Intolerance of uncertainty (IU) is commonly defined as the tendency for one to interpret uncertainty as negative or threatening. Most general or non-specific measures of IU show a strong relationship with worry and generalized anxiety disorder symptoms; however, a specialized measure of intolerance of uncertainty in social situations could provide insight into the role of IU in social anxiety. The purpose of this study was the development and preliminary validation of the Intolerance of Uncertainty in Social Interactions Scale (IU-SIS), a comprehensive measure designed to assess intolerance of uncertainty in social situations. Participants consisted of a non-referred sample. Based on an exploratory factor analysis, a two-factor solution was retained, with factors labelled Social Ambiguity and Need to Reduce. Both subscales were found to have good reliability and validity. Both subscales of the IU-SIS predicted up variance on measures of social anxiety after controlling for variance explained by a well-established general/non-specific measure of IU. Overall, the IU-SIS shows promise as a tool to elucidate the association between intolerance of uncertainty and social anxiety.

Sensory differences and anxiety disorders are highly prevalent in autistic individuals with and without ADHD. Studies have shown that sensory differences and anxiety are associated and that intolerance of uncertainty (IU) plays an important role in this relationship. However, it is unclear as to how different levels of the sensory processing pathway (i.e., perceptual, affective, or behavioral) contribute. Here, we used psychophysics to assess how alterations in tactile perception contribute to questionnaire measures of sensory reactivity, IU, and anxiety. Thirty-eight autistic children (aged 8-12 years; 27 with co-occurring ADHD) were included. Consistent with previous findings, mediation analyses showed that child-reported IU fully mediated an association between parent-reported sensory reactivity and parent-reported anxiety and that anxiety partially mediated an association between sensory reactivity and IU. Of the vibrotactile thresholds, only simultaneous frequency discrimination (SFD) thresholds correlated with sensory reactivity. Interestingly, we found that sensory reactivity fully mediated an association between SFD threshold and anxiety, and between SFD threshold and IU. Taken together, those findings suggest a mechanistic pathway whereby tactile perceptual alterations contribute to sensory reactivity at the affective level, leading in turn to increased IU and anxiety. This stepwise association can inform potential interventions for IU and anxiety in autism.

Intolerance of uncertainty (IU) is a cognitive bias that leads to perception and intolerance of uncertainty and has associated negative cognitive, emotional, and behavioural responses. It plays a strong role in social anxiety disorder (SAD; Counsell et al., 2017). Our experimental study examined the impact of uncertainty related to a social stressor on SAD using a speech task. We examined features of SAD including anticipatory anxiety, anxiety during the task, willingness to perform the task, and avoidance of the task. Undergraduate students (N = 110, 88% female) with significant social anxiety completed a series of questionnaires, then were randomised to one of two conditions related to level of uncertainty about an impromptu speech task. The experimental condition (state IU) did not predict any of the outcome variables, while trait IU significantly predicted anxiety levels. Results indicate that increased uncertainty of a social situation does not impact acute anxiety levels in SAD and reinforce the strong role of trait IU as a transdiagnostic cognitive variable. Neither trait nor state IU predicted the willingness and avoidance variables. Results also highlighted the central role of the experience of anxiety on avoidance behaviours, above cognitive factors such as IU.

Intolerance of uncertainty (IoU) is important in the development and maintenance of worry and generalized anxiety disorder (GAD; Dugas et al., 1997). However, it remains unclear why some people respond so negatively to uncertainty and have poor clinical outcomes. We adapted the IoU model to include the influence of developmental and/or attachment factors, and their possible importance to intolerability of uncertainty and associated hypothetical worries. Seven consecutive GAD referrals for CBT were naturalistically treated with the novel approach. All participants completed the 7-item Generalized Anxiety Disorder Scale (GAD-7; Spitzer et al., 2006), the Penn State Worry Questionnaire (PSWQ; Meyer et al., 1990), as well as a novel 10-item Premonition Bias Questionnaire (PBQ; C. Chigwedere et al., unpublished). From pre- to post-treatment, results for both GAD (p=.001) and worry (p=.005) improved significantly. Clinically significant change or a post-treatment score within the normal population range were observed for both the GAD-7 and PSWQ. The change in believability of worry, measured on the PBQ was also significant from pre- to post-treatment (p=.008). Overall, the novel approach may be an alternative approach to treating GAD, with some potential, both as an adjunctive or standalone treatment. However, this is a small case series and the presented novel approach requires empirical support and evaluation in larger experimental studies.

