Intolerance of uncertainty prospectively predicts the transdiagnostic severity of emotional psychopathology: Evidence from a Veteran sample

The different mediation role of habit features between intolerance of uncertainty and psychopathological symptom dimensions: A transdiagnostic perspective

BACKGROUND

Intolerance of uncertainty (IU) is a transdiagnosed vulnerability for many mental disorders. Habit is a potential cognitive construct that links to intolerance of uncertainty and symptom dimensions. This study adopted a transdiagnose perspective to investigate the mediation effect of habit features between symptom dimensions and intolerance of uncertainty in a Chinese community sample.

METHODS

We recruited 4102 Chinese adults age ranged from 18 to 67 (M = 26.9, SD = 8.01) to extract psychopathological symptom dimensions and explore the mediation roles of habit features.

RESULTS

The study extracted three symptom dimensions (compulsivity, addiction and affective stress dimension). All symptom dimensions, IU and habit features were significantly related (p < 0.01). IU had a direct positive influence on all three dimensions (compulsivity: effect = 0.41; affective stress: effect = 0.58; addiction: effect = 0.13), it lso have an indirect positive impact via habit feature of automaticity (compulsivity: effect = 0.095; affective stress: effect = 0.062; addiction: effect = 0.050). Additionally, IU can positively influence compulsivity dimension (effect = 0.053) and negatively affective stress (effect = -0.026) dimension through routine feature of habit.

CONCLUSIONS

Higher level of IU can intensify symptom dimension by habit feature of automaticity, while habit feature of routine can alleviate affective stress dimension and aggravate compulsivity dimension.

Bidirectional relationships between intolerance of uncertainty and generalized anxiety among adolescents: insights from cross-lagged panel network analysis

BACKGROUND

Intolerance of uncertainty (IU) has received increasing attention for its role in the development and maintenance of generalized anxiety. However, little is known about the temporal and causal relationships between IU and generalized anxiety, particularly in adolescents. Furthermore, much of the existing literature treats IU and generalized anxiety as unidimensional constructs, limiting a detailed understanding of their internal elements and specific symptom interactions. To address the gaps, this study employed a cross-lagged panel network (CLPN) approach to examine the temporal interactions and predictive relationships between IU elements and generalized anxiety symptoms.

METHODS

A sample of 7,434 nonclinical adolescents (mean age = 15.33 years, range = 11-19 years, 50.6% girls) completed the Intolerance of Uncertainty Scale (Short Form) for Children (IUSC-12) and the Generalized Anxiety Disorder Scale (GAD-7) across two waves, six months apart. Data was analyzed using the CLPN approach.

RESULTS

Bidirectional predictive relationships were found between IU elements and generalized anxiety symptoms, with generalized anxiety symptoms more frequently predicting IU elements. The generalized anxiety symptom named "nervousness" was the strongest predictor of increases in both IU elements and other generalized anxiety symptoms over time, while the IU elements named "frustration" and "work with hindrance" were the strongest predictors of future generalized anxiety symptoms.

CONCLUSIONS

This study provides new insights into the reciprocal relationships between IU and generalized anxiety among adolescents, highlighting the complex interplay between vulnerability and mental health problems. By identifying key IU elements and generalized anxiety symptoms that drive these relationships, the findings contribute to a more nuanced understanding of adolescent psychopathology and inform targeted interventions.

Perceived Social Support, Intolerance of Uncertainty, and War-Related Stress: Unraveling the Nexus with Treatment Burden in Adult-Child Caregivers During War

Adult-child caregivers encounter various challenges due to their array of roles and tasks, often leading to a substantial sense of treatment burden. While previous research has explored factors contributing to treatment burden, much of it has centered on routine periods, leaving a gap in the understanding of this issue during crisis situations characterized by heightened stress and uncertainty. Therefore, this study aims to address this gap by investigating the mediating role of intolerance of uncertainty and war-related stress in the relationship between perceived social support and treatment burden among adult-child caregivers during the Israel-Hamas war. The study involved Israeli adult-child caregivers who completed a structured questionnaire distributed online. The findings showed that perceived social support was negatively associated with intolerance of uncertainty, which, in turn, was positively associated with war-related stress. Consequently, a positive correlation was observed between war-related stress and treatment burden. Perceived social support was found to be negatively associated with war-related stress. These findings underscore the significance of social support in reducing treatment burden, particularly during periods of heightened stress such as wartime. Understanding the interplay between these factors can inform the development of effective interventions aimed at alleviating the burden experienced by adult-child caregivers.

An Examination of Intolerance of Uncertainty in Schizophrenia

INTRODUCTION

Schizophrenia is associated with multiple comorbidities and symptoms, suggestive of common transdiagnostic processes. Elevated intolerance of uncertainty (IU) is one such transdiagnostic process, but little research has been conducted on IU in schizophrenia.

