An experimental exploration of behavioral and cognitive–emotional aspects of intolerance of uncertainty in eating disorder patients

Sternheim, Lot; Startup, Helen; Schmidt, Ulrike

doi:10.1016/j.janxdis.2011.03.020

Cited by 91 publications

(94 citation statements)

References 44 publications

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“…The manipulations have included tasks such as overt behavioral assessments, a typing task, bead selection tasks, and a cold pressor task. The results have indicated people with higher IU 1) prefer immediately available rewards, even when they are less probable or less valuable (Luhmann, Ishida, & Hajcak, 2011); 2) are less confident about high risk decisions, but also less likely to change their decisions despite receiving new information (Jensen, Kind, Morrison, & Heimberg, 2014); 3) are more likely to seek additional information to increase certainty in nonclinical samples (Jacoby et al, 2014;Jacoby, Abramowitz, Reuman, & Blakey, this issue;Ladouceur, Talbot, & Dugas, 1997;Rosen & Knäuper, 2009), though not consistently in clinical samples (Sternheim, Startup, & Schmidt, 2011); 4) are more likely to increase certainty by behaving, reacting, or deciding more slowly in clinical (Jacoby et al, 2014) and nonclinical samples (Jacoby et al, 2014;Jacoby et al, this issue;Thibodeau et al, 2013); and 5) are more likely to be distressed by uncertainty in clinical (Jacoby et al, 2014) and nonclinical samples (Jacoby et al, this issue). Taken together, these experimental results suggest that manipulating uncertainty may adversely impact behaviors and decision-making, even with relatively low levels of perceived threat.…”

Section: What Is Known?mentioning

confidence: 98%

“…IU has been associated with symptoms of obsessive-compulsive disorder (Holaway, Heimberg, & Coles, 2006;Tolin et al, 2003), social anxiety disorder (Boelen & Reijntjes, 2009;Carleton, Collimore, & Asmundson, 2010), panic disorder with or without agoraphobia (Carleton, Fetzner, Hackl, & McEvoy, 2013;Fetzner, Horswill, Boelen, & Carleton, 2013), health anxiety (Boelen & Carleton, 2012;Fetzner et al, 2013;Wright et al, (Konstantellou, Campbell, Eisler, Simic, & Treasure, 2011;Renjan, McEvoy, Handley, Fursland, & Byrne, this issue;Sternheim et al, 2011), autism spectrum disorders (Boulter, Freeston, South, & Rodgers, 2014), prolonged grief (Boelen, 2010;Boelen et al, this issue), hoarding behaviors (Oglesby et al, 2013;Wheaton, Abramowitz, Jacoby, Zwerling, & Rodriguez, 2016), adult separation anxiety (Boelen, Reijntjes, & Carleton, 2014), and anger-related emotions (Anderson, Deschênes, & Dugas, this issue;Fracalanza, Koerner, Deschênes, & Dugas, 2014). Not only is IU associated with multiple disorders, but trait and disorder-specific IU are correlated with escalating comorbidity (Dupuy & Ladouceur, 2008;McEvoy & Mahoney, 2012;Yook, Kim, Suh, & Lee, 2010).…”

Section: What Is Known?mentioning

confidence: 99%

See 1 more Smart Citation

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

Shihata

McEvoy

Mullan

et al. 2016

Journal of Anxiety Disorders

240

189

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The current paper presents a future research agenda for intolerance of uncertainty (IU), which is a transdiagnostic risk and maintaining factor for emotional disorders. In light of the accumulating interest and promising research on IU, it is timely to emphasize the theoretical and therapeutic significance of IU, as well as to highlight what remains unknown about IU across areas such as development, assessment, behavior, and relationships to emotional disorders. The present paper was designed to provide a synthesis of what is known and unknown about IU, and, in doing so, proposes broad and novel directions for future research to address the remaining uncertainties in the literature.Keywords: intolerance of uncertainty, review, emotional disorders, transdiagnostic, disorder-specific, research agenda WHAT UNCERTAINTIES REMAIN? 3 Intolerance of Uncertainty in Emotional Disorders: What Uncertainties Remain?The current paper briefly reviews what is known about intolerance of uncertainty (IU) before highlighting what remains unknown. Due to rapidly increasing interest and research focus on IU, culminating in the current special issue, a review is both timely and necessary to set a future research agenda. This paper will review IU with respect to conceptual foundations and definitional issues, development, assessment, behavioral consequences, associations to threat and risk, other cognitive vulnerability factors, emotional disorders, as well as clinical applications.Within each of these domains, what is currently known will first be briefly reviewed followed by what remains unknown. The major contribution of the current paper is the description of future research avenues to address the known unknowns. Conceptual Foundations of Intolerance of Uncertainty What is known?Models of psychopathology posit that uncertainty is a central feature in anxiety-related experience (Carleton, 2016) and the incapacity to endure unknowns appears to be a robust vulnerability factor associated with a range of psychological disorders (Grupe & Nitschke, 2013;Hong & Cheung, 2015). IU was originally defined as a broad construct that reflects "cognitive, emotional, and behavioral reactions to uncertainty in everyday life situations" (Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994, p. 792). Freeston and colleagues (1994) speculated that people with IU may engage in worry to increase their sense of certainty and control when faced with ambiguity. The definition of IU evolved as research on IU shifted from an initial focus on generalized anxiety disorder (GAD) to other disorders. A revised and broader definition described IU as a predisposition to negatively perceive and respond to uncertain information and situations irrespective of its probability and outcomes (Ladouceur, Blais, WHAT UNCERTAINTIES REMAIN? 4 Freeston, & Dugas, 1998;Ladouceur, Gosselin, & Dugas, 2000). IU has also been conceptualized as a cognitive filter and as the excessive tendency to perceive and interpret negative events as unacceptable (Buhr & Dugas...

