Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder
Open accessAbstract
Growing evidence suggests that intolerance of uncertainty (IU) is a cognitive vulnerability that is a central feature across diverse anxiety disorders, including generalized anxiety disorder (GAD). Although cognitive behavioral therapy (CBT) has been shown to reduce IU, it remains to be established whether or not reductions in IU mediate reductions in worry. This study examined the process of change in IU and worry in a sample of 28 individuals with GAD who completed CBT. Changes in IU and worry, assessed bi-weekly during treatment, were analyzed using multilevel mediation models. Results revealed that change in IU mediated change in worry (ab. =. -0.20; 95% CI [-.35, -.09]), but change in worry did not mediate change in IU (ab. =. -0.16; 95% CI [-.06, .12]). Findings indicated that reductions in IU accounted for 59% of the reductions in worry observed over the course of treatment, suggesting that changes in IU are not simply concomitants of changes in worry. Findings support the idea that IU is a critical construct underlying GAD. © 2015 Elsevier Ltd.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 10 cited sources checked · 0 supported · 0 flagged
- Findingown data
Reductions in intolerance of uncertainty accounted for 59% of the reductions in worry observed over the course of treatment.
“Findings indicated that reductions in IU accounted for 59% of the reductions in worry observed over the course of treatment”
- Also stated in: § Abstract · plain
“reductions in IU accounted for 59% of the reductions in worry observed over the course of treatment”
- Also stated in: § 3.2. Intolerance of uncertainty reduction as a mediator of worry reduction · plain
“change in IU accounted for 59% of the effect of time on worry reduction.”
Quote in the paperSubstantial claim - Also stated in: § Abstract · plain
- Findingown data
Change in worry accounted for less than 1% of the effect of time on intolerance of uncertainty reduction.
“change in worry accounted for less than 1% of the effect of time on IU reduction.”
Quote in the paperSubstantial claim - Findingown data
Intolerance of uncertainty scores decreased over the course of treatment.
“IUS scores decreased over the course of treatment (B = -1.68, p < .001; path a)”
- Also stated in: § 3.1. Demographic and clinical variables · plain
“IUS: F(1, 114) = 51.69, p < .001, ηp2 = .41”
Quote in the paperSubstantial claim - Also stated in: § 3.1. Demographic and clinical variables · plain
- Findingown data
Change in intolerance of uncertainty mediated change in worry, with an indirect effect of -0.20 and a 95% confidence interval from -0.35 to -0.09.
“Results revealed that change in IU mediated change in worry (ab = -0.20; 95% CI [-.35, -.09])”
- Also stated in: § 3.2. Intolerance of uncertainty reduction as a mediator of worry reduction · plain
“confidence intervals for the indirect effect did not cross zero (ab = -0.20; 95% CI [-.35, -0.09])”
Quote in the paperSubstantial claim - Also stated in: § 3.2. Intolerance of uncertainty reduction as a mediator of worry reduction · plain
- Findingown data
Time was no longer a significant predictor of worry when intolerance of uncertainty was included in the model.
“time was no longer a significant predictor (B = -.14, p = .23; path c′)”
Quote in the paperSubstantial claim
- Findingown data
Change in worry did not mediate change in intolerance of uncertainty, with an indirect effect of -0.16 and a 95% confidence interval from -0.06 to 0.12.
“but change in worry did not mediate change in IU (ab = -0.16; 95% CI [-.06, .12])”
- Also stated in: § 3.2. Intolerance of uncertainty reduction as a mediator of worry reduction · plain
“There was no evidence of statistically significant mediation (ab = -0.16; 95% CI [-0.06, 0.12])”
Quote in the paperSubstantial claim - Also stated in: § 3.2. Intolerance of uncertainty reduction as a mediator of worry reduction · plain
- Findingown data
Worry symptoms significantly decreased during the course of treatment.
“worry symptoms significantly reduced during treatment (B = -.34, p < .001, path c)”
- Also stated in: § 3.1. Demographic and clinical variables · plain
“PSWQ-A: F(1, 122) = 8.23, p < .01, ηp2 = .12”
Quote in the paperSubstantial claim - Also stated in: § 3.1. Demographic and clinical variables · plain
- Findingown data
In the reverse mediation model, the effect of time on intolerance of uncertainty remained significant and was minimally attenuated.
“the effect of time on IU remained significant and was minimally attenuated (B = -2.20, p < .001; path c′)”
Quote in the paperSubstantial claim - Findingown data
When time and intolerance of uncertainty were entered simultaneously to predict worry, intolerance of uncertainty predicted worry.
“IU predicted worry (B = .12, p < .001; path b)”
Quote in the paperSubstantial claim - Findingown data
The effect size for reductions on the abbreviated Penn State Worry Questionnaire was modest.
“The effect size observed for reductions in the PSWQ-A were also modest.”
Quote in the paperSubstantial claim - Interpretationown data
Changes in intolerance of uncertainty are not merely concomitant with changes in worry.
“suggesting that changes in IU are not simply concomitants of changes in worry.”
Quote in the paperSubstantial claim - Interpretationown data
Intolerance of uncertainty may be causally linked to worry.
“suggesting that IU is not only associated with worry but may be causally linked to it”
Quote in the paperSubstantial claim - Premisecitation
Intolerance of uncertainty is an important cognitive vulnerability in the development and maintenance of anxiety disorders, including generalized anxiety disorder.
“Growing evidence suggests that intolerance of uncertainty (IU) is a cognitive vulnerability that is a central feature across diverse anxiety disorders, including generalized anxiety disorder (GAD).”
- Also stated in: § 1. Introduction · plain
“Intolerance of uncertainty (IU), the dispositional tendency to experience fear of the unknown, is considered to be an important factor in the development and maintenance of anxiety disorders (Carleton, 2012).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Carleton, 2012 source
- Also stated in: § 1. Introduction · plain
- Interpretationown data
Intolerance of uncertainty is a critical construct underlying generalized anxiety disorder.
“Findings support the idea that IU is a critical construct underlying GAD.”
- Also stated in: § 4. Conclusions · hedged
“Results are consistent with theoretical models outlining the importance of IU as a cognitive vulnerability to GAD that operates via its effect on worry.”
Quote in the paperSubstantial claim - Also stated in: § 4. Conclusions · hedged
- Interpretationown data
Reductions in intolerance of uncertainty precede reductions in worry over the course of treatment.
“longitudinal observation of changes across constructs establishes temporal precedence of change in a group of individuals completing treatment.”
Quote in the paperSubstantial claim - Study design and conductreasoning
The design did not allow comparison of mediation processes to a control group.
“The design did not allow for comparison of mediation processes to a control group.”