METHODS

This study assessed the associations between IU, schizophrenia diagnosis and schizophrenia symptoms using a between-group cross-sectional design. The sample comprised 113 participants, 72 people with a schizophrenia diagnosis and 41 control participants without (73 male, 40 female, age range 19-69 [M = 42.1, SD = 13.0]). Measures of schizophrenia symptoms, IU, depression and anxiety symptoms, rumination, executive functioning and rumination were taken.

RESULTS

Schizophrenia diagnosis was predicted by lower prospective IU and higher levels of inhibitory IU. Specifically, the prospective subscale was uniquely associated with general schizophrenia symptoms. Higher levels of positive symptoms were associated with higher prospective IU and lower inhibitory IU, however, not when anxiety and depressive symptoms, rumination and verbal fluency were controlled for. No unique associations were found with negative symptoms.

CONCLUSIONS

Different directions of association between the subtypes of IU and schizophrenia diagnosis as well as distinct relationships between IU and symptom subtypes suggest that prospective and inhibitory IU have distinct associations with the disorder.

Predictors of Change in Vaccination Decisions Among the Vaccine Hesitant: Examining the Roles of Age and Intolerance of Uncertainty

BACKGROUND

Vaccine hesitancy and resistance pose significant threats to controlling pandemics and preventing infectious diseases. In a group of individuals unvaccinated against the disease caused by the SARS-CoV-2 coronavirus (COVID-19), we investigated how age, intolerance of uncertainty (IU), and their interaction affected the likelihood of having changed one's vaccination decision a year later. We hypothesized that higher IU would increase the likelihood of becoming vaccinated, particularly among individuals of younger age. We predicted that this effect would remain significant, even after controlling for delay discounting and trust in science.

PURPOSE

The goal of this research was to understand the factors influencing changes in vaccination decisions among the vaccine hesitant.

METHODS

In a larger longitudinal study, ~7,500 participants from Prolific.co completed demographic and vaccination status questions, a delay discounting task, and the Intolerance of Uncertainty Scale in June-August 2021. Approximately 3,200 participants completed a follow-up survey in July-August 2022, answering questions about vaccination status, reasons for vaccination decision, and trust in science. We analyzed data from 251 participants who initially had no intention of getting vaccinated and completed the follow-up survey; 38% reported becoming vaccinated in the intervening year.

RESULTS

Data were analyzed using multilevel logistic regression. Over and above other factors related to vaccination decisions (delay discounting, trust in science), younger participants were more likely to change their decision and become vaccinated a year later, especially if they had higher IU, confirming our predictions. Primary reasons for becoming vaccinated were necessity and seeking protection against the virus.

CONCLUSIONS

These findings highlight the complex interplay between age, uncertainty, and vaccination decisions, and inform health policies by suggesting the need for tailoring interventions to specific concerns in different age groups.

Intolerance of uncertainty on distress and impairment: The mediating role of repetitive negative thinking

Repetitive negative thinking and intolerance of uncertainty are risk and maintenance factors for emotional disorders. Although emerging evidence suggests that intolerance of uncertainty predicts increases in distress through repetitive negative thinking, these relationships have yet to be investigated among veterans. The present study examines if repetitive negative thinking mediates the relationships of intolerance of uncertainty with stress, disordered symptoms and impairment among a mixed clinical sample of veterans. Two hundred and forty-four treatment-seeking veterans with diagnoses of major depressive disorder, panic disorder, or posttraumatic stress disorder completed measures of intolerance of uncertainty, repetitive negative thinking, stress, impairment, depression, panic, and posttraumatic stress prior to receiving treatment. Mediation models revealed indirect effects of intolerance of uncertainty through repetitive negative thinking on stress and impairment in the full sample, and on disordered symptoms in subsamples with major depressive disorder and posttraumatic stress disorder. Conversely, intolerance of uncertainty did not have direct or indirect effects on disordered symptoms in a panic disorder subsample. Findings suggest that repetitive negative thinking and intolerance of uncertainty uniquely contribute to stress, impairment, and disordered symptoms, but repetitive negative thinking, may, in part, drive intolerance of uncertainty's contribution to emotional disorders. Interventions for repetitive negative thinking might improve the efficacy of existing transdiagnostic treatment protocols. Cross-sectional data is a limitation of the present study. Prospective designs in civilian samples can better establish the temporality of these relationships and if they are generalizable to the larger population.

Longitudinal Associations Between Depression, Suicidal Ideation, and Lack of Certainty in Control among Adolescents: Disaggregation of Within-Person and Between-Person Effects

PURPOSE

Depression and suicidal ideation (SI) are common in adolescents. However, the relation between the two is unclear. According to the cognitive model of suicidal behavior and learned helplessness theory, lack of certainty in control (LCC), referring to individuals' deficiency in predictability, certainty, and control of life, may be an important factor linking the two. Thus, the current study aimed to investigate the temporal relation between depression and SI in adolescents and to assess the mediating role of LCC in this relation.

METHODS

A three-wave survey was carried out at intervals of 1 and 1.5 years among 516 adolescents at several middle schools in Sichuan Province, China. The random-intercept cross-lagged panel model was used to examine the temporal relations between depression, SI, and LCC among adolescents, which can effectively distinguish between-person and within-person differences.

