Intolerance of uncertainty in emotional disorders: What uncertainties remain?

Abstract

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...

The relationship between intolerance of uncertainty in chiropractic students and their treatment intervention choices

“…More recent research has suggested that measures of IU should be designed around the specific situations in which they occur [1, 2, 44]. For example the items in the IUS-12 could be altered in future studies to make them specific to the diagnosis and treatment of lower back pain to improve our capacity to understand the role of IU in low back pain care.…”

“…In this context, intolerance of uncertainty (IU) could be one such psychological factor. IU refers to a dispositional characteristic that reflects a set of negative beliefs about uncertainty and its implications and represents an underlying fear of the unknown [1, 2]. IU has also been described as an incapacity to endure the aversive response triggered by the absence of salient, key or sufficient information [3].…”

“…clinical tests) when not required, and a propensity to react and behave overly cautiously even in low levels of perceived threat [2, 12]. However, the art of clinical practice involves learning to deal with varying levels of uncertainty.…”

“…In contrast, those who have low levels of IU have been shown to be more psychologically flexible, less distressed by uncertainty, and enjoy higher levels of psychological health [2, 19]. Further they are more likely to act in a timely and measured manner [20].…”

Preliminary evidence that reactivity to uncertain threat is an endophenotype for alcohol use disorder

“…Reactivity to U-threat may therefore be a vulnerability factor for problematic alcohol use that precedes AUD onset. In addition, because sensitivity to uncertainty is posited to be a dispositional characteristic that emerges early in life and has neurobiological underpinnings (Shihata et al, 2016; Shankman et al, 2014), exaggerated reactivity to U-threat may be an endophenotype for AUD.…”