Quote in the paperSubstantial claim - Study design and conductreasoning
Selection of participants based on neuroimaging inclusion and exclusion criteria limits generalizability.
“First, selection of participants based on neuroimaging inclusion and exclusion criteria limits generalizability (e.g., participants utilizing certain medications or substances were excluded).”
Quote in the paperNot a substantial claim - Interpretationreasoning
One cannot conclude that changes in worry and intolerance of uncertainty were directly attributable to the treatment components rather than to non-specific factors or the passage of time.
“Thus, one cannot conclude that the changes in worry and IU were directly attributable to the treatment components per se, as opposed to non-specific factors or the passage of time.”
Quote in the paperSubstantial claim - Interpretationown data
Intolerance of uncertainty is malleable with treatment.
“Thus, IU is malleable with treatment and targeting IU during treatment may be one effective strategy to reduce worry.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 10
- May combine two claims. 5
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe abbreviated Penn State Worry Questionnaire has adequate psychometric properties and correlates highly with the full-length Penn State Worry Questionnaire.
“The PSWQ-A is an 8-item assessment of the tendency to worry. It possesses adequate psychometric properties (i.e., high internal consistency, test-retest reliability, convergent-divergent validity) and correlates highly with the full-length PSWQ (Crittendon & Hopko, 2006; Hopko et al., 2003).”
Quote in the paperNot a substantial claim0 of 2 sources checkedMay combine two claims.
Study design and conductown dataTherapists adhered to the treatment protocol and appropriately delivered the CALM intervention components.
“In all cases, therapists received ratings of “2”, indicating they adhered to the treatment protocol, and appropriately delivered the components of the CALM intervention.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataCronbach's alpha for the abbreviated Penn State Worry Questionnaire ranged from 0.84 to 0.92.
“Cronbach's αs ranged from 0.84 to 0.92.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductcitationThe Intolerance of Uncertainty Scale has adequate psychometric properties.
“This measure possesses adequate psychometric properties (Buhr & Dugas, 2002, 2006; Carleton, Sharpe, & Asmundson, 2007; Norton, 2005).”
Quote in the paperSubstantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataDiagnostic status was determined using the MINI administered by trained interviewers, with quality assurance procedures to support diagnostic accuracy.
“To determine diagnostic status and other initial eligibility criteria, a study clinician administered the MINI (Sheehan et al., 1998). Interviewers were individuals with prior clinical diagnostic experience (e.g., psychologists, marriage and family counselors), and underwent training to develop proficiency in the MINI assessment. Quality assurance procedures were in place to assure diagnostic accu”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Sheehan et al., 1998
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationreasoningPatterns of change within the measured sessions or beyond the acute phase of treatment cannot be determined.
“Patterns of change within the measured sessions or beyond the acute phase of treatment thus cannot be determined.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductnone givenAll participants were analyzed using an intent-to-treat approach.
“All participants in the study were analyzed using an intent-to-treat approach.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Interpretationown dataThe analysis extends examination of change over time to a sample of clinically anxious individuals completing cognitive behavioral therapy.
“our analysis of treatment data extends examination of change over time to a sample of clinically anxious individuals completing CBT.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductcitationThe 12-item version of the Intolerance of Uncertainty Scale demonstrates reduced item redundancy while maintaining sound psychometric properties relative to the full 27-item version.
“Based on evidence that the 12-item version of this measure demonstrates reduced redundancy in items while maintaining sound psychometric properties relative to the full 27-item version (Carleton, Norton, & Asmundson, 2007; Carleton, Thibodeau, Osborne, & Asmundson, 2012; Gentes & Ruscio, 2011; Khawaja & Yu, 2010), we analyzed the 12-item IUS derived from this questionnairei.”
Quote in the paperSubstantial claim0 of 3 sources checkedClassified as probably not a substantial claim.
PremisereasoningA multilevel modeling framework effectively handles missing data and varied numbers of observations across individuals.
“A multilevel modeling framework, which effectively handles missing data and varied numbers of observations across individuals, was thus appropriate for the data structure.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataCronbach's alpha for the Intolerance of Uncertainty Scale ranged from 0.92 to 0.94.
“Cronbach's αs ranged from 0.92 to 0.94.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenAssessments were conducted every other session only within the acute phase of treatment.
“Finally, assessments were conducted every other session only within the acute phase of treatment.”
Quote in the paperSubstantial claim
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
IU maintains worry and changes in IU account for a significant amount of change in chronic worry in CBT for GAD.
“Furthermore, IU maintains worry and changes in IU account for a significant amount of change in chronic worry in CBT for GAD (Bomyea et al ., 2015).”
From Effectiveness and predictors of group cognitive behaviour therapy outcome for generalised anxiety disorder in an out-patient hospital setting (2024) · cites this paper as Bomyea et al., 2015
The Results (§3.2; page unavailable) report that changes in IU significantly mediated reductions in worry during CBT for GAD, accounting for 59% of the reduction. The Conclusions (§4; page unavailable) say IU may be causally linked to worry, but the uncontrolled design cannot establish that IU maintains worry as a causal fact. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe study was not designed to demonstrate the causal role of change in intolerance of uncertainty.
“The study was not designed to demonstrate the causal role of change in intolerance of uncertainty (as shown by Bomyea et al. [52]) but to document the relative contribution of specific and non-specific factors associated with the treatment outcomes of CBT-IU.”
From A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference (2022) · cites this paper as [52]
Bomyea et al. report in Results §3.2 that reductions in intolerance of uncertainty preceded and mediated subsequent reductions in worry, supporting a role for that change in treatment outcomes. But Conclusions §4 says the findings suggest IU may be causally linked to worry and notes that the design lacked a control group. The citation therefore supports a mediating role, not a demonstrated causal role; the statement about what the citing authors’ own study was designed to do is not attributed to Bomyea et al. (LLM, conf=0.83)
Experimental — accuracy not yet measuredOne 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”
From Intolerance of Uncertainty and Parental Accommodation: Promising Targets for Personalized Intervention for Youth Anxiety. (2020) · cites this paper as [54]
Change in intolerance of uncertainty has been shown to mediate treatment outcome and to precede changes in the symptoms of GAD.
“Change in intolerance of uncertainty, a putative process specific to CBT for GAD, has been shown to mediate treatment outcome and to precede changes in the symptoms of GAD [52].”
The finding that change in intolerance of uncertainty was statistically non-inferior in VCP compared to face-to-face therapy, and significantly associated with treatment success, is consistent with expectations about CBT for GAD.
“The finding that change in intolerance of uncertainty was statistically non-inferior in VCP compared to face-to-face therapy, and significantly associated with treatment success, is consistent with expectations about CBT for GAD [12,52].”