RESULTS

The results revealed that depression, SI, and LCC had positive intercorrelations at the between-person level. At the within-person level, early depression predicted subsequent depression and SI via LCC among adolescents. Additionally, early LCC promoted later SI through depression.

DISCUSSION

These findings highlight the mediating role of LCC, clarify the temporal relation between depression and SI, and provide theoretical support for interventions to address depression and suicide.

Integrating Palliative Care and Hematologic Malignancies: Bridging the Gaps for Our Patients and Their Caregivers

Patients with hematologic malignancies (HMs) struggle with immense physical and psychological symptom burden, which negatively affect their quality of life (QOL) throughout the continuum of illness. These patients are often faced with substantial prognostic uncertainty as they navigate their illness course, which further complicates their medical decision making, especially at the end of life (EOL). Consequently, patients with HM often endure intensive medical care at the EOL, including frequent hospitalization and intensive care unit admissions, and they often die in the hospital. Our EOL health care delivery models are not well suited to meet the unique needs of patients with HMs. Although studies have established the role of specialty palliative care for improving QOL and EOL outcomes in patients with solid tumors, numerous disease-, clinician-, and system-based barriers prevail, limiting the integration of palliative care for patients with HMs. Nonetheless, multiple studies have emerged over the past decade identifying the role of palliative care integration in patients with various HMs, resulting in improvements in patient-reported QOL, symptom burden, and psychological distress, as well as EOL care. Importantly, these studies have also identified active components of specialty palliative care interventions, including strategies to promote adaptive coping especially in the face of prognostic uncertainty. Future work can leverage the knowledge gained from specialty palliative care integration to develop and test primary palliative care interventions by training clinicians caring for patients with HMs to incorporate these strategies into their clinical practice.

The chain mediating role of psychological resilience and neuroticism between intolerance of uncertainty and perceived stress among medical university students in Southwest China

BACKGROUND

Medical university students are confronted with unprecedented uncertainty and stress compared with their peers. Research has explored the effect of intolerance of uncertainty on perceived stress, but little attention was paid to investigate the mediating mechanisms behind this relationship, especially among medical university students. The aim of this study was to examine whether psychological resilience and neuroticism played a mediating role between medical university students' intolerance of uncertainty and perceived stress.

METHODS

A total of 717 medical university students from Chongqing in Southwest China were recruited to participate in our study and completed demographic information, Intolerance of Uncertainty Scale Short Version (IUS-12), Chinese Version of Perceived Stress Scale (CPSS), Connor-Davidson Resilience Scale-10 (CD-RISC-10) and Eysenck Personality Questionnaire (EPQ).

RESULTS

(1) Significant correlations between intolerance of uncertainty, perceived stress, psychological resilience and neuroticism were found. (2) Intolerance of uncertainty affected medical university students' perceived stress via three paths: the mediating effect of psychological resilience, the mediating effect of neuroticism, and the chain mediating effect of both psychological resilience and neuroticism.

CONCLUSIONS

Intolerance of uncertainty could directly affect the perceived stress of medical university students, and also affected perceived stress through the mediating roles of psychological resilience and neuroticism, as well as through the chain mediating role of these two variables.

Targeting intolerance of uncertainty in treatment: A meta-analysis of therapeutic effects, treatment moderators, and underlying mechanisms

OBJECTIVE

Anxiety-related disorders are among the most prevalent psychiatric conditions and cause significant impairment. Intolerance of uncertainty (IU) contributes to the emergence, maintenance, and symptom severity of anxiety-related disorders, yet information regarding treatment-related changes in IU is limited. This systematic review and meta-analysis examined the efficacy of evidence-based treatments for anxiety-related disorders on IU, explored factors moderating treatment effects of IU, and examined whether therapeutic improvement in IU corresponded with improvements in anxiety symptom severity.

METHODS

PubMED and PsycINFO were searched for randomized controlled trials (RCTs) using the terms "intolerance of uncertainty" AND "treatment" OR "therapy." Data for pre and post-treatment measures and patient, intervention, and trial-level characteristics were extracted from 28 RCTs. Separate random effects models examined the treatment efficacy of interventions on IU and symptom severity. Moderators of therapeutic effects were analyzed via method-of-moments meta-regression or an analog to the analysis of variance.

RESULTS

Across RCTs, interventions exhibited a large therapeutic effect on IU compared to control conditions (g = 0.89). Treatment effects on IU positively corresponded with improved symptom severity and accounted for 36 % of the variance. Interestingly, comorbid depression and certain treatment approaches were associated with larger improvements in IU.

CONCLUSION

Evidence-based treatments are effective in improving IU, highlighting the importance of IU in the treatment of anxiety-related disorders. Moderator analyses identified patient and intervention-level factors to inform approaches to improve therapeutic effects on IU. Future research is needed to optimize interventions targeting IU and evaluate long-term efficacy of interventions on IU for anxiety-related disorders.