Intolerance of uncertainty and difficulties in emotion regulation: Proposal for an integrative model of generalized anxiety disorder

Intolerance of uncertainty, aging, and anxiety and mental health concerns: A scoping review and meta-analysis

Although intolerance of uncertainty (IU) is associated with negative outcomes, studies focusing on older adults are still emerging. Specifically, the relationship between IU and psychological health in this population remains unclear. Moreover, no review has focused on understanding the unique contributions of IU and aging to anxiety and mental health in older adults. This scoping review and meta-analysis addressed this gap and provided a comprehensive understanding of the relationship between IU, aging, and mental health. Among 45 studies reviewed, 37 were included in the meta-analysis using mixed effect analysis to examine the relationship between IU and age across adulthood. The remaining eight studies, along with seven selected from the meta-analysis, were included in the scoping review to evaluate the relationship between IU, anxiety, and mental health. Among these, 12 studies focused on late adulthood, two on overall adulthood, and one included both late and overall adulthood. Results of the meta-analysis revealed an overall significant age difference in IU throughout adulthood. Moreover, results of the scoping review indicated a direct correlation between IU and anxiety, and other psychological issues in elderly. These findings provide insights for future research and interventions aimed at reducing IU and improving mental health among older adults.

Intolerance of Uncertainty and Emotion Dysregulation as Predictors of Generalized Anxiety Disorder Severity in a Clinical Population

Background/objectives: Several factors have been shown to play a role in the development and maintenance of generalized anxiety disorder (GAD), including intolerance of uncertainty and emotion dysregulation. Although the individual contribution of both of these factors is well documented, their combined effect has yet to be studied in a clinical population with GAD. The aim of the present study was to examine the relative contribution of intolerance of uncertainty and emotion dysregulation to the prediction of worry and GAD severity in adults with GAD. Methods: The sample consisted of 108 participants diagnosed with GAD. The participants completed measures of worry, GAD severity, depressive symptoms, intolerance of uncertainty, and emotion dysregulation. Results: Multiple regression indicated that both intolerance of uncertainty and emotion dysregulation significantly contributed to both worry and GAD severity, over and above the contribution of depressive symptoms. Of note, the model explained 36% of the variance in GAD severity scores. Conclusions: The present results provide preliminary evidence of complementarity among dominant models of GAD, and point to the potential role of integrative conceptualizations and treatment strategies for GAD.

The role of intolerance of uncertainty in health anxiety in cancer patients: Exploring demographic and cancer-related variations

PURPOSE

Health anxiety (HA) is a critical issue for cancer patients. This study investigates the role of intolerance of uncertainty (IU) in HA among a heterogeneous sample of cancer patients, comparing those with hematological malignancies and solid tumor cancers. It also explores the impact of demographic and cancer-related factors on HA.

METHODS

A total of 184 cancer patients participated in this study. Measurement model and structural model were assessed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to evaluate the reliability, validity, direct and indirect effect, explanatory power, and predictive power of constructs in the model. Multigroup analyses and moderation effects of demographic and cancer-related variables were also examined.

RESULTS

IU significantly predicted HA, mediated by negative problem orientation (NPO) and positive beliefs about worry (PBW). females scored higher in HA, NPO, and cognitive avoidance (CA), while males scored higher in PBW. Solid tumor patients exhibited a stronger positive relationship between IU and HA than hematological malignancy patients. Age and marital status also affected the relationships between IU, NPO, and PBW. Patients without a history of chronic illness or COVID displayed stronger associations between IU and NPO.

CONCLUSION

IU is a key predictor of HA in cancer patients, with varying impacts across demographic and clinical groups. Tailored interventions addressing IU and related constructs help reduce HA, especially among patients with solid tumor cancers, female, married, older, lower educated, and newly diagnosed without former disease diagnosis. This study emphasizes the importance of considering patient heterogeneity in psychological interventions for HA.

The Influence of Intolerance of Uncertainty on Social Anxiety in University Students: The Sequential Mediating Effect of Core Self-Evaluation and Attentional Control

Social anxiety is a serious and prevalent psychological problem among university students, with intolerance of uncertainty playing an important role in its formation and development. The underlying mediating processes remain elusive despite the existing research on the association between these two constructs. This investigation developed a sequential mediation model grounded in the triadic reciprocal determinism theory to examine the intermediary roles of core self-evaluation and attentional control. Utilizing a convenience sampling method, a total of 1580 undergraduate students were recruited for this study. The study variables were assessed using scales measuring intolerance of uncertainty, core self-evaluation, attention control, and social interaction anxiety. The results revealed a significant and positive predictive relationship between intolerance of uncertainty and social anxiety (effect = 0.10; SE = 0.02; 95% CI = [0.00, 0.05]; p < 0.001). Intolerance of uncertainty directly and indirectly impacted social anxiety via three pathways: the independent mediating influence of core self-evaluation (effect = 0.15; SE = 0.02; 95% CI = [0.12, 0.18]; p < 0.001), the independent mediating influence of attentional control (effect = 0.03; SE = 0.01; 95% CI = [0.02, 0.05]; p < 0.001), and a serial mediation effect involving both core self-evaluation and attentional control (effect = 0.04; SE = 0.01; 95% CI = [0.03, 0.06]; p < 0.001). These direct and indirect effects contributed 30.03% and 69.97% to the overall effect, respectively. This study offers novel insights for interventions and treatments targeting social anxiety in university students.

Persian version of the Short Health Anxiety Inventory (SHAI) for patients with cancer: Evaluation of psychometric properties, factor structure, and association with related constructs

OBJECTIVE

This study aims to evaluate the psychometric properties of the Short Health Anxiety Inventory (SHAI=short health anxiety inventory) in a sample of patients diagnosed with cancer. Factor structure, internal consistency, convergent validity, and gender differences in SHAI scores were assessed.

METHODS

202 patients diagnosed with cancer participated, with 18 questionnaires excluded for incomplete data. Confirmatory Factor Analysis was conducted to confirm the factor structure. Internal consistency was also assessed using Cronbach's alpha.

RESULTS

A two-factor model (thought intrusion and fear of illness) provided the best fit for the data (SBχ2 (64) = 114.346, p < 0.001, CFI = 0.944, GFI = 0.908, RMSEA = 0.065). Internal consistency was high for the SHAI total score (α = 0.864) and its subscales (thought intrusion: α = 0.753; fear of illness: α = 0.825). Female patients also scored significantly higher than male patients on the SHAI total score (U = 5232.500, p = 0.012), thought intrusion subscale (U = 5189.00, p = 0.008) and fear of illness subscale (U = 5069.500, p = 0.018).

