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

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) To understand the conceptual foundations of TA and IU in the cognitive model of anxiety. (2) To understand the empirical evidence supporting the role of both TA and IU in anxiety. (3) To appreciate the potential relationship between these concepts in anxiety.

Towards a model of uncertainty distress in the context of Coronavirus (COVID-19)

“…Beck et al, 1985), Salkovskis (1991Salkovskis ( , 1996 proposed an integrated account across disorders that anxiety can be understood as a response to the perceived likelihood of actual danger multiplied by the perceived awfulness or cost of that danger mitigated by the sum of coping and rescue factors. Milne et al (2019) provide a review of the development of these ideas and summarise the limited research that has directly tested this model. They conclude that while the full equation has rarely been tested with the denominator terms included (rescue and coping), there is good evidence for the two separate components of likelihood and cost and limited evidence that the multiplicative component of the model predicts anxiety over and beyond the additive effects of likelihood and cost.…”

“…In a further study by Milne et al . (2017), 295 community adults (75% were 25 years or older), participated in a vignette-based study. Thirty per cent met criteria for elevated anxiety.…”

Making friends with uncertainty: experiences of developing a transdiagnostic group intervention targeting intolerance of uncertainty in IAPT. Feasibility, acceptability and implications

“…Conversely, the MFWU group seeks to target the uncertainty component (B), to increase knowledge and awareness of the responses to uncertainty discomfort and to support individuals to build a new relationship with uncertainty, where safe uncertainty can be more accurately assessed and uncertainty discomfort can be tolerated, with a likely corresponding effect on symptoms. Previous research suggests that a reduction in IU can have a corresponding effect on symptoms of common difficulties (Milne et al, 2019;p. 12).…”

“…The 'Making Friends with Uncertainty' group was novel because it focused on a single transdiagnostic process for people with different and co-morbid anxiety disorders. Studies have shown that IU appears in 'varying degrees from non-clinical to clinical populations : : : and is applicable to people in everyday life situations' (Milne et al, 2019;p. 8).…”

The Relationship Between Anxiety and Intolerance of Uncertainty Levels in Individuals Who Received Liver Transplant: A Descriptive Cross-Sectional Study

“…To be more specific, individuals with IU perceive uncertainty as stressful, annoying and worrying, and they believe that uncertain situations must be avoided. It has been reported that IU is one of the cognitive processes that lead to the development of many psychiatric disorders, primarily anxiety, and that it is one the parameters that should be considered in assessing such disorders (Milne et al, 2019; Tanovic et al, 2018). Although the uncertainty-anxiety and IU-anxiety relationship has been well established, only a few studies have investigated the effect of uncertainty and IU on anxiety (Chen et al, 2018; Oglesby & Schmidt, 2017; Rosen & Knäuper, 2009).…”