Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment

Gillett, Carrie B.; Bilek, Emily L.; Hanna, Gregory L.; Fitzgerald, Kate D.

doi:10.1016/j.cpr.2018.01.007

Cited by 86 publications

(52 citation statements)

References 125 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Intolerance of uncertainty (IoU) is a trait characterised by the overvaluation of predictability and the tendency to become overwhelmed by the unexpected or the unknown (Birrell et al, 2011;Carleton, 2016;Koerner & Dugas, 2006). In neurotypical populations, IoU is recognised as a dispositional risk factor in the development of generalised anxiety disorder (Carleton et al, 2012;Freeston et al, 1994) and plays a substantial role in social anxiety (Boelen & Reijntjes, 2009;Teale Sapach et al, 2015), obsessivecompulsive disorder (Holaway et al, 2006;Lind & Boschen, 2009;Tolin et al, 2003) and depression (Carleton et al, 2012;de Jong-Meyer et al, 2009;McEvoy & Mahoney, 2012;Nelson et al, 2014). Across diagnostic groups, meta-analytic studies have revealed a robust association between IoU and anxiety in children (Osmanağaoğlu et al, 2018) and in adults (Gentes & Ruscio, 2011).…”

Section: Intolerance Of Uncertaintymentioning

confidence: 99%

The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis

Jenkinson

Milne

Thompson

2020

Autism

110

View full text Add to dashboard Cite

The association between intolerance of uncertainty and anxiety has proved robust in neurotypical populations and has led to effective interventions targeting intolerance of uncertainty. The aim of this systematic review and meta-analysis was to investigate this association in autistic people, given the high prevalence of anxiety in this population and the limited effectiveness of therapies used currently to treat anxiety in autism. A protocol was published on the Prospero database (CRD42019125315), and electronic databases were searched using terms related to intolerance of uncertainty, anxiety and autism. Included in the systematic review were 12 studies, of which 10 were included in a meta-analysis. Results showed that anxiety and intolerance of uncertainty were consistently elevated in autistic participants. Examining the correlation between these two constructs, the meta-analysis revealed a large sample-weighted effect size, r = 0.62, 95% confidence interval = [0.52, 0.71], p < 0.001. The strength of this association was comparable to meta-analyses conducted on neurotypical populations, and therefore, it was concluded intolerance of uncertainty may be an appropriate target for intervention for autistic individuals. However, conclusions were limited due to the small number of relevant studies that were available and due to issues with methodological quality. Lay abstract People who find it especially hard to cope with the unexpected or unknown are said to have an intolerance of uncertainty. Autistic individuals often report a preference for certainty and experience levels of anxiety that can interfere with their daily life. Understanding more about the link between the intolerance of uncertainty and anxiety in autistic people might lead to better treatments for anxiety being developed. Therefore, this work aimed to review previous research in order to explore this link. Twelve studies were found and their results were compared and contrasted. The autistic people who participated in the studies completed questionnaires that suggested a large number of them experienced very high levels of anxiety and intolerance of uncertainty. Of 10 studies that used relevant statistics, nine found a statistically significant link between anxiety and the intolerance of uncertainty. In general, the strength of the link was about the same as previous research found in people who did not have a diagnosis of autism. This might mean that interventions that aim to help people who are intolerant of uncertainty could be effective for autistic individuals.

show abstract

Section: Intolerance Of Uncertaintymentioning

confidence: 99%

The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis

Jenkinson

Milne

Thompson

2020

Autism

110

View full text Add to dashboard Cite

show abstract

“…Whilst we may expect a delay between theoretical proposition of a mechanism and generation of a substantial body of evidence investigating its causal influence, the propositions of IU's relevance to difficulties such as GAD (e.g., Dugas et al 1998) and OCD (e.g., OCCWG 1997) are well established, yet sufficient evaluation of causality remains lacking. Notably, IU appears considered a clinically relevant target for intervention (see Gillett et al 2018), despite the limited causal research available to substantiate this focus. This review vehemently echoes Shihata et al (2016) imploration for a greater body of research explicitly exploring IU as a causal mechanism of psychological difficulty through experimental and longitudinal designs.…”