CONCLUSION

The SHAI demonstrates adequate psychometric properties for assessing health anxiety in cancer patients.

The Trajectory and Influencing Factors of Fear of Childbirth in Third Trimester Primiparas: A Prospective Longitudinal Study

BACKGROUND

Maternal fear of childbirth fluctuates throughout pregnancy. However, no studies have investigated the changing characteristics and influencing factors of fear of childbirth.

AIMS

This study aimed to identify the trajectory patterns of fear of childbirth in third-trimester primiparas and to examine the factors influencing these patterns.

METHODS

This study followed the STROBE checklist for observational research. A prospective longitudinal design was employed, using the Intolerance of Uncertainty Scale, Childbirth Self-Efficacy Inventory and Childbirth Attitudes Questionnaire as primary measures. Data were collected from 226 primiparous women at 28-29 weeks, 32-33 weeks, 36-37 weeks and 39-41 weeks of gestation. Growth mixture modelling (GMM) was fitted using Mplus 8.3 software to analyse the trajectory of fear of childbirth. Logistic regression was conducted to identify the factors influencing these trajectories.

RESULTS

The results revealed heterogeneity in the trajectory of fear of childbirth, which could be categorised into six groups: a normal group without fear, a group with no initial fear but increased fear later, a group with mild fear that decreased, a group with mild fear that worsened, a mild fear stable group and a moderate fear stable group. Logistic regression showed that intolerance of uncertainty, childbirth self-efficacy and childbirth preference were the primary factors influencing these trajectories (p < 0.05).

CONCLUSIONS

This study highlights the varying trajectories of fear of childbirth in third-trimester primiparas. Different categories of fear emerge, each following a distinct path of change. Healthcare providers can use this information to create individualised interventions, addressing specific concerns and influencing factors at various stages, to support the psychological well-being of primiparas during the perinatal period.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Healthcare providers should be vigilant about primiparas' awareness of and response to childbirth fear. This study shows that the fear of childbirth often begins to increase or decrease between 32 and 33 weeks of gestation. Screening and interventions should thus be initiated during this period, with follow-up mechanisms in place. Providers should also assess primiparas' capacity to cope with childbirth fear, offering targeted guidance and education to reduce uncertainty, enhance childbirth self-efficacy and ultimately alleviate fear.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT STATEMENT

This study is of great interest to health care providers, suggesting that health care providers should be vigilant about primiparas' awareness of and response to childbirth fear. This study shows that the fear of childbirth often begins to increase or decrease between 32 and 33 weeks of gestation. Screening and interventions should thus be initiated during this period, with follow-up mechanisms in place. Providers should also assess primiparas' capacity to cope with childbirth fear, offering targeted guidance and education to reduce uncertainty, enhance childbirth self-efficacy and ultimately alleviate fear.

Dimensions of Emotion Regulation as Mediators of the Relationship Between Emotion Controllability Beliefs With Stress and Well-Being

Although beliefs about the extent to which emotions are amenable versus immutable to control (i.e., implicit theories of emotion) have been linked to various mental health indices, mediators of this relationship remain unclear. This study extends prior research by examining dimensions of emotion regulation (ER) difficulties as parallel mediators in the relationship between emotion controllability beliefs and stress and well-being among university students (n = 483). Higher emotion controllability beliefs were found to be associated with fewer difficulties in emotional clarity, emotional acceptance, effective ER strategy access, impulse control, and goal-directed behaviour. Moreover, the relationship between emotion controllability beliefs and stress and well-being was mediated by emotional clarity and strategy access. Results implicate difficulties understanding one's own emotions and accessing effective ER strategies as key mechanisms through which lower emotion controllability beliefs may be associated with higher stress and lower well-being. Conversely, better emotional clarity and greater access to effective ER strategies may explain why higher emotion controllability beliefs are associated with better mental health. The present study provides support for the role of implicit theories of emotion in clarifying patterns of adaptive versus maladaptive emotional responding, and sheds light on the cognitive processes underlying individual differences in emotion regulation and mental health. Furthermore, findings offer novel insight regarding the specific emotion regulatory mechanisms through which emotion controllability beliefs may be associated with mental health.

Childhood Maltreatment and Spiritual Well-Being: Intolerance of Uncertainty and Emotion Regulation as Mediators in Turkish Sample

Spiritual well-being is a phenomenon that enhances the quality of life and acts as a protective factor against stress and negative emotions. The purpose of this study was to investigate whether childhood psychological maltreatment is related to spiritual well-being and whether intolerance of uncertainty and emotion regulation serially mediate this relationship. The study sample comprised 330 participants aged between 18 and 55 years from 46 out of the 81 cities in Türkiye. The study participants completed the Psychological Maltreatment Questionnaire, Intolerance of Uncertainty Scale, Emotion Regulation Scale, and Spiritual Well-Being Scale, a scale derived from the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being that measures spiritual well-being by using the conceptualization of meaning and peace. The data obtained were analyzed using a two-step structural equation modeling approach, which indicated that childhood psychological maltreatment has an association with spiritual well-being, and this relationship is mediated by both intolerance of uncertainty and emotion regulation. The findings are discussed in the context of the literature on spiritual well-being.

Intolerance of uncertainty and mental health in China "Post-pandemic" age: The mediating role of difficulties in emotion regulation

The Chinese government adjusted its national epidemic prevention and control policy in December 2022 after the worldwide declaration of COVID-19 as a common influenza. After the policy adjustment, there has been widespread infection in China, which has brought a lot of uncertainty to the lives and studies of Chinese university students. This study focused on the impact of the intolerance of uncertainty for COVID-19 (IUC) on the emotional and mental health of college students in China "Post-pandemic" age. This study examined the mediating role of difficulties in emotion regulation (DER) between IUC and mental health (MH). 1,281 university students in China were surveyed using the intolerance of uncertainty for COVID-19 scale, the difficulties in emotion regulation scale and the mental health scale. A structural equation model was used to test the hypothesis model, and it was shown that IUC had a significant negative effect on the MH of college students and a significant positive effect on the DER. DER had a significant negative effect on the MH, and DER had a complete mediation effect between IUC and MH. The findings of this study enrich our understanding of the influencing factors of mental health of university students under the background of post-epidemic in China, and provide practical reference for universities on how to prevent mental health problems under the current uncertain environment in China.

