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A review of the relationship between intolerance of uncertainty and threat appraisal in anxiety

Published online by Cambridge University Press:  09 August 2019

S. Milne ,
C. Lomax  and
M. H. Freeston
S. Milne*
Affiliation:
Great Ormond Street Children’s Hospital NHS Foundation Trust, London, UK
C. Lomax
Affiliation:
Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
M. H. Freeston
Affiliation:
Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK Newcastle University, Newcastle upon Tyne, UK
*
*Corresponding author. Email: Sara_milne@hotmail.co.uk
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Abstract

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.

Key learning aims

  1. (1) To understand the conceptual foundations of TA and IU in the cognitive model of anxiety.

  2. (2) To understand the empirical evidence supporting the role of both TA and IU in anxiety.

  3. (3) To appreciate the potential relationship between these concepts in anxiety.

Keywords

anxietyintolerance of uncertaintythreat appraisaluncertainty
Type
Review Paper
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e38
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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References

Further reading

A chapter on ‘Intolerance of Uncertainty’ in the book Overcoming Worry by Kevin Meares and Mark Freeston, Basic Books Publisher.Google Scholar

References

Anderson, J. G., Dugas, M. J., Koerner, N., Radomsky, A. S., Savard, P., & Turcotte, J. (2012). Interpretive style and intolerance of uncertainty in individuals with anxiety disorders: A focus on generalized anxiety disorder. Journal of Anxiety Disorders 26, 823–832. doi: 10.1016/j.janxdis.2012.08.003 CrossRefGoogle ScholarPubMed
Andrews, G., Creamer, M., Crino, R., Hunt, C., Lampe, L., & Page, A. (2003). The Treatment of Anxiety Disorders: Clinician Guides and Patient Manuals. 2. Cambridge, UK: Cambridge University Press.Google Scholar
Bandura, A. (1981). Self-referent thought: a developmental analysis of self-efficacy In Social Cognitive Development: Frontiers and Possible Futures (ed. Flavell, J. H and Ross, L), pp. 200–239. Cambridge, UK: Cambridge University Press.Google Scholar
Barlow, D. H. (2002) Anxiety and its Disorders: The Nature and Treatment of Anxiety and Panic (2nd edn). New York, USA: Guilford Press.Google Scholar
Barlow, D. H. (2000). Unravelling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist 55, 1247–1263. doi: 10.1037/0003-066X.55.11.1247 CrossRefGoogle Scholar
Birrell, J., Meares, K., Wilkinson, A., & Freeston, M. (2011). Toward a definition of intolerance of uncertainty: a review of factor analytical studies of the Intolerance of Uncertainty Scale. Clinical Psychology Review 31, 1198–1208. doi: 10.1016/j.cpr.2011.07.009 CrossRefGoogle Scholar
Beck, A. T. (1970). Cognitive therapy: nature and relation to behaviour therapy. Behaviour Therapy 1, 184–200. doi: 10.1016/S0005-7894(70)80030-2 CrossRefGoogle Scholar
Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. New York, USA: International Universities Press.Google Scholar
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive Therapy of Depression. New York, USA: Guilford Press.Google Scholar
Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. New York, USA: Basic Books.Google Scholar
Boelen, P. A., & Reijntjes, A. (2009). Intolerance of uncertainty and social anxiety. Journal of Anxiety Disorders 23, 130–135. doi: 10.1016/j.janxdis.2008.04.00 CrossRefGoogle ScholarPubMed
Berenbaum, H., Thompson, R. J., & Pomerantz, E. M. (2007). The relationship between worrying and concerns: the importance of perceived probability and cost. Behaviour Research and Therapy 45, 301–311. doi: 10.1016/j.brat.2006.03.009 CrossRefGoogle Scholar
Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Intolerance of uncertainty: a common factor in the treatment of emotional disorders. Journal of Clinical Psychology 69, 630–645. doi: 101.1002/jclp.21965 CrossRefGoogle ScholarPubMed
