. G., Horswill, S. C., Boelen, P. A., & Carleton, R. N. (2013) · Cognitive Therapy and Research · doi:10.1007/s10608-013-9531-6 · Cited by 165 · see citing works
Behavioral Experiments for Intolerance of Uncertainty: Challenging the Unknown in the Treatment of Generalized Anxiety Disorder
Hebert, E. A., & Dugas, M. J. (2019) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2018.07.007 · Cited by 165 · see citing works
The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty
McEvoy, P. M., & Erceg-Hurn, D. M. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.002 · Cited by 155 · see citing works
Self-citation
Nothing is safe: Intolerance of uncertainty is associated with compromised fear extinction learning
Morriss, J., Christakou, A., & van Reekum, C. M. (2016) · Biological Psychology · doi:10.1016/j.biopsycho.2016.05.001 · Cited by 152 · see citing works
Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria
Norr, A. M., Albanese, B. J., Oglesby, M. E., Allan, N. P., & Schmidt, N. B. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.11.023 · Cited by 138 · see citing works
Modeling the cognitive mechanisms linking autism symptoms and anxiety in adults.
Maisel, M. E., Stephenson, K. G., South, M., Rodgers, J., Freeston, M. H., & Gaigg, S. B. (2016) · Journal of Abnormal Psychology · doi:10.1037/abn0000168 · Cited by 132 · see citing works
Seeking certainty about intolerance of uncertainty: Addressing old and new issues through the Intolerance of Uncertainty Scale-Revised
Bottesi, G., Noventa, S., Freeston, M. H., & Ghisi, M. (2019) · PLoS ONE · doi:10.1371/journal.pone.0211929 · Cited by 132 · see citing works
Intolerance of uncertainty as a contributor to fear and avoidance symptoms of panic attacks
Carleton, R. N., Fetzner, M. G., Hackl, J. L., & McEvoy, P. (2013) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2013.792100 · Cited by 126 · see citing works
Self-citation
Intolerance of uncertainty predicts fear extinction in amygdala-ventromedial prefrontal cortical circuitry
Morriss, J., Christakou, A., & van Reekum, C. M. (2015) · Biology of Mood & Anxiety Disorders · doi:10.1186/s13587-015-0019-8 · Cited by 106 · see citing works
“But it might be a heart attack”: Intolerance of uncertainty and panic disorder symptoms
Carleton, R. N., Duranceau, S., Freeston, M. H., Boelen, P. A., McCabe, R. E., & Antony, M. M. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.04.006 · Cited by 118 · see citing works
Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event
Oglesby, M. E., Boffa, J. W., Short, N. A., Raines, A. M., & Schmidt, N. B. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.01.005 · Cited by 109 · see citing works
Trait versus situation-specific intolerance of uncertainty in a clinical sample with anxiety and depressive disorders
Mahoney, A. E. J., & McEvoy, P. M. (2012) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.622131 · Cited by 103 · see citing works
Self-citation
Brief Report: Inter-Relationship between Emotion Regulation, Intolerance of Uncertainty, Anxiety, and Depression in Youth with Autism Spectrum Disorder
Cai, R. Y., Richdale, A. L., Dissanayake, C., & Uljarević, M. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3318-7 · Cited by 107 · see citing works
Just to be certain: Confirming the factor structure of the Intolerance of Uncertainty Scale in patients with obsessive-compulsive disorder
Jacoby, R. J., Fabricant, L. E., Leonard, R. C., Riemann, B. C., & Abramowitz, J. S. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.07.008 · Cited by 102 · see citing works
Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment
Gillett, C. B., Bilek, E. L., Hanna, G. L., & Fitzgerald, K. D. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.01.007 · Cited by 99 · see citing works
Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediators of repetitive negative thinking in a clinical sample with anxiety disorders
McEvoy, P. M., & Mahoney, A. E. J. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.01.006 · Cited by 99 · see citing works
Self-citation
Intolerance of uncertainty, social support, and loneliness in relation to anxiety and depressive symptoms among women diagnosed with ovarian cancer
Hill, E. M., & Hamm, A. (2019) · Psycho-Oncology · doi:10.1002/pon.4975 · Cited by 84 · see citing works
Changes in intolerance of uncertainty during cognitive behavior group therapy for social phobia.