Key factors behind various specific phobia subtypes

While it has been suggested that more than a quarter of the whole population is at risk of developing some form of specific phobia (SP) during their lives, we still know little about the various risk and protective factors and underlying mechanisms. Moreover, although SPs are distinct mental disorder categories, most studies do not distinguish between them, or stress their differences. Thus, our study was manifold. We examined the psychometric properties of the Specific Phobia Questionnaire (SPQ) and assessed whether it can be used for screening in the general population in a large sample (N = 685). Then, using general linear modeling on a second sample (N = 432), we tested how potential socio-demographic, cognitive emotion regulatory, and personality variables were associated with the five SP subtypes. Our results show that the SPQ is a reliable screening tool. More importantly, we identified transdiagnostic (e.g., younger age, female gender, rumination, catastrophizing, positive refocusing) as well as phobia-specific factors that may contribute to the development and maintenance of SPs. Our results support previous claims that phobias are more different than previously thought, and, consequently, should be separately studied, instead of collapsing into one category. Our findings could be pertinent for both prevention and intervention strategies.

An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

Early maladaptive schemas, emotion regulation difficulties and alexithymia: A systematic review and meta-analysis

BACKGROUND

Emotion regulation is an integral part of the schema therapy model. The aim of this systematic review and meta-analysis was to synthesize the evidence on the associations between early maladaptive schemas (EMSs), difficulties with emotion regulation and alexithymia.

METHOD

PsycINFO, PubMed and CINAHL Complete databases were searched on 28 May 2022 and 3 February 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Included studies were in English, in peer-reviewed journals and reported on the association between one or more of the 18 EMSs or five schema domains and emotion regulation difficulties or alexithymia. Methodological quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Meta-analyses were conducted to examine difficulties with emotion regulation and alexithymia as correlates of each EMS and domain.

RESULTS

A total of 19 studies published between 2008 and 2022 were included (Pooled N = 5957). Difficulties with emotion regulation were positively correlated with all 18 EMSs (range: entitlement r(7) = .28, 95% CI [.13, .42] to negativity pessimism r(5) = .53, 95% CI [.23, .74]) and schema domains (range: impaired limits r(5) = .34, 95% CI [.08, .56] to disconnection rejection r(5) = .44, 95% CI [.33, .73]). Alexithymia was positively correlated with the other-directedness domain (r(2) = .40, 95% CI [.09, .64]) and 16 of the 18 EMSs (range: unrelenting standards r(5) = .21, 95% CI [.12, .28] to emotional inhibition r(5) = .50, 95% CI [.34, .63]).

CONCLUSIONS

The findings suggested that almost all 18 EMSs are implicated in emotion regulation difficulties and alexithymia, particularly those relating to unmet needs for attachment and autonomy.

Understanding Pedophilia: A Theoretical Framework on the Development of Sexual Penchants

Pedophilia is a significant public health problem. Despite its cost to society, little effort has been directed toward understanding idiographic differences in the development and maintenance of pedophilia. Extant literature emphasizes biological underpinnings and predictors of re-offense. In this article, we posit that pedophilic penchants in males originate due to language, cognition, emotions, and emotion regulation. Adverse childhood experiences, such as emotional and sexual abuse, are posited as a major contributor to the etiology of pedophilia. However, not all individuals attracted to minors present with similar childhood adversities. The development of pedophilia, in the absence of such direct training (childhood adversities), is difficult to comprehend. Relational frame theory, a comprehensive account of human language and cognition, aids in deciphering the idiographic underpinnings of pedophilia. The role of maladaptive emotion regulation in maintaining pedophilia is also described. This article presents examples of how relational frames are established and activated in distressing contexts. Finally, implications for future research are discussed.

Interplay between uncertainty intolerance, emotion regulation, cognitive flexibility, and psychopathology during the COVID-19 pandemic: a multi-wave study

The COVID-19 pandemic has created a significant mental health burden on the global population. Studies during the pandemic have shown that risk factors such as intolerance of uncertainty and maladaptive emotion regulation are associated with increased psychopathology. Meanwhile, protective factors such as cognitive control and cognitive flexibility have been shown to protect mental health during the pandemic. However, the potential pathways through which these risk and protective factors function to impact mental health during the pandemic remain unclear. In the present multi-wave study, 304 individuals (18 years or older, 191 Males), residing in the USA during data collection, completed weekly online assessments of validated questionnaires across a period of five weeks (27th March 2020-1st May 2020). Mediation analyses revealed that longitudinal changes in emotion regulation difficulties mediated the effect of increases in intolerance of uncertainty on increases in stress, depression, and anxiety during the COVID-19 pandemic. Further, individual differences in cognitive control and flexibility moderated the relationship between intolerance of uncertainty and emotion regulation difficulties. While intolerance of uncertainty and emotion regulation difficulties emerged as risk factors for mental health, cognitive control and flexibility seems to protect against the negative effects of the pandemic and promote stress resilience. Interventions aimed at enhancing cognitive control and flexibility might promote the protection of mental health in similar global crises in the future.

Heterogeneity in College Student's Technology-Facilitated Intimate Partner Violence Perpetration Occurring Post-Breakup: A Latent Profile Analysis

Technology-facilitated intimate partner violence (T-IPV), including social media surveillance (SMS) and cyber dating abuse (CDA), are increasingly common post-breakup experiences among college students. Although a large body of research has focused on identifying risk factors for both types of T-IPV, perpetrators of T-IPV may differ in their pattern of risk factors. Using the I³ model as a guiding framework, the current study sought to identify typologies of college students engaging in post-breakup SMS and CDA. Specifically, 710 college students' responses on self-report measures were examined for similarities in known risk factors, namely attachment anxiety, impulse control difficulties, lack of emotion regulation strategies, intolerance of uncertainty, distress tolerance, and problematic alcohol use. Three distinct perpetrator profiles emerged with attachment anxiety, alcohol use, and intolerance of uncertainty presenting as distinguishing features. Problematic alcohol use was evident in the moderate and high levels of SMS and CDA perpetration profiles. Contrary to what was expected, there appeared to be little variability in emotional regulation and impulse control abilities across the three profiles such that individuals belonging to low and high perpetration profiles did not differ in the degree to which they were able to control their impulses or access emotion regulation strategies. Results highlight the potential importance of tailoring interventions, while reducing transdiagnostic risk factors, to account for the heterogeneity in risk factors among T-IPV perpetrators.

