Cognitive Behaviour Therapy, 2015 Vol. 44, No. 1, 54–62, http://dx.doi.org/10.1080/16506073.2014.959039
Domain-Specific Intolerance of Uncertainty in Socially Anxious and Contamination-Focused Obsessive – Compulsive Individuals Dane Jensen and Richard G. Heimberg Department of Psychology, Temple University, Philadelphia, PA 19122, USA Abstract. Intolerance of uncertainty (IU) has been increasingly recognized as a transdiagnostic factor across anxiety disorders and depression and is associated with substantial cognitive, behavioral, and emotional impairment. IU is typically construed as a dispositional tendency to view ambiguous stimuli and unknown outcomes as unacceptably threatening regardless of context, but recent findings suggest that the domain in which uncertainty is encountered may be relevant. Taking that research to the next step, the aim of the present study was to determine whether IU is more salient in concerncongruent versus incongruent domains and whether domain-specific IU is a better predictor of anxiety symptoms than trait IU. A total of 102 undergraduates were recruited into analog socially anxious (SA), obsessive –compulsive contamination (OCC), and nonanxious control (NAC) groups based on responses to measures of SA and OCC symptoms. Both groups reported more domain-congruent IU than trait IU or domain-incongruent IU. The SA group reported more social interaction IU than the OCC and NAC groups; the OCC group reported more cleanliness IU than the SA and NAC groups. Domain-specific IU predicted social anxiety and OCC fears above and beyond trait IU. Results suggest that IU has a substantial context-specific component and should be examined both transdiagnostically and transsituationally. Key words: intolerance of uncertainty; social anxiety; obsessive–compulsive disorder; transdiagnostic; contextual. Received 20 June 2014; Accepted 25 August 2014 Correspondence address: Richard G. Heimberg, Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA. Tel: þ1 215 204 1575. Email: [email protected]
Evidence suggests that intolerance of uncertainty (IU; the tendency to view ambiguous stimuli and unknown outcomes as unacceptably threatening) is a transdiagnostic factor across the emotional disorders, including generalized anxiety disorder (GAD; e.g., Dugas, Gagnon, Ladouceur, & Freeston, 1998), social anxiety disorder (SAD; e.g., Boelen & Reijntjes, 2009; Carleton, Collimore, & Asmundson, 2010), obsessive – compulsive disorder (OCD; e.g., Holaway, Heimberg, & Coles, 2006; Sarawgi, Oglesby, & Cougle, 2013), post-traumatic stress disorder (Fetzner, Horswill, Boelen, & Carleton, 2013), panic disorder and agoraphobia (e.g., Carleton, Fetzner, Hackl, & McEvoy, 2013), health anxiety (e.g., Fergus, 2013), and depression (de Jong-Meyer, Beck, & Riede, 2009). Associations of IU to multiple disorders have been reported both across and within studies (Mahoney & McEvoy, 2012c). IU q 2014 Swedish Association for Behaviour Therapy
predicts anxiety symptoms above and beyond other cognitive vulnerability factors (Norr et al., 2013) and is also associated with considerable cognitive and behavioral impairment, including poor performance in problem-solving and decision-making tasks (e.g., Koerner & Dugas, 2006; Luhmann, Ishida, & Hajcak, 2011), behavioral inhibition in the face of uncertainty (Buhr & Dugas, 2002), information-processing biases (Dugas et al., 2005), increased information-seeking (Ladouceur, Talbot, & Dugas, 1997), and overestimation of the probability and impact of negative events (Bredemeier & Berenbaum, 2008; Luhmann et al., 2011). IU is central to Dugas et al.’s (1998) model of worry and GAD and has been suggested as a potential moderating factor in the traditional diathesisstress model of anxiety (Chen & Hong, 2010). Evidence suggests that reductions in IU correlate with symptom reduction across
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disorders in transdiagnostic cognitive-behavioral therapy (Boswell, Thompson-Hollands, Farchione, & Barlow, 2013) and in treatment of SAD (Mahoney & McEvoy, 2012a), GAD (e.g., Dugas et al., 2003) and OCD (Overton & Menzies, 2005). Treatments specifically targeting IU have also been shown to reduce symptoms of GAD (van der Heiden, Muris, & van der Molen, 2012), SAD (Hewitt, Egan, & Rees, 2009), and health anxiety (Langlois & Ladouceur, 2004). Though extant research predominantly conceptualizes IU as a dispositional trait, recent evidence suggests situational context may contribute to the salience of uncertain stimuli (Mahoney & McEvoy, 2012b). Mahoney and McEvoy modified the Intolerance of Uncertainty Scale—12-item version (IUS-12; Carleton, Norton, & Asmundson, 2007) to direct individuals to consider IU in specific situations. Participants were recruited from a specialist anxiety disorder treatment service and had primary diagnoses spanning the range of anxiety disorders and depression. They were asked to describe a distressing, regularly occurring situation relevant to their domain of primary concern (e.g., social interactions, excessive worries about everyday matters) and respond to the questionnaire in regard to that specific situation. For example, the original IUS-12 item “I can’t stand being taken by surprise” was altered to read, “I can’t stand being taken by surprise in this situation.” Participants achieved significantly higher scores on the measure of situation-specific IU (modified IUS-12) than on the measure of trait IU (standard IUS-12), suggesting that IU is more salient in idiographically distressing situations. Further, situation-specific IU significantly predicted symptoms of depression and panic disorder above and beyond trait IU, although it failed to do so for symptoms of social anxiety, obsessive – compulsive disorder, or worry. These findings have several theoretical and clinical implications. A higher level of situation-specific IU than trait IU may indicate that state and trait IU are qualitatively different depending on the context in which state IU is stimulated. IU may be elevated in circumstances in which negative outcomes are perceived as particularly probable or as having an exceptionally high cost. As a result, facets of IU may be differentially expressed based on situational factors. For example,
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socially-anxious individuals find social evaluation more threatening and distressing than negative outcomes in other contexts. Thus, they may experience elevated IU in social situations, as their uncertainty regards social evaluation, which, for them, is intolerable. In this circumstance, behavioral inhibition associated with IU may be more salient than increased information-seeking, as information-seeking may be more visible, subjecting individuals to evaluation. Conversely, individuals with obsessive –compulsive traits may exhibit greater information-seeking in the form of frequent checking to reduce their uncertainty and may display little behavioral inhibition, or perhaps activation in the form of other compulsions. If this is the case, determining the situational characteristics that elicit IU in various disorders may allow us to improve treatments targeting IU or to better understand how IU contributes to the maintenance of emotional disorder. Though Mahoney and McEvoy’s (2012b) findings are an important first step in understanding IU as a situation-specific construct, they must be interpreted in the context of some limitations. Given that a diagnostically heterogeneous sample was examined and data on situation-specific IU were collected for only a single situation per participant, demonstration of the ability of situation-specific IU to predict symptoms above and beyond the contributions of trait IU are incomplete. Situation-specific IU was measured for different individuals in very different types of situations; for some participants, the questionnaire measured situation-specific IU in social contexts, for others, in regards to panic-inducing situations, and so on. It may be that there are differences in situation-specific IU depending on domain of concern or on the characteristics of the specific situation itself. Further, the study examined IU in distressing but not neutral situations, limiting our comparative scope. A more thorough examination of domainspecific IU is merited, which focuses on both domain-congruent and domain-incongruent situational content. The aim of the present study was to examine whether IU is more salient in domains of concern than in neutral domains for individuals with distinct symptom profiles. We compared IU in two analog anxious groups (socially anxious [SA] and obsessive–compulsive with
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contamination fears [OCC]) and a nonanxious control (NAC) group. Consistent with the findings from Mahoney and McEvoy (2012b), we hypothesized that individuals would achieve higher scores on a measure of domain-specific IU than trait IU, but we further hypothesized that this pattern would be evident only for domain-congruent situations. In addition, we hypothesized that domain-specific IU would predict domain-congruent symptoms above and beyond the contributions of trait IU.
