Psychological mechanisms underpinning change in intolerance of uncertainty across anxiety-related disorders: New insights for translational research
Open accessAbstract
Intolerance of uncertainty (IU), the tendency to find uncertainty negative, is a fundamental transdiagnostic dimension across anxiety-related disorders. Over the past two decades, there has been an increase in both clinical and experimental research on the role of IU in the maintenance and treatment of anxiety-related disorders. However, there has been a lack of integration of research findings from a mechanistic perspective, which has slowed progress in translational research. This review seeks to fill this gap by synthesising the clinical (e.g. randomised controlled trials) and experimental (e.g. lab-based) literature on the psychological mechanisms that drive change in IU across anxiety-related disorders. The review highlighted that: (1) cognitive restructuring, supported by mechanisms such as cognitive appraisal, modify IU-related cognitions, (2) behavioural exposures, supported by mechanisms such as inhibitory learning, alter IU-related cognitions and physiological arousal, and (3) mindfulness techniques underpinned by mechanisms such as attentional monitoring, decentering, and acceptance, change IU-related cognitions. Across the different therapeutic techniques reviewed, there was a lack of evidence for how different mechanisms change IU-related emotions and behaviours. Directions for further research include directly comparing the effectiveness of different mechanisms that produce change in IU across anxiety disorders and other mental health disorders, and examining the specificity of change in IU over other anxious traits. Overall, the findings provide a foundation for future translational research efforts to build upon maximising existing treatment interventions and/or to develop novel treatment interventions to target dispositional IU and situational uncertainty-related distress in anxiety-related disorders and beyond.
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IU is a transdiagnostic risk factor for youth mental health problems.
“IU is a transdiagnostic risk factor for youth mental health problems (Morriss, 2025).”
From A single session online training reduces intolerance of uncertainty and improves mental health in emerging adults. (2025) · cites this paper as Morriss, 2025
The review describes IU as transdiagnostic across several disorders and says it is relevant to developing populations (section 6). But it says the literature has primarily focused on adults and does not establish IU as a transdiagnostic risk factor specifically for youth mental health problems. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIntolerance of uncertainty is a transdiagnostic risk factor for mental health problems including depression and anxiety.
“IU, reacting more negatively to uncertainty (Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994), is a transdiagnostic risk factor for mental health problems including depression and anxiety (Mahoney & McEvoy, 2012; Morriss, 2025).”
From A single session online training reduces intolerance of uncertainty and improves mental health in emerging adults. (2025) · cites this paper as Morriss, 2025
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“Current research suggests that entire CBT (McEvoy and Erceg-Hurn, 2016), UP (Khakpoor et al., 2019), mindfulness protocols (Alimehdi et al., 2016), and components of CBT (e.g. behavioural, cognitive) and relaxation, compared to passive controls, are effective in treating IU in anxiety-related…”
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Self-citationKim, H., & Newman, M. G. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.08.045 · Cited by 33 · see citing works
It's time: A commentary on fear extinction in the human brain using fMRI
Morriss, J., Hoare, S., & van Reekum, C. M. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.06.025 · Cited by 32 · see citing works
Self-citationMorriss, J., McSorley, E., & van Reekum, C. M. (2017) · Cognition & Emotion · doi:10.1080/02699931.2017.1370418 · Cited by 31 · see citing works
Self-citationHuang, V., Yu, M., Carleton, R., & Beshai, S. (2019) · PLoS ONE · doi:10.1371/journal.pone.0224865 · Cited by 31 · see citing works
Ricciardelli, R., Mitchell, M. M., Taillieu, T., Angehrn, A., Afifi, T. O., & Carleton, R. N. (2021) · Criminal Justice and Behavior · doi:10.1177/00938548211050112 · Cited by 31 · 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
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 · cited 1× · see citing works
“…evidence that other components of psychother-apies such as psychoeducation (Hebert and Dugas, 2019; Shapiro et al., 2023), and psychopharmacological interventions related to serotonin (Kanen et al., 2021; Zemestani et al., 2021; Zemestani et al., 2022) may change IU and associated symptoms.”