Trait Emotional Intelligence and Self-regulated Learning in University Students during the COVID-19 pandemic: the mediation role of Intolerance of Uncertainty and COVID-19 Perceived Stress

The coronavirus pandemic strongly impacted the higher education system, challenging university students, who were required to make a considerable effort in terms of revising their personal study approach and managing their emotions. The present study aimed to examine the impact of Trait Emotional Intelligence (TEI) on Self-Regulated Learning (SRL) strategies directly, and indirectly through the mediation of COVID-19 perceived stress (PS) and Intolerance of Uncertainty (IU). 1055 Italian university students (mean age = 22.44 years, SD = 2.39) reached via social media, filled out the tools assessing TEI, COVID-19 PS, IU and SRL. Five mediation analyses performed with PROCESS showed that TEI positively predicted all SRL dimensions, and negatively influenced COVID-19 PS and Prospective and Inhibitory IU. COVID-19 PS and Inhibitory and Prospective IU differently predicted specific SRL dimensions. The indirect effects observed suggest that TEI may help university students to cope with stressful and uncertain psychological experiences in order to achieve higher levels of SRL strategies. The study highlights that TEI plays a pivotal role in academic SRL strategies, underlining the importance of its buffering effect in distressing circumstances such as the COVID-19 pandemic.

Intolerance of Uncertainty and Emotional Processing in Adolescence: Separating Between-Person Stability and Within-Person Change

Previous research on the relation between Intolerance of Uncertainty (IU) and Emotional Processing (EP) during adolescence is limited. The present study aimed to clarify how IU and EP evolve over time, to what extent they are related, and whether changes in one precede or follow changes in the other. A total of 457 Italian adolescents (53.1% girls) aged 11 to 18 years (M = 14.1 ± 2.27) completed the IU and EP scales on three separate occasions three months apart (T1, T2, and T3). Data were modeled using a Random-Intercept Cross-Lagged Panel Model (RI-CLPM) that separates individual differences between individuals from intraindividual changes. Descriptive analyses showed that IU was relatively stable between T1 and T2 and decreased slightly between T2 and T3. Consistent with the view that emotion regulation improves as adolescents develop, EP difficulties were found to decrease between T1 and T2 and between T2 and T3. The RI-CLPM revealed a strong between-person effect, showing that individual differences in IU and EP remained consistent throughout the study. In addition, significant within-person change was found, with adolescents who increased their IU at T1 and T2 also increasing their EP difficulties at T2 and T3, respectively. The opposite effect had a smaller effect size. In sum, our study showed that IU and EP are intertwined in adolescents and that changes in IU precede corresponding changes in EP. These results suggest a priority of change between IU and EP and confirm the relationship between IU and emotion regulation problems in adolescence.

The Application of the Intolerance of Uncertainty Model to Gambling Urge and Involvement

BACKGROUND

Drawing on the intolerance of uncertainty model, this study aimed to examine whether intolerance of uncertainty and emotion regulation difficulties (in terms of impulse control difficulties and limited access to emotion regulation strategies) contributed to individual differences in gambling urge and involvement.

METHODS

Convenience sampling was used to recruit Chinese adult participants who had engaged in buying lottery tickets and other gambling activities in the past year. They were asked to complete an anonymous questionnaire survey, and a total of 580 valid cases (M_age = 34.07, SD = 13.36; 50.4% female) were collected for data analysis.

RESULTS

Path analysis showed that the total effect of intolerance of uncertainty on gambling urge and involvement was significant and positive. However, only impulse control difficulties and not limited access to emotion regulation strategies fully mediated the effect of intolerance of uncertainty.

CONCLUSIONS

As the first study to apply the intolerance of uncertainty model to real-life gambling, it found that individuals' intolerance of uncertainty and impulse control difficulties contributed to more gambling urge and involvement. Improving emotion regulation skill (e.g., impulse control training) may, therefore, be considered in programs for promoting responsible gambling among Chinese gamblers.

Childhood behavioral inhibition and attachment: Links to generalized anxiety disorder in young adulthood

Generalized anxiety disorder (GAD) is under-treated yet prevalent among young adults. Identifying early risk factors for GAD would contribute to its etiological model and identify potential targets for intervention. Insecure attachment patterns, specifically ambivalent and disorganized, have long been proposed as childhood risk factors for GAD. Similarly, childhood behavioral inhibition has been consistently associated with anxiety disorders in adulthood, including GAD. Intolerance of uncertainty (IU), the tendency to react negatively to uncertain situations, has also been shown to be a crucial component of GAD. Furthermore, maternal anxiety is an important feature of developmental models of anxiety including GAD. Yet, to date, no study has examined, within a comprehensive model, how attachment and behavioral inhibition in childhood, maternal anxiety in adolescence, and IU in emerging adulthood contribute to GAD in adulthood. The present study thus examines these links using a longitudinal design with 62 Canadian participants and their mothers. At age 6, participants' attachment and behavioral inhibition were assessed observationally. Maternal anxiety was measured when participants were 14 years of age. IU and GAD were assessed when participants were 21 and 23 years of age, respectively. Structural equation modeling showed that IU mediates the relationships between behavioral inhibition and GAD, while controlling for maternal anxiety. Ambivalent and disorganized-controlling attachment patterns are also indirectly associated with increased GAD symptoms via greater IU scores. Furthermore, a direct and positive effect of behaviorally disorganized attachment was found on GAD symptoms. This longitudinal study supports integrating attachment, behavioral inhibition, and IU in a model of GAD.

