Stomaching uncertainty: Relationships among intolerance of uncertainty,eating disorder pathology,and comorbid emotional symptoms

Intolerance of uncertainty (IU) is proposed to be a transdiagnostic vulnerability factor for various emotional disorders. There is robust evidence for the role of IU in anxiety and depressive disorders, but a paucity of evidence in eating disorders (ED). This study evaluated the factorial validity, internal consistency, and convergent validity of the Intolerance of Uncertainty Scale—Short Form (IUS-12; Carleton, Norton, & Asmundson, 2007), and examined whether IU is associated with ED pathology and comorbid emotional symptoms, in a clinical sample with EDs (N = 134). A unitary factor solution provided the best fit. The IUS-12 showed excellent internal consistency, and good convergent validity. IU had an indirect effect on dietary restraint, purging, and emotional symptoms via overvaluation of eating, weight, and shape. The indirect effect was not significant for bingeing. Findings provide partial support for the notion that IU is a vulnerability factor for ED pathology and support the notion that IU is a transdiagnostic vulnerability factor for emotional symptoms. Limitations, research implications, and future directions for research are discussed.     

Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression

Evidence is accumulating that intolerance of uncertainty (IU) may be a transdiagnostic maintaining factor across the anxiety disorders and depression. However, psychometric studies of the most commonly used measure of IU have typically used undergraduate students, and the factor structure has been highly inconsistent. Previous studies have also tended to focus on one diagnostic subgroup or related symptom, thereby limiting transdiagnostic comparisons. The first aim of this study was to test the latent structure of a commonly used measure of IU in a treatment-seeking sample with anxiety and depression (n = 463). The second aim was to examine psychometric properties of the best fitting solution, including internal reliability, convergent validity, and discriminant validity. Confirmatory factor analysis was used to compare the goodness of fit of five models previously found with undergraduate and community samples. A two-factor solution, comprising of prospective anxiety and inhibitory anxiety, was the best fitting model. The total scale and subscales demonstrated excellent internal reliability. Convergent validity was demonstrated by the scales correlating with symptoms associated with five anxiety disorders and depression, as well as neuroticism, distress and disability. IU explained unique variance in all symptom measures, even after controlling for neuroticism and other symptom measures. Evidence of discriminant validity was also found for each IU subscale. Findings support reliability and validity of the two-factor solution, and are consistent with IU being a transdiagnostic maintaining factor.     

The prevalence,comorbidity and risks of prolonged grief disorder among bereaved Chinese adults

Few epidemiological studies have investigated prolonged grief disorder (PGD) in the general population of Asian countries, including China. The aim of this study was to explore the rates and risks of PGD, and the association between PGD, post-traumatic stress disorder (PTSD), depression and anxiety in bereaved Chinese adults. The PG-13, PTSD Checklist-Civilian Version (PCL-C), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) were administered to 445 subjects. Prevalence within the general population of China was 1.8% (i.e., 8/445). Among the eight subjects who met the PGD diagnosis, 75%, 87.5% and 75% scored above the cut-off point on the PCL-C, SDS and SAS, respectively, although a portion remained free from comorbidity. ANOVA, correlation analysis and stepwise multiple regression analysis demonstrated that kinship to deceased, age of the deceased, religion belief and cause of death were predictive of prolonged grief. A small proportion of bereaved persons may exhibit PGD. There is a substantial but far from complete overlap between PGD and the other three diagnoses. Bereaved parents and the widowed have high risk of PGD. These findings highlight the need for prevention, diagnosis and treatment for PGD patients.     

Dissemination and implementation of prolonged exposure therapy for posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a highly prevalent, often chronic and disabling psychiatric disorder that is associated with significant adverse health and life consequences. Although several evidence-based treatments (EBTs), including Prolonged Exposure therapy (PE), have been found effective and efficacious in reducing PTSD symptomology, the majority of individuals with this disorder receive treatments of unknown efficacy. Thus, it is imperative that EBTs such as PE be made available to PTSD sufferers through widespread dissemination and implementation. We will review some of the efforts to increase the availability of PE and the common barriers to successful dissemination and implementation. We also discuss novel dissemination strategies that are harnessing technology to overcome barriers to dissemination.     