An independent clinical trial found that change in intolerance of uncertainty, as measured with the Intolerance of Uncertainty Scale, mediated change in worry, whereas change in worry did not mediate change in intolerance of uncertainty.
“An independent clinical trial [48] found that change in intolerance of uncertainty, as measured with the Intolerance of Uncertainty Scale (IUS) [49], mediated change in worry, whereas change in worry did not mediate change in intolerance of uncertainty.”
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 [37]
The mediator and outcome variable were time lagged to conduct a more rigorous test of mediation in which the mediator temporally precedes the outcome.
“The mediator and outcome variable were time lagged (Aderka, Foa, Applebaum, Shafran, & Gilboa-Schechtman, 2011; Bomyea et al., 2015) in order to conduct a more rigorous test of mediation in which the mediator temporally precedes the outcome (Kazdin, 2007).”
From Enhancing social connectedness in anxiety and depression through amplification of positivity: Preliminary treatment outcomes and process of change (2020) · cites this paper as Bomyea et al., 2015
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- ConsistentF(1, 122) = 8.23reported p < .01 · recomputed p = .005
“F(1, 122) = 8.23, p < .01”
- ConsistentF(1, 114) = 51.69reported p < .001 · recomputed p < .001
“F(1, 114) = 51.69, p < .001”
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.
Reverse-mediation estimate falls outside its reported confidence interval
MinorThe reported indirect-effect estimate is −0.16, but its 95% confidence interval runs from −0.06 to 0.12. The interval does not contain the estimate it is reported for.
“ab = -0.16”
“95% CI [-0.06, 0.12]”
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.51.6.1173 · Cited by 91,542 · see citing works
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.51.6.1173 · Cited by 91,532 · see citing works
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
(1998) · PubMed · Cited by 10,216 · see citing works
The mini international neuropsychiatric interview
Lecrubier, Y., Sheehan, D. V., Hergueta, T., & Weiller, E. (1998) · European Psychiatry · doi:10.1016/s0924-9338(99)80239-9 · Cited by 5,882 · see citing works
MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007) · Annual Review of Psychology · doi:10.1146/annurev.psych.58.110405.085542 · Cited by 5,688 · see citing works
Mediators and Mechanisms of Change in Psychotherapy Research
Kazdin, A. E. (2007) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.3.022806.091432 · Cited by 2,504 · cited 2× · see citing works
“Establishing IU as a process relevant to symptom reduction is critical to validate cognitive theories and to identify treatment strategies to optimize therapeutic outcomes (Kazdin, 2007; Smits, Julian, Rosenfield, & Powers, 2012).”
BackgroundFearing the unknown: A short version of the Intolerance of Uncertainty Scale
Carleton, R. N., Norton, M. A. P. J., & Asmundson, G. J. G. (2007) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2006.03.014 · Cited by 2,288 · see citing works
Bauer, D. J., Preacher, K. J., & Gil, K. M. (2006) · Psychological Methods · doi:10.1037/1082-989x.11.2.142 · Cited by 1,704 · see citing works
The intolerance of uncertainty scale: psychometric properties of the English version
Buhr, K., & Dugas, M. J. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00092-4 · Cited by 1,391 · cited 1× · see citing works
“IU includes beliefs that uncertainty is threatening, stressful, and anxiety provoking, as well as the desire to avoid situations where uncertainty and ambiguity may be present (Buhr & Dugas, 2002; Dugas, Gosselin, & LaDoucuer, 2001).”
BackgroundGeneralized anxiety disorder: A preliminary test of a conceptual model
Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)00070-3 · Cited by 1,072 · see citing works
Lower level mediation in multilevel models.
Kenny, D. A., Korchmaros, J. D., & Bolger, N. (2003) · Psychological Methods · doi:10.1037/1082-989x.8.2.115 · Cited by 687 · see citing works
Gentes, E. L., & Ruscio, A. M. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.05.001 · Cited by 601 · see citing works
Worry and rumination: Repetitive thought as a concomitant and predictor of negative mood
Segerstrom, S. C., Tsao, J. C. I., Alden, L. E., & Craske, M. G. (2000) · Cognitive Therapy and Research · doi:10.1023/a:1005587311498 · Cited by 599 · see citing works
Carleton, R. N. (2012) · Expert Review of Neurotherapeutics · doi:10.1586/ern.12.82 · Cited by 599 · cited 2× · see citing works
“Although IU likely contributes to multiple anxiety disorders (e.g., Carleton, 2012), the most comprehensive conceptual model of the relationships between IU and anxiety psychopathology was designed primarily to account for symptoms of generalized anxiety disorder (GAD; Dugas, Gagnon, Ladouceur, &…”
BackgroundIntolerance of uncertainty and worry: investigating specificity in a nonclinical sample
Dugas, M. J., Gosselin, P., & Ladouceur, R. (2001) · Cognitive Therapy and Research · doi:10.1023/a:1005553414688 · Cited by 538 · see citing works
Experimental manipulation of intolerance of uncertainty: a study of a theoretical model of worry
Ladouceur, R., Gosselin, P., & Dugas, M. J. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00133-3 · Cited by 524 · see citing works
Intolerance of Uncertainty: A Common Factor in the Treatment of Emotional Disorders
Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.21965 · Cited by 495 · see citing works
Interpreting Multiple Linear Regression: A Guidebook of Variable Importance
Nathans, L., Oswald, F. L., & Nimon, K. (2020) · doi:10.7275/5fex-b874 · Cited by 479 · see citing works
Buhr, K., & Dugas, M. J. (2006) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2004.12.004 · Cited by 421 · see citing works
Rush, A. J., Bernstein, I. H., Trivedi, M. H., Carmody, T. J., Wisniewski, S., Mundt, J. C., Shores-Wilson, K., Biggs, M. M., Woo, A., Nierenberg, A. A., et al. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.08.022 · Cited by 385 · cited 1× · see citing works
“…with comorbid depression were eligible provided the level of depression was not in the severe range (operationalized as Quick Inventory of Depression Symptomology −6 ≤ 18 and neither of depressed mood or anhedonia most of the day nearly every day during the past two weeks; Rush et al., 2006).”
BackgroundIntolerance of uncertainty and information processing: Evidence of biased recall and interpretations
Dugas, M. J., Hedayati, M., Karavidas, A., Buhr, K., Francis, K., & Phillips, N. A. (2005) · Cognitive Therapy and Research · doi:10.1007/s10608-005-1648-9 · Cited by 349 · cited 1× · see citing works
“…is proposed to trigger maladaptive behavioral and cognitive reactivity (e.g., biased interpretations of the situation, increased need for information during decision-making) that serve to increase worry and anxiety (Dugas et al., 2005; Dugas & Robichaud, 2007; Ladouceur, Gosselin, & Dugas, 2000).”