Brown, M., Robinson, L., Campione, G. C., Wuesnch, K., Hildebrandt, T., & Micali, N. (2017). Intolerance of uncertainty in eating disorders: a systematic review and meta-analysis. European Eating Disorders Review 25, 329–343. doi: 10.1002/erv.2523 CrossRefGoogle ScholarPubMed
Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: psychometric properties of the English version. Behaviour Research and Therapy 40, 931–945. doi: 10.1016/S0005-7967(01)00092-4 CrossRefGoogle ScholarPubMed
Butler, G., & Mathews, A. (1983). Cognitive processes in anxiety. Advances in Behaviour Research and Therapy 5, 51–62. doi: 10.1016/0146-6402(83)90015-2 CrossRefGoogle Scholar
Carleton, R. N. (2012). The intolerance of uncertainty construct in the context of anxiety disorders: theoretical and practical perspectives. Expert Review of Neurotherapeutics 12, 937–947. doi: 10.1586/ern.12.82 CrossRefGoogle ScholarPubMed
Carleton, R. N. (2016). Into the unknown: a review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders 39, 30–43. doi: 10.1016/j.janxdis.2016.02.007 CrossRefGoogle ScholarPubMed
Carleton, R. N., Collimore, C., & Asmundson, G. J. G. (2010). ‘It’s not just the judgements – it’s that I don’t know’: intolerance of uncertainty as a predicator of social anxiety. Journal of Anxiety Disorders 24, 189–195. doi: 10.1016/j.janxdis.2009.10.007 CrossRefGoogle Scholar
Carleton, R. N., Norton, M. A., & Asmundson, G. J. G. (2007a). Fearing the unknown: a short version of the intolerance of uncertainty scale. Journal of Anxiety Disorders 21, 105–117. doi: 10.1016/j.janxdis.2006.03.014 CrossRefGoogle Scholar
Carleton, R. N., Sharpe, D., & Asmundson, G. (2007b). Anxiety sensitivity and intolerance of uncertainty: requisites of the fundamental fears? Behaviour Research & Therapy 45, 2307–2316. doi: 10.1016/j.brat.2007.04.006 CrossRefGoogle ScholarPubMed
Carleton, R. N., Thibodeau, M. A., Osborne, J. W., Taylor, S., & Asmundson, J. G. (2014). Revisiting the fundamental fears: towards establishing construct independence. Personality and Individual Differences 63, 94–99. doi: 10.1016/j.paid.2014.01.040 CrossRefGoogle Scholar
Carleton, R., Weeks, J., Howell, A., Asmundson, G., Antony, M., & McCabe, R. (2012) Assessing the latent structure of the intolerance of uncertainty construct: an initial taxometric analysis. Journal of Anxiety Disorders 26, 150–157. doi: 10.1016/j.janxdis.2011.10.006 CrossRefGoogle ScholarPubMed
Carr, A. T. (1971). Compulsive neurosis: two psychological studies. Bulletin of the British Psychological Society 24, 256–257. Available at: https://psycnet.apa.org/record/1974-30284-001 Google Scholar
Carr, A. T. (1974). Compulsive neurosis: a review of the literature. Psychological Bulletin 81, 311–331. doi: 10.1037/h0036473 CrossRefGoogle ScholarPubMed
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy 24, 461–470. doi: 10.1016/0005-7967(86)90011-2 CrossRefGoogle ScholarPubMed
Clark, D. M. (1999). Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy 37, 5–27. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=doi=10.1.1.483.5792&rep=repl&type=pdf CrossRefGoogle Scholar
Clark, D. A., & Beck, A. T. (2010). Cognitive Therapy of Anxiety Disorders: Science and Practice. New York, USA: Guilford Press.Google Scholar
Dugas, M. J., Freeston, M. H., & Ladouceur, R. (1997). Intolerance of uncertainty and problem orientation in worry. Cognitive Therapy and Research 21, 596–606. doi: 10.1023/A:1021890322153 CrossRefGoogle Scholar
Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: a preliminary test of a conceptual model. Behaviour Research and Therapy 36, 215–226. doi: 10.1016/S0005-7967(97)00070-3 CrossRefGoogle ScholarPubMed
Dugas, M. J., & Ladouceur, R. (2000). Treatment of GAD: targeting intolerance of uncertainty in two types of worry. Behaviour Modification 24, 635–637. doi: 10.1177/0145445500245002.CrossRefGoogle Scholar