Intolerance of uncertainty,posttraumatic stress,depression, and fears for the future among displaced refugees

IntroductionThe vast majority of the 100 million forcibly displaced persons worldwide live in a state of prolonged uncertainty with limited resettlement prospects and access to resources. Little is known, however, regarding how refugees and asylum-seekers cope with this uncertainty.MethodsIn this study, we investigated the longitudinal association between a measure of how people cope with uncertainty (intolerance of uncertainty (IU)), fears for the future, posttraumatic stress disorder (PTSD) symptoms and depression symptoms. A sample of 1,237 refugees displaced in Indonesia completed an online survey in Arabic, Farsi, Dari, Somali or English at two time-points six-months apart.ResultsResults indicated that greater IU-inhibitory anxiety (IU-IA or impairment related to uncertainty) was associated with subsequent increases in PTSD and depression symptoms and fears for the future. Greater PTSD symptoms and fears for the future were associated with increases in IU-prospective anxiety (IU-PA or distress related to uncertainty), and greater depression symptoms were associated with increases in IU-IA.DiscussionThese findings provide evidence for the mechanistic role of IU in psychological symptoms amongst displaced refugees. Results underscore the importance of policies to reduce uncertainty in displacement environments, and highlight IU as a potential intervention target to help refugees cope with protracted displacement.     

无法忍受不确定性对焦虑的影响及其机制

本文目的是对近年来国内外关于无法忍受不确定性（IU）对焦虑影响及机制的相关研究进行综述。IU是指个体无法忍受因感知到缺乏突出的、关键的或充分的信息而产生的厌恶反应,具有个体倾向性。IU在焦虑的发生发展中起着重要作用,但具体过程和机制尚不明确。本文就IU对焦虑的影响进行综述,并从认知、情绪和行为三个角度阐明其对焦虑产生和发展的作用机制,为预防一般焦虑情绪发展为焦虑障碍以及研发新的心理干预与治疗策略提供参考。     

Comparison of latent typologies of posttraumatic stress disorder and depression symptoms across military personnel from India and the US

Research has identified heterogeneous subgroups of individuals based on posttraumatic stress disorder (PTSD) and depression symptoms. Using data collected from military personnel in India (N = 146) and U.S. (N = 194), we examined (1) the best-fitting latent class solution; (2) multi-group invariance of the class solution; and (3) construct validity of optimal class solution. Results indicated that the optimal 4-class solution differed in severity and severity/type in the India and U.S. samples respectively. With similarity in the optimal number of classes across cultural samples, the meaning/nature of classes differed. In the India sample, anxiety severity predicted the Low Severity Class vs. all other classes, and the Moderately High Severity/High Severity Classes vs. the Moderately Low Severity Class; number of traumas predicted the High Severity Class vs. other classes; and resilience predicted the Moderately Low Severity Class vs. the Moderately High Severity Class. In the U.S. sample, alcohol use predicted the High Severity Class vs. all other classes, and the High Depression-Low PTSD Class vs. the Low Severity Class; rumination significantly predicted the High Severity and High Depression-Low PTSD Classes vs. each of the High PTSD-Low Depression and Low Severity Classes. Thus, meaning and nature of PTSD-depression subgroups may vary culturally; hence, culturally-sensitive interventions need to account for this heterogeneity.     

Family psychiatric history, peritraumatic reactivity, and posttraumatic stress symptoms: A prospective study of police

Background

Family history of psychiatric and substance use disorders has been associated with posttraumatic stress disorder (PTSD) in cross-sectional studies.

Method

Using a prospective design, we examined the relationships of family history of psychiatric and substance use disorders to posttraumatic stress symptoms in 278 healthy police recruits. During academy training, recruits were interviewed on family and personal psychopathology, prior cumulative civilian trauma exposure, and completed self-report questionnaires on nonspecific symptoms of distress and alcohol use. Twelve months after commencement of active duty, participants completed questionnaires on critical incident exposure over the previous year, peritraumatic distress to the worst critical incident during this time, and posttraumatic stress symptoms.