7% as Asian-American/Asian, 1% as Native American, and 4% as Other; 7% of the sample also identified as Hispanic. Groups did not differ on age, F(2, 97) ¼ 0.78, p ¼ .46, race, x 2(8) ¼ 12.17, p ¼ .14,1 or number of years of education, F(2, 97) ¼ 0.39, p ¼ .68. Groups differed significantly on sex, x 2(2) ¼ 8.10, p ¼ .02, SA group 67.6% female, OCC group 93.9% female, and NAC group 84.8% female.
Materials
Methods Participants
In total, 102 undergraduates enrolled at Temple University were recruited into the study from a larger research participation pool based on responses to two validated self-report measures—the Social Interaction Anxiety Scale—Straightforward Items (SIAS-S; Mattick & Clarke, 1998; Rodebaugh, Woods, & Heimberg, 2007) and the Obsessive –Compulsive Inventory—Revised (OCI-R; Foa et al., 2002)—as administered on the university’s research participation website. Participants scoring in the upper quartile on the SIAS-S (. 23) and below the median of the contamination subscale of the OCI-R (, 2) were recruited into the SA group, and participants scoring the upper quartile on the OCI-R contamination subscale (. 2) and below the median of the SIAS-S (, 16) were recruited into the OCC group. Participants scoring below the median on both the SIAS-S and the OCI-R contamination subscale were recruited into the NAC group. These cutoffs were selected to ensure the recruitment of relatively distinct SA and OCC groups and a comparison group with low levels of both categories of symptoms. Participants were not excluded on the basis of any demographic characteristics and were given partial course credit for their participation. Two of the initial 102 participants did not complete the battery of questionnaires (including the IUS-12 and its derivatives) and were thus excluded from subsequent analyses. The final sample consisted of 100 participants (82% female; age M ¼ 21.7, SD ¼ 3.8). The sample was ethnically and racially diverse: 72% self-identified as Caucasian/White, 15% as African-American/Black,
Self-report questionnaires Social Interaction Anxiety Scale—straightforward items. The SIAS (Mattick & Clarke, 1998) is a 20-item self-report measure designed to evaluate fears of social interactions in dyads and groups. Each item is rated on a five-point Likert-type scale from 0 (Not at all characteristic or true of me) to 4 (Extremely characteristic or true of me). The SIAS has demonstrated good reliability and validity in a number of studies (e.g., Brown et al., 1997; Safren, Turk, & Heimberg, 1998). Rodebaugh et al. (2007) have demonstrated that the straightforward items are more robust predictors of social interaction anxiety than the reverse-scored items in both undergraduate and clinical samples and therefore recommend utilizing only the 17 straightforward items (SIAS-S) to calculate the total score; thus, the SIAS-S was used in the present study. Both the SIAS and SIAS-S have evidenced adequate internal consistency in undergraduate samples (SIAS: a ¼ .88, Mattick & Clarke, 1998; SIAS-S: a ¼ .93, Rodebaugh et al., 2007). Internal consistency for the SIAS-S in the present sample was high, a ¼ .97. Obsessive– compulsive inventory—revised. The OCI-R (Foa et al., 2002) is an abbreviated 18item version of the Obsessive – Compulsive Inventory (Foa, Kozak, Salkovskis, Coles, & Amir, 1998), which was designed to assess the various symptom domains relevant to obsessive –compulsive disorder. Each item is rated on a five-point Likert-type scale from 0 (not at all) to 4 (extremely), corresponding to the level of symptom distress. The OCI-R has evidenced good reliability and validity in a number of studies (e.g., Abramowitz & Deacon, 2006; Foa et al., 2002), including good internal consistency (a ¼ .90, Foa et al., 2002; a ¼ .88, Hajcak, Huppert, Simons, & Foa, 2004). The OCI-R has consistently demonstrated six
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factors: (1) washing, (2) checking, (3) obsessions, (4) mental neutralizing, (5) ordering, and (6) hoarding (e.g., Abramowitz & Deacon, 2006; Foa et al., 2002). Subscales based on each factor include three items. Internal consistency in the present sample was high for the total score, a ¼ .90, and for the contamination subscale, a ¼ .91. Intolerance of uncertainty scale—12-item version. The IUS-12 (Carleton et al., 2007) is an abbreviated version of the Intolerance of Uncertainty Scale (IUS; Freeston, Rhe´aume, Letarte, Dugas, & Ladouceur, 1994). The original IUS consists of 27 items intended to assess emotional, cognitive, and behavioral reactions to uncertain situations, problems with feeling uncertain, and attempts to control future events. The IUS-12 shows a strong correlation with the original scale (r ¼ .96; Carleton et al., 2007). Items on the IUS-12 are rated on a five-point Likert-type scale ranging from 1 (Not at all characteristic of me) to 5 (Entirely characteristic of me). Both the original IUS and the IUS-12 have demonstrated good internal consistency in undergraduate samples (IUS: a ¼ .91, Freeston et al., 1994; IUS-12: a ¼ .91, Carleton et al., 2007). For the purpose of this study, the standard IUS-12 was used as the measure of trait IU. In addition, versions orienting the participant to particular contexts were used as measures of domain-specific IU (e.g., “For this questionnaire, please consider the statements as they pertain specifically to social interactions [e.g., initiating conversations with someone you don’t know very well, going on a first date, interviewing for a job]”). Internal consistency in the present sample was high for the standard IUS-12, a ¼ .90, social interaction IU, a ¼ .95, and cleanliness IU,2 a ¼ .95.
Procedure
Prior to participation in the laboratory portion of the study, participants completed a battery of questionnaires online through the university’s research participation website. Included in this battery were items assessing demographic characteristics, as well as the SIAS-S and OCI-R. Eligible participants were recruited via email to participate in the laboratory portion of the study. Upon arrival at the laboratory, participants provided written informed consent. Participants then
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completed a computer-administered questionnaire battery consisting of the trait IUS-12 and four domain-specific versions of the IUS-12 (social interactions, cleanliness, and two distractor versions assessing IU regarding finances and world affairs; distractor versions were not included in statistical analyses), randomly ordered, as well as other measures unrelated to the present study.