BackgroundTreatment of Gad: Targeting Intolerance of Uncertainty in Two Types of Worry
Dugas, M. J., & Ladouceur, R. (2000) · Behavior Modification · doi:10.1177/0145445500245002 · Cited by 334 · cited 2× · see citing works
“Dugas and colleagues (e.g., Dugas et al., 2003, 2010; Dugas & Ladouceur, 2000) have developed a cognitive-behavioral intervention specifically to address IU as part of a comprehensive treatment for GAD, which has been shown to effectively decrease IU and other symptoms (e.g.,…”
BackgroundDugas, M. J., Ladouceur, R., Léger, E., Freeston, M. H., Langolis, F., Provencher, M. D., & Boisvert, J.-M. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.71.4.821 · Cited by 331 · cited 1× · see citing works
“Dugas and colleagues (e.g., Dugas et al., 2003, 2010; Dugas & Ladouceur, 2000) have developed a cognitive-behavioral intervention specifically to address IU as part of a comprehensive treatment for GAD, which has been shown to effectively decrease IU and other symptoms (e.g.,…”
BackgroundHopko, D. R., Reas, D. L., Beck, J. G., Stanley, M. A., Wetherell, J. L., Novy, D. M., & Averill, P. M. (2003) · Psychological Assessment · doi:10.1037/1040-3590.15.2.173 · Cited by 271 · see citing works
van der Heiden, C., Muris, P., & van der Molen, H. T. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.12.005 · Cited by 265 · cited 1× · see citing works
“Modules did not specifically aim to target IU; however, in the course of therapy participants completed activities or discussed thoughts that may have addressed concerns about uncertainty (see Mahoney & McEvoy, 2012, and van der Heiden et al., 2012 for examples of general CBT’s effects on IU).”
BackgroundDugas, M. J., Brillon, P., Savard, P., Turcotte, J., Gaudet, A., Ladouceur, R., Leblanc, R., & Gervais, N. J. (2010) · Behavior Therapy · doi:10.1016/j.beth.2008.12.004 · Cited by 216 · cited 1× · see citing works
“Dugas and colleagues (e.g., Dugas et al., 2003, 2010; Dugas & Ladouceur, 2000) have developed a cognitive-behavioral intervention specifically to address IU as part of a comprehensive treatment for GAD, which has been shown to effectively decrease IU and other symptoms (e.g.,…”
BackgroundA comparison of the 27-item and 12-item intolerance of uncertainty scales
Khawaja, N. G., & Yu, L. N. H. (2010) · Clinical Psychologist · doi:10.1080/13284207.2010.502542 · Cited by 181 · see citing works
Crittendon, J., & Hopko, D. R. (2006) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2005.11.006 · Cited by 177 · see citing works
Smits, J. A. J., Julian, K., Rosenfield, D., & Powers, M. B. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0028957 · Cited by 162 · see citing works
A Cognitive Model of Generalized Anxiety Disorder
Wells, A. (1999) · Behavior Modification · doi:10.1177/0145445599234002 · Cited by 156 · see citing works
A psychometric analysis of the Intolerance of Uncertainty Scale among four racial groups
Norton, P. J. (2005) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2004.08.002 · Cited by 118 · see citing works
Treatment for anxiety disorders: Efficacy to effectiveness to implementation
Craske, M. G., Roy-Byrne, P. P., Stein, M. B., Sullivan, G., Sherbourne, C., & Bystritsky, A. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.07.012 · Cited by 98 · cited 1× · see citing works
“The intervention was adapted from the protocol developed as part of a multi-site trial of evidence-based treatment for anxiety in primary care (Coordinated Anxiety Learning and Management program [CALM]; for a detailed review of treatment components see Craske et al., 2009).”
MethodSelf-citationChanges 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 · cited 1× · see citing works
“Modules did not specifically aim to target IU; however, in the course of therapy participants completed activities or discussed thoughts that may have addressed concerns about uncertainty (see Mahoney & McEvoy, 2012, and van der Heiden et al., 2012 for examples of general CBT’s effects on IU).”
BackgroundAderka, I. M., Foa, E. B., Applebaum, E., Shafran, N., & Gilboa-Schechtman, E. (2011) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0023318 · Cited by 64 · see citing works
The Impact of Written Exposure on Worry: A Preliminary Investigation
Goldman, N., Dugas, M. J., Sexton, K. A., & Gervais, N. J. (2007) · Behavior Modification · doi:10.1177/0145445506298651 · Cited by 57 · 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
Exploring Item Order in Anxiety-Related Constructs: Practical Impacts of Serial Position
Carleton, R. N., Thibodeau, M. A., Osborne, J. W., & Asmundson, G. J. G. (2020) · Scholarworks (University of Massachusetts Amherst) · doi:10.7275/e43n-cn20 · Cited by 45 · see citing works
Donegan, E., & Dugas, M. J. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0028132 · Cited by 44 · see citing works
Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice
Robichaud, M., & Dugas, M. J. (2012) · doi:10.4324/9780203891964 · Cited by 31 · see citing works
Preliminary investigation of intolerance of uncertainty treatment for anxiety disorders.
Hewitt, S. N., Egan, S., & Rees, C. (2009) · Clinical Psychologist · doi:10.1080/13284200802702056 · Cited by 30 · see citing works
A Cognitive Model of Generalized Anxiety Disorder
Robichaud, M., & Dugas, M. J. (2012) · doi:10.4324/9780203891964-6 · Cited by 3 · see citing works
Flagged first, then by citations
2 of the 45 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Stein, M. B., & Sareen, J. (2015) · New England Journal of Medicine · doi:10.1056/nejmcp1502514 · Cited by 523 · see citing works
Self-citationIntolerance 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
Rosser, B. A. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-018-9964-z · Cited by 157 · see citing works
The history of generalized anxiety disorder as a diagnostic category
Crocq, M.-A. (2017) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2017.19.2/macrocq · Cited by 159 · see citing works
Özmete, E., & Pak, M. (2020) · Social Work in Public Health · doi:10.1080/19371918.2020.1808144 · Cited by 150 · see citing works
Mennin, D. S., Fresco, D. M., O'Toole, M. S., & Heimberg, R. G. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000289 · Cited by 119 · see citing works
“Also, for GAD, other variables such as intolerance of uncertainty and anxiety sensitivity have mediated outcomes for treatments that appear to incorporate both less and more elaborative treatments, as well (e.g., Bomyea et al., 2015).”