Papenfuss, I., Lommen, M. J. J., Huisman, M., & Ostafin, B. D. (2022) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2022.06.014 · Cited by 27 · cited 1× · see citing works
“Two experiments in student samples have examined the impact of mindfulness interventions on IU and associated symptoms (Moser et al., 2024; Papenfuss et al., 2022).”
Freeston, M. H., & Komes, J. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2022.101827 · Cited by 27 · see citing works
Zemestani, M., Ommati, P., Rezaei, F., & Gallagher, M. W. (2022) · Personality Disorders: Theory, Research, and Treatment · doi:10.1037/per0000482 · Cited by 26 · see citing works
Let's get specific about intolerance of uncertainty and emotion regulation
Morriss, J. (2023) · Personality and Individual Differences · doi:10.1016/j.paid.2023.112336 · Cited by 26 · see citing works
Self-citationAlimehdi, M., Ehteshamzadeh, P., Naderi, F., Eftekharsaadi, Z., & Pasha, R. (2016) · Asian Social Science · doi:10.5539/ass.v12n4p179 · Cited by 25 · cited 1× · see citing works
“Current research suggests that entire CBT (McEvoy and Erceg-Hurn, 2016), UP (Khakpoor et al., 2019), mindfulness protocols (Alimehdi et al., 2016), and components of CBT (e.g. behavioural, cognitive) and relaxation, compared to passive controls, are effective in treating IU in anxiety-related…”
Feeling safe: Judgements of safety and anxiety as a function of worry and intolerance of uncertainty
Cupid, J., Stewart, K. E., Sumantry, D., & Koerner, N. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103973 · Cited by 24 · see citing works
Shapiro, M. O., Allan, N. P., Raines, A. M., & Schmidt, N. B. (2023) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-022-10002-y · Cited by 21 · cited 1× · see citing works
“There is emerging evidence that other components of psychother-apies such as psychoeducation (Hebert and Dugas, 2019; Shapiro et al., 2023), and psychopharmacological interventions related to serotonin (Kanen et al., 2021; Zemestani et al., 2021; Zemestani et al., 2022) may change IU and associated…”
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
Intolerance of uncertainty and psychosis: A systematic review
Morriss, J., Butler, D., & Ellett, L. (2025) · British Journal of Clinical Psychology · doi:10.1111/bjc.12509 · Cited by 21 · see citing works
Self-citationNewman, M. G., Lafreniere, L. S., & Jacobson, N. C. (2018) · Psychotherapy Research · doi:10.1080/10503307.2016.1253891 · Cited by 21 · see citing works
Mason, J. E., & Asmundson, G. J. G. (2018) · Mental health and physical activity · doi:10.1016/j.mhpa.2018.02.006 · Cited by 21 · see citing works
Wake, S. J., Verde, A. D., Biagi, N., van Reekum, C. M., & Morriss, J. (2022) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2022.06.011 · Cited by 20 · see citing works
Self-citationCarsten, H. P., Härpfer, K., & Riesel, A. (2022) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2022.06.018 · Cited by 20 · see citing works
Morriss, J., Biagi, N., & Dodd, H. (2020) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2020.07.009 · Cited by 18 · see citing works
Self-citationLi, J., Gao, J., Zhang, Q., Li, C., & Cui, L. (2021) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-020-09832-5 · Cited by 17 · see citing works
A meta-analysis of CBT components for anxiety disorders.