Trait Intolerance of Uncertainty Is Associated with Decreased Reappraisal Capacity and Increased Suppression Tendency

The COVID-19 pandemic has been a time of great uncertainty for the general population and highlights the need to understand how attitudes towards uncertainty may affect well-being. Intolerance of uncertainty is a trait associated with worry, anxiety, and mood disorders. As adaptive emotion regulation supports well-being and mental health, it is possible that intolerance of uncertainty is also associated with the ability and tendency to regulate emotions. However, the relationships between intolerance of uncertainty and widely studied cognitive emotion regulation strategies - such as reappraisal and suppression - have received little attention. In two studies that recruited participants online from the United States, we tested the hypotheses that higher trait intolerance of uncertainty would be associated with greater worry, decreased capacity and tendency to use reappraisal, and increased tendency to use suppression in daily life. Study 1 provided an initial test of our hypotheses. Study 2 was a confirmatory, preregistered study that replicated findings in a young adult sample, demonstrating that scores on the Intolerance of Uncertainty Scale (IUS) were associated with greater COVID-related worry, decreased capacity to regulate negative emotions on a task that manipulated the use of reappraisal, and greater self-reported use of suppression in daily life. Together, these results indicate that intolerance of uncertainty is associated with the capacity and tendency to use emotion regulation strategies important for well-being.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-022-00115-8.

Cognitive Training via a Mobile Application to Reduce Obsessive-Compulsive-Related Distress and Cognitions During the COVID-19 Outbreaks: A Randomized Controlled Trial Using a Subclinical Cohort

Obsessive-compulsive disorder (OCD) is a persistent psychiatric disorder causing significant impairment in functioning. The COVID-19 pandemic has exacerbated OCD-related symptoms and interrupted access to treatment. Recent research suggests mHealth apps are promising tools for coping with OCD symptoms. This randomized controlled trial evaluated the effects of a CBT-based mobile application designed to reduce OCD symptoms and cognitions in community participants considered at high risk of developing OCD symptoms. Following initial screening (n = 924), fifty-five community participants scoring 2 standard deviations above the OCI-R mean were randomized into two groups. In the immediate-app use group (iApp; n = 25), participants started using the application at baseline (T0), 4 min a day, for 12 days (T0-T1). Participants in the delayed-app group (dApp; n = 20) started using the mobile application at T1 (crossover) and used the app for the following 12 consecutive days (T1-T2). Intention to treat analyses indicated that using the app for 12 consecutive days was associated with large effect-size reductions (Cohen's d ranging from .87 to 2.73) in OCD symptoms and maladaptive cognitions in the iApp group (from T0 to T1) and dApp group (from T1 to T2). These reductions were maintained at follow-up. Our findings underscore the usefulness of brief, low-intensity, portable interventions in reducing OCD symptoms and cognitions during the pandemic.

Emotional dysregulation as trans-nosographic psychopathological dimension in adulthood: A systematic review

Introduction

Emotional dysregulation (ED) is characterized by inappropriate emotional reactions related to environmental or cognitive stimuli. In most recent years, increasing interest has been devoted to its definition and detection across mental disorders for its detrimental role progressively highlighted in both neurodevelopment and adult mental disorders, with implications on the severity of clinical manifestations. The aim of this systematic review was to evaluate and gather the scientific evidence about ED in adult psychiatric population to elucidate the concept of ED as trans-nosographic entity.

Methods

The electronics databases PubMed, Scopus and Web of Science was reviewed to identify studies in accordance with the PRISMA guidelines; at the end of the selection process a total of 29 studies (N = 709; N = 658; N = 1,425) was included. All studies included assessed the presence of ED symptoms, by means of a validate scale in adult (>18 years of age), in clinically diagnosed patients as well as healthy control participants.

Results

Our results suggest ED as a trans-diagnostic factor across multiple mental disorders, such as bipolar disorder, attention deficit hyperactivity disorder, autism spectrum disorder, personality disorders; a better definition of this concept could be helpful to interpret and clarify many clinical cases and improve their diagnostic and therapeutic management.

Times Are Harsh, Be Kind to Yourself! Anxiety, Life Satisfaction, and the Mediating Role of Self-Compassion

The present research aimed to explore the indirect effect of self-compassion on the relationship between two dimensions of intolerance of uncertainty (i.e., prospective and inhibitory anxiety) and life satisfaction. One hundred sixty-four Romanian adult participants formed our sample from the country's eastern side. Their ages ranged between 18 and 61 (M = 23.45, SD = 7.70, 72% females). The study was conducted in 2021, when the Delta wave of COVID-19 was at its peak. Our findings suggested significant negative associations between prospective anxiety, self-compassion, and life satisfaction. A similar negative significant association was suggested between inhibitory anxiety and self-compassion. Age did not significantly correlate with any of our primary variables. Mediation analyses indicated a total mediating effect of self-compassion on the relationship between participants' prospective and inhibitory anxiety and their life satisfaction. We discuss the implications of our findings, considering their relevance for therapeutical interventions aimed to promote psychological wellbeing when facing adversity.

Broad and Narrow Transdiagnostic Risk Factors in Eating Disorders: A Preliminary Study on an Italian Clinical Sample

Eating disorders are multifaceted psychopathologies and the transdiagnostic approach is currently considered a useful framework to understand their complexity. This preliminary study aimed to investigate both broad (i.e., intolerance of uncertainty and emotion dysregulation) and narrow (i.e., extreme body dissatisfaction) transdiagnostic risk factors underlying eating disorders. 50 Italian female patients seeking treatment for an eating disorder were involved (M_age = 31.6 years ± 12.8, 18–65). They completed self-report measures assessing emotion regulation difficulties, intolerance of uncertainty, extreme body dissatisfaction, general psychological distress, and eating disorder symptomatology. To explore whether the abovementioned transdiagnostic factors predicted patients’ psychological distress and eating disorder symptoms, two linear regressions were performed. Emotion dysregulation emerged as the only significant predictor of distress, while extreme body dissatisfaction was the only significant predictor of overall eating disorder symptomatology. Then, to analyze the differences between patients with anorexia nervosa and bulimia nervosa in intolerance of uncertainty and emotion regulation problems, t-tests were conducted. The two groups differed significantly in intolerance of uncertainty levels only, with higher scores obtained by patients with anorexia nervosa. Overall, our findings suggest that emotion dysregulation and extreme body dissatisfaction may be relevant constructs in eating disorders in general, while intolerance of uncertainty may be more involved in restrictive eating disorders. The clinical implications of such results are discussed.

Psychological well-being, risk factors, and coping strategies with social isolation and new challenges in times of adversity caused by the COVID-19 pandemic

Objective

COVID-19 triggers anxiety and fear due to several reasons, and thus, dealing with it requires prolonged coping mechanisms. When the number of infections soared, to slow the spread, many governments decided to close universities and dormitories and move teaching to online platforms. The majority of the university students decided to move back home to their parents changing their social lives. Here, we aimed to point to risk, as well as protective factors, and understand the influence of these factors on both physical and psychological indicators of well-being. Further, to discover how university students cope with maintaining their social lives during the COVID-19 pandemic.