BackgroundAdventurous Play as a Mechanism for Reducing Risk for Childhood Anxiety: A Conceptual Model
Dodd, H. F., & Lester, K. J. (2021) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-020-00338-w · Cited by 112 · see citing works
Intolerance of uncertainty and emotion regulation: A meta-analytic and systematic review
Sahib, A., Chen, J., Cárdenas, D., & Calear, A. L. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2023.102270 · Cited by 124 · see citing works
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 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
Taylor, C. T., Pearlstein, S. L., Kakaria, S., Lyubomirsky, S., & Stein, M. B. (2020) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10102-7 · Cited by 81 · see citing works
“The mediator and outcome variable were time lagged (Aderka et al. 2011; Bomyea et al. 2015) in order to conduct a more rigorous test of mediation in which the mediator temporally precedes the outcome (Kazdin 2007).”
MethodSelf-citationOuellet, C., Langlois, F., Provencher, M. D., & Gosselin, P. (2019) · European Review of Applied Psychology · doi:10.1016/j.erap.2019.01.001 · Cited by 79 · see citing works
Intolerance of Uncertainty Predicts Anxiety Outcomes Following CBT in Youth with ASD.
Keefer, A., Kreiser, N. L., Singh, V., Blakeley-Smith, A., Duncan, A., Johnson, C., Klinger, L., Meyer, A., Reaven, J., & Vasa, R. A. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-2852-z · Cited by 72 · see citing works
“Unlike findings in TD youth, levels of IU and worry did not decrease following the FYF intervention (Bomyea et al. 2015; Boswell et al. 2013).”
BackgroundWilson, 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
Cognitive-Behavioral Therapy: Nature and Relation to Non-Cognitive Behavioral Therapy
Lorenzo‐Luaces, L., Keefe, J. R., & DeRubeis, R. J. (2016) · Behavior Therapy · doi:10.1016/j.beth.2016.02.012 · Cited by 66 · see citing works
“Similarly, Bomyea et al. (2015) reported that changes in intolerance of uncertainty preceded and predicted change in GAD symptoms.”
BackgroundKendall, P. C., Norris, L. A., Rabner, J. C., Crane, M. E., & Rifkin, L. S. (2020) · Current Psychiatry Reports · doi:10.1007/s11920-020-01170-3 · Cited by 50 · see citing works
Assaf, M., Rabany, L., Zertuche, L., Bragdon, L., Tolin, D., Goethe, J., & Diefenbach, G. (2018) · Brain and Behavior · doi:10.1002/brb3.1015 · Cited by 48 · see citing works
Wilson, E. J., Abbott, M. J., & Norton, A. R. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102729 · Cited by 52 · see citing works
Taylor, C. T., Pearlstein, S. L., & Stein, M. B. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.03.007 · Cited by 47 · see citing works
Self-citationKhakpoor, S., Mohammadi Bytamar, J., & Saed, O. (2019) · Research in Psychotherapy: Psychopathology, Process and Outcome · doi:10.4081/ripppo.2019.379 · Cited by 34 · see citing works
“In line with this finding, various studies suggest that IU can be considered as a potential mediator of treatment outcomes in different cognitive-behavior therapies (Bomyea et al., 2015; McEvoy & Erceg-Hurn, 2016).”
ResultCoping with academic stress: Ambiguity and uncertainty tolerance in college students
Paralkar, U., & Knutson, D. (2021) · Journal of American College Health · doi:10.1080/07448481.2021.1965148 · Cited by 45 · see citing works
“16 Extensive research has been done on tolerance of uncertainty as a clinical and transdiagnostic variable in worry and anxiety disorders, 17,18 depression, 19 and stress.”
BackgroundHunt, C., Exline, J. J., Fletcher, T. L., & Teng, E. J. (2022) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2022.102530 · Cited by 34 · see citing works
Uncertainty and psychological distress during COVID-19: What about protective factors?
Salah, A. B., DeAngelis, B. N., & Al’Absi, M. (2022) · Current Psychology · doi:10.1007/s12144-022-03244-2 · Cited by 40 · see citing works
Hui, C., & Zhihui, Y. (2017) · Aging & Mental Health · doi:10.1080/13607863.2016.1222349 · Cited by 34 · see citing works
“However, despite several studies showing the effectiveness of CBT as treatment for GAD (Bomyea et al., 2015; Bush et al., 2012; Dugas et al., 2010; Mohlman, 2013; Nutt et al., 2002), the effect size remains inadequate and the mechanism by which CBT is effective in GAD requires further exploration.”
BackgroundInfluentialRen, L., Yang, Z., Wang, Y., Cui, L.-B., Jin, Y., Ma, Z., Zhang, Q., Wu, Z., Wang, H.-N., & Yang, Q. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02849-w · Cited by 33 · see citing works
“A significant body of research has proven that IU plays an important role in the development and maintenance of WO [15, 87].”
BackgroundThe relationship between worry and intolerance of uncertainty subtypes
Groves, D., Clark, L. H., & Clark, G. I. (2019) · Australian Psychologist · doi:10.1111/ap.12421 · Cited by 30 · 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
Zemestani, M., Beheshti, N., Rezaei, F., van der Heiden, C., & Kendall, P. C. (2021) · Behaviour Change · doi:10.1017/bec.2021.16 · Cited by 27 · see citing works
Freeston, M. H., & Komes, J. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2022.101827 · Cited by 30 · see citing works
Gibson, B., Rosser, B. A., Schneider, J., & Forshaw, M. J. (2023) · PLoS ONE · doi:10.1371/journal.pone.0286198 · Cited by 31 · see citing works
“For example, Cognitive Behavioural Therapy (CBT) specifically targeting IU has demonstrated reductions in distress associated with IU as well as other symptoms of psychological difficulty [92–94], and so too has CBT even without a specific IU focus [95, 96].”
Perrin, S., Bevan, D., Payne, S., & Bolton, D. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10020-3 · Cited by 26 · see citing works
Targeting hyperarousal: Mantram Repetition Program for PTSD in US veterans
Crawford, J. N., Talkovsky, A. M., Bormann, J. E., & Lang, A. J. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1665768 · Cited by 26 · see citing works
“Using repeatedmeasures, we ‘lagged’ our proposed mediators to examine whether changes in themediator at time t predicted the outcome variable at t+ 1 (for example, see Aderka, Foa, Applebaum, Shafran, & Gilboa-Schechtman, 2011; Bomyea et al., 2015; Donegan& Dugas, 2012).”
MethodSelf-citationTalkovsky, A. M., & Norton, P. J. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.04.104 · Cited by 24 · see citing works
The Impact of Intolerance of Uncertainty and Cognitive Behavioural Instructions on Safety Learning
Wake, S., van Reekum, C. M., Dodd, H., & Morriss, J. (2020) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10113-4 · Cited by 20 · 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
Bouchard, S., Dugas, M. J., Belleville, G., Langlois, F., Gosselin, P., Robillard, G., Corno, G., & Marchand, A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11195924 · Cited by 21 · see citing works
“Change in intolerance of uncertainty, a putative process specific to CBT for GAD, has been shown to mediate treatment outcome and to precede changes in the symptoms of GAD [52].”