Mahoney, A. E. J., & McEvoy, P. M. (2012) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2011.12.004 · Cited by 88 · see citing works
Self-citation
Intolerance of uncertainty and transdiagnostic group cognitive behavioral therapy for anxiety
Talkovsky, A. M., & Norton, P. J. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.05.002 · Cited by 85 · see citing works
Intolerance of uncertainty in eating disorders: an update on the field
Kesby, A., Maguire, S., Brownlow, R., & Grisham, J. R. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.07.002 · Cited by 83 · see citing works
Uncertainty is associated with increased selective attention and sustained stimulus processing
Dieterich, R., Endrass, T., & Kathmann, N. (2016) · Cognitive, Affective, & Behavioral Neuroscience · doi:10.3758/s13415-016-0405-8 · Cited by 76 · see citing works
Concurrent and prospective associations of intolerance of uncertainty with symptoms of prolonged grief, posttraumatic stress, and depression after bereavement
Boelen, P. A., Reijntjes, A., & Smid, G. E. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.03.004 · Cited by 76 · see citing works
Stress and worry: examining intolerance of uncertainty's moderating effect
Zlomke, K. R., & Jeter, K. M. (2014) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2013.835400 · Cited by 73 · see citing works
Psychometric properties of the Intolerance of Uncertainty Scale-12 in generalized anxiety disorder: Assessment of factor structure, measurement properties and clinical utility
Wilson, E. J., Stapinski, L., Dueber, D. M., Rapee, R. M., Burton, A. L., & Abbott, M. J. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102309 · Cited by 71 · see citing works
Randomized control trial investigating the efficacy of a computer-based intolerance of uncertainty intervention
Oglesby, M. E., Allan, N. P., & Schmidt, N. B. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.05.007 · Cited by 68 · see citing works
Conspiratorial thinking during COVID-19: The roles of paranoia, delusion-proneness, and intolerance of uncertainty
Larsen, E. M., Donaldson, K. R., Liew, M., & Mohanty, A. (2020) · doi:10.31234/osf.io/mb65f · Cited by 71 · see citing works
Short report: relationships between sensory processing, repetitive behaviors, anxiety, and intolerance of uncertainty in autism spectrum disorder and Williams syndrome
Glod, M., Riby, D. M., & Rodgers, J. (2019) · Autism Research · doi:10.1002/aur.2096 · Cited by 70 · see citing works
Cognitive Constructs and Social Anxiety Disorder: Beyond Fearing Negative Evaluation
Teale Sapach, M. J. N., Carleton, R. N., Mulvogue, M. K., Weeks, J. W., & Heimberg, R. G. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.961539 · Cited by 65 · see citing works
Increasing intolerance of uncertainty over time: the potential influence of increasing connectivity
Carleton, R. N., Desgagné, G., Krakauer, R., & Hong, R. Y. (2019) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2018.1476580 · Cited by 64 · see citing works
Intolerance of uncertainty and startle potentiation in relation to different threat reinforcement rates
Chin, B., Nelson, B. D., Jackson, F., & Hajcak, G. (2016) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2015.11.006 · Cited by 60 · see citing works
Factor structure of the intolerance of uncertainty scale for children
Cornacchio, D., Sanchez, A. L., Coxe, S., Roy, A., Pincus, D. B., Read, K. L., Holaway, R. M., Kendall, P. C., & Comer, J. S. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.07.003 · Cited by 59 · see citing works
I Doubt It Is Safe: A Meta-analysis of Self-reported Intolerance of Uncertainty and Threat Extinction Training
Morriss, J., Wake, S., Elizabeth, C., & van Reekum, C. M. (2021) · Biological Psychiatry Global Open Science · doi:10.1016/j.bpsgos.2021.05.011 · Cited by 52 · see citing works
“For example, selfreported IU accounts for unique variance in anxiety and depression symptoms when controlling for neuroticism (18,19) and has been shown to mediate the relationship between anxiety and depression symptoms and neuroticism (20).”