Results

A path model indicated: (1) family loading for mood and anxiety disorders had an indirect effect on posttraumatic stress symptoms at 12 months that was mediated through peritraumatic distress to the officer’s self-identified worst critical incident, (2) family loading for substance use disorders also predicted posttraumatic stress symptoms at 12 months and this relationship was mediated through peritraumatic distress.

Conclusion

These findings support a model in which family histories of psychopathology and substance abuse are pre-existing vulnerability factors for experiencing greater peritraumatic distress to critical incident exposure which, in turn, increases the risk for development of symptoms of posttraumatic stress disorder. Replication in other first responders, military and civilians will be important to determine generalizability of these findings.     

Inflammation as a predictor of disease course in posttraumatic stress disorder and depression: A prospective analysis from the Mind Your Heart Study

BackgroundPrior research has focused largely on the pro-inflammatory states of PTSD and depression, with few studies evaluating the direction of inflammation’s association with these disorders. To clarify whether inflammation plays a role in the development of PTSD or depression, we assessed the predictive value of inflammatory biomarkers on the courses of these conditions in a cohort of Veterans.MethodsThis research was part of the Mind Your Heart Study, a prospective cohort study designed to examine PTSD-related health outcomes. Between 2008 and 2010, 746 San Francisco area Veterans Administration patients were enrolled. At baseline, inflammatory biomarkers were measured from fasting morning venous blood draws, and cortisol and catecholamine levels were measured from 24-hour urine samples. PTSD was diagnosed using the PTSD Checklist at baseline and annual follow-up. Depression was evaluated using the 9-item Patient Health Questionnaire at baseline and follow-up. Ordinal logistic regression models were used to assess the predictive value of baseline biomarker levels on clinically relevant courses of PTSD and depression categorized and ordered as none, resolved, developed, and chronic.ResultsAfter adjustment for age and sex, elevated levels of white blood cell count (OR = 1.27(1.10–1.47), p = 0.001), C-reactive protein (OR = 1.20(1.04–1.39), p = 0.02), fibrinogen (OR = 1.19(1.03–1.38), p = 0.02), and ESR (OR = 1.17(1.00–1.36, p = 0.05), and decreased levels of urine cortisol (OR = 0.84(0.71–0.99), p = 0.04) were significant predictors of poorer courses of PTSD. Elevated levels of WBC count (OR = 1.31(1.14–1.50), p < 0.001), CRP (OR = 1.24(1.07–1.43), p = 0.003), fibrinogen (OR = 1.26(1.09–1.46), p = 0.002), and catecholamines (OR = 1.17(1.01–1.36), p = 0.04) were significant predictors of poorer courses of depression. After additionally controlling for physical activity, elevated WBC count (p = 0.002) and decreased levels of urine cortisol (p = 0.05) remained significant predictors of PTSD course, and elevated WBC count (p = 0.001), CRP (p = 0.03), and fibrinogen (p = 0.02) remained significant predictors of depression course. After adjusting for all significant variables, elevated WBC count (p = 0.02) was a significant predictor of a poorer course of PTSD, and elevated WBC count (p = 0.04) and platelet count (p = 0.03) were significant predictors of a poorer course of depression.ConclusionsIncreased levels of several inflammatory biomarkers were associated with significantly increased odds of clinically worse courses of PTSD and depression. Inflammation may be a target for prevention and treatment of these mental health disorders.     

Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event

Intolerance of uncertainty (IU) has been associated with elevated post-traumatic stress symptoms (PTSS) in the extant literature. However, no research to date has investigated whether pre-trauma IU predicts PTSS following trauma exposure. The current study prospectively examined the relationship between IU and PTSS within a sample of individuals with various levels of exposure to a university campus shooting. We hypothesized that pre-trauma IU would predict elevated PTSS following a campus shooting, even after covarying for anxiety sensitivity (AS), a known correlate of PTSS. Participants included undergraduates (n = 77) who completed a self-report battery in Introductory Psychology. After a campus shooting, they were invited to complete measures of PTSD symptoms and level of exposure to the shooting. As anticipated, results revealed pre-trauma IU as a significant predictor of elevated PTSS following the campus shooting. These results remained significant after covarying for pre-trauma levels of AS. Our results are the first to demonstrate that elevated pre-trauma levels of IU predict later PTSS following exposure to a traumatic event. This finding is discussed in terms of promising directions for future research and treatment strategies.     