InfluentialMalivoire, B. L., Marcos, M., Pawluk, E., Tallon, K., Kusec, A., & Koerner, N. (2018) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2018.1508247 · Cited by 15 · see citing works
“Cognitive-behavioral therapies that focus on increasing tolerance for uncertainty have found that reductions in IU precede corresponding decreases in chronic worry, which supports that IU has a role in maintaining worry (e.g. Bomyea et al., 2015; Dugas & Ladouceur, 2000).”
BackgroundValidation of the intolerance of uncertainty scale as a screening tool for perinatal anxiety
Furtado, M., Frey, B. N., & Green, S. M. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-04296-1 · Cited by 22 · see citing works
“Further, intolerance of uncertainty has been demonstrated as a significant predictor and mediator of treatment response to cognitive behavioural therapy in non-perinatal populations [37].”
BackgroundIntolerance of uncertainty as a transdiagnostic vulnerability to anxiety disorders in youth
Zemestani, M., Heshmati, R., Comer, J. S., & Kendall, P. C. (2023) · Current Psychology · doi:10.1007/s12144-022-03645-3 · Cited by 20 · see citing works
“…of view, modifying these interpretations or reductions to the intense negative emotions provoked by IU during treatment predict anxiety disorder symptoms improvement (Bomyea et al., 2015; Correa et al., 2019; Jacoby, 2020; Kendall et al., 2020; Talkovsky & Nor-ton, 2016; Wahlund et al., 2020).”
Payette, M., Bélanger, C., Benyebdri, F., Filiatrault, J., Bherer, L., Bertrand, J., Nadeau, A., Bruneau, M., Clerc, D., Saint-Martin, M., et al. (2017) · Clinical Gerontologist · doi:10.1080/07317115.2017.1296523 · Cited by 19 · see citing works
“Based on our current knowledge of GAD and challenges related to intolerance of uncertainty (Bomyea et al., 2015), it seems important that future studies verify if patients with GAD and FOF can benefit from traditional interventions generally based on exercise, home modifications and medication adjustments.”
BackgroundWang, W., & Wang, X. (2023) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2023.152407 · Cited by 19 · see citing works
Sternheim, L. C., & Harrison, A. (2018) · Cogent Psychology · doi:10.1080/23311908.2018.1441594 · Cited by 16 · see citing works
“Moreover, a reduction in levels of IU has been associated with reductions in other psychological symptoms such as worry, social anxiety, general anxiety and depression (Bomyea et al., 2015; Boswell, Thompson-Hollands, Farchione, & Barlow, 2013; McEvoy & Mahoney, 2012).”
BackgroundPanjwani, A. A., Applebaum, A. J., Revenson, T. A., Erblich, J., & Rosenfeld, B. (2024) · Journal of Behavioral Medicine · doi:10.1007/s10865-023-00419-5 · Cited by 17 · see citing works
“…decreases in IU are associated with reductions in worry, anxiety, and depression in cognitive behavioural therapy (CBT) intervention studies (Bomyea et al., 2015 ; Boswell et al., 2013 ; Talkovsky et al., 2018 ), CBT demon - strates lower efficacy for patients managing advanced can - cer…”
Baeken, C., Wu, G., Rogiers, R., Remue, J., Lemmens, G. M. D., & Raedt, R. D. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.02.011 · Cited by 17 · see citing works
Zemestani, M., Ezzati, S., Nasiri, F., Gallagher, M. W., Barlow, D. H., & Kendall, P. C. (2024) · Psychological Medicine · doi:10.1017/s0033291723001903 · Cited by 15 · see citing works
Suppression May Improve Adaptation to Worry When Facing Uncertainty: Studying COVID-19 Pandemic
Khatibi, A., Sharpe, L., Dehghani, M., Ghalibaf, E., Hosseinchi, P., Mazidi, M., Ranjbar, S., Deldar, Z., Gevers‐Montoro, C., Alizadeh, P., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.778375 · Cited by 14 · see citing works
“Research clearly suggests that intolerance of uncertainty is a key factor in the experience of worry and anxiety (3).”
BackgroundLaposa, 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
Brosof, L. C., Egbert, A. H., Reilly, E. E., Wonderlich, J. A., Karam, A. M., Vanzhula, I. A., Steward, T., & Levinson, C. A. (2019) · Eating Behaviors · doi:10.1016/j.eatbeh.2019.101340 · Cited by 14 · see citing works
Perceived Effects of Improv on Psychological Wellbeing: A Qualitative Study
Reid-Wisdom, Z., & Perera-Delcourt, R. P. (2020) · Journal of Creativity in Mental Health · doi:10.1080/15401383.2020.1856016 · Cited by 14 · see citing works
“Intolerance to uncertainty is a factor in the development and maintenance of a number of psychological problems including generalized anxiety disorder (Bomyea et al., 2015).”
BackgroundSouth, M., Hanley, M., Normansell, K. M., Russell, N. C. C., Cawthorne, T., & Riby, D. M. (2021) · Autism Research · doi:10.1002/aur.2554 · Cited by 15 · see citing works
“IU is a transdiagnostic concept defined as “the dispositional tendency to experience fear of the unknown” (Bomyea et al., 2015).”
BackgroundCO2 reactivity as a biomarker of exposure-based therapy non-response: study protocol
Smits, J. A. J., Monfils, M., Otto, M. W., Telch, M. J., Shumake, J., Feinstein, J. S., Khalsa, S. S., Cobb, A. R., Parsons, E. M., Long, L. J., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04478-x · Cited by 12 · see citing works
Effect of Psychotherapy on Intolerance of Uncertainty: A Systematic Review and Meta‐Analysis
Näsling, J., Åström, E., Jacobsson, L., & Ljungberg, J. K. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.3026 · Cited by 12 · see citing works
Donegan, E., Frey, B. N., McCabe, R. E., Streiner, D. L., & Green, S. M. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.02.005 · Cited by 10 · see citing works
Marcotte-Beaumier, G., Bouchard, S., Gosselin, P., Langlois, F., Belleville, G., Marchand, A., & Dugas, M. J. (2021) · JMIR Mental Health · doi:10.2196/24541 · Cited by 11 · see citing works
“An independent clinical trial [48] found that change in intolerance of uncertainty, as measured with the Intolerance of Uncertainty Scale (IUS) [49], mediated change in worry, whereas change in worry did not mediate change in intolerance of uncertainty.”
MethodLaposa, J. M., & Fracalanza, K. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000249 · Cited by 11 · see citing works
“Bomyea et al. (2015) reported that IU mediated change in worry frequency in GAD CBT. Torbit and Laposa (2016) found that in group CBT for GAD, both IU and GAD symptoms improved over treatment, and IU mediated the changes in both worry severity and worry domains.”