Background
Revising the Intolerance of Uncertainty Model of Generalized Anxiety Disorder: Evidence from UK and Italian Undergraduate Samples
Bottesi, G., Ghisi, M., Carraro, E., Barclay, N., Payne, R., & Freeston, M. H. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01723 · Cited by 54 · see citing works
Investigating the effect of intolerance of uncertainty on catastrophic worrying and mood
Meeten, F., Dash, S. R., Scarlet, A. L. S., & Davey, G. C. L. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.08.003 · Cited by 53 · see citing works
Biological and psychosocial predictors of anxiety worsening in the postpartum period: A longitudinal study
Furtado, M., Van Lieshout, R. J., Van Ameringen, M., Green, S. M., & Frey, B. N. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.02.064 · Cited by 50 · see citing works
Cognitive factors predicting checking, procrastination and other maladaptive behaviours: prospective versus inhibitory intolerance of uncertainty
Fourtounas, A., & Thomas, S. J. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.02.003 · Cited by 51 · see citing works
The Influence of Intolerance of Uncertainty on Anxiety and Depression Symptoms in Chinese-speaking Samples: Structure and Validity of The Chinese Translation of The Intolerance of Uncertainty Scale
Yao, N., Qian, M., Jiang, Y., & Elhai, J. D. (2021) · Journal of Personality Assessment · doi:10.1080/00223891.2020.1739058 · Cited by 44 · see citing works
COVID-19 information overload: Intolerance of uncertainty moderates the relationship between frequency of internet searching and fear of COVID-19
Baerg, L., & Bruchmann, K. (2022) · Acta Psychologica · doi:10.1016/j.actpsy.2022.103534 · Cited by 46 · see citing works
“What If I Make a Mistake?”: Intolerance of Uncertainty Is Associated With Poor Behavioral Performance
Thibodeau, M. A., Carleton, R. N., Gómez-Pérez, L., & Asmundson, G. J. G. (2013) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e3182a21298 · Cited by 48 · see citing works
Intolerance of uncertainty in opioid dependency–Relationship with trait anxiety and impulsivity
Garami, J., Haber, P., Myers, C. E., Allen, M. T., Misiak, B., Frydecka, D., & Moustafa, A. A. (2017) · PLoS ONE · doi:10.1371/journal.pone.0181955 · Cited by 45 · see citing works
Prospective associations between intolerance of uncertainty and psychopathology
Shapiro, M. O., Short, N. A., Morabito, D., & Schmidt, N. B. (2020) · Personality and Individual Differences · doi:10.1016/j.paid.2020.110210 · Cited by 44 · see citing works
Sensory Sensitivity and Intolerance of Uncertainty Influence Anxiety in Autistic Adults
Normansell-Mossa, K. M., Top, D. N., Russell, N., Freeston, M., Rodgers, J., & South, M. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.731753 · Cited by 45 · see citing works
Ventromedial Prefrontal Cortex Lesions Alter Neural and Physiological Correlates of Anticipation
Motzkin, J. C., Philippi, C. L., Wolf, R. C., Baskaya, M. K., & Koenigs, M. (2014) · Journal of Neuroscience · doi:10.1523/jneurosci.1446-14.2014 · Cited by 44 · see citing works
From dispositional traits to psychopathological symptoms: Social-cognitive vulnerabilities as intervening mechanisms
Hong, R. Y. (2013) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-013-9350-9 · Cited by 42 · see citing works
What do I do now? Intolerance of uncertainty is associated with discrete patterns of anticipatory physiological responding to different contexts
Morriss, J. (2019) · Psychophysiology · doi:10.1111/psyp.13396 · Cited by 42 · see citing works
Impact of mindfulness-based cognitive therapy on intolerance of uncertainty in patients with panic disorder
Kim, M. K., Lee, K. S., Kim, B., Choi, T. K., & Lee, S.-H. (2016) · Psychiatry Investigation · doi:10.4306/pi.2016.13.2.196 · Cited by 40 · see citing works
Between Action and Emotional Survival During the COVID-19 era: Sensorimotor Pathways as Control Systems of Transdiagnostic Anxiety-Related Intolerance to Uncertainty
Goldstein Ferber, S., Shoval, G., Zalsman, G., Mikulincer, M., & Weller, A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.680403 · Cited by 40 · see citing works
The role of intolerance of uncertainty in current and remitted internalizing and externalizing psychopathology
Correa, K. A., Liu, H., & Shankman, S. A. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2019.01.001 · Cited by 37 · see citing works
A worrying trend in Social Anxiety: To what degree are worry and its cognitive factors associated with youth Social Anxiety Disorder?