Distress tolerance in OCD and anxiety disorders,and its relationship with anxiety sensitivity and intolerance of uncertainty

There is a growing interest in the role of distress tolerance (i.e., the capacity to withstand negative emotions) in the onset and maintenance of anxiety. However, both empirical and theoretical knowledge regarding the role of distress tolerance in the anxiety disorders is relatively under examined. Accumulating evidence supports the relationship between difficulties tolerating distress and anxiety in nonclinical populations; however, very few studies have investigated distress tolerance in participants with diagnosed anxiety disorders. Individuals with social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder with and without agoraphobia (PD/A) and obsessive-compulsive disorder (OCD) completed measures of distress tolerance (DT), conceptually related measures (i.e., anxiety sensitivity (AS), intolerance of uncertainty (IU)), and anxiety symptom severity. Results showed that DT was negatively associated with AS and IU. DT was correlated with GAD, SAD and OCD symptoms, but not PD/A symptoms, in individuals with those respective anxiety disorders. DT was no longer a significant predictor of OCD or anxiety disorder symptom severity when AS and IU were also taken into account. There were no between group differences on DT across OCD and the anxiety disorder groups. Implications for the role of distress tolerance in anxiety pathology are discussed.     

The prospective influence of COVID-19 affective risk assessments and intolerance of uncertainty on later dimensions of health anxiety

The COVID-19 pandemic is likely to increase risk for the development of health anxiety. Given that elevated health anxiety can contribute to maladaptive health behaviors, there is a need to identify individual difference factors that may increase health anxiety risk. This study examined the unique and interactive relations of COVID-19 affective risk assessments (worry about risk for contracting/dying from COVID-19) and intolerance of uncertainty to later health anxiety dimensions. A U.S. community sample of 364 participants completed online self-report measures at a baseline assessment (Time 1) and one month later (Time 2). Time 1 intolerance of uncertainty was uniquely associated with the Time 2 health anxiety dimension of body vigilance. Time 1 affective risk assessments and intolerance of uncertainty were uniquely associated with later perceived likelihood that an illness would be acquired and anticipated negative consequences of an illness. The latter finding was qualified by a significant interaction, such that affective risk assessments were positively associated with anticipated negative consequences of having an illness only among participants with mean and low levels of intolerance of uncertainty. Results speak to the relevance of different risk factors for health anxiety during the COVID-19 pandemic and highlight targets for reducing health anxiety risk.     

Shame,guilt, and posttraumatic stress symptoms: A three-level meta-analysis

Existing empirical findings are inconsistent on the correlations of shame and guilt with posttraumatic stress symptoms (PTSS). This study aimed to quantitatively summarize the strength of the associations of shame and guilt with PTSS and explore potential moderators. Based on a three-level meta-analytic method, shame was positively correlated with PTSS, no matter whether the effects of guilt were controlled; guilt also had a positive correlation with PTSS, regardless of whether the effects of shame were partialling out. Moderator analyses showed that type of shame measure (generalized vs. contextual vs. trauma-specific shame) moderated the relation between shame and PTSS, and type of guilt measure (generalized vs. contextual vs. trauma-specific guilt) moderated the relation between guilt and PTSS. In addition, culture had a marginally significant moderating effect on the relation between guilt and PTSS, with a stronger association of guilt with PTSS in Western culture than in Eastern culture. These results supported the links of shame and guilt to PTSS and implied that we should focus on the conceptual underpinnings of the manifest psychometric issue and maintain cultural sensitivity in future research. The implications for posttraumatic stress disorder treatment were also discussed.     

Developing scales measuring disorder-specific intolerance of uncertainty (DSIU): A new perspective on transdiagnostic

Intolerance of uncertainty (IU) is a construct of growing prominence in literature on anxiety disorders and major depressive disorder. Existing measures of IU do not define the uncertainty that respondents perceive as distressing. To address this limitation, we developed eight scales measuring disorder-specific intolerance of uncertainty (DSIU) relating to various anxiety disorders and major depressive disorder. We used exploratory factor analysis and item characteristic curves in two large undergraduate samples (Ns = 627 and 628) to derive eight three-item DSIU scales (24 items total) that exhibited excellent psychometric properties. Confirmatory factor analysis supported the factor structures of the scales and the transdiagnostic nature of IU. Each scale predicted unique variance in its respective symptom measure beyond a traditional measure of IU. DSIU represents a theoretically proximal and causal intermediary between known vulnerability factors and disorder symptomatology. The DSIU scales can be used to advance theories of psychopathology and inform case conceptualization and treatment planning.     