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Section: What Is Known?mentioning

confidence: 98%

Section: What Is Known?mentioning

confidence: 99%

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

Shihata

McEvoy

Mullan

et al. 2016

Journal of Anxiety Disorders

240

189

View full text Add to dashboard Cite

show abstract

“…This corroborates findings by Carleton, Collimore, et al (2010), who particularly demonstrated the importance of the relationship between the Inhibitory Anxiety component of the IU construct and SA. Other pathologies that have been associated with IU are panic disorder (PD) (Dugas, Gagnon, et al, 1998;Dugas, et al, 2001;Tolin, et al, 2003), state anxiety (Chen & Hong, 2010;Greco & Roger, 2001), obsessive compulsive personality disorder (Gallagher, South, & Oltmanns, 2003), eating disorders (Konstantellou, et al, 2011;Sternheim, et al, 2011), and somatoform disorders (Deacon & Abramowitz, 2008;Boelen & Carleton, 2012). However, IU does not seem to be critical for depressive disorders (Boelen & Reijntjes, 2009;Dugas, Schwartz, & Francis, 2004).…”

Section: Cfa Indicated That the Ius-12 Model With The Two Factors Promentioning

confidence: 99%

“…Worry is a central characteristic of Generalized Anxiety Disorder (GAD), but also occurs frequently in other mental disorders such as obsessive compulsive disorder (Sica, Coradeschi, Sanavio, & Novara, 2004), social anxiety (Boelen & Reijntjes, 2009), depression (Yook, Kim, Suh, & Lee, 2010), panic disorder with agoraphobia (Dugas, Marchand, & Ladouceur, 2005), post-traumatic stress disorder (Boelen, 2010), eating disorders (Konstantellou, Campbell, Eisler, Simic, & Treasure, 2011;Sternheim, Startup, & Schmidt, 2011), and somatoform disorders (Deacon & Abramowitz, 2008;Boelen & Carleton, 2012). …”

Section: Introductionmentioning

confidence: 99%

Confirmatory factor analysis of the Dutch Intolerance of Uncertainty Scale: Comparison of the full and short version

Helsen

Bussche

Vlaeyen

et al. 2013

Journal of Behavior Therapy and Experimental Psychiatry

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Background and Objectives. The Intolerance of Uncertainty Scale (IUS) was developed for assessing reactions to ambiguous situations, uncertainty, and future events. The IUS has been validated in different languages, but equivocal factor structures, in combination with highly interrelated items and factors, resulted in a redundancy of the items of the English version. In the current study, the psychometric properties of the Dutch version of the IUS were examined, and compared with the shortened 12-item version (IUS-12).Methods. Confirmatory factor analyses were used to investigate different factor structures of both the full and short version of the IUS. Results. Results indicated that the IUS-12 model with two factors (ProspectiveAnxiety and Inhibitory Anxiety) provides the best fit. The reduced measure has equally good internal consistency, and is highly correlated with the full version.Limitations. Future research could investigate whether the current findings generalize to clinical populations. Conclusion.To summarize, the usage of the short 12-item version of the IUS should be encouraged in future research concerning intolerance of uncertainty.

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“…Finally, patients were sent the revised version of the MANTRA workbook. This included (1) a traffic light system of relapse risk for patients to complete, to increase their awareness of potential indicators of such risk; (2) a nutrition plan that was designed for weight maintenance and also gave information on what to do if more weight gain was needed; (3) a module addressing anxiety-related processes, such as worry and intolerance of uncertainty and strategies to reduce them (this was included as patients with AN generally have high levels of anxiety, worry and intolerance of uncertainty, [287][288][289][290] and it was thought that during the post-discharge period this would be particularly intensive and therefore an important treatment target); and (4) strategies to prevent and cope with deterioration and lapses.…”

Section: Internet-based Maudsley Model Of Anorexia Nervosa Treatment mentioning

confidence: 99%

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

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An experimental exploration of behavioral and cognitive–emotional aspects of intolerance of uncertainty in eating disorder patients

Cited by 91 publications

References 44 publications

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

Confirmatory factor analysis of the Dutch Intolerance of Uncertainty Scale: Comparison of the full and short version

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

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