Section: Developing Further Research Exploring Causalitymentioning

confidence: 99%

Intolerance of Uncertainty as a Transdiagnostic Mechanism of Psychological Difficulties: A Systematic Review of Evidence Pertaining to Causality and Temporal Precedence

Rosser

2018

Cogn Ther Res

120

View full text Add to dashboard Cite

Intolerance of uncertainty (IU) is proposed to be a transdiagnostic causal mechanism of psychological difficulties. The systematic review sought to evaluate the status of evidence pertaining to IU's proposed causal influence upon symptoms of psychological conditions. The review collated evidence from studies involving experimental manipulation and assessment of temporal precedence to ensure direct assessment of causality. The search strategy and eligibility screening identified 12 articles, detailing 15 eligible studies (experimental manipulations: n = 10; temporal precedence studies: n = 5). Available evidence comprised symptoms of anxiety-and mood-related conditions, including obsessive-compulsive disorder (OCD). The greatest support for IU as a causal mechanism was evident for anxiety-related difficulties and, to a lesser extent, negative affect; limited support was found for OCD-related difficulties. However, notable inconsistency across study findings for all difficulty types precludes absolute conclusions. Implications and recommendations are discussed.

show abstract

“…In OCD, increased exploration of nonoptimal decks may be related to greater intolerance of uncertainty, reduced confidence in memories and decisions, and increased need for information sampling in the disorder 71 , 72 , 73 , 74 . In other words, OCD patients may have decreased confidence in their assessment of deck expectancies and their memories of previous outcomes, with this underlying an increased tendency to recheck the alternative decks (75) .…”

Section: Discussionmentioning

confidence: 99%

Frontostriatal Dysfunction During Decision Making in Attention-Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder

Norman

Carlisi

Christakou

et al. 2018

Biological Psychiatry: Cognitive Neuroscience and Neuroimaging

View full text Add to dashboard Cite

BackgroundThe aim of the current paper is to provide the first comparison of computational mechanisms and neurofunctional substrates in adolescents with attention-deficit/hyperactivity disorder (ADHD) and adolescents with obsessive-compulsive disorder (OCD) during decision making under ambiguity.MethodsSixteen boys with ADHD, 20 boys with OCD, and 20 matched control subjects (12–18 years of age) completed a functional magnetic resonance imaging version of the Iowa Gambling Task. Brain activation was compared between groups using three-way analysis of covariance. Hierarchical Bayesian analysis was used to compare computational modeling parameters between groups.ResultsPatient groups shared reduced choice consistency and relied less on reinforcement learning during decision making relative to control subjects, while adolescents with ADHD alone demonstrated increased reward sensitivity. During advantageous choices, both disorders shared underactivation in ventral striatum, while OCD patients showed disorder-specific underactivation in the ventromedial orbitofrontal cortex. During outcome evaluation, shared underactivation to losses in patients relative to control subjects was found in the medial prefrontal cortex and shared underactivation to wins was found in the left putamen/caudate. ADHD boys showed disorder-specific dysfunction in the right putamen/caudate, which was activated more to losses in patients with ADHD but more to wins in control subjects.ConclusionsThe findings suggest shared deficits in using learned reward expectancies to guide decision making, as well as shared dysfunction in medio-fronto-striato-limbic brain regions. However, findings of unique dysfunction in the ventromedial orbitofrontal cortex in OCD and in the right putamen in ADHD indicate additional, disorder-specific abnormalities and extend similar findings from inhibitory control tasks in the disorders to the domain of decision making under ambiguity.

show abstract

Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment

Cited by 86 publications

References 125 publications

The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis

The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis

Intolerance of Uncertainty as a Transdiagnostic Mechanism of Psychological Difficulties: A Systematic Review of Evidence Pertaining to Causality and Temporal Precedence

Frontostriatal Dysfunction During Decision Making in Attention-Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder

Contact Info

Product

Resources

About