Aversive Reactivity: A Transdiagnostic Functional Bridge Between Neuroticism and Avoidant Behavioral Coping

Aversive reactivity to negative affect has been described as a transdiagnostic mechanism that links distal temperamental vulnerabilities to clinically relevant behaviors. However, the abundance of constructs reflecting aversive reactivity has resulted in a proliferation of models that may ultimately be redundant. We performed a circumscribed review of studies measuring associations between six constructs – anxiety sensitivity, experiential avoidance, distress intolerance, intolerance of uncertainty, thought-action fusion, and negative urgency – and ten relevant coping behaviors. Results suggested that most constructs were measured in relation to a limited number of coping behaviors. Additionally, constructs were most often measured in isolation, rather than with similar constructs. Implications and suggestions for future research and treatment are discussed.

Testing times: the association of intolerance of uncertainty and metacognitive beliefs to test anxiety in college students

Background Test anxiety has a detrimental effect on test performance but current interventions for test anxiety have limited efficacy. Therefore, examination of newer psychological models of test anxiety is now required. Two transdiagnostic psychological models of emotional disorders that can account for anxiety are the intolerance of uncertainty model (IUM) and the Self-Regulatory Executive Function (S-REF) model. Intolerance of uncertainty, the stable disposition to find uncertainty distressing, is central to the IUM, while beliefs about thinking, metacognition, are central to the S-REF model. We tested for the first time the role of both intolerance of uncertainty and metacognitive beliefs in test anxiety. Methods A cross-sectional design was used, with college students (n = 675) completing questionnaires assessing their test anxiety, intolerance of uncertainty, and metacognitive beliefs. Hierarchical linear regressions examined if intolerance of uncertainty and metacognitive beliefs were associated with test anxiety, after controlling for age and gender. Results Females reported significantly more test anxiety than males. Partial correlations, controlling for gender, found intolerance of uncertainty and metacognitive beliefs were significantly and positively correlated with test anxiety. Hierarchical linear regressions found metacognitive beliefs explained an additional 13% of variance in test anxiety, after controlling for intolerance of uncertainty. When the order of entry was reversed, intolerance of uncertainty was only able to explain an additional 2% of variance, after controlling for metacognitive beliefs. In the final regression model, gender, intolerance of uncertainty and the metacognitive belief domains of ‘negative beliefs about the uncontrollability and danger of worry’ and ‘cognitive confidence’ were all significantly associated test anxiety, with ‘negative beliefs about the uncontrollability and danger of worry’ having the largest association. Conclusions Both intolerance of uncertainty and metacognitive beliefs are linked to test anxiety, but results suggest metacognitive beliefs have more explanatory utility, providing greater support for the S-REF model. Modification of intolerance of uncertainty and metacognitive beliefs could alleviate test anxiety and help students fulfil their academic potential.

Further development of the intolerance of uncertainty model of GAD: a case series

Intolerance of uncertainty (IoU) is important in the development and maintenance of worry and generalized anxiety disorder (GAD; Dugas et al., 1997). However, it remains unclear why some people respond so negatively to uncertainty and have poor clinical outcomes. We adapted the IoU model to include the influence of developmental and/or attachment factors, and their possible importance to intolerability of uncertainty and associated hypothetical worries. Seven consecutive GAD referrals for CBT were naturalistically treated with the novel approach. All participants completed the 7-item Generalized Anxiety Disorder Scale (GAD-7; Spitzer et al., 2006), the Penn State Worry Questionnaire (PSWQ; Meyer et al., 1990), as well as a novel 10-item Premonition Bias Questionnaire (PBQ; C. Chigwedere et al., unpublished). From pre- to post-treatment, results for both GAD (p=.001) and worry (p=.005) improved significantly. Clinically significant change or a post-treatment score within the normal population range were observed for both the GAD-7 and PSWQ. The change in believability of worry, measured on the PBQ was also significant from pre- to post-treatment (p=.008). Overall, the novel approach may be an alternative approach to treating GAD, with some potential, both as an adjunctive or standalone treatment. However, this is a small case series and the presented novel approach requires empirical support and evaluation in larger experimental studies.