Results Preliminary analyses
Prior to analysis, data were examined to ensure satisfaction of statistical assumptions. Questionnaire scores were normally distributed, and no outliers were detected. As groups differed significantly by sex, independent samples t-tests were conducted on all dependent variables. Males achieved significantly higher social anxiety scores on the SIAS-S than women (men, M ¼ 23.67; SD ¼ 17.43; women, M ¼ 15.29; SD ¼ 13.99), t (98) ¼ 2.20, p ¼ .03.3 No other significant differences emerged. To account for any confounding of sex, we controlled for sex in all analyses in which social anxiety was the dependent variable. A one-way analysis of covariance followed by planned contrasts revealed that the SA group reported significantly greater social anxiety (M ¼ 35.56; SD ¼ 8.79) than the OCC group (M ¼ 8.51; SD ¼ 4.46; p , .001, 95% CI [24.07, 30.38]) and the NAC group (M ¼ 5.75; SD ¼ 4.33; p , .001, 95% CI [27.11, 33.31]), after controlling for sex, F (2, 95) ¼ 222.63, p , .001, h^ 2 ¼ .79. A oneway analysis of variance (ANOVA) followed by planned contrasts revealed that the OCC group reported significantly more fears of contamination (M ¼ 5.15; SD ¼ 2.27) than the SA group (M ¼ 0.29; SD ¼ 0.46; p , .001, 95% CI [4.21, 5.49]) and the NAC group (M ¼ 0.12; SD ¼ 0.33; p , .001, 95% CI [4.36, 5.64]), F(2, 97) ¼ 149.99, p , .001, h^ 2 ¼ .76.
Intolerance of uncertainty
IU scores were submitted to a 3 (group: SA, OCC, NAC) £ 3 (IU type: trait IU, social interaction IU, cleanliness IU) ANOVA with repeated measurement on the second factor. The main effect of IU type was nonsignificant, F(2, 194) ¼ 1.19, p ¼ .31,
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h^ 2 ¼ .01. The main effect of group was significant, F(2, 97) ¼ 10.06, p , .001, h^ 2 ¼ .21, but was qualified by a significant group by IU type interaction, F(2, 97) ¼ 6.11, p , .01, h^ 2 ¼ .17. To probe this interaction, repeated measures ANOVAs were conducted within each group. The main effect of IU type was significant within the SA group, F(2, 66) ¼ 11.39, p , .001, h^ 2 ¼ .26, and the OCC group, F(2, 64) ¼ 4.87, p , .05, h^ 2 ¼ .11, but not the NAC group, F(2, 64) ¼ 1.71, p ¼ .19. Planned contrasts were conducted within each analog anxiety group (SA, OCC) between domain-congruent IU (i.e., social interaction IU in the SA group, cleanliness IU in the OCC group) and trait IU, and domaincongruent IU and domain-incongruent IU (i.e., cleanliness IU in the SA group, social interaction IU in the OCC group). The SA group reported more social interaction IU than trait IU, F(1, 33) ¼ 10.30, p , .01, h^ 2 ¼ .31, and more social interaction IU than cleanliness IU, F(1, 33) ¼ 13.64, p , .01, h^ 2 ¼ .41. The OCC group reported more cleanliness IU than trait IU, F(1, 32) ¼ 4.38, p , .05, h^ 2 ¼ .14, and more cleanliness IU than social interaction IU, F(1, 32) ¼ 6.12, p , .05, h^ 2 ¼ .19. See Figure 1. 40
IU Score
35
30
25
Trait IU 20
Social IU Cleanliness IU
0
NAC
SA
OC
Group
Figure 1. IU scores by group. NAC, nonanxious control group; SA, social anxiety group; OCC, obsessive– compulsive contamination fear group.
One-way ANOVAs were conducted across group within each type of IU. There were significant effects of group within trait IU, F(2, 97) ¼ 6.41, p # .01, h^ 2 ¼ .12, social interaction IU, F(2, 97) ¼ 14.46, p # .001, h^ 2 ¼ .23, and cleanliness IU, F(2, 97) ¼ 7.48, p , .01, h^ 2 ¼ .13. Post hoc Tukey’s HSD tests revealed that both analog anxiety groups (SA, OCC) reported significantly more trait IU than the NAC group (SA group, M ¼ 31.09; SD ¼ 8.82; OCC group, M ¼ 29.18; SD ¼ 8.94; NAC group, M ¼ 24.21; SD ¼ 6.19; all ps , .05) but that there was no significant difference in trait IU between the SA and OCC groups. The SA group reported more social interaction IU (M ¼ 35.21, SD ¼ 12.52) than the OCC (M ¼ 27.42, SD ¼ 10.18; p , .05) and NAC (M ¼ 21.30, SD ¼ 8.72; p , .001) groups, but there was no significant difference between the OCC and NAC groups, p . .05. The OCC group reported more cleanliness IU (M ¼ 32.12, SD ¼ 11.21) than the SA (M ¼ 25.56, SD ¼ 9.99; p , .05) and NAC (M ¼ 22.55, SD ¼ 9.60; p , .01) groups, but there was no significant difference between the SA and NAC groups, p . .05. To examine the ability of domain-specific IU to predict symptoms above and beyond trait IU, a series of hierarchical linear regression analyses was performed. In each set of regressions, trait IU was entered before domain-congruent IU (i.e., social interaction IU when predicting social anxiety symptoms, cleanliness IU when predicting OCC fears). Before the hierarchical multiple regression analyses were performed, independent variables were examined for collinearity. All tolerance values were greater than .39, suggesting multicollinearity was not problematic. Sex was entered in block one of the regression predicting social anxiety to control for group differences, R 2 ¼ .05, F(1, 98) ¼ 4.83, p , .05, see Table 1. In block two, trait IU significantly predicted SIAS-S scores above and beyond sex, DR 2 ¼ .11, F(1, 97) ¼ 12.88, p , .01. In block three, social interaction IU predicted SIAS-S scores above and beyond trait IU and sex, DR 2 ¼ .12, F(1, 96) ¼ 16.64, p , .001. In block one of the regression predicting OCC fears, trait IU did not significantly predict OCI-R contamination scores, R 2 ¼ .01, F(1, 98) ¼ 1.12, p . .05, see Table 2. In block two, however, cleanliness IU
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Domain-Specific Intolerance of Uncertainty
Table 1. Social interaction IU predicts social anxiety symptoms above and beyond Trait IU
b
Variable Block 1 Sex Block 2 Sex Trait IU Block 3 Sex Trait IU Social interaction IU
2 0.217* 2 0.216* 0.334** 2 0.148 2 0.109 0.570***
DR 2 0.047* 0.112** 0.124***
Notes. IU, intolerance of uncertainty; *p , .05; **p , .01; ***p , .001.
Table 2. Cleanliness IU predicts OCC fears above and beyond trait IU Variable Block 1 Trait IU Block 2 Trait IU Cleanliness IU
b
DR 2 0.011
0.106 2 0.076 3.859**
0.132***
Notes. IU, intolerance of uncertainty; **p , .01; ***p , .001.
significantly predicted OCI-R contamination scores above and beyond trait IU, DR 2 ¼ .13, F(1, 97) ¼ 14.89, p , .001.
