Abstract
The conceptual overlap between intolerance of uncertainty (IU) and anxiety sensitivity (AS) has gained recent attention, with researchers theorizing that IU may lead individuals to have greater difficulty tolerating the uncertainty about feared consequences of anxiety-related symptoms. Research has indicated that AS may mediate the relationship between IU and certain disorder-specific anxiety symptoms; however, it remains unclear if this relationship is consistent in a treatment-seeking sample of adults with transdiagnostic anxiety-related disorders. We hypothesized that there would be a significant indirect effect of IU, including both inhibitory and prospective subscales, on anxiety symptoms through greater levels of global AS, as well as specifically through physical and cognitive AS dimensions in a transdiagnostic sample of 287 treatment-seeking adults diagnosed with anxiety-related disorders. Partially consistent with hypotheses, there was a significant indirect effect of global IU on anxiety through global AS, as well as specifically through physical and cognitive, but not social, AS dimensions. There was also a significant indirect effect of prospective IU on anxiety through global AS and physical and cognitive, but not social, AS dimensions. There was no indirect effect of inhibitory IU on anxiety symptoms through AS. Findings suggest that AS may be one mechanism of the association between IU and increased anxiety symptoms transdiagnostically.
Similar content being viewed by others
Availability of Data and Material
Data are available from the corresponding author upon request.
References
Abramowitz, J. S., Olatunji, B. O., & Deacon, B. J. (2007). Health anxiety, hypochondriasis, and the anxiety disorders. Behavior Therapy, 38(1), 86–94. https://doi.org/10.1016/j.beth.2006.05.001
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Publishing.
Boelen, P. A. (2019). Intolerance of uncertainty predicts analogue posttraumatic stress following adverse life events. Anxiety, Stress, & Coping, 32(5), 498–504. https://doi.org/10.1080/10615806.2019.1623881
Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behaviour Research and Therapy, 35, 79–89. https://doi.org/10.1016/S0005-7967(96)00068-X
Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110(4), 585–599. https://doi.org/10.1037/0021-843x.110.4.585
Calamari, J. E., Rector, N. A., Woodard, J. L., Cohen, R. J., & Chik, H. M. (2008). Anxiety sensitivity and obsessive-compulsive disorder. Assessment, 15(3), 351–363. https://doi.org/10.1177/1073191107312611
Carleton, R. N. (2016). Into the Unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43. https://doi.org/10.1016/j.janxdis.2016.02.007
Carleton, R. N., Duranceau, S., Freeston, M. H., Boelen, P. A., McCabe, R. E., & Antony, M. M. (2014). “But it might be a heart attack”: Intolerance of uncertainty and panic disorder symptoms. Journal of Anxiety Disorders, 28(5), 463–470. https://doi.org/10.1016/j.janxdis.2014.04.006
Carleton, R. N., Norton, M. P. J., & Asmundson, G. J. (2007). Fearing the unknown: A short version of the intolerance of uncertainty scale. Journal of Anxiety Disorders, 21, 105–117. https://doi.org/10.1016/j.janxdis.2006.03.014
Carleton, R. N., Sharpe, D., & Asmundson, G. J. G. (2007). Anxiety sensitivity and intolerance of uncertainty: Requisites of the fundamental fears? Behavioral Research and Therapy, 45(10), 2307–2316. https://doi.org/10.1016/j.brat.2007.04.006
Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., Mccabe, R. E., Antony, M. M., & Asmundson, G. J. (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26(3), 468–479. https://doi.org/10.1016/j.janxdis.2012.01.011
Carleton, R. N. (2012). The intolerance of uncertainty construct in the context of anxiety disorders: Theoretical and practical perspectives. Expert Review of Neurotherapeutics, 12(8), 937–947. https://doi.org/10.1586/ern.12.82
Carleton, R. N., Fetzner, M. G., Hackl, J. L., & Mcevoy, P. (2013). Intolerance of Uncertainty as a Contributor to Fear and Avoidance Symptoms of Panic Attacks. Cognitive Behaviour Therapy, 42(4), 328–341. https://doi.org/10.1080/16506073.2013.792100
Craske, M. G., Rauch, S. L., Ursano, R., Prenoveau, J., Pine, D. S., & Zinbarg, R. E. (2009). What is an anxiety disorder? Depression and Anxiety, 26(12), 1066–1085. https://doi.org/10.1002/da.20633
Dugas, M. J., Laugesen, N., & Bukowski, W. M. (2012). Intolerance of Uncertainty, Fear of Anxiety, and Adolescent Worry. Journal of Abnormal Child Psychology, 40(6), 863–870. https://doi.org/10.1007/s10802-012-9611-1
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guilford Press.