Method

We collected online survey data from multiple university sources. Participants (N = 605) completed measures of emotion regulation strategies, knowledge on the disease, contamination fear, perceived social support, worrying and intolerance of uncertainty, quality of sleep, well-being, emotional stability, anxiety, and depression.

Results

Our results showed that the most prominent risk and protective factors that were most strongly associated with the indicators of well-being were rumination, catastrophizing, positive refocusing, and social support from family; respectively.

Conclusion

These results have implications for professionals working with and helping (e.g., as counselors) people during the challenges of an emergency.

The role of emotion regulation and intolerance to uncertainty on the relationship between fear of COVID-19 and distress

The COVID-19 pandemic is increasing negative consequences on mental health around the globe. To date, research on what psychological factors could influence individuals' distress is still scarce. The current study aims to test a multiple mediation model to examine the role of Intolerance of Uncertainty (IU) and emotional regulation (i.e., expressive suppression and cognitive reappraisal) as joint factors, which can increase understanding of psychological distress due to the COVID-19 outbreak. An online survey measuring fear of COVID-19, IU, emotional regulation, and psychological distress was administered to 3863 Italian adults (females 73.3%; M age  = 36.44; SD = 14.74) during lockdown. Results showed that IU partially mediated the effect of fear of COVID-19 on depression, anxiety and stress. Moreover, individuals with difficulties in managing the uncertainties due to their fear of COVID-19 may be at risk for heightened use of expressive suppression and depression. However, individuals with both higher IU and expressive suppression showed lower level of stress. High cognitive reappraisal has a mediational effect on the relationship between fear of COVID-19, IU, and lower psychological distress. Findings suggest that IU and emotional regulation should be targeted for informing the development of tailored treatments to reduce the negative consequences of the outbreak.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03071-5.

Anxiety predicts impulsive-compulsive behaviours in Parkinson's disease: Clinical relevance and theoretical implications

Patients with Parkinson's disease (PD) often present symptoms of anxiety, depression and apathy. These negative affect manifestations have been recently associated with the presence of impulsive compulsive behaviours (ICBs). However, their relation with the use of dopamine replacement therapy (DRT), a renewed risk factor for ICBs, is still not fully understood. Elucidating the role of these different ICBs predictors in PD could inform both prevention/intervention recommendations as well as theoretical models. In the present study, we have analysed data collected in 417 PD patients, 50 patients with Parkinsonian symptoms but with scan without evidence of dopaminergic deficit (SWEDD), and 185 healthy controls (HC). We examined each patient's clinical profile over a two-year time window, investigating the role of both negative affect and DRT on ICBs. Results confirmed the presence of higher levels of anxiety in both the clinical groups, and of higher level of ICBs in SWEDD patients, respect to both PD and HC. Mixed model analyses revealed a statistically significant association between anxiety and ICBs in the SWEDD patients who did not take any DRT. Findings suggest the independence between anxiety and DRT in ICBs development, and provide new evidence for the motivational opponency theoretical framework.

Interrelation between intolerance of uncertainty and the time perspective profile in the military

BACKGROUND

Time perspective (TP) theory suggests that people tend to categorize their experience in terms of the past, the present, and the future. Studies have shown that a balanced TP profile supports well-being while misbalance in the TP profile is associated with various psychopathology. On the other hand, an intolerance of uncertainty (IU) underpins a variety of affective disorders. There are still a lot of questions about the relationship between IU and the TP. The purpose of this study was to clarify the interrelation between the time perspective distortion and intolerance of uncertainty level and to examine the degree to which IU and TP scales are associated with posttraumatic stress symptoms in a military sample.

PARTICIPANTS AND PROCEDURE

The sample of servicemen (N = 129) completed ZTPI, the IUS-12 and PCL-5 questionnaires. Correlational and regression analyses were conducted with IU scores, TP scales and DBTP and DBTP-r coefficients.

RESULTS

IU total score correlates with Past Negative (PN), Present Hedonistic (PH), Present Fatalistic (PF), and Future (F) time perspectives in the military sample. Groups that differ in the level of IU have a significant difference in Past Negative TP. Regression analysis models using DBTP as well as DBTP-r coefficients showed similar results. Inhibitory IU, not Prospective IU, turned out to be a predictor of post-traumatic stress symptoms in this military, non-clinical sample.

CONCLUSIONS

Further studies should determine directions of associations between intolerance of uncertainty and time perspective.

Validation of the intolerance of uncertainty scale as a screening tool for perinatal anxiety

Background

To date, there is a significant lack of research validating clinical tools for early and accurate detection of anxiety disorders in perinatal populations. Intolerance of uncertainty was recently identified as a significant risk factor for postpartum anxiety symptoms and is a key trait of non-perinatal anxiety disorders. The present study aimed to validate the Intolerance of Uncertainty Scale (IUS) in a perinatal population and evaluate its use as a screening tool for anxiety disorders.

Methods

Psychiatric diagnoses were assessed in a sample of perinatal women (n = 198), in addition to completing a self-report battery of questionnaires. Psychometric properties including internal consistency and convergent and discriminant validity were assessed. Determination of an optimal clinical cut-off score was measured through a ROC analysis in which the area under the curve, sensitivity, specificity, as well as positive and negative predictive values were calculated.

Results

The IUS demonstrated excellent internal consistency (α = 0.95) and an optimal clinical cut-off score of 64 or greater was established, yielding a sensitivity of 89%. The IUS also demonstrated very good positive (79%) and negative (80%) predictive values.

Conclusions

These findings suggest that the IUS represents a clinically useful screening tool to be used as an aid for the early and accurate detection of perinatal anxiety.

Interpersonal dysfunction in individuals high in chronic worry: relations with interpersonal problem-solving

BACKGROUND

Interpersonal dysfunction has been proposed as an important maintenance factor in chronic worry and generalized anxiety disorder (GAD). Perceptions of problems and the problem-solving process as threatening, and unhelpful (e.g. avoidant, impulsive) problem-solving styles are implicated in worry and have also been suggested to be associated with dysfunctional interpersonal styles.

AIMS

The present study assessed the relationships between interpersonal dysfunction and problem-solving orientation, approach, and effectiveness in a sample of individuals high in chronic worry and investigated the indirect effect of interpersonal dysfunction on GAD symptom severity through negative problem-solving beliefs and approaches.

