I doubt it is safe: A meta-analysis of self-reported intolerance of uncertainty and threat extinction training

Abstract

Intolerance of uncertainty (IU), the tendency to find uncertainty distressing, is an important transdiagnostic dimension in mental health disorders. Higher self-reported IU has been linked to poorer threat extinction training (i.e., the updating of threat to safe associations), a key process that is targeted in exposure-based therapies. However, it remains to be seen whether IU-related effects during threat extinction training are reliably and specifically driven by the IU construct or a particular subcomponent of the IU construct over other self-reported measures of anxiety. A meta-analysis of studies from different laboratories (experiment n = 18; sample n = 1006) was conducted on associations between different variants of self-reported IU (i.e., 27-item, 12-item, inhibitory and prospective subscales), trait anxiety and threat extinction training via skin conductance response. The specificity of IU and threat extinction training was assessed against measures of trait anxiety. All of the self-reported variants of IU, but not trait anxiety, were associated with threat extinction training via skin conductance response (i.e., continued responding to the old threat cue). Specificity was observed for the majority of self-reported variants of IU over of trait anxiety. The findings suggest that the IU construct broadly accounts for difficulties in threat extinction training and is specific over other measures of self-reported anxiety. These findings demonstrate the robustness and specificity of IU-related effects during threat extinction training and highlight potential opportunities for translational work to target uncertainty in therapies that rely on threat extinction principles such as exposure therapy.

An examination of intolerance of uncertainty effects on subjective, psychophysiological, and neural markers during uninstructed and instructed threat acquisition and extinction training

“…(4) Higher IU will be specifically associated with greater skin conductance responding and BOLD activity in the salience network (i.e. amygdala, insula, ventromedial prefrontal cortex) to learned threat vs. safe cues during uninstructed threat extinction training, similar to previous research (Morriss, Wake, et al, 2021;Morriss, Zuj, et al, 2021).…”

“…Classical threat conditioning mechanisms have been typically examined to model the development and treatment of anxiety, trauma, and obsessive-compulsive disorders (Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014;Jacoby & Abramowitz, 2016;McNally, 2007;Pittig, Treanor, LeBeau, & Craske, 2018). An emerging body of research has identified IU as an important modulator of classical threat conditioning mechanisms (Lonsdorf & Merz, 2017;Morriss, Wake, Elizabeth, & van Reekum, 2021;Morriss, Zuj, & Mertens, 2021). While evidence is inconclusive on the role of IU in the initial learning of threat and safety associations during acquisition training (i.e.…”

Effects of intolerance of uncertainty on subjective and psychophysiological measures during fear acquisition and delayed extinction

“…Secondly, the lack of IU-related effect on psychophysiological measures during delayed extinction training may be due to a methodological difference. More specifically, a recent meta-analysis (Morriss, Wake, et al, 2021) highlighted that IU-related differences on skin conductance response were observed during the late part of extinction training (i.e. defined as the last 6-10 trials per CS type in studies with over 24 trials in total).…”

“…(2) Higher IU, over STAI-T, will be specifically associated with greater skin conductance responding to learned fear vs. safe cues during delayed extinction training, like prior work of immediate extinction training (Morriss, Wake, et al, 2021;Morriss, Zuj, et al, 2021).…”

“…For instance, during reinstatement, an unsignalled US typically results in a return of the conditioned responding (for review see, . 4 Promisingly, a growing body of research has identified a critical role of IU in modulating classical fear conditioning mechanisms during different classical fear conditioning procedures (for review see, Lonsdorf & Merz, 2017;Morriss, Wake, Elizabeth, & van Reekum, 2021;Morriss, Zuj, & Mertens, 2021;Sjouwerman, Scharfenort, & Lonsdorf, 2020). Currently, the findings have been mixed with regards to how IU influences initial learning of fear and safety associations during fear acquisition training (for review see, Morriss, Zuj et al, 2021).…”