Hearn, C. S., Donovan, C. L., Spence, S. H., & March, S. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.09.052 · Cited by 38 · see citing works
Associations between Personality Traits, Intolerance of Uncertainty, Coping Strategies, and Stress in Italian Frontline and Non-Frontline HCWs during the COVID-19 Pandemic—A Multi-Group Path-Analysis
Bongelli, R., Canestrari, C., Fermani, A., Muzi, M., Riccioni, I., Bertolazzi, A., & Burro, R. (2021) · Healthcare · doi:10.3390/healthcare9081086 · Cited by 38 · see citing works
Association of Environmental Uncertainty With Altered Decision-making and Learning Mechanisms in Youths With Obsessive-Compulsive Disorder
Marzuki, A. A., Tomić, I., Ip, S. H. Y., Gottwald, J., Kanen, J. W., Kaser, M., Sule, A., Conway-Morris, A., Sahakian, B. J., & Robbins, T. W. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.36195 · Cited by 32 · see citing works
How many times do I need to see to believe? The impact of intolerance of uncertainty and exposure experience on safety-learning and retention in young adults
Morriss, J., Wake, S., Lindner, M., McSorley, E., & Dodd, H. (2020) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2020.04.012 · Cited by 33 · see citing works
Mediators of transdiagnostic group cognitive behavior therapy
Talkovsky, A. M., & Norton, P. J. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.09.017 · Cited by 35 · see citing works
Examination of the Intolerance of Uncertainty Construct in Youth With Generalized Anxiety Disorder
Cowie, J., Clementi, M. A., & Alfano, C. A. (2018) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2016.1212358 · Cited by 34 · see citing works
Development of a scale to evaluate young children’s responses to uncertainty and low environmental structure
Sanchez, A. L., Cornacchio, D., Chou, T., Leyfer, O., Coxe, S., Pincus, D., & Comer, J. S. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.11.006 · Cited by 36 · see citing works
Psychophysiological arousal and auditory sensitivity in a cross-clinical sample of autistic and non-autistic anxious adults
Top Jr., D. N., Luke, S. G., Stephenson, K. G., & South, M. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00783 · Cited by 36 · see citing works
“Although IU is typically a factor associated with generalized anxiety disorder, IU has shown to negatively aﬀect depression as well as other anxiety disorders (37, 38).”
Background
Emotional dysregulation and uncertainty intolerance as transdiagnostic mediators of anxiety in adults with autism spectrum disorders and intellectual disability
Sáez-Suanes, G. P., García-Villamisar, D., del Pozo Armentia, A., & Dattilo, J. (2020) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2020.103784 · Cited by 33 · see citing works
Coping Styles Mediate Perfectionism Associations with Depression among Undergraduate Students
Abdollahi, A., Hosseinian, S., & Asmundson, G. J. G. (2018) · The Journal of General Psychology · doi:10.1080/00221309.2017.1421137 · Cited by 31 · see citing works
Emotion regulation mediates the relation between intolerance of uncertainty and emotion difficulties: A longitudinal investigation
Sahib, A., Chen, J., Cárdenas, D., Calear, A. L., & Wilson, C. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.056 · Cited by 34 · see citing works
A test of the core process account of psychopathology in a heterogenous clinical sample of anxiety and depression: a case of the blind men and the elephant?