BackgroundJacoby, R. J., Szkutak, A., Shin, J. Y., Lerner, J. S., & Wilhelm, S. (2023) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2023.100842 · Cited by 11 · see citing works
Geok, E.-T., Lee, K. Y. C., & Sündermann, O. (2021) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2021.101718 · Cited by 11 · see citing works
Toro, R., Prieto, B. L. A., & Espinosa, N. M. V. (2019) · CES Psicología · doi:10.21615/cesp.13.1.9 · Cited by 11 · see citing works
“…Abbott, Kemp, & Quintana, 2016); and it has also been observed that, by therapeutically modifying the IU, the sign of concern in generalized anxiety disorders can be reduced by up to 59%, making it a key variable in the treatment of different emotional disorders (e.g. Bomyea et al., 2015).”
BackgroundThe Application of the Intolerance of Uncertainty Model to Gambling Urge and Involvement
Zhou, H., Hung, E. P. W., Li, X., Yuan, Z., & Wu, A. M. S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192214738 · Cited by 10 · see citing works
“On one hand, individuals with a high level of intolerance of uncertainty interpret ambiguity as threatening [14] and, therefore, are prone to overwhelming worry [13,33], which leads to an increased need for emotion regulation in general.”
BackgroundKopelman-Rubin, D., Omer, H., & Dar, R. (2017) · Journal of Psychotherapy Integration · doi:10.1037/int0000100 · Cited by 9 · see citing works
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
Alfasi, Y., Maytles, R., & Avi Besser, A. (2025) · Behavioral Sciences · doi:10.3390/bs15020148 · Cited by 8 · see citing works
“…between attachment anxiety and poorer mental health (supporting H3), consistent with research showing that individuals with high intolerance of uncertainty experience increased anxiety and struggle to cope effectively with ambiguous situations (e.g., Carleton et al., 2012; Bomyea et al., 2015).”
Bijsterbosch, J. M., Keizer, A., Boelen, P. A., van den Brink, F., Danner, U. N., & Sternheim, L. C. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-021-00523-4 · Cited by 8 · see citing works
Beheshti, N., Zemestani, M., & Rezaei, F. (2018) · Iranian Journal of Psychiatry and Clinical Psychology · doi:10.32598/ijpcp.24.3.240 · Cited by 10 · see citing works
Telehealth: the general practice perspective.
McPhee, E. (2014) · PubMed · Cited by 8 · see citing works
Arani, A. M., Hosseini, S., Lotfinia, S., Ebrahimi, L. S., Mousavi, S. E., Mohammadzadeghan, R., & Hosseini, S. M. (2023) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-022-09917-1 · Cited by 7 · see citing works
Larochelle, S., Dugas, M. J., Langlois, F., Gosselin, P., Belleville, G., & Bouchard, S. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14051502 · Cited by 9 · see citing works
“Research indicates that patients with GAD are more intolerant of uncertainty than are adults without GAD [21,23–25] or those who have various other anxiety disorders [25].”
Baeken, C., Xu, Y., Wu, G., Dockx, R., Peremans, K. Y., & Raedt, R. D. (2021) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-021-01243-1 · Cited by 7 · see citing works
“, biased contextual interpretations of the situation, poor decision-making) may not only increase worry and anxiety [17], but intolerance of uncertainty may also mediate the relationship between GAD symptoms and anger [18].”
BackgroundKusec, A., Murphy, F. C., Peers, P. V., & Manly, T. (2023) · Assessment · doi:10.1177/10731911231182693 · Cited by 6 · see citing works
“In the general population, there have been reported successes in the use of cognitive behavioral therapy in modifying IU (Bomyea et al., 2015; Hebert & Dugas, 2019).”
BackgroundWilson, E. J., Abbott, M. J., Norton, A. R., Berle, D., & Rapee, R. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2478246 · Cited by 6 · see citing works
“One study found that IU preceded reductions in worry and not vice versa, during individual psychological treatment (Bomyea et al., 2015).”
Efectos de la sobrecarga de información en el comportamiento del consumidor de noticias
Fernández, P. C. (2023) · VISUAL REVIEW International Visual Culture Review / Revista Internacional de Cultura Visual · doi:10.37467/revvisual.v10.4592 · Cited by 7 · see citing works
Cognitive‐Behavioral Models of Generalized Anxiety Disorder (GAD)
Koerner, N., McEvoy, P. M., & Tallon, K. (2020) · Wiley eBooks · doi:10.1002/9781119189909.ch7 · Cited by 9 · see citing works
Belleville, G., Boily, L.-A., Provencher, M. D., & Morin, C. M. (2020) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2020.03.011 · Cited by 5 · see citing works
Psychometric properties of the PSWQ in a sample of pregnant and postpartum women
Inness, B. E., Furtado, M., Barrett, E. S., Stallwood, E., Streiner, D. L., McCabe, R. E., & Green, S. M. (2023) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2023.2209101 · Cited by 6 · see citing works
“The GAD-7 and IUS were used as indicators of convergent validity, as excessive worry is the core feature of GAD (APA, 2013) and IU has been found to maintain worry symptoms (Bomyea et al., 2015) and is associated with GAD (Gentes & Ruscio, 2011).”
Moreno, L. Y. D., de Villalobos, M. M. D., & Silva, N. L. (2019) · Ciencia y enfermería/Ciencia y enfermería · doi:10.4067/s0717-95532019000100201 · Cited by 5 · see citing works
Malivoire, B. L., Stewart, K. E., Cameron, D., Rowa, K., & McCabe, R. E. (2024) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465823000632 · Cited by 4 · see citing works
“Furthermore, IU maintains worry and changes in IU account for a significant amount of change in chronic worry in CBT for GAD (Bomyea et al ., 2015).”