Given the high prevalence and adverse outcomes associated with generalized anxiety disorder (GAD), development and expansion of effective treatment modalities are important. The present study compared the effectiveness of cognitive behavior therapy targeting intolerance of uncertainty (CBT-IU) and selective serotonin reuptake inhibitors (SSRIs) for treating GAD. A total of 30 Iranian patients with GAD (Mage = 25.16 ± 6.73) were randomised to receive either CBT-IU (n = 15) or SSRI (n = 15). Measures included the Structured Clinical Interview for DSM-5 (SCID-5), Penn State Worry Questionnaire (PSWQ), Why Worry-II (WW-II), Intolerance of Uncertainty Scale (IUS), and Negative Problem Orientation Questionnaire (NPOQ). Repeated measures analysis of variance tested differential treatment outcomes. The results of intention-to-treat (ITT) analysis indicated that although both CBT-IU and SSRI were effective treatments for GAD, CBT-IU produced significantly better results than SSRI at post-treatment. This clinical trial provides preliminary cross-cultural support for the treatment of GAD using CBT-IU, with findings suggesting that this non-medication intervention reduces GAD symptoms.

The development and conceptual relationship of the constructs of threat appraisal (TA) and intolerance of uncertainty (IU) are explored in the context of anxiety disorders. A narrative review tracking the development of these constructs and their relationship is undertaken. There is some evidence to suggest that the interaction between the components of threat appraisal (probability × cost) may partially account for or provide a theoretical framework which explains presenting levels of anxiety. Furthermore, research suggested that IU is a construct which contributes to a broad range of anxiety disorders. It was concluded that distinctive cognitive biases linked with IU – such as interpreting ambiguous and uncertain (both positive and negative) information as highly concerning – suggests that IU is interpreted negatively independent of threat appraisal. These findings mean a number of issues remain unclear, including whether IU in anxiety-provoking situations is sufficient in itself – independent of threat appraisal – in eliciting high levels of anxiety. Additionally, it is unclear whether threat appraisal and IU act as independent constructs, or more in an interactive manner in anxiety. To achieve further clarity on these issues, methodological recommendations for future research are made.

Intolerance of Uncertainty (IU) has been shown to underlie a range of disorders. Technological advances have produced a decline in our development of an ability to wait in the face of uncertainty. The paper provides an update on empirical, theoretical and neural research in IU. Einstein's extended trandiagnostic model of IU is described. This model is based on control theory. The research update and IU model propose specific tools which can be implemented within transdiagnostic treatment approaches.

Background: Although worry is common in children, empirical models of worry remain largely untested in youth. A small number of studies have established preliminary links between cognitive variables and worry in children younger than 12 years old. These cognitive variables include positive and negative beliefs about worry, intolerance of uncertainty, and problem orientation. Aims: The current study examined these variables concurrently and their association with worry. We also examined the extent to which intolerance of uncertainty mediated the association between worry and beliefs about worry. Method: Eighty elementary school children aged 8 to 12 years completed a battery of self-report measures. Results: As a group, the cognitive variables significantly predicted worry scores; negative beliefs about worry was the only significant individual predictor. As a group, the four cognitive variables discriminated clinical from nonclinical levels of worry; positive beliefs about worry and intolerance of uncertainty were the only significant individual predictors. Finally, intolerance of uncertainty mediated the association between worry and both positive and negative beliefs about worry. Conclusions: Components of a cognitive model of worry are largely applicable to children. Negative beliefs about worry were associated with worry across the continuum, while intolerance of uncertainty and positive beliefs about worry were more strongly associated with clinical levels of worry. Intolerance of uncertainty accounted for a significant portion of the association between metacognition and worry and may be a particularly effective target for treatment. Further implications for conceptual models and treatment interventions are discussed.

Background: Many older adults have at least one chronic disease and experience greater health problems than young adults. However, little is known about factors other than health that account for health anxiety (HA) among older adults. The overall objective of the present study was to develop a better understanding of HA among older and young adults.

Methods: We examined how anxiety-related constructs (anxiety sensitivity, intolerance of uncertainty, anxiety control, and emotion regulation) predict two core components of HA described in the cognitive–behavioral model of HA (illness likelihood and negative consequences) in older and young adults. We also examined the extent to which the predictor variables differentially account for HA in both age groups. Older and young adult participants completed several self-report surveys.