Dugas, M. J., Gosselin, P., & Ladouceur, R. (2001). Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognitive Therapy and Research 5, 551–558. doi: 10.1023/A:100555341468 CrossRefGoogle Scholar
Dugas, M. J., Hedayati, M., Karavidas, A., Buhr, K., Francis, K., & Phillips, N. A. (2005). Intolerance of uncertainty and information processing: evidence of biased recall and interpretations. Cognitive Therapy and Research 29, 57–70. doi: 10.1007/s10608-005-1648-9 CrossRefGoogle Scholar
Dugas, M. J., & Robichaud, M. (2007). Cognitive-Behavioural Treatment for Generalized Anxiety Disorder: From Science to Practice. New York, USA: Routledge.Google Scholar
Einstein, D. A. (2014). Extension of the transdiagnostic model to focus on intolerance of uncertainty: a review of the literature and implications for treatment. Clinical Psychology: Science and Practice 21, 280–300. doi: 10.1111/cusp.12077 Google ScholarPubMed
Ford, M. (2011). Why is uncertainty so intolerable? Investigating the contribution of appraisals in an adolescent sample. Unpublished doctorate thesis, Newcastle University Doctorate in Clinical Psychology.Google Scholar
Freeston, M., Gagnon, F., Ladouceur, R., Thibodeau, N., Letarte, H., & Rheaume, J. (1994). Health related intrusive thoughts. Journal of Psychosomatic Research 38, 203–215. doi: 10.1016/0191-8869(94)90048-5 CrossRefGoogle ScholarPubMed
Gentes, E., & Ruscio, A. (2011). A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive-compulsive disorder. Clinical Psychology Review 31, 923–933. doi: 10.1016/j.cpr.2011.05.001 CrossRefGoogle ScholarPubMed
Grenier, S., Barrette, A., & Ladouceur, R. (2005) Intolerance of uncertainty and intolerance of ambiguity: similarities and differences. Personality and Individual Differences 39, 593–600. doi: 10.1016/j.paid.2005.02.014 CrossRefGoogle Scholar
Grupe, D. W., & Nitsche, J. B. (2013) Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature Review Neuroscience, 14, 488–501. doi: 10.1038/nrn3524 CrossRefGoogle ScholarPubMed
Koerner, N., & Dugas, M. J. (2008). An investigation of appraisals in individuals vulnerable to excessive worry: the role of intolerance of uncertainty. Cognitive Therapy and Research 32, 619–638. doi: 10.1007/s10608-007-9125-2 CrossRefGoogle Scholar
Ladouceur, R., Gosselin, P., & Dugas, M. J. (2000). Experimental manipulation of intolerance of uncertainty: a study of a theoretical model of worry. Behaviour Research and Therapy 38, 933–994. doi: 10.1016/S0005-7967(99)00133-3 CrossRefGoogle Scholar
Ladouceur, R., Talbot, F., & Dugas, M. J. (1997). Behavioural expressions of intolerance of uncertainty in worry: experimental findings. Behaviour Modification 21, 335–371. doi: 10.1177/01454455970213006 CrossRefGoogle ScholarPubMed
Langlois, F., & Ladouceur, R. (2004). Adaption of a GAD treatment for hypochondriasis. Cognitive and Behavioural Practice 11, 393–404. doi: 10.1016/S1077-7229(04)80056-7 CrossRefGoogle Scholar
Lazarus, R. S., (1966). Psychological Stress and the Coping Process. New York, USA: McGraw-Hill.Google Scholar
Mahoney, A. E., & McEvoy, P. M. (2012a). Trait versus situation-specific intolerance of uncertainty in a clinical sample with anxiety and depressive disorders. Cognitive Behaviour Therapy 41, 26–39. doi: 10.1080/16506073.2011.622131.CrossRefGoogle Scholar
Mahoney, A., & McEvoy, P. (2012b). A transdiagnostic examination of intolerance of uncertainty across anxiety and depressive disorders. Cognitive Behaviour Therapy 41, 212–222. doi: 10.1080/16506073.2011.622130 CrossRefGoogle ScholarPubMed
McEvoy, O. M., & Erceg-Hurn, D. (2016). The search for universal transdiagnostic and trans-therapy change processes. Evidence for intolerance of uncertainty. Journal of Anxiety Disorders 20, 157–174. doi: 10.1016/j.janxdis.2005.01.002 Google Scholar
McEvoy, P. M., & Mahoney, A. E. J. (2011). Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression. Journal of Anxiety Disorders 25, 112–122. doi: 10.1016/j.janxdis.2010.08.010 CrossRefGoogle Scholar
