Cognitive flexibility mediates the relation between intolerance of uncertainty and safety signal responding in those with panic disorder
Open accessAbstract
There is a growing literature associating anxiety disorders with an inability to inhibit defensive responding during safety conditions of threatening tasks. However, investigations on the relation between panic disorder (PD) and defensive responding to safety have yielded mixed results. A recent study from our laboratory revealed that intolerance of uncertainty (IU) moderates this association, such that only individuals with PD and a high IU exhibit heightened startle potentiation during safety. The mechanism underlying this relationship is unknown. Given that safety conditions typically alternate with periods of threat, cognitive flexibility (i.e., the ability to adjust one's habitual responding to a situation, given the input of new information) may be involved in the ongoing reappraisal of danger and adjustment of defensive responding. Thus, the present study sought to investigate whether deficits in cognitive flexibility mediate the association between IU and defensive responding to safety among a sample of 71 adults diagnosed with PD. As hypothesised, cognitive flexibility mediated the relationship between IU and heightened startle potentiation during safety conditions. This finding suggests that within this subgroup, a failure to inhibit defensive responding during safety conditions may be due to deficits in cognitive flexibility.
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The finding that intolerance of uncertainty via cognitive flexibility predicts health anxiety is consistent with previous research.
“این یافته با پژوهشهای پیشین از نظر ارتباط بین عدم تحمل ابهام و انعطافپذیری شناختی و ارتباط بین اضطراب سلامت و انعطافپذیری شناختی همسو بود ( )29,27 .”
From Predicting Health Anxiety Based on Intolerance of Uncertainty: Investigating the Mediating Role of Cognitive Flexibility and Cyberchondria in Breast Cancer Survivors (2023) · cites this paper as [29]
The Results (Mediating Effect of Cognitive Flexibility; page unavailable) report that greater intolerance of uncertainty predicted less cognitive flexibility in people with panic disorder. The paper examines defensive responding to safety signals, not health anxiety, so it does not support the attributed relationship between health anxiety and cognitive flexibility or a prediction of health anxiety. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe finding that intolerance of uncertainty predicts cognitive flexibility is consistent with previous research.
“این یافته همسو با پژوهشهای پیشین بود که نتایج آنها نشان داد بین عدم تحمل ابهام و انعطافپذیری شناختی رابطهی معناداری وجود دارد ( )35,29 .”
The finding that intolerance of uncertainty via cyberchondria predicts health anxiety is consistent with previous research.
“این یافته با پژوهشهای پیشین که نشان دهندهی ارتباط سایبرکندریا با اضطراب سلامت و رابطهی بین عدم تحمل ابهام با سایبرکندریا بود، همسو است ( .)29 ,27,12”
From Predicting Health Anxiety Based on Intolerance of Uncertainty: Investigating the Mediating Role of Cognitive Flexibility and Cyberchondria in Breast Cancer Survivors (2023) · cites this paper as [29]
The Methods section (page unavailable) describes a measure of intolerance of uncertainty, and the Abstract discusses panic disorder and responses to safety signals. Searches for cyberchondria, health anxiety, and online health-information seeking found no passage addressing either claimed relationship or the proposed pathway through cyberchondria. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe finding that intolerance of uncertainty predicts cyberchondria is consistent with previous research.
“این یافته همسو با پژوهشهای است که نتایج آنها نشان دهندهی ارتباط بین عدم تحمل ابهام و سایبرکندریا بود ( .)29, 27”
From Predicting Health Anxiety Based on Intolerance of Uncertainty: Investigating the Mediating Role of Cognitive Flexibility and Cyberchondria in Breast Cancer Survivors (2023) · cites this paper as [29]
The Methods section describes measuring intolerance of uncertainty, and the Discussion relates it to worry and safety-signal responding in people with panic disorder. Searches for cyberchondria and online health-information seeking found no passage addressing a relationship between intolerance of uncertainty and cyberchondria. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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- Authors
- Lieberman, L., Gorka, S. M., Sarapas, C., & Shankman, S. A.
- Affiliations
- University of Illinois Chicago (US)
- Corresponding author
- Shankman, Stewart A.
- Venue
- Cognition and Emotion
- Publisher
- Informa UK Limited
- Published
- 2015-07-25
- Volume
- 30
- Issue
- 8
- Pages
- 1495-1503
- ISSN
- 0269-9931 (ISSN-L)
- 1464-0600
- PMC
- PMC5135660
- OpenAlex
- W1580013049
- Cited by
- 33
- References
- 38
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 2 · 2022: 10 · 2021: 2 · 2020: 3 · 2019: 4 · 2018: 1 · 2017: 3 · 2016: 1
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cognition & Emotion (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01 MH098093,R21 MH080689)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Keywords
- cognitive flexibility, intolerance of uncertainty, panic disorder, defensive responding, startle potentiation, threat appraisal, mediation, anxiety disorders
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