Discussion IU has been predominantly examined as a trait construct, tapping reactivity to uncertainty independent of context, but results of the present analyses suggest that uncertainty in domains of concern is less tolerable than uncertainty in other domains. Individuals high in social anxiety reported higher IU in social interactions than trait IU or IU regarding cleanliness; similarly, individuals high in OCC fears reported higher IU regarding cleanliness than trait IU or IU in social interaction. Individuals high in social anxiety but low in OCC fears reported levels of IU regarding cleanliness similar to NACs, and individuals high in OCC fears but low in social anxiety reported levels of IU in social situations similar to NACs. Further, IU in domaincongruent contexts significantly predicted
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symptoms above and beyond trait IU; that is, IU in social interactions predicted social anxiety symptoms after accounting for trait IU, and IU regarding cleanliness predicts OCC fears after accounting for trait IU. These results support the findings of Mahoney and McEvoy (2012b) that individuals find uncertainty more distressing in situations they find aversive. Extending beyond Mahoney and McEvoy’s work, these results provide evidence that, in some situations, uncertainty is not aversive, even for individuals with high trait IU and significant anxiety symptoms. These findings support the transdiagnostic conceptualization of IU but indicate that IU may not be purely dispositional or transsituational; rather, IU appears to have a component that is context-dependent. Given findings that IU is associated with overestimation of the likelihood and impact of negative events (Bredemeier & Berenbaum, 2008; Luhmann et al., 2011), it may be that uncertainty is intolerable in relation to perceived threat. For example, individuals high in social anxiety and low in OCC fears perceive increased threat in social situations but not in situations in which cleanliness is in question; thus, social uncertainty is distressing and cleanliness uncertainty is not. Future research should examine the relationship between perceived threat and IU to determine whether changes in perceived threat impact IU. For example, does manipulating the probability and cost of negative outcomes in domains of concern impact selfreported IU? In addition, our finding that domainspecific IU predicts social anxiety and OCC concerns above and beyond trait IU stands in contrast to Mahoney and McEvoy’s (2012b) findings that situation-specific IU predicted symptoms associated with depression, panic disorder, and agoraphobia, but not social anxiety or obsessive – compulsive disorder. Mahoney and McEvoy’s assessment of situation-specific IU was conducted across diagnostic groups and included heterogeneous situations, whereas the present study examined discrete analog diagnostic groups and their corresponding contexts. Further, Mahoney and McEvoy examined a population with high comorbidity. It may be that trait IU is a better independent predictor when more domains are distressing. These findings
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suggest that domain-specific IU is associated with symptoms of relevant disorders and not necessarily with psychological symptoms more broadly, providing further rationale for examining IU in relation to perceived threat. Strengths of this study include the relatively distinct analog groups, providing confidence in our ability to examine the effects of specific domains within varying symptom types. Further, randomization provided a strong counter to potential order effects. Despite these strengths, the study is limited by the cross-sectional undergraduate sample, a restricted range of OCI-R contamination subscale scores, and group differences in distribution of participants by sex. Though the use of a cross-sectional undergraduate sample may limit generalizability, our results offer strong preliminary evidence for the domain-specificity of IU. The restricted range of OCI-R contamination scores may have limited the separation between high and low OCC participants, but our results indicate that the difference was sufficient to elicit a fairly substantial effect. Also, this study examined an analog OC group with contamination concerns, limiting generalizability to OC symptoms more broadly. The exclusion of individuals demonstrating broader OC symptoms may account for the finding that trait IU did not predict OC contamination fears, despite substantial literature demonstrating strong associations between trait IU and OC symptoms. It may be that other OC domains are more closely tied to trait IU. Lastly, group differences in sex ratio denote less-thanideal sampling; however, we controlled for sex in all potentially affected analyses and the findings held. Still, future research should extend past these limitations by examining these phenomena in clinical populations of the several disorders associated with IU; with prospective, longitudinal designs; in samples demonstrating a wider range of OC symptoms, and within groups balanced by sex. In sum, our findings indicate that IU is sensitive and specific to context and that domain-specific IU may predict symptoms related to psychological distress better than trait IU. A contextual perspective on IU requires that we consider circumstantial factors in our examinations of IU, within and across disorders, and in models of the etiology, maintenance, and treatment of
emotional disorders. Though considerable research suggests IU is transdiagnostic, clarifying the unique role of IU within disorder and within context is an important research agenda.
Disclosure statement The authors have declared that no conflict of interest exists.
Notes 1. For this analysis, the expected frequency of some cells
2.
3.
was less than five. However, the Chi-square test has been found to provide adequate estimates of Type I error probability with expected frequencies of cells as low as 1 or 2 (Camilli & Hopkins, 1978). The IU measure referred to cleanliness rather than contamination; thus, the label “cleanliness IU” is used. The subscale of the OCI-R used to screen participants is referred to as the “contamination” subscale, and the group is labeled accordingly. Following this test, we realized the possibility that there may be a gender by anxiety group confound, in that the social anxiety group included a higher proportion of males (32.4%) than the OCC (6.1%) and NAC (15.2%) groups. Thus, we ran followup two (sex) by three (group) ANOVAs to determine if dependent variables differed significantly by sex. No significant interactions or main effects of sex emerged, but we controlled for sex in analyses using social anxiety as an outcome variable regardless.