Coping moderates the relationship between intolerance of uncertainty and stress in men during the Covid-19 pandemic

Objective: To test the explanatory power of coping strategies and intolerance of uncertainty on men’s perceived stress levels and test the moderating role of coping strategies in the relationship between intolerance of uncertainty and perceived stress during the Covid-19 pandemic. Method: This was an online cross-sectional study in which 1,006 men living in Brazil during the Covid-19 pandemic participated. Participants were recruited using a snowball sampling technique and completed a questionnaire containing measures of all study variables. Data were examined using a correlation and a regression analysis. Results: Intolerance of uncertainty (β = .51) and refusal (β = .15) positively predicted perceived stress, whereas control (β = –.31) and isolation (β = –.06) negatively predicted it. Together, these variables explained 52% of men’s perceived stress (p < .001). Isolation and social support lessened the relationship between intolerance of uncertainty and stress (p < .001). Conclusion: Men high in intolerance of uncertainty and refusal were more vulnerable to stress during the pandemic. However, coping helped mitigate the relationship between intolerance of uncertainty and perceived stress, thus being a promising psychosocial intervention in this context.

Mediation Role of Anxiety Sensitivity on the Relationships between Intolerance of Uncertainty and Fear of COVID-19

The aim of the present study is exploring the mediation role of anxiety sensitivity on the relationships between intolerance of uncertainty and fear of COVID-19. The study was conducted with the relational screening method. The research data were collected online from 302 individuals (Male n = 76, Female n = 226) with Fear of COVID-19 Scale, Anxiety Sensitivity Index-3, Intolerance of Uncertainty Scale. The result of both mediation analysis and bootstrapping analysis (with 5000 bootstrap resamples) showed that the relationship between intolerance of uncertainty and fear of COVID-19 was mediated by anxiety sensitivity. Anxiety sensitivity decreased the effect of intolerance of uncertainty on fear of COVID-19. Moreover, comparing intolerance of uncertainty and anxiety sensitivity in terms of their predictive levels of the fear of COVID-19, it was concluded that anxiety sensitivity predicted the fear of COVID-19 more, and that anxiety sensitivity included the variance of intolerance to uncertainty associated with the fear of COVID-19. El objetivo del presente estudio es explorar el papel mediador de la sensibilidad a la ansiedad en las relaciones entre la intolerancia a la incertidumbre y el miedo al COVID-19. El estudio se realizó con el método de cribado relacional. Los datos de la investigación se recopilaron en línea de 302 personas (hombres n = 76, mujeres n = 226) con la escala de miedo a COVID-19, índice de sensibilidad a la ansiedad-3, escala de intolerancia a la incertidumbre. El resultado tanto del análisis de mediación como del análisis bootstrapping (con un remuestreo de 5000 bootstrap) mostró que la relación entre la intolerancia a la incertidumbre y el miedo al COVID-19 estaba mediada por la sensibilidad a la ansiedad. La sensibilidad a la ansiedad disminuyó el efecto de la intolerancia a la incertidumbre sobre el miedo al COVID-19. Además, al comparar la intolerancia a la incertidumbre y la sensibilidad a la ansiedad en términos de sus niveles predictivos del miedo al COVID-19, se concluyó que la sensibilidad a la ansiedad predijo más el miedo al COVID-19 y que la sensibilidad a la ansiedad incluyó la varianza de la intolerancia a la incertidumbre asociada. con el miedo al COVID-19.

Evaluation of an Augmented Cognitive Behavioural Group Therapy for Perinatal Generalized Anxiety Disorder (GAD) during the COVID-19 Pandemic

The perinatal period is considered a window of vulnerability given the increased risk of psychiatric difficulties during this time, such as mood and anxiety disorders (ADs). Pre-pandemic rates of ADs in perinatal women were one in five but have since increased with the onset of the COVID-19 pandemic (COVID). In addition, recent research suggests that the focus of worry has shifted during the pandemic, with perinatal women reporting significantly more COVID-specific worries. The objective of this study was to augment our current evidence-based Cognitive Behavioural Group Therapy (CBGT) for perinatal anxiety protocol by targeting intolerance of uncertainty and tailoring existing strategies to address COVID-related worry and impact. Pregnant (n = 19) and postpartum (n = 49) women were recruited from regular clinic patient flow from a university-affiliated teaching hospital between September 2020 and March 2021. Improvements in generalized anxiety symptoms, worry, intolerance of uncertainty, and mood were observed at post-treatment, maintained at 3-months, and the intervention received high ratings of treatment satisfaction. This is the first study to examine an augmented CBGT for perinatal women with GAD during the pandemic and supports the inclusion of strategies that target intolerance of uncertainty as well as specific pandemic and perinatal worry content for effective outcomes.