METHOD

Fifty-nine community participants completed questionnaires and an interpersonal problem-solving task.

RESULTS

Greater interpersonal dysfunction was significantly associated with greater negative problem-solving orientation and greater habitual avoidant and impulsive/careless problem-solving styles. Greater interpersonal dysfunction was associated with poorer effectiveness of solutions when the task problem involved conflict with a romantic partner. Negative problem-solving orientation fully mediated the relationship between interpersonal dysfunction and GAD symptoms.

CONCLUSIONS

These findings support that problem-solving processes are implicated in interpersonal dysfunction and that negative beliefs about problem-solving account for the relationship between interpersonal dysfunction and GAD symptoms. Theoretical implications are discussed.

Cognitive Behavior Therapy Targeting Intolerance of Uncertainty Versus Selective Serotonin Reuptake Inhibitor for Generalized Anxiety Disorder: A Randomized Clinical Trial

Given the high prevalence and adverse outcomes associated with generalized anxiety disorder (GAD), development and expansion of effective treatment modalities are important. The present study compared the effectiveness of cognitive behavior therapy targeting intolerance of uncertainty (CBT-IU) and selective serotonin reuptake inhibitors (SSRIs) for treating GAD. A total of 30 Iranian patients with GAD (Mage = 25.16 ± 6.73) were randomised to receive either CBT-IU (n = 15) or SSRI (n = 15). Measures included the Structured Clinical Interview for DSM-5 (SCID-5), Penn State Worry Questionnaire (PSWQ), Why Worry-II (WW-II), Intolerance of Uncertainty Scale (IUS), and Negative Problem Orientation Questionnaire (NPOQ). Repeated measures analysis of variance tested differential treatment outcomes. The results of intention-to-treat (ITT) analysis indicated that although both CBT-IU and SSRI were effective treatments for GAD, CBT-IU produced significantly better results than SSRI at post-treatment. This clinical trial provides preliminary cross-cultural support for the treatment of GAD using CBT-IU, with findings suggesting that this non-medication intervention reduces GAD symptoms.

Anxious temperament and cyberchondria as mediated by fear of COVID-19 infection: A cross-sectional study

This study's main goal was to evaluate the association between anxious temperament and the fear of COVID-19-related self-infection and infection in loved ones (family members, friends, relatives) and cyberchondria. The sample consisted of 499 men and women aged between 18 and 72 who were gathered from the general population via an online recruitment platform. A numerical rating scale comprising 11 degrees of fear was used to assess participants' COVID-19-related fear, and affective temperaments were evaluated using Akiskal's Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) scales. Cyberchondria was assessed using McElroy and Shevlin's Cyberchondria Severity Scale (CSS). Small to medium positive correlations were found between depressive, cyclothymic, irritable and anxious temperaments and cyberchondria and between depressive and anxious temperaments and COVID-19 fears. However, no correlation was observed between the hyperthymic temperament and cyberchondria. Cyberchondria positively correlated with both COVID-19 fears scales, though the correlation coefficients were medium. Based on the results of linear regression analysis, only anxious temperament and COVID-19 fear of self-infection were significant predictors of cyberchondria. The analysis also revealed a significant indirect effect of anxious temperament on cyberchondria through fear of COVID-19 self-infection as a mediator between anxious temperament and cyberchondria.

Dealing with uncertainty: A high-density EEG investigation on how intolerance of uncertainty affects emotional predictions

Intolerance of uncertainty (IU) can influence emotional predictions, constructed by the brain (generation stage) to prearrange action (implementation stage), and update internal models according to incoming stimuli (updating stage). However, neurocomputational mechanisms by which IU affects emotional predictions are unclear. This high-density EEG study investigated if IU predicted event-related potentials (ERPs) and brain sources activity developing along the stages of emotional predictions, as a function of contextual uncertainty. Thirty-six undergraduates underwent a S1-S2 paradigm, with emotional faces and pictures as S1s and S2s, respectively. Contextual uncertainty was manipulated across three blocks, each with 100%, 75%, or 50% S1-S2 emotional congruency. ERPs, brain sources and their relationship with IU scores were analyzed for each stage. IU did not affect prediction generation. During prediction implementation, higher IU predicted larger Contingent Negative Variation in the 75% block, and lower left anterior cingulate cortex and supplementary motor area activations. During prediction updating, as IU increased P2 to positive S2s decreased, along with P2 and Late Positive Potential in the 75% block, and right orbito-frontal cortex activity to emotional S2s. IU was therefore associated with altered uncertainty assessment and heightened attention deployment during implementation, and to uncertainty avoidance, reduced attention to safety cues and disrupted access to emotion regulation strategies during prediction updating.

The Indirect Effect of Parental Intolerance of Uncertainty on Perinatal Mental Health via Mindfulness During COVID-19

Objectives

The COVID-19 pandemic is associated with mental health difficulties, especially during pregnancy and early postpartum. Intolerance of uncertainty (IU) and reduced capacity for mindfulness-a protective factor for child-bearers-may be particularly relevant factors driving mental health problems given the unpredictable nature of the pandemic. The current study aims to shed light on modifiable paths to perinatal psychological distress by testing whether there is an indirect effect of IU on psychological symptoms through a perceived reduction in mindfulness during the pandemic.

Methods

Pregnant individuals (67%, n = 133) and new mothers within 6 months postpartum (33%, n = 66) participated in a cross-sectional online survey assessing IU, current and retrospective pre-pandemic mindfulness (FFMQ), and psychological symptoms (anxiety, depression, somatization; BSI). Perceived change in mindfulness was captured by including retrospective mindfulness as a covariate in the PROCESS macro used for analyses.

Results

Tests of the direct association between mindfulness, IU, and psychological symptoms showed significant effects of IU (b = 0.46, SE = 0.064; p < .001) and perceived decrease in mindfulness during the pandemic (b =  - 0.72, SE = 0.08, p < .001) on psychological symptoms (R ² = .21-.34; F[2, 197] = 51.13-52.81, p < .001). The indirect effect of IU on symptoms via perceived decrease in mindfulness during the pandemic (b = 0.13, SE = 0.043, 95%CI [.060, .226]) was significant (R ² = .41, F[3, 195] = 45.08, p < .001).