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Fetzner, M.G., Horswill, S.C., Boelen, P.A., & Carleton, R.N. (2013). Intolerance of uncertainty and PTSD symptoms: Exploring the construct relationship in a community sample with a heterogeneous trauma history. Cognitive Therapy and Research, 37, 725– 734. doi:10. 1007/s10608-013-9531-6 Foa, E.B., Huppert, J.D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P.M. (2002). The Obsessive – Compulsive Inventory: Development and validation of a short version. Psychological Assessment, 14, 485– 496. Foa, E.B., Kozak, M.J., Salkovskis, P.M., Coles, M.E., & Amir, N. (1998). The validation of a new Obsessive – Compulsive Disorder Scale: The Obsessive – Compulsive Inventory. Psychological Assessment, 10, 206– 214. doi:10.1037/ 1040-3590.10.3.206 Freeston, M.H., Rhe´aume, J., Letarte, H., Dugas, M.J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791– 802. doi:10.1016/0191-8869(94)90048-5 Hajcak, G., Huppert, J.D., Simons, R.F., & Foa, E. B. (2004). Psychometric properties of the OCIR in a college sample. Behaviour Research and Therapy, 42, 115– 123. doi:10.1016/j.brat.2003. 08.002 Hewitt, S.N., Egan, S., & Rees, C. (2009). Preliminary investigation of intolerance of uncertainty treatment for anxiety disorders. Clinical Psychologist, 13, 52– 58. doi:10.1080/ 13284200802702056 Holaway, R.M., Heimberg, R.G., & Coles, M.E. (2006). A comparison of intolerance of uncertainty in analogue obsessive – compulsive disorder and generalized anxiety disorder. Journal of Anxiety Disorders, 20, 158– 174. doi:10.1016/ j.janxdis.2005.01.002 Koerner, N., & Dugas, M.J. (2006). A cognitive model of generalized anxiety disorder: The role of intolerance of uncertainty. In G.C.L. Davey & A. Wells (Eds.), Worry and its psychological disorders: Theory, assessment and treatment (pp. 201– 216). West Sussex: Wiley. Ladouceur, R., Talbot, F., & Dugas, M.J. (1997). Behavioral expressions of intolerance of uncertainty in worry: Experimental findings. Behavior Modification, 21, 355 – 371. doi:10.1177/ 01454455970213006 Langlois, F., & Ladouceur, R. (2004). Adaptation of a GAD treatment for hypochondriasis. Cognitive and Behavioral Practice, 11, 393– 404. doi:10.1016/S1077-7229(04)80056-7 Luhmann, C.C., Ishida, K., & Hajcak, G. (2011). Intolerance of uncertainty and decisions about delayed, probabilistic rewards. Behavior Therapy, 42, 378– 386. doi:10.1016/j.beth.2010. 09.002 Mahoney, A.E.J., & McEvoy, P.M. (2012a). Changes in intolerance of uncertainty during cognitive behavior group therapy for social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 43, 849– 854. doi:10. 1016/j.jbtep.2011.12.004
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Mahoney, A.E.J., & McEvoy, P.M. (2012b). Trait versus situation-specific intolerance of uncertainty in a clinical sample with anxiety and depressive disorders. Cognitive Behaviour Therapy, 41, 26 – 39. doi:10.1080/16506073. 2011.622131 Mahoney, A.E.J., & McEvoy, P.M. (2012c). A transdiagnostic examination of intolerance of uncertainty across anxiety and depressive disorders. Cognitive Behaviour Therapy, 41, 212–222. doi:10.1080/16506073.2011.622130 Mattick, R.P., & Clarke, J.C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455– 470. doi:10.1016/S0005-7967(97)10031-6 Norr, A.M., Oglesby, M.E., Capron, D.W., Raines, A.M., Korte, K.J., & Schmidt, N.B. (2013). Evaluating the unique contribution of intolerance of uncertainty relative to other cognitive vulnerability factors in anxiety psychopathology. Journal of Affective Disorders, 151, 136–142. doi:10.1016/j.jad.2013.05.063 Overton, S.M., & Menzies, R.G. (2005). Cognitive change during treatment of compulsive check-
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Domain-Specific Intolerance of Uncertainty in Socially Anxious and Contamination-Focused Obsessive – Compulsive Individuals Dane Jensen and Richard G. Heimberg Department of Psychology, Temple University, Philadelphia, PA 19122, USA Abstract. Intolerance of uncertainty (IU) has been increasingly recognized as a transdiagnostic factor across anxiety disorders and depression and is associated with substantial cognitive, behavioral, and emotional impairment. IU is typically construed as a dispositional tendency to view ambiguous stimuli and unknown outcomes as unacceptably threatening regardless of context, but recent findings suggest that the domain in which uncertainty is encountered may be relevant. Taking that research to the next step, the aim of the present study was to determine whether IU is more salient in concerncongruent versus incongruent domains and whether domain-specific IU is a better predictor of anxiety symptoms than trait IU. A total of 102 undergraduates were recruited into analog socially anxious (SA), obsessive –compulsive contamination (OCC), and nonanxious control (NAC) groups based on responses to measures of SA and OCC symptoms. Both groups reported more domain-congruent IU than trait IU or domain-incongruent IU. The SA group reported more social interaction IU than the OCC and NAC groups; the OCC group reported more cleanliness IU than the SA and NAC groups. Domain-specific IU predicted social anxiety and OCC fears above and beyond trait IU. Results suggest that IU has a substantial context-specific component and should be examined both transdiagnostically and transsituationally. Key words: intolerance of uncertainty; social anxiety; obsessive–compulsive disorder; transdiagnostic; contextual. Received 20 June 2014; Accepted 25 August 2014 Correspondence address: Richard G. Heimberg, Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA. Tel: þ1 215 204 1575. Email: [email protected]
Evidence suggests that intolerance of uncertainty (IU; the tendency to view ambiguous stimuli and unknown outcomes as unacceptably threatening) is a transdiagnostic factor across the emotional disorders, including generalized anxiety disorder (GAD; e.g., Dugas, Gagnon, Ladouceur, & Freeston, 1998), social anxiety disorder (SAD; e.g., Boelen & Reijntjes, 2009; Carleton, Collimore, & Asmundson, 2010), obsessive – compulsive disorder (OCD; e.g., Holaway, Heimberg, & Coles, 2006; Sarawgi, Oglesby, & Cougle, 2013), post-traumatic stress disorder (Fetzner, Horswill, Boelen, & Carleton, 2013), panic disorder and agoraphobia (e.g., Carleton, Fetzner, Hackl, & McEvoy, 2013), health anxiety (e.g., Fergus, 2013), and depression (de Jong-Meyer, Beck, & Riede, 2009). Associations of IU to multiple disorders have been reported both across and within studies (Mahoney & McEvoy, 2012c). IU q 2014 Swedish Association for Behaviour Therapy
predicts anxiety symptoms above and beyond other cognitive vulnerability factors (Norr et al., 2013) and is also associated with considerable cognitive and behavioral impairment, including poor performance in problem-solving and decision-making tasks (e.g., Koerner & Dugas, 2006; Luhmann, Ishida, & Hajcak, 2011), behavioral inhibition in the face of uncertainty (Buhr & Dugas, 2002), information-processing biases (Dugas et al., 2005), increased information-seeking (Ladouceur, Talbot, & Dugas, 1997), and overestimation of the probability and impact of negative events (Bredemeier & Berenbaum, 2008; Luhmann et al., 2011). IU is central to Dugas et al.’s (1998) model of worry and GAD and has been suggested as a potential moderating factor in the traditional diathesisstress model of anxiety (Chen & Hong, 2010). Evidence suggests that reductions in IU correlate with symptom reduction across
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disorders in transdiagnostic cognitive-behavioral therapy (Boswell, Thompson-Hollands, Farchione, & Barlow, 2013) and in treatment of SAD (Mahoney & McEvoy, 2012a), GAD (e.g., Dugas et al., 2003) and OCD (Overton & Menzies, 2005). Treatments specifically targeting IU have also been shown to reduce symptoms of GAD (van der Heiden, Muris, & van der Molen, 2012), SAD (Hewitt, Egan, & Rees, 2009), and health anxiety (Langlois & Ladouceur, 2004). Though extant research predominantly conceptualizes IU as a dispositional trait, recent evidence suggests situational context may contribute to the salience of uncertain stimuli (Mahoney & McEvoy, 2012b). Mahoney and McEvoy modified the Intolerance of Uncertainty Scale—12-item version (IUS-12; Carleton, Norton, & Asmundson, 2007) to direct individuals to consider IU in specific situations. Participants were recruited from a specialist anxiety disorder treatment service and had primary diagnoses spanning the range of anxiety disorders and depression. They were asked to describe a distressing, regularly occurring situation relevant to their domain of primary concern (e.g., social interactions, excessive worries about everyday matters) and respond to the questionnaire in regard to that specific situation. For example, the original IUS-12 item “I can’t stand being taken by surprise” was altered to read, “I can’t stand being taken by surprise in this situation.” Participants achieved significantly higher scores on the measure of situation-specific IU (modified IUS-12) than on the measure of trait IU (standard IUS-12), suggesting that IU is more salient in idiographically distressing situations. Further, situation-specific IU significantly predicted symptoms of depression and panic disorder above and beyond trait IU, although it failed to do so for symptoms of social anxiety, obsessive – compulsive disorder, or worry. These findings have several theoretical and clinical implications. A higher level of situation-specific IU than trait IU may indicate that state and trait IU are qualitatively different depending on the context in which state IU is stimulated. IU may be elevated in circumstances in which negative outcomes are perceived as particularly probable or as having an exceptionally high cost. As a result, facets of IU may be differentially expressed based on situational factors. For example,