McNally, R. J., & Foa, E. B. (1987). Cognition and agoraphobia: bas in the interpretation of threat. Cognitive Therapy and Research 11, 567–581. doi: 10.1007/BF01183859 CrossRefGoogle Scholar
Miranda, R., Fontes, M., & Marroquin, B. (2008). Cognitive content-specificity in future expectancies: role of hopelessness and intolerance of uncertainty in depression and GAD symptoms. Behaviour and Research Therapy 16, 1151–1159. doi: 10.1016/j.brat.2008.05.009 CrossRefGoogle Scholar
Poulton, R. G., & Andrews, G. (1996). Change in danger cognitions in agoraphobia and social phobia during treatment. Behaviour Research and Therapy 34, 413–421. doi: 10.1016/0005-7967(96)00009-5 CrossRefGoogle ScholarPubMed
Pepperdine, E., Lomax, C., & Freeston, M. H. (2018). Disentangling intolerance of uncertainty and threat appraisal in everyday situations. Journal of Anxiety Disorders 57, 31–38. doi: 10.1016/j.janxdis.2018.04.002 CrossRefGoogle ScholarPubMed
Rachman, S. (1990). Fear and Courage. New York, USA: Freeman.Google Scholar
Rachman, S. (2015). The evolution of behaviour therapy and cognitive behaviour therapy. Behaviour Research and Therapy 64, 1–8. doi: 10.1016/j.brat.2014.10.006 CrossRefGoogle ScholarPubMed
Reuman, L., Ryan, J. J., Fabricant, L. E., Herring, B., & Jonathan, S. A. (2015). Uncertainty as an anxiety cue at high and low levels of threat. Journal of Behaviour Therapy and Experimental Psychiatry 47, 111–119. doi: 10.1016/j.jbtep.2014.12.002 CrossRefGoogle ScholarPubMed
Rosen, J. B., & Schulkin, J. (1998). From normal fear to pathological anxiety. Psychological Review 105, 325–350. doi: 10.1037/0033-295X.105.2.325 CrossRefGoogle ScholarPubMed
Rosen, N., & Knauper, B. (2009) A little uncertainty goes a long way: state and trait differences in uncertainty interact to increase information seeking but also increase worry. Health Communication 24, 228–238. doi: 10.1080/10410230902804125 CrossRefGoogle Scholar
Salkovskis, P. (1996). The cognitive approach to anxiety: threat beliefs, safety-seeking behaviour, and the special case of health anxiety and obsessions In Frontiers of Cognitive Therapy (ed. Salkovskis, P), pp. 48–50. London, UK: Guildford Press.Google Scholar
Shihata, S., McEvoy, P. M., Mullan, A. B., & Carleton, R. N. (2016). Intolerance of uncertainty in emotional disorders: what uncertainties remain? Journal of Anxiety Disorders 41, 115–124. doi: 10.1016/j.janxdis.2016.05.001 CrossRefGoogle ScholarPubMed
Smits, J. A., Rosenfield, D., McDonald, R., & Telch, M. J. (2006). Cognitive mechanisms of social anxiety reduction: an examination of specificity and temporality. Journal of Consulting and Clinical Psychology 74, 1203–1212. doi: 10.1037/0022-006X.74.6.1203 CrossRefGoogle ScholarPubMed
Smits, J. A., Julian, K., Rosenfield, D., & Powers, M. B. (2012). Threat reappraisal as a mediator of symptom change in cognitive-behavioral treatment of anxiety disorders: a systematic review. Journal of Consulting and Clinical Psychology 80, 624–635. doi: 10.1037/a0028957 CrossRefGoogle ScholarPubMed
Steketee, G., Frost, R. O., & Cohen, I. (1998). Beliefs in obsessive-compulsive disorder. Journal of Anxiety Disorders 12, 525–537. doi: 10.1016/S0887-6185(98)00030-9 CrossRefGoogle ScholarPubMed
Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., & Foa, E. B. (2003). Intolerance of uncertainty in obsessive-compulsive disorder. Journal of Anxiety Disorders 17, 233–242. doi: 10.1016/j.jocrd.2014.08.004 CrossRefGoogle ScholarPubMed
Uren, T. H., Szabo, M., & Lovibond, P. F. (2004). Probability and cost estimates for social and physical outcomes in social phobia and panic disorders. Anxiety Disorders 18, 481–498. doi: 10.1016/s0887-6185(03)00028-8 CrossRefGoogle Scholar
Woods, C. M., Frist, R. O., & Steketee, G. (2002). Obsessive compulsive (oc) symptoms and subjective severity, probability, and coping ability estimations of future negative events. Clinical Psychology and Psychotherapy 9, 104–111. doi: 10.1002/cpp.304 CrossRefGoogle Scholar
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