Conclusions

Results suggest that mothers who are less able to tolerate uncertainty experience more psychological symptoms, in part due to perceived reduction in mindfulness during the pandemic. Future research should examine whether IU is a screening risk marker and target for mindfulness-based interventions to improve maternal well-being and family outcomes.

The association between BIS/BAS and fear of COVID-19 infection among women

BACKGROUND

The main goal of this cross-sectional study was to evaluate, in women, the association between the behavioural inhibition system/behavioural activation system (BIS/BAS) and fear of COVID-19-related self-infection and infection of loved ones (family members, friends, relatives). Several studies have indicated that the psychological consequences of COVID-19 are serious especially among women. On the other hand, little is known about the role of the BIS and BAS in shaping responses and behaviour during the COVID-19 pandemic. The article deals with this issue.

PARTICIPANTS AND PROCEDURE

The sample consisted of 415 women between the ages of 18 and 67. A numerical rating scale comprising 11 degrees of fear was used to assess participants' COVID-19-related fear, and the BIS and BAS were evaluated using Carver and White's BIS/BAS scales.

RESULTS

A small positive correlation was observed between the BIS and participants' COVID-19-related fear of loved ones' infection. The BIS explained two percent of the COVID-19-related fear of loved ones' infection dimension.

CONCLUSIONS

The BIS weakly, but significantly correlated with women's fear of their loved ones being infected by COVID-19. This study highlights the possible role of the BIS mechanism in women's response to COVID-19-related fear, but only when the threat affects loved ones. Comparative studies between men and women are necessary.

Psychological distress associated with the COVID-19 lockdown: A two-wave network analysis

BACKGROUND

Although preliminary research has evidenced negative psychological consequences of the COVID-19 pandemic among the general population, little research has been carried out examining the interplay among the broader dimensions and correlates of individual distress. Via network analysis, the current study investigated the pathways that underlie some components of psychological distress and their changes over time (during and post COVID-19-related lockdown).

METHODS

1,129 adult participants (79.1% women) completed a two-wave online survey during and after the lockdown, and reported on variables such as depression, anxiety, stress, fear of COVID, intolerance of uncertainty, emotion regulation and social support. The networks were estimated via Gaussian Graphical Models and their temporal changes were compared through the centrality measures.

RESULTS

Depression, stress, anxiety and fear of COVID formed a spatially contiguous pattern, which remained unchanged in both the two waves. After the lockdown, the fear of COVID node reduced its strength in the network, whereas inhibitory intolerance of uncertainty and emotion suppression were associated with depression. Emotion regulation was connected to depression, but not to stress and anxiety during both waves. Perceived emotional support had few connections to the other nodes.

LIMITATIONS

Only 32.7% of participants provided complete responses for both waves.

CONCLUSION

The COVID-19 outbreak has had a significant psychosocial impact on adults. In the context of the network approach, depressive symptoms had the highest strength and their associations to other dimensions of individual distress may be key factors in understanding the influence of exposure to the COVID-19 outbreak on mental health.

Suppression May Improve Adaptation to Worry When Facing Uncertainty: Studying COVID-19 Pandemic

The COVID-19 pandemic has been associated with increased uncertainty, fear and worry in everyone's life. The effect of changes in daily life has been studied widely, but we do not know how emotion-regulation strategies influence adaptation to a new situation to help them overcome worry in the face of uncertainty. Here, 1,064 self-selected Farsi speaking participants completed an online battery of questionnaires that measured fear of virus and illness, worry, intolerance of uncertainty, and emotion regulation (two subscales: reappraisal, suppression). We also documented the number of daily COVID-19 cases and deaths due to COVID-19 on the day in which participants completed the questionnaire. Our findings suggest a correlation between contamination fear and the number of daily-confirmed cases (r = 0.11), and the number of reported deaths due to COVID-19 (r = 0.09). Worry mediated the relationship between intolerance of uncertainty and fear of virus and illness (b = 0.16, 0.1141 < CI < 0.2113). In addition, suppression moderated the relationship between intolerance of uncertainty and worry (p < 0.01). Our results suggest that suppression (at least in the short term) can be an adaptive response to the worry associated with uncertainty. Suppression can reduce worry, which in turn can decrease fear of contamination and improve adaptation to social distancing requirements. Although, the observed correlations were significant, but considering the sample size, they are not strong, and they should be interpreted cautiously.

Emotional dysregulation and uncertainty intolerance as transdiagnostic mediators of anxiety in adults with autism spectrum disorders and intellectual disability

BACKGROUND

There is extensive documentation supporting the comorbidity of anxiety and autistic spectrum disorder (ASD). Transdiagnostic factors such as executive functions, emotion regulation, and uncertainty intolerance are associated with anxiety in ASD.

AIM

The primary aim of this paper is to study anxiety symptoms in adults with ASD and ID and their relationship with transdiagnostic variables.

METHOD

121 adults (M = 35.46 years, SD = 9.46) with ASD and intellectual disabilities (ID) were evaluated to determine the predictive and mediating role of executive functioning, emotional regulation and intolerance to uncertainty.

RESULTS

Hierarchical linear regression showed uncertainty intolerance was a predictor of anxiety. A multiple mediation analysis supported the mediating role of uncertainty intolerance and emotional regulation between ASD and anxiety.

CONCLUSIONS AND IMPLICATIONS

These findings suggest that interventions designed to reduce anxiety symptoms in people with ASD and ID should include among their goals emotional regulation and especially intolerance of uncertainty.

Alterations in the amplitude and burst rate of beta oscillations impair reward-dependent motor learning in anxiety

Anxiety results in sub-optimal motor learning, but the precise mechanisms through which this effect occurs remain unknown. Using a motor sequence learning paradigm with separate phases for initial exploration and reward-based learning, we show that anxiety states in humans impair learning by attenuating the update of reward estimates. Further, when such estimates are perceived as unstable over time (volatility), anxiety constrains adaptive behavioral changes. Neurally, anxiety during initial exploration increased the amplitude and the rate of long bursts of sensorimotor and prefrontal beta oscillations (13-30 Hz). These changes extended to the subsequent learning phase, where phasic increases in beta power and burst rate following reward feedback were linked to smaller updates in reward estimates, with a higher anxiety-related increase explaining the attenuated belief updating. These data suggest that state anxiety alters the dynamics of beta oscillations during reward processing, thereby impairing proper updating of motor predictions when learning in unstable environments.