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socially-anxious individuals find social evaluation more threatening and distressing than negative outcomes in other contexts. Thus, they may experience elevated IU in social situations, as their uncertainty regards social evaluation, which, for them, is intolerable. In this circumstance, behavioral inhibition associated with IU may be more salient than increased information-seeking, as information-seeking may be more visible, subjecting individuals to evaluation. Conversely, individuals with obsessive –compulsive traits may exhibit greater information-seeking in the form of frequent checking to reduce their uncertainty and may display little behavioral inhibition, or perhaps activation in the form of other compulsions. If this is the case, determining the situational characteristics that elicit IU in various disorders may allow us to improve treatments targeting IU or to better understand how IU contributes to the maintenance of emotional disorder. Though Mahoney and McEvoy’s (2012b) findings are an important first step in understanding IU as a situation-specific construct, they must be interpreted in the context of some limitations. Given that a diagnostically heterogeneous sample was examined and data on situation-specific IU were collected for only a single situation per participant, demonstration of the ability of situation-specific IU to predict symptoms above and beyond the contributions of trait IU are incomplete. Situation-specific IU was measured for different individuals in very different types of situations; for some participants, the questionnaire measured situation-specific IU in social contexts, for others, in regards to panic-inducing situations, and so on. It may be that there are differences in situation-specific IU depending on domain of concern or on the characteristics of the specific situation itself. Further, the study examined IU in distressing but not neutral situations, limiting our comparative scope. A more thorough examination of domainspecific IU is merited, which focuses on both domain-congruent and domain-incongruent situational content. The aim of the present study was to examine whether IU is more salient in domains of concern than in neutral domains for individuals with distinct symptom profiles. We compared IU in two analog anxious groups (socially anxious [SA] and obsessive–compulsive with
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contamination fears [OCC]) and a nonanxious control (NAC) group. Consistent with the findings from Mahoney and McEvoy (2012b), we hypothesized that individuals would achieve higher scores on a measure of domain-specific IU than trait IU, but we further hypothesized that this pattern would be evident only for domain-congruent situations. In addition, we hypothesized that domain-specific IU would predict domain-congruent symptoms above and beyond the contributions of trait IU.
7% as Asian-American/Asian, 1% as Native American, and 4% as Other; 7% of the sample also identified as Hispanic. Groups did not differ on age, F(2, 97) ¼ 0.78, p ¼ .46, race, x 2(8) ¼ 12.17, p ¼ .14,1 or number of years of education, F(2, 97) ¼ 0.39, p ¼ .68. Groups differed significantly on sex, x 2(2) ¼ 8.10, p ¼ .02, SA group 67.6% female, OCC group 93.9% female, and NAC group 84.8% female.
Materials
Methods Participants
In total, 102 undergraduates enrolled at Temple University were recruited into the study from a larger research participation pool based on responses to two validated self-report measures—the Social Interaction Anxiety Scale—Straightforward Items (SIAS-S; Mattick & Clarke, 1998; Rodebaugh, Woods, & Heimberg, 2007) and the Obsessive –Compulsive Inventory—Revised (OCI-R; Foa et al., 2002)—as administered on the university’s research participation website. Participants scoring in the upper quartile on the SIAS-S (. 23) and below the median of the contamination subscale of the OCI-R (, 2) were recruited into the SA group, and participants scoring the upper quartile on the OCI-R contamination subscale (. 2) and below the median of the SIAS-S (, 16) were recruited into the OCC group. Participants scoring below the median on both the SIAS-S and the OCI-R contamination subscale were recruited into the NAC group. These cutoffs were selected to ensure the recruitment of relatively distinct SA and OCC groups and a comparison group with low levels of both categories of symptoms. Participants were not excluded on the basis of any demographic characteristics and were given partial course credit for their participation. Two of the initial 102 participants did not complete the battery of questionnaires (including the IUS-12 and its derivatives) and were thus excluded from subsequent analyses. The final sample consisted of 100 participants (82% female; age M ¼ 21.7, SD ¼ 3.8). The sample was ethnically and racially diverse: 72% self-identified as Caucasian/White, 15% as African-American/Black,
Self-report questionnaires Social Interaction Anxiety Scale—straightforward items. The SIAS (Mattick & Clarke, 1998) is a 20-item self-report measure designed to evaluate fears of social interactions in dyads and groups. Each item is rated on a five-point Likert-type scale from 0 (Not at all characteristic or true of me) to 4 (Extremely characteristic or true of me). The SIAS has demonstrated good reliability and validity in a number of studies (e.g., Brown et al., 1997; Safren, Turk, & Heimberg, 1998). Rodebaugh et al. (2007) have demonstrated that the straightforward items are more robust predictors of social interaction anxiety than the reverse-scored items in both undergraduate and clinical samples and therefore recommend utilizing only the 17 straightforward items (SIAS-S) to calculate the total score; thus, the SIAS-S was used in the present study. Both the SIAS and SIAS-S have evidenced adequate internal consistency in undergraduate samples (SIAS: a ¼ .88, Mattick & Clarke, 1998; SIAS-S: a ¼ .93, Rodebaugh et al., 2007). Internal consistency for the SIAS-S in the present sample was high, a ¼ .97. Obsessive– compulsive inventory—revised. The OCI-R (Foa et al., 2002) is an abbreviated 18item version of the Obsessive – Compulsive Inventory (Foa, Kozak, Salkovskis, Coles, & Amir, 1998), which was designed to assess the various symptom domains relevant to obsessive –compulsive disorder. Each item is rated on a five-point Likert-type scale from 0 (not at all) to 4 (extremely), corresponding to the level of symptom distress. The OCI-R has evidenced good reliability and validity in a number of studies (e.g., Abramowitz & Deacon, 2006; Foa et al., 2002), including good internal consistency (a ¼ .90, Foa et al., 2002; a ¼ .88, Hajcak, Huppert, Simons, & Foa, 2004). The OCI-R has consistently demonstrated six
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factors: (1) washing, (2) checking, (3) obsessions, (4) mental neutralizing, (5) ordering, and (6) hoarding (e.g., Abramowitz & Deacon, 2006; Foa et al., 2002). Subscales based on each factor include three items. Internal consistency in the present sample was high for the total score, a ¼ .90, and for the contamination subscale, a ¼ .91. Intolerance of uncertainty scale—12-item version. The IUS-12 (Carleton et al., 2007) is an abbreviated version of the Intolerance of Uncertainty Scale (IUS; Freeston, Rhe´aume, Letarte, Dugas, & Ladouceur, 1994). The original IUS consists of 27 items intended to assess emotional, cognitive, and behavioral reactions to uncertain situations, problems with feeling uncertain, and attempts to control future events. The IUS-12 shows a strong correlation with the original scale (r ¼ .96; Carleton et al., 2007). Items on the IUS-12 are rated on a five-point Likert-type scale ranging from 1 (Not at all characteristic of me) to 5 (Entirely characteristic of me). Both the original IUS and the IUS-12 have demonstrated good internal consistency in undergraduate samples (IUS: a ¼ .91, Freeston et al., 1994; IUS-12: a ¼ .91, Carleton et al., 2007). For the purpose of this study, the standard IUS-12 was used as the measure of trait IU. In addition, versions orienting the participant to particular contexts were used as measures of domain-specific IU (e.g., “For this questionnaire, please consider the statements as they pertain specifically to social interactions [e.g., initiating conversations with someone you don’t know very well, going on a first date, interviewing for a job]”). Internal consistency in the present sample was high for the standard IUS-12, a ¼ .90, social interaction IU, a ¼ .95, and cleanliness IU,2 a ¼ .95.