Results: Young adults reported higher levels of HA than older adults. Anxiety sensitivity and reappraisal predicted illness likelihood for older and young adults. Intolerance of uncertainty predicted negative consequences in both age groups. Anxiety sensitivity predicted negative consequences for older adults only. Anxiety control did not predict illness likelihood or negative consequences for either age group.

Conclusions: Results suggest that anxiety sensitivity and intolerance of uncertainty may predispose older and young adults to HA, which is influenced by reappraisal. Implications for the cognitive–behavioral model of HA in both age groups are discussed.

This study explored how meta-worry and intolerance of uncertainty relate to pathological worry, generalised anxiety, obsessive–compulsive disorder, social phobia, and depression. University students (n = 253) completed a questionnaire battery. A series of regression analyses were conducted. The results indicated that meta-worry was associated with GAD, social phobia, obsessive–compulsive, and depressive symptoms. Intolerance of uncertainty was related to GAD, social phobia, and obsessive–compulsive symptoms, but not depressive symptoms. The importance of meta-worry and intolerance of uncertainty as predictors of pathological worry, GAD, social phobia, obsessive–compulsive and depressive symptoms was also examined. Even though both factors significantly predicted the aforementioned symptoms, meta-worry emerged as a stronger predictor of GAD and obsessive compulsive symptoms than did intolerance of uncertainty. Intolerance of uncertainty, compared with meta-worry, appeared as a stronger predictor of social phobia symptoms. Findings emphasise the importance of addressing meta-worry and/or intolerance of uncertainty not only for the assessment and treatment of generalised anxiety disorder (GAD), but also obsessive–compulsive disorder, social phobia, and depression.

Objective: This study aimed to extend current research into cognitive models of obsessive–compulsive disorder (OCD) in a pediatric sample by examining the impact of perceived responsibility on memory confidence, intolerance of uncertainty (IU) and checking urge using an experimental design to manipulate perceived responsibility. It was hypothesised that the high responsibility condition would result in higher ratings of responsibility, lower memory confidence and higher IU, which would also result in higher ratings on urge to check. Moreover, it was hypothesised that adolescents would report significantly higher ratings of responsibility than children. Finally, it was hypothesised that the effect of perceived inflated responsibility on the urge to check in a high responsibility condition would be mediated by IU.

Method: Twenty-seven children and adolescents diagnosed with OCD completed an experimental cognitive appraisal task (CAT) in which they heard two standardised vignettes presented in counterbalanced order; one in which participants were responsible and one in which they were not responsible for preventing harm to a friend's pet cat. Memory confidence, IU and checking urge were assessed after each scenario using Likert scales.

Results: The manipulation of perceived responsibility was successful with children and adolescents rating increased responsibility in the high compared with the low responsibility scenario. There were no differences across high and low responsibility conditions, however, in ratings of memory confidence, IU or the urge to check. There were no significant age-related differences; however, there was a trend for adolescents to report higher ratings across all variables. Finally, the relationship between perceived inflated responsibility and the urge to check was not mediated by IU.

Conclusions: Responsibility is not related to ratings of memory confidence, IU or the urge to check in a pediatric sample, suggesting that biases of responsibility may not be central to the formulation of childhood OCD. Results are discussed in terms of implications for cognitive formulations and cognitive approaches to treatment in pediatric OCD.

This study explored whether intolerance of uncertainty and/or meta-worry discriminate between non-clinical individuals and those diagnosed with generalised anxiety disorder (GAD group). The participants were 107 GAD clients and 91 university students. The students were divided into two groups (high and low GAD symptom groups). A multivariate analysis of covariance (MANCOVA) adjusting for age indicated that intolerance of uncertainty distinguished between the low GAD symptom group and the high GAD symptom group, and between the low GAD symptom group and the GAD group. Meta-worry distinguished all three groups. A discriminant function including intolerance of uncertainty and meta-worry classified 94.4% of the GAD group and 97.9% of the low GAD symptom group. Only 6.8% of the high GAD symptom group was classified correctly, 77.3% of the high GAD symptom group was classified as GAD. Findings indicated that intolerance of uncertainty and meta-worry may assist with the diagnosis and treatment of GAD.