Intolerance of uncertainty mediates the relationship ...

Personality and Individual Differences 112 (2017) 97–102

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Intolerance of uncertainty mediates the relationship between adult attachment and worry Carmel J. Wright, Gavin I. Clark ⁎, Adam J. Rock, William L. Coventry School of Behavioural, Cognitive and Social Sciences, University of New England, Australia

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Article history: Received 20 October 2016 Received in revised form 16 February 2017 Accepted 17 February 2017 Keywords: Adult attachment Attachment anxiety Attachment avoidance Intolerance of uncertainty Worry

a b s t r a c t Background: Attachment anxiety and avoidance have been found to be associated with worry. A substantial body of research suggests that intolerance of uncertainty (IOU) is a phenomenon which predicts level of worry, yet the relationship between attachment, IOU and worry remains to be investigated. Methods: The present study recruited 281 participants from the community within Australia to complete an online survey incorporating the Intolerance of Uncertainty Scale, the Experiences in Close Relationships Scale-Revised, and the Penn State Worry Questionnaire. Results: The analyses revealed attachment anxiety and attachment avoidance were positively correlated with IOU, and that attachment anxiety, attachment avoidance and IOU were positively correlated with worry. Furthermore, IOU was found to mediate the relationship between attachment anxiety and worry, even when attachment avoidance was entered as a covariate. By contrast, for the relationship between attachment avoidance and worry, intolerance of uncertainty only mediated the association if attachment anxiety was ignored. Conclusions: The results of the study suggest that IOU may play a key role in the relationship between adult attachment difficulties and the experience of worry. These findings may have significant implications for the conceptualisation and psychological treatment of attachment related difficulties. © 2017 Elsevier Ltd. All rights reserved.

1. Introduction

1.1. Intolerance of uncertainty and worry

Worry has been defined as a cognitive phenomenon reflecting negative recurrent thoughts, concerning the future, which elicit anxiety (e.g., Borkovec, Robinson, Pruzinsky, & DePree, 1983; Freestone, Rhéaume, Letarte, Dugas, & Ladouceur, 1994). Excessive worry has been shown to be associated with psychological distress (Olatunji, Broman-Fulks, Green, & Zlomke, 2010) and poor quality of life (Dugas, Schwartz, & Francis, 2004) and has been hypothesised to maintain anxiety through the occurrence of arousal-inducing appraisals of potential uncertainties as threats (de Jong-Meyer, Beck, & Riede, 2009). A variety of variables have been implicated in the aetiology and maintenance of worry. Intolerance of uncertainty (IOU) and adult attachment style are two constructs which have been demonstrated to be associated with worry (e.g., Buhr & Dugas, 2006; Simonelli, Ray, & Pincus, 2004). However, to date, there has been no investigation of the relationship between adult attachment, IOU and worry.

Intolerance of uncertainty is conceptualised as a cognitive bias that affects how one perceives, interprets, and responds to uncertainties at a behavioural, cognitive and emotional level (Dugas et al., 2004). It has been further discussed as reflecting an individual's negative beliefs about uncertainty and their ability to cope with the distress associated with uncertainty and the tendency to experience ambiguity as stressful (Buhr & Dugas, 2006). Individuals with high levels of IOU perceive uncertainty about their future as unacceptable, anxiety provoking and impairing (Chen & Hong, 2010). Intolerance of uncertainty has been mostly researched and discussed in relation to worry, with a variety of research having been conducted in both clinical and non-clinical populations (Dugas, Gosselin, & Ladouceur, 2001). Much of this research has focussed on its links with the Diagnostic and Statistical Manual of Mental Disorders-IV diagnosis of Generalised Anxiety Disorder (GAD; APA, 1994, 2000), a diagnosis characterised by pathological worry. Although IOU has historically been conceptualised to be a dimension of worry, it is now typically considered a distinct construct and has been investigated in relation to numerous psychological variables and psychological disorders (e.g., Einstein, 2014). A wide body of research has demonstrated that IOU is positively associated with worry and that individuals who engage in excessive worry tend to have higher reported levels of IOU (Dugas, Freeston, & Ladouceur, 1997). Furthermore, individuals with high levels of IOU

⁎ Corresponding author at: Department of Psychology, School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW 2351, Australia. E-mail address: [email protected] (G.I. Clark).

http://dx.doi.org/10.1016/j.paid.2017.02.039 0191-8869/© 2017 Elsevier Ltd. All rights reserved.