Procedure
Prior to participation in the laboratory portion of the study, participants completed a battery of questionnaires online through the university’s research participation website. Included in this battery were items assessing demographic characteristics, as well as the SIAS-S and OCI-R. Eligible participants were recruited via email to participate in the laboratory portion of the study. Upon arrival at the laboratory, participants provided written informed consent. Participants then
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completed a computer-administered questionnaire battery consisting of the trait IUS-12 and four domain-specific versions of the IUS-12 (social interactions, cleanliness, and two distractor versions assessing IU regarding finances and world affairs; distractor versions were not included in statistical analyses), randomly ordered, as well as other measures unrelated to the present study.
Results Preliminary analyses
Prior to analysis, data were examined to ensure satisfaction of statistical assumptions. Questionnaire scores were normally distributed, and no outliers were detected. As groups differed significantly by sex, independent samples t-tests were conducted on all dependent variables. Males achieved significantly higher social anxiety scores on the SIAS-S than women (men, M ¼ 23.67; SD ¼ 17.43; women, M ¼ 15.29; SD ¼ 13.99), t (98) ¼ 2.20, p ¼ .03.3 No other significant differences emerged. To account for any confounding of sex, we controlled for sex in all analyses in which social anxiety was the dependent variable. A one-way analysis of covariance followed by planned contrasts revealed that the SA group reported significantly greater social anxiety (M ¼ 35.56; SD ¼ 8.79) than the OCC group (M ¼ 8.51; SD ¼ 4.46; p , .001, 95% CI [24.07, 30.38]) and the NAC group (M ¼ 5.75; SD ¼ 4.33; p , .001, 95% CI [27.11, 33.31]), after controlling for sex, F (2, 95) ¼ 222.63, p , .001, h^ 2 ¼ .79. A oneway analysis of variance (ANOVA) followed by planned contrasts revealed that the OCC group reported significantly more fears of contamination (M ¼ 5.15; SD ¼ 2.27) than the SA group (M ¼ 0.29; SD ¼ 0.46; p , .001, 95% CI [4.21, 5.49]) and the NAC group (M ¼ 0.12; SD ¼ 0.33; p , .001, 95% CI [4.36, 5.64]), F(2, 97) ¼ 149.99, p , .001, h^ 2 ¼ .76.
Intolerance of uncertainty
IU scores were submitted to a 3 (group: SA, OCC, NAC) £ 3 (IU type: trait IU, social interaction IU, cleanliness IU) ANOVA with repeated measurement on the second factor. The main effect of IU type was nonsignificant, F(2, 194) ¼ 1.19, p ¼ .31,
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h^ 2 ¼ .01. The main effect of group was significant, F(2, 97) ¼ 10.06, p , .001, h^ 2 ¼ .21, but was qualified by a significant group by IU type interaction, F(2, 97) ¼ 6.11, p , .01, h^ 2 ¼ .17. To probe this interaction, repeated measures ANOVAs were conducted within each group. The main effect of IU type was significant within the SA group, F(2, 66) ¼ 11.39, p , .001, h^ 2 ¼ .26, and the OCC group, F(2, 64) ¼ 4.87, p , .05, h^ 2 ¼ .11, but not the NAC group, F(2, 64) ¼ 1.71, p ¼ .19. Planned contrasts were conducted within each analog anxiety group (SA, OCC) between domain-congruent IU (i.e., social interaction IU in the SA group, cleanliness IU in the OCC group) and trait IU, and domaincongruent IU and domain-incongruent IU (i.e., cleanliness IU in the SA group, social interaction IU in the OCC group). The SA group reported more social interaction IU than trait IU, F(1, 33) ¼ 10.30, p , .01, h^ 2 ¼ .31, and more social interaction IU than cleanliness IU, F(1, 33) ¼ 13.64, p , .01, h^ 2 ¼ .41. The OCC group reported more cleanliness IU than trait IU, F(1, 32) ¼ 4.38, p , .05, h^ 2 ¼ .14, and more cleanliness IU than social interaction IU, F(1, 32) ¼ 6.12, p , .05, h^ 2 ¼ .19. See Figure 1. 40
IU Score
35
30
25
Trait IU 20
Social IU Cleanliness IU
0
NAC
SA
OC
Group
Figure 1. IU scores by group. NAC, nonanxious control group; SA, social anxiety group; OCC, obsessive– compulsive contamination fear group.
One-way ANOVAs were conducted across group within each type of IU. There were significant effects of group within trait IU, F(2, 97) ¼ 6.41, p # .01, h^ 2 ¼ .12, social interaction IU, F(2, 97) ¼ 14.46, p # .001, h^ 2 ¼ .23, and cleanliness IU, F(2, 97) ¼ 7.48, p , .01, h^ 2 ¼ .13. Post hoc Tukey’s HSD tests revealed that both analog anxiety groups (SA, OCC) reported significantly more trait IU than the NAC group (SA group, M ¼ 31.09; SD ¼ 8.82; OCC group, M ¼ 29.18; SD ¼ 8.94; NAC group, M ¼ 24.21; SD ¼ 6.19; all ps , .05) but that there was no significant difference in trait IU between the SA and OCC groups. The SA group reported more social interaction IU (M ¼ 35.21, SD ¼ 12.52) than the OCC (M ¼ 27.42, SD ¼ 10.18; p , .05) and NAC (M ¼ 21.30, SD ¼ 8.72; p , .001) groups, but there was no significant difference between the OCC and NAC groups, p . .05. The OCC group reported more cleanliness IU (M ¼ 32.12, SD ¼ 11.21) than the SA (M ¼ 25.56, SD ¼ 9.99; p , .05) and NAC (M ¼ 22.55, SD ¼ 9.60; p , .01) groups, but there was no significant difference between the SA and NAC groups, p . .05. To examine the ability of domain-specific IU to predict symptoms above and beyond trait IU, a series of hierarchical linear regression analyses was performed. In each set of regressions, trait IU was entered before domain-congruent IU (i.e., social interaction IU when predicting social anxiety symptoms, cleanliness IU when predicting OCC fears). Before the hierarchical multiple regression analyses were performed, independent variables were examined for collinearity. All tolerance values were greater than .39, suggesting multicollinearity was not problematic. Sex was entered in block one of the regression predicting social anxiety to control for group differences, R 2 ¼ .05, F(1, 98) ¼ 4.83, p , .05, see Table 1. In block two, trait IU significantly predicted SIAS-S scores above and beyond sex, DR 2 ¼ .11, F(1, 97) ¼ 12.88, p , .01. In block three, social interaction IU predicted SIAS-S scores above and beyond trait IU and sex, DR 2 ¼ .12, F(1, 96) ¼ 16.64, p , .001. In block one of the regression predicting OCC fears, trait IU did not significantly predict OCI-R contamination scores, R 2 ¼ .01, F(1, 98) ¼ 1.12, p . .05, see Table 2. In block two, however, cleanliness IU
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Table 1. Social interaction IU predicts social anxiety symptoms above and beyond Trait IU
b
Variable Block 1 Sex Block 2 Sex Trait IU Block 3 Sex Trait IU Social interaction IU
2 0.217* 2 0.216* 0.334** 2 0.148 2 0.109 0.570***
DR 2 0.047* 0.112** 0.124***
Notes. IU, intolerance of uncertainty; *p , .05; **p , .01; ***p , .001.