Adams, T. G., Brady, R. E., Lohr, J. M., & Jacobs, W. J. (2015) · Behavior Therapy · Cited by 14 · see citing works
Imagery versus verbal interpretive cognitive bias modification for compulsive checking
Black, M. J., & Grisham, J. R. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.05.009 · Cited by 13 · 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
Azad, M. A., Manshaei, G., & Ghamarani, A. (2019) · Quarterly Journal of Child Mental Health · doi:10.29252/jcmh.6.1.8 · Cited by 12 · see citing works
Correa, K. A., Li, L. Y., Nelson, B. D., & Shankman, S. A. (2022) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2022.01.016 · Cited by 12 · see citing works
Palumbo, R., & Manna, R. (2020) · Journal of Organizational Change Management · doi:10.1108/jocm-05-2020-0147 · Cited by 11 · see citing works
Jacoby, R. J., Reuman, L., Blakey, S. M., Hartsock, J. T., & Abramowitz, J. S. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.11.003 · Cited by 8 · see citing works
Intolerance of uncertainty and novelty facilitated extinction: The impact of reinforcement schedule
Wake, S. J., Dodd, H. F., & Morriss, J. (2021) · British Journal of Psychology · doi:10.1111/bjop.12538 · Cited by 5 · see citing works
Self-citationTör-Çabuk, K., & Koç, V. (2024) · PsyCh Journal · doi:10.1002/pchj.742 · Cited by 5 · see citing works
Toozandehjani, H., Beheshtian, E., & Saffarian Tousi, M. (2020) · Journal of Nursing and Midwifery Sciences · doi:10.4103/jnms.jnms_29_19 · Cited by 4 · cited 1× · see citing works
“Similar results for mindfulness-based interventions and IU have also been observed in single studies on populations with generalisaed anxiety disorder (Alimehdi et al., 2016; Beheshtian et al., 2020) and obsessive compulsive disorder (Asli Azad et al., 2019; Saberizadeh and Zarehneyestanak, 2024).”
The impact of modifying obsessive-compulsive beliefs about perfectionism
Wong, S. F., Lim, V., Black, M., & Grisham, J. R. (2021) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2021.101675 · Cited by 4 · see citing works
Koscinski, B., Do, C., Allan, N. P., & Suhr, J. A. (2024) · Aging & Mental Health · doi:10.1080/13607863.2024.2367704 · Cited by 4 · 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
Self-Guided Mindfulness Reduces College Student Anxiety: A Scalable, Preregistered Pilot Study
Moser, A. D., Neilson, C., Peterson, E. C., Wagers, T. P., Fassett-Carman, A. N., Wicks, J. J., Taylor, M. M., Snyder, H. R., & Kaiser, R. H. (2024) · Mindfulness · doi:10.1007/s12671-024-02364-z · Cited by 2 · see citing works
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“IU is a transdiagnostic risk factor for youth mental health problems (Morriss, 2025).”
Intolerance of uncertainty modulates amygdala habituation to emotional faces
Jeon, J., Kim, H., Hur, J., & Kim, M. J. (2026) · NeuroImage · doi:10.1016/j.neuroimage.2026.121691 · Cited by 2 · see citing works
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Exploring the role of interoception in anxious traits and symptoms
Snell, L., Reynolds, S. J., Garner, M. J., Pfeifer, G., & Morriss, J. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1769315 · Cited by 1 · see citing works
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Intolerance of uncertainty as a factor in hoarding treatment
Wheaton, M. G., Boxtel, R. V., & Rodríguez, C. I. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.12.044
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Who declines neurocognitive testing? A cross-sectional study in people with multiple sclerosis
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Tolerance of uncertainty as a psychological resource of personality in a society in crisis
Yankovska, L. A., Sopilnyk, L., Pitsykevych, V. V., Piven, M. V., & Мартинишин, В. П. (2026) · Academic Visions · doi:10.66556/2786-586x.58.yankovska-l
- Authors
- Morriss, J.
- Affiliations
- University of Southampton (GB)
- Corresponding author
- Morriss, Jayne
- ORCID
- Morriss, Jayne
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2025-06
- Volume
- 173
- Pages
- 106138
- ISSN
- 0149-7634 (ISSN-L)
- OpenAlex
- W4409291323
- Cited by
- 28
- References
- 129
- Citations by year
- 2026: 18 · 2025: 10
- FWCI
- 4.65
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- intolerance of uncertainty, anxiety-related disorders, cognitive restructuring, cognitive appraisal, inhibitory learning, physiological arousal, mindfulness, attention monitoring, decentering, acceptance, transdiagnostic mechanisms, translational research
- MeSH terms
- Anxiety Disorders, Humans, Uncertainty, Translational Research, Biomedical, Mindfulness
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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.
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