Mansell, W., & McEvoy, P. M. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.06.008 · Cited by 30 · see citing works
Self-citation
Psychological mechanisms underpinning change in intolerance of uncertainty across anxiety-related disorders: New insights for translational research
Morriss, J. (2025) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2025.106138 · Cited by 28 · see citing works
Psychometric properties of the brazilian intolerance of uncertainty scale – short version (Ius-12)
Kretzmann, R. P., & Gauer, G. (2020) · Trends in Psychiatry and Psychotherapy · doi:10.1590/2237-6089-2018-0087 · Cited by 25 · see citing works
Intolerance of uncertainty as a cognitive vulnerability for obsessive-compulsive disorder: A qualitative review.
Knowles, K. A., & Olatunji, B. O. (2023) · Clinical Psychology: Science and Practice · doi:10.1037/cps0000150 · Cited by 26 · see citing works
The Indirect Effect of Parental Intolerance of Uncertainty on Perinatal Mental Health via Mindfulness During COVID-19
Sbrilli, M. D., Haigler, K., & Laurent, H. K. (2021) · Mindfulness · doi:10.1007/s12671-021-01657-x · Cited by 19 · see citing works
Do worry and its associated cognitive variables alter following CBT treatment in a youth population with Social Anxiety Disorder? Results from a randomized controlled trial
Hearn, C. S., Donovan, C. L., Spence, S. H., & March, S. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.11.005 · Cited by 21 · see citing works
Group CBT for GAD: The Role of Change in Intolerance of Uncertainty in Treatment Outcomes.
Torbit, L., & Laposa, J. M. (2016) · International Journal of Cognitive Therapy · doi:10.1521/ijct_2016_09_17 · Cited by 22 · see citing works
Symptoms of social anxiety and depression: Acceptance of socially anxious thoughts and feelings as a moderator
Flynn, M. K., Bordieri, M. J., & Berkout, O. V. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.12.002 · Cited by 19 · see citing works
A transdiagnostic examination of decreased intolerance of uncertainty and treatment outcome
Stevens, K., Rogers, T., Campbell, M., Björgvinsson, T., & Kertz, S. (2018) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1338311 · Cited by 18 · see citing works
The Mediating Relationship between Maladaptive Behaviours, Cognitive Factors, and Generalised Anxiety Disorder Symptoms
Mahoney, A. E. J., Hobbs, M. J., Williams, A. D., Andrews, G., & Newby, J. M. (2018) · Behaviour Change · doi:10.1017/bec.2018.13 · Cited by 15 · see citing works
Self-citation
Factor mixture modeling of intolerance of uncertainty.
Oglesby, M. E., Allan, N. P., Short, N. A., Raines, A. M., & Schmidt, N. B. (2017) · Psychological Assessment · doi:10.1037/pas0000357 · Cited by 15 · see citing works
Longitudinal changes in intolerance of uncertainty and worry severity during CBT for generalized anxiety disorder
Laposa, J. M., Katz, D. E., Lisi, D. M., Hawley, L. L., Quigley, L., & Rector, N. A. (2022) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2022.102623 · Cited by 14 · see citing works
Dimensional Assessment of Emotional Disorder Outcomes in Transdiagnostic Treatment: A Clinical Case Study
Boettcher, H., Correa, J., Cassiello-Robbins, C., Ametaj, A., Rosellini, A. J., Brown, T. A., Kennedy, K., Farchione, T. J., & Barlow, D. H. (2020) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2019.11.001 · Cited by 13 · see citing works
Investigating the Effects of Transdiagnostic Processes on Anxiety and Depression Symptoms in Autistic Young People: the Mediating Role of Emotion Dysregulation.