Temporal allocation of attention toward threat in individuals with posttraumatic stress symptoms

Research suggests that individuals with posttraumatic stress disorder (PTSD) selectively attend to threat-relevant information. However, little is known about how initial detection of threat influences the processing of subsequently encountered stimuli. To address this issue, we used a rapid serial visual presentation paradigm (RSVP; Raymond, J. E., Shapiro, K. L., &; Arnell, K. M. (1992). Temporary suppression of visual processing in an RSVP task: An attentional blink? Journal of Experimental Psychology: Human Perception and Performance, 18, 849–860) to examine temporal allocation of attention to threat-related and neutral stimuli in individuals with PTSD symptoms (PTS), traumatized individuals without PTSD symptoms (TC), and non-anxious controls (NAC). Participants were asked to identify one or two targets in an RSVP stream. Typically processing of the first target decreases accuracy of identifying the second target as a function of the temporal lag between targets. Results revealed that the PTS group was significantly more accurate in detecting a neutral target when it was presented 300 or 500 ms after threat-related stimuli compared to when the target followed neutral stimuli. These results suggest that individuals with PTSD may process trauma-relevant information more rapidly and efficiently than benign information.     

The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty

The search for universal processes associated with symptom change across emotional disorders and different forms of psychotherapy offers hope of increased theoretical parsimony and treatment efficiencies. This study investigated whether intolerance of uncertainty (IU) is a universal process by examining whether changes in IU were associated with changes in symptoms across three different cognitive behavior therapy protocols for depression (n = 106), social anxiety disorder (n = 88), or generalized anxiety disorder (n = 62) in a community mental health clinic. IU was associated with reductions in repetitive negative thinking in all treatments, which is consistent with IU being a transdiagnostic and ‘trans-therapy’ process of change. Changes in IU were also associated with symptom relief in the social anxiety disorder and generalized anxiety disorder groups, but not in the depression group. Implications of these findings are discussed within the broader literature of transdiagnostic approaches to emotional disorders.     

Predictors of posttraumatic stress disorder, depression, and suicidal ideation among Canadian Forces personnel in a National Canadian Military Health Survey

Despite efforts to elucidate the relationship between traumatic event exposure and adverse mental health outcomes, our ability to understand why only some trauma-exposed individuals become emotionally affected remains challenged. The aim of the current study is to determine the relations between social support, religiosity, and number of lifetime traumatic events experienced on past-12 month posttraumatic stress disorder (PTSD), depression, and suicidal ideation (SI) in a nationally representative sample of Canadian Forces personnel. The current study used data from the Canadian Community Health Survey Cycle 1.2 - Canadian Forces Supplement. The impact of a number of predictive and mediating factors was assessed using structural equation modeling. Social support and number of lifetime traumatic events experienced were significant predictors of past-year PTSD, depression, and SI; however PTSD did not mediate the relationship between number of traumatic events and SI nor between social support and SI. Conversely, depression mediated the relationship between number of traumatic events and SI. Possible mechanisms for these findings and their implications are discussed.     

The wonder and angst of exploring the unknown: Introduction to the special issue on intolerance of uncertainty

Interest in the relationship between intolerance of uncertainty (IU) and emotional disorders has rapidly increased over the last decade. Early theory and research focused on the relationship between IU and generalized anxiety disorder in particular; but, the roles that IU and the underlying ‘fear of the unknown’ play in the development, maintenance, and treatment of a broad array of emotional disorders have been explored more recently. This introduction provides a brief overview of the contributions to the special issue, which (a) summarize our current state of knowledge, (b) describe innovative methods for assessing and increasing our understanding IU within the context of various emotions and emotional disorders, (c) investigate associations between IU and therapeutic change, and (d) propose future research directions.