Table 2. Cleanliness IU predicts OCC fears above and beyond trait IU Variable Block 1 Trait IU Block 2 Trait IU Cleanliness IU
b
DR 2 0.011
0.106 2 0.076 3.859**
0.132***
Notes. IU, intolerance of uncertainty; **p , .01; ***p , .001.
significantly predicted OCI-R contamination scores above and beyond trait IU, DR 2 ¼ .13, F(1, 97) ¼ 14.89, p , .001.
Discussion IU has been predominantly examined as a trait construct, tapping reactivity to uncertainty independent of context, but results of the present analyses suggest that uncertainty in domains of concern is less tolerable than uncertainty in other domains. Individuals high in social anxiety reported higher IU in social interactions than trait IU or IU regarding cleanliness; similarly, individuals high in OCC fears reported higher IU regarding cleanliness than trait IU or IU in social interaction. Individuals high in social anxiety but low in OCC fears reported levels of IU regarding cleanliness similar to NACs, and individuals high in OCC fears but low in social anxiety reported levels of IU in social situations similar to NACs. Further, IU in domaincongruent contexts significantly predicted
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symptoms above and beyond trait IU; that is, IU in social interactions predicted social anxiety symptoms after accounting for trait IU, and IU regarding cleanliness predicts OCC fears after accounting for trait IU. These results support the findings of Mahoney and McEvoy (2012b) that individuals find uncertainty more distressing in situations they find aversive. Extending beyond Mahoney and McEvoy’s work, these results provide evidence that, in some situations, uncertainty is not aversive, even for individuals with high trait IU and significant anxiety symptoms. These findings support the transdiagnostic conceptualization of IU but indicate that IU may not be purely dispositional or transsituational; rather, IU appears to have a component that is context-dependent. Given findings that IU is associated with overestimation of the likelihood and impact of negative events (Bredemeier & Berenbaum, 2008; Luhmann et al., 2011), it may be that uncertainty is intolerable in relation to perceived threat. For example, individuals high in social anxiety and low in OCC fears perceive increased threat in social situations but not in situations in which cleanliness is in question; thus, social uncertainty is distressing and cleanliness uncertainty is not. Future research should examine the relationship between perceived threat and IU to determine whether changes in perceived threat impact IU. For example, does manipulating the probability and cost of negative outcomes in domains of concern impact selfreported IU? In addition, our finding that domainspecific IU predicts social anxiety and OCC concerns above and beyond trait IU stands in contrast to Mahoney and McEvoy’s (2012b) findings that situation-specific IU predicted symptoms associated with depression, panic disorder, and agoraphobia, but not social anxiety or obsessive – compulsive disorder. Mahoney and McEvoy’s assessment of situation-specific IU was conducted across diagnostic groups and included heterogeneous situations, whereas the present study examined discrete analog diagnostic groups and their corresponding contexts. Further, Mahoney and McEvoy examined a population with high comorbidity. It may be that trait IU is a better independent predictor when more domains are distressing. These findings
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suggest that domain-specific IU is associated with symptoms of relevant disorders and not necessarily with psychological symptoms more broadly, providing further rationale for examining IU in relation to perceived threat. Strengths of this study include the relatively distinct analog groups, providing confidence in our ability to examine the effects of specific domains within varying symptom types. Further, randomization provided a strong counter to potential order effects. Despite these strengths, the study is limited by the cross-sectional undergraduate sample, a restricted range of OCI-R contamination subscale scores, and group differences in distribution of participants by sex. Though the use of a cross-sectional undergraduate sample may limit generalizability, our results offer strong preliminary evidence for the domain-specificity of IU. The restricted range of OCI-R contamination scores may have limited the separation between high and low OCC participants, but our results indicate that the difference was sufficient to elicit a fairly substantial effect. Also, this study examined an analog OC group with contamination concerns, limiting generalizability to OC symptoms more broadly. The exclusion of individuals demonstrating broader OC symptoms may account for the finding that trait IU did not predict OC contamination fears, despite substantial literature demonstrating strong associations between trait IU and OC symptoms. It may be that other OC domains are more closely tied to trait IU. Lastly, group differences in sex ratio denote less-thanideal sampling; however, we controlled for sex in all potentially affected analyses and the findings held. Still, future research should extend past these limitations by examining these phenomena in clinical populations of the several disorders associated with IU; with prospective, longitudinal designs; in samples demonstrating a wider range of OC symptoms, and within groups balanced by sex. In sum, our findings indicate that IU is sensitive and specific to context and that domain-specific IU may predict symptoms related to psychological distress better than trait IU. A contextual perspective on IU requires that we consider circumstantial factors in our examinations of IU, within and across disorders, and in models of the etiology, maintenance, and treatment of
emotional disorders. Though considerable research suggests IU is transdiagnostic, clarifying the unique role of IU within disorder and within context is an important research agenda.
Disclosure statement The authors have declared that no conflict of interest exists.
Notes 1. For this analysis, the expected frequency of some cells
2.
3.
was less than five. However, the Chi-square test has been found to provide adequate estimates of Type I error probability with expected frequencies of cells as low as 1 or 2 (Camilli & Hopkins, 1978). The IU measure referred to cleanliness rather than contamination; thus, the label “cleanliness IU” is used. The subscale of the OCI-R used to screen participants is referred to as the “contamination” subscale, and the group is labeled accordingly. Following this test, we realized the possibility that there may be a gender by anxiety group confound, in that the social anxiety group included a higher proportion of males (32.4%) than the OCC (6.1%) and NAC (15.2%) groups. Thus, we ran followup two (sex) by three (group) ANOVAs to determine if dependent variables differed significantly by sex. No significant interactions or main effects of sex emerged, but we controlled for sex in analyses using social anxiety as an outcome variable regardless.
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