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C.J. Wright et al. / Personality and Individual Differences 112 (2017) 97–102

tend to employ vigilant coping strategies and display preferential processing of threatening stimuli (Grenier, Barrette, & Ladouceur, 2005). Dugas et al. (2004) proposed that IOU is associated with information processing biases that contribute to the maintenance and development of worry in individuals with anxiety disorders such as GAD. Dugas et al. (1997) noted that social interactions are often ambiguous and outcomes uncertain, and that worry has been shown to be primarily social in nature. Consequently, individuals high in IOU would be expected to experience the uncertainty inherent in social situations as more intolerable and distressing than those low in IOU. Consequently, the nature of an individual's security within relationships and perception of threatening outcomes within these relationships may have significant implications for their ability to tolerate uncertainty and for their experience of worry. Emerging research suggests that IOU may emerge early in a child's psychological and emotional development and may be a product of early caregiver interaction (Sanchez, Kendall & Comer, 2016). Consequently, early caregiver relationships, as well as adult interpersonal functioning, could potentially play a significant role in the development of IOU.,

1.2. Attachment Attachment refers to the ability of an individual to stay or maintain close contact with an attachment figure (Fraley & Shaver, 2000). According to Brennan, Clark, and Shaver (1998), adult attachment styles can be conceptualised as being represented across two continuous orthogonal dimensions: attachment anxiety and attachment avoidance. These two dimensions can be combined to form four regions that represent four continuously distributed styles of adult attachment: Secure, Preoccupied, Dismissing and Fearful (Bartholomew, 1990; Brennan et al., 1998). However, a number of authors have argued that it is more useful and valid to conceptualise these as two continuous variables rather than as discrete categories (Bartholomew & Horowitz, 1991; Fraley, Waller, & Brennan, 2000; Hazan & Shaver, 1987). Both dimensions have been demonstrated to be positively associated with individual level of worry (e.g., Simonelli et al., 2004). An individual's position on the attachment anxiety dimension indicates the degree to which the person worries that a partner will be unavailable and unsupportive in times of need, which heightens efforts to maintain closeness (Bartholomew & Horowitz, 1991). An individual's position on the avoidance dimension indicates the extent to which the individual distrusts their partners' goodwill and capacity to help, which heightens their efforts to maintain a safe degree of independence and self-reliance (Mikulincer, 1998). Attachment is believed to influence individuals' interpretation and regulation of emotional experiences and ideas of self-worth, as well as the manner in which they think and feel about, and interact with, attachment figures (Eng, Heimberg, Hart, Schneier, & Liebowitz, 2001; Fraley & Shaver, 2000). Individuals low on attachment anxiety and avoidance are conceptualised as having positive perceptions of self, others in the relationship, of the relationship itself, and lower self-reported levels of anxiety (Eng et al., 2001). Such individuals do not typically worry about being abandoned (Bartholomew & Horowitz, 1991). The development of an inner sense of security is seen as providing a sense of strength and resilience (Mikulincer, Shaver, & Pereg, 2003). Insecurely attached adults (i.e., those high on attachment anxiety and/or attachment avoidance) are prone to denying their own needs for attachment, may perceive others as untrustworthy, and worry about abandonment, potentially limiting their ability to form secure attachments (Mikulincer et al., 2003). Individuals who score high in either domain are more likely to worry about their relationships and their perceived ability to cope with uncertainty within these relationships (Bartholomew & Horowitz, 1991; Hazan & Shaver, 1987).