Costa, M. D. A., Russell, T. A., Gosmann, N. P., Gonçalves, F., Tatton‐Ramos, T., de Oliveira, F. B., & Manfro, G. G. (2023) · British Journal of Clinical Psychology · doi:10.1111/bjc.12402 · Cited by 4 · see citing works
The Effect of Unpreparedness for Immigration Court on Psychopathology
Bailey, C. A., Venta, A. C., Crosby, J. W., Varela, J. G., & Boccaccini, M. T. (2018) · Journal of International Migration and Integration / Revue de l integration et de la migration internationale · doi:10.1007/s12134-018-0614-9 · Cited by 4 · see citing works
“…(Ladouceur et al. 1999), intolerance of uncertainty has now been implicated as a significant factor in the development of other anxiety disorders (Bomyea et al. 2015; Carleton et al. 2014; Ladouceur et al. 1999; Nelson et al. 2015), depression (Boswell et al. 2013; Nelson et al. 2014), obsessive…”
BackgroundHow to Help Parents, Couples, and Clinicians When an Extremely Premature Infant Is Born
Howe, E. G. (2015) · The Journal of Clinical Ethics · doi:10.1086/jce2015263195 · Cited by 4 · see citing works
The impact of intolerance of uncertainty and cognitive behavioural instructions on safety learningPreprint
Wake, S. J., van Reekum, C. M., Dodd, H. F., et al. (2020) · doi:10.31234/osf.io/z5vbn · Cited by 4 · see citing works
Trauma Type and Posttraumatic Stress Symptoms in Youth
Doehrmann, A., Bibb, S. A., Kreutzer, K. A., & Gorka, S. M. (2025) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001837 · Cited by 3 · see citing works
Zhang, M., Yang, F., Chen, C., Huang, N., Guo, J., & Fan, J. (2025) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-025-02761-2 · Cited by 3 · see citing works
Torres, X., Menjivar, A., Baillés, E., Rangil, T., Delgado, I. G., Musquera, M., Paredes, D., Martínez‐Alonso, M., Avinyó, N., Vallés, C. B., et al. (2021) · Transplantation Direct · doi:10.1097/txd.0000000000001100 · Cited by 4 · see citing works
Johnson, M., & Saunderson, H. (2023) · Frontiers in Education · doi:10.3389/feduc.2023.1179015 · Cited by 4 · see citing works
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
“Studies showed that targeting IU using reception-based behavioral therapy can reduce generalized anxiety disorder symptoms (Bomyea et al., 2015; Newman et al., 2022), consistent with the present study suggesting that mind-fulness has a direct negative predictive effect on IU.”
Watt, S., Salway, T., Gómez-Ramírez, O., Ablona, A., Barton, L., Chang, H.-J., Pedersen, H., Haag, D., LeMoult, J., & Gilbert, M. (2022) · Sexual Health · doi:10.1071/sh21198 · Cited by 2 · see citing works
Clayton, M., Renna, M. E., Weingast, L. T., Panjwani, A. A., Spaeth, P. E., Heimberg, R. G., Fresco, D. M., & Mennin, D. S. (2023) · Journal of Emotion and Psychopathology · doi:10.55913/joep.v1i1.36 · Cited by 2 · see citing works
“However, this study relied on an open trial design, which limits the interpretation of the findings (Bomyea et al., 2015).”
BackgroundMethodDonegan, E. (2016) · Spectrum Research Repository (Concordia University) · Cited by 2 · see citing works
The Psychological Treatment of Generalized Anxiety Disorder
McCabe‐Bennett, H., Fracalanza, K., & Antony, M. M. (2017) · Wiley eBooks · doi:10.1002/9781119462996.ch5 · Cited by 2 · see citing works
Cognitive Behavioral Therapy for Generalized Anxiety Disorder:
Dunkley, C. R., & Robichaud, M. (2021) · Evidence-Based Treatment for Anxiety Disorders and Depression · doi:10.1017/9781108355605.010 · Cited by 1 · see citing works
Anxiety and Fear-Related Disorders: Generalized Anxiety Disorder
Rosellini, A. J., & Brown, T. A. (2024) · Tasman’s Psychiatry · doi:10.1007/978-3-030-51366-5_74 · Cited by 1 · see citing works
熊, 芸. (2024) · Advances in Social Sciences · doi:10.12677/ass.2024.13111013 · Cited by 1 · see citing works
Death anxiety during warfare: Roles of meaning, cognitive age, and uncertainty intolerance
Maytles, R., & Hamama‐Raz, Y. (2025) · Death Studies · doi:10.1080/07481187.2025.2556127 · Cited by 1 · see citing works
Zhang, F., Wang, Y., & Li, X. (2025) · Personality and Individual Differences · doi:10.1016/j.paid.2025.113494 · Cited by 1 · see citing works
Cognitive Behavioral Therapy for Anxiety Disorders
(2021) · Cambridge University Press eBooks · doi:10.1017/9781108355605.003 · Cited by 1 · see citing works
Anxiety and Fear-Related Disorders: Generalized Anxiety Disorder
Rosellini, A. J., & Brown, T. A. (2023) · Springer eBooks · doi:10.1007/978-3-030-42825-9_74-1 · Cited by 1 · see citing works
Yaygın Anksiyete Bozukluğunda Çevrim İçi Yürütülen Bilişsel ve Davranışçı Terapi: Bir Olgu Sunumu
ZEREYALP, M., Kurtoğlu, M. B., & Boz, C. (2024) · Ayna Klinik Psikoloji Dergisi · doi:10.31682/ayna.1242363 · Cited by 1 · see citing works
Philanthropy Under Uncertainty: Muslim Religious Giving During the COVID-19 Pandemic
Umarji, O., Wasif, R., Siddiqui, S., & Noor, Z. (2024) · Journal of Public and Nonprofit Affairs · doi:10.20899/jpna.c7vvvv81 · Cited by 1 · see citing works
Furtado, M., Frey, B. N., Inness, B. E., McCabe, R. E., & Green, S. M. (2026) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2025.2495928
“IU has also been shown to be a significant predictor and mediator of cognitive behavioural therapy (CBT) treatment response, specifically related to reductions in worry and anxiety (Bomyea et al., 2015; Katz et al., 2017; Marcotte-Beaumier et al., 2021; Miller & McGuire, 2023).”
- Authors
- Bomyea, J., Ramsawh, H., Ball, T. M., Taylor, C. T., Paulus, M. P., Lang, A. J., & Stein, M. B.
- Affiliations
- University of California San Diego (US)
- Uniformed Services University of the Health Sciences (US)
- San Diego State University (US)
- Corresponding author
- Bomyea, J.
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2015-06
- Volume
- 33
- Pages
- 90-94
- ISSN
- 0887-6185 (ISSN-L)
- PMC
- PMC4480197
- OpenAlex
- W336141019
- Semantic Scholar
- 90fb7b4f2115b63faea4fc66ee694322a8672746
- Cited by
- 126
- References
- 45
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 8 · 2023: 18 · 2022: 14 · 2021: 14 · 2020: 11 · 2019: 12 · 2018: 11 · 2017: 7 · 2016: 8 · 2015: 2 · 2014: 1
- FWCI
- 9.04
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion)
- Funders
- NIMH
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- intolerance of uncertainty, generalized anxiety disorder, worry, cognitive behavioral therapy, mediation, cognitive vulnerability, change processes, anxiety disorders
- MeSH terms
- Adolescent, Adult, Anxiety, Anxiety Disorders, Cognition, Female, Humans, Male
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