Barnes, G. L., Ozsivadjian, A., Baird, G., Absoud, M., & Hollocks, M. J. (2025) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06246-0 · Cited by 12 · see citing works
Does intolerance of uncertainty mediate improvement in anger during group CBT for GAD? A preliminary investigation
Laposa, J. M., & Fracalanza, K. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000249 · Cited by 11 · see citing works
Infraslow closed-loop brain training for anxiety and depression (ISAD): a protocol for a randomized, double-blind, sham-controlled pilot trial in adult females with internalizing disorders
Perez, T. M., Glue, P., Adhia, D. B., Navid, M. S., Zeng, J., Dillingham, P., Smith, M., Niazi, I. K., Young, C. K., & De Ridder, D. (2022) · Trials · doi:10.1186/s13063-022-06863-z · Cited by 8 · see citing works
Global Adversities, the Media, and Mental Health
Kesner, L., & Horáček, J. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.809239 · Cited by 9 · see citing works
Intolerance of uncertainty, aging, and anxiety and mental health concerns: A scoping review and meta-analysis
Yu, M. H. M., Cao, Y., Fung, S. S. Y., Kwan, G. S. Y., Tse, Z. C. K., & Shum, D. H. K. (2025) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2025.102975 · Cited by 8 · see citing works
Examining the Relationship Between Prospective and Inhibitory Intolerance of Uncertainty, Obsessive Compulsive Disorder Symptoms and Treatment Outcome
Laposa, J. M., & Puccinelli, C. (2026) · Journal of Clinical Psychology · doi:10.1002/jclp.70081 · Cited by 3 · see citing works
Generalized anxiety disorder: Assessment and treatment
Gerlach, A. L., & Stevens, S. (2014) · The Wiley Handbook of Anxiety Disorders · doi:10.1002/9781118775349.ch48 · Cited by 3 · see citing works
Mindfulness and anxiety among medicine college students: a moderated mediation model of intolerance of uncertainty and neuroticism.
Ji, Z., Zhang, Y., Xu, X., Yan, X., Gao, B., Sun, Q., Wu, L., Mu, H., & Zhao, M. (2026) · Psychology, Health & Medicine · doi:10.1080/13548506.2025.2539932 · Cited by 2 · see citing works
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Authors: McEvoy, P. M., & Mahoney, A. E. J.
Affiliations: The University of Western Australia (AU)
Corresponding author: McEvoy, Peter M.
ORCID: McEvoy, Peter M.
Mahoney, Alison E.J.
Venue: Behavior Therapy
Publisher: Elsevier BV
Published: 2012-09
Volume: 43
Issue: 3
Pages: 533-545
ISSN: 0005-7894 (ISSN-L)
DOI: 10.1016/j.beth.2011.02.007
OpenAlex: W1972848592
Cited by: 468
References: 75
Citations by year: 2026: 27 · 2025: 29 · 2024: 44 · 2023: 44 · 2022: 39 · 2021: 51 · 2020: 38 · 2019: 34 · 2018: 31 · 2017: 25 · 2016: 34 · 2015: 19 · 2014: 25 · 2013: 18 · 2012: 5
FWCI: 21.42
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Behavior Therapy (publishedVersion)
PubMed (publishedVersion)
UWA Profiles and Research Repository (UWA) (submittedVersion)
eSpace (Curtin University) (submittedVersion)
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 › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords: intolerance of uncertainty, neuroticism, anxiety disorders, depression, generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, panic disorder, agoraphobia, worry, mediation
MeSH terms: Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Models, Psychological, Personality Inventory, Psychiatric Status Rating Scales, Uncertainty

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To Be Sure, To Be Sure: Intolerance of Uncertainty Mediates Symptoms of Various Anxiety Disorders and Depression

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