Hayes, A. F., & Rockwood, N. J. (2017). Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation. Behaviour Research and Therapy, 98, 39–57. https://doi.org/10.1016/j.brat.2016.11.001
Hofmann, S. G., & Hayes, S. C. (2018). The Future of Intervention Science: Process-Based Therapy. Clinical Psychological Science, 7(1), 37–50. https://doi.org/10.1177/2167702618772296
Hong, R. Y., & Cheung, M. W. L. (2015). The structure of cognitive vulnerabilities to depression and anxiety: Evidence for a common core etiologic process based on a meta-analytic review. Association for Psychological Science, 3(6), 892–912. https://doi.org/10.1177/2167702614553789
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., & Wang, P. S. (2003). The Epidemiology of Major Depressive Disorder. Jama, 289(23), 3095. https://doi.org/10.1001/jama.289.23.3095
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, (33), 335–343.
Mahoney, A. E. J., & McEvoy, P. M. (2012). A transdiagnostic examination of intolerance of uncertainty across anxiety and depressive disorders. Cognitive Behaviour Therapy, 41(3), 212–222. https://doi.org/10.1080/16506073.2011.622130
Mcevoy, P. M., & Mahoney, A. E. (2011). Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression. Journal of Anxiety Disorders, 25(1), 112–122. https://doi.org/10.1016/j.janxdis.2010.08.010
Naragon-Gainey, K. (2010). Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological Bulletin, 136(1), 128–150. https://doi.org/10.1037/a0018055
O’Bryan, E. M., & Mcleish, A. C. (2017). An Examination of the Indirect Effect of Intolerance of Uncertainty on Health Anxiety Through Anxiety Sensitivity Physical Concerns. Journal of Psychopathology and Behavioral Assessment, 39(4), 715–722. https://doi.org/10.1007/s10862-017-9613-y
Olatunji, B. O., Deacon, B. J., Abramowitz, J. S., & Valentiner, D. P. (2007). Body vigilance in nonclinical and anxiety disorder samples: Structure, correlates, and prediction of health concerns. Behavior Therapy, 38(4), 392–401. https://doi.org/10.1016/j.beth.2006.09.002
Oglesby, M. E., Boffa, J. W., Short, N. A., Raines, A. M., & Schmidt, N. B. (2016). Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event. Journal of Anxiety Disorders, 41, 82–87. https://doi.org/10.1016/j.janxdis.2016.01.005
Rodriguez, B. F., Bruce, S. E., Pagano, M. E., Spencer, M. A., & Keller, M. B. (2004). Factor structure and stability of the Anxiety Sensitivity Index in a longitudinal study of anxiety disorder patients. Behaviour Research and Therapy, 42(1), 79–91. https://doi.org/10.1016/S0005-7967(03)00074-3
Schmidt, N. B., Lerew, D. R., & Jackson, R. J. (1997). The role of anxiety sensitivity in the pathogenesis of panic: Prospective evaluation of spontaneous panic attacks during acute stress. Journal of Abnormal Psychology, 106(3), 355–364. https://doi.org/10.1037/0021-843x.106.3.355
Schmidt, N. B., Lerew, D. R., & Jackson, R. J. (1999). Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: Replication and extension. Journal of Abnormal Psychology, 108(3), 532–537. https://doi.org/10.1037/0021-843x.108.3.532
Schmidt, N. B., Keough, M. E., Timpano, K. R., & Richey, J. A. (2008). Anxiety sensitivity profile: Predictive and incremental validity. Journal of Anxiety Disorders, 22(7), 1180–1189. https://doi.org/10.1016/j.janxdis.2007.12.003
Shihata, S., Mcevoy, P. M., & Mullan, B. A. (2017). Pathways from uncertainty to anxiety: An evaluation of a hierarchical model of trait and disorder-specific intolerance of uncertainty on anxiety disorder symptoms. Journal of Anxiety Disorders, 45, 72–79. https://doi.org/10.1016/j.janxdis.2016.12.001
Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., & Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19, 176–188. https://doi.org/10.1037/1040-3590.19.2.176
Tolin, D. F., Gilliam, C., Wootton, B. M., Bowe, W., Bragdon, L. B., Davis, E., & Hallion, L. S. (2018). Psychometric properties of a structured diagnostic interview for DSM-5 anxiety, mood, and obsessive-compulsive and related disorders. Assessment, 25(1), 3–13. https://doi.org/10.1177/1073191116638410
Wright, K. D., Lebell, M. A. A., & Carleton, R. N. (2016). Intolerance of uncertainty, anxiety sensitivity, health anxiety, and anxiety disorder symptoms in youth. Journal of Anxiety Disorders, 41, 35–42. https://doi.org/10.1016/j.janxdis.2016.04.011
Author information
Authors and Affiliations
Contributions
All authors contributed significantly to the manuscript.
Corresponding author
Ethics declarations
Ethics Approval
This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Consent to Participate
A waiver of informed consent was granted by the IRB as these data were collected as part of routine clinical practice.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
O’Bryan, E.M., Stevens, K.T., Bimstein, J.G. et al. Intolerance of Uncertainty and Anxiety Symptoms: Examining the Indirect Effect Through Anxiety Sensitivity Among Adults with Anxiety-Related Disorders. J Psychopathol Behav Assess 44, 353–363 (2022). https://doi.org/10.1007/s10862-021-09912-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10862-021-09912-0