1.2.1. Attachment anxiety Anxiously attached individuals are believed to rely on worrying as a coping skill to avoid distress and will often perceive more conflict in their relationships (Campbell, Simpson, Boldry, & Kashy, 2005), will miss cues from their interpersonal environment and are, thus, more predisposed to relationship difficulties (Cassidy, Lichtenstein-Phelps, Sibrava, Thomas, & Borkovec, 2009). Individuals high in attachment anxiety are, therefore, more likely to employ “hyperactivating” strategies (involving hyperactivation of the attachment system) including energetic, insistent attempts to obtain care, support and love from relationship partners (Mikulincer et al., 2003). Such strategies may be conceptualised as reflecting efforts to minimise uncertainty concerning potential threats within their relationships. Sanchez et al. (2016) suggested that children may develop IOU though observing parental avoidance of unpredictable situations and/ or by being prevented from engaging with uncertain situations and having to overcome associated distress. The formation of beliefs regarding lack of ability or competence to engage with uncertainty and manage the attendant distress may be seen to closely parallel beliefs regarding worthiness and competence as a result of an individual's attachment relationships. Consequently, individuals high in attachment anxiety may be predisposed to perceive uncertainty within their interpersonal relationships as more threatening than individuals with lower levels of attachment anxiety and to doubt their capacity to manage such uncertainty. 1.2.2. Attachment avoidance Individuals high in attachment avoidance have been described as being uncomfortable with being close or dependent on partners. Such individuals have been described as having little hope of receiving the care and support of others and as tending to suppress their need for attachment figures in order to maintain self-esteem, autonomy, and control (Mikulincer, 1998; Noftle & Shaver, 2006). Thus, they are conceptualised as having a positive working model of themselves and a negative model of others as malevolent or untrustworthy (Bartholomew & Horowitz, 1991; Fraley et al., 2000). Individuals high in attachment avoidance are characterised as being highly self-reliant, avoiding intimacy in close relationships (Hazan & Shaver, 1987) and employing “deactivating” strategies, such as suppression and avoidance, which deactivate the attachment system (Mikulincer et al., 2003). Given that ambiguity within interpersonal relationships may be appraised as indicating threat (i.e., confirming others' negative intentions and/or resulting in potential negative interpersonal outcomes; Campbell et al., 2005; Collins, 1996), individuals with high attachment avoidance may be hypothesised to be predisposed towards IOU. It would, therefore, be expected that attachment avoidance would be positively associated with IOU. 1.3. The relationship between adult attachment style, IOU and worry To date, here has been no research into the relationship between IOU, adult attachment and worry. The research described above may suggest that individuals with heightened attachment anxiety and attachment avoidance may be predisposed to experience uncertainty as threatening (i.e., have higher levels of IOU), which, in turn, renders them more vulnerable to experiencing worry. Based on this hypothesis, two mediation models were developed in order to explore the relationship between the following: (i) attachment anxiety, IOU, and worry, and (ii) attachment avoidance, IOU and worry. The theoretical rationale for the two models is that negative early attachment experiences may encourage individuals to develop heightened attachment anxiety and/or attachment avoidance. Heightened attachment anxiety and/or attachment avoidance may contribute to maladaptive emotion regulation and perceived inability to deal with uncertainty and associated distress (i.e., IOU). Heightened IOU, in turn, may lead to heightened worry (i.e., negative recurrent thoughts


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The aim of the present study was to explore the relationship between adult attachment, IOU, and worry. To date, no published research has investigated these constructs together. The following hypotheses were formulated:

and excellent internal consistency (Buhr & Dugas, 2002). In the present study, Chronbach's alpha for the IUS was 0.94. Adult attachment was examined using the Experiences in Close Relationships-Revised questionnaire (ECR-R; Fraley et al., 2000). The ECR-R is a 36-item measure that assesses attachment anxiety and attachment avoidance. The ECR-R presents a series of statements regarding individual experiences within relationships which participants respond to on a seven-point likert scale from 1 (strongly disagree) to 7 (strongly agree). A score is computed for each attachment dimension by computing an average score for the 18 items pertaining to each domain. The scale has high internal consistency and good test-retest reliability (Wei, Russell, Mallinckrodt, & Vogel, 2007). In the present study, Chronbach's alpha was 0.91 for attachment anxiety and 0.88 for attachment avoidance. Participants' level of worry was measured using the 16-item Penn State Worry Questionnaire (PSWQ; Meyer et al., 1990). Participants rate worry-related statements on a five-point likert scale from 1 (not at all typical of me) to 5 (very typical of me) with scores summed to produce a total score ranging from 16-to-80. The PSWQ has good test-retest reliability and high internal consistency (Meyer et al., 1990). In the present study, Chronbach's alpha was 0.95.

H1. Attachment anxiety will be positively associated with IOU and worry;

2.3. Procedure

regarding potential future threats, much of which may pertain to attachment and potential difficulties in interpersonal relationships). In support of these mediation models, it can be hypothesised that changes in either attachment domain in the present day would lead to changes in IOU (i.e., one's perceived ability to cope with uncertainty), which, in turn, would promote fluctuations in level of worry. Therefore, a hypothetical causal chain may be postulated whereby an independent variable (X), attachment anxiety, promotes fluctuations in a mediator (M), IOU, which promotes fluctuations in a dependent variable (Z), worry; thus X → M → Z. In the second model, an independent variable (Y), attachment avoidance, promotes fluctuations in a mediator (M), IOU, which promotes fluctuations in a dependent variable (Z) worry; thus Y → M → Z. 1.4. Present study

H2. Attachment avoidance will be positively associated with IOU and worry; H3. IOU will mediate the relationship between attachment anxiety and worry; and H4. IOU will mediate the relationship between attachment avoidance and worry.

2. Materials and method 2.1. Participants A total of 290 participants commenced the study. Responses from nine participants contained missing data and thus their data was excluded from the final analysis through listwise deletion (Musil, Warner, Yobas, & Jones, 2002), yielding a final sample of 281 participants. This sample comprised 219 females (78%) and 62 males (22%) aged 18 to 74 years. Individuals who identified themselves as being 18 years or older were recruited from throughout Australia, with participants asked to complete the study questionnaire online via a link to Qualtrics survey software (Qualtrics, Version 3092224, 2015). The sample demonstrated a range of scores (M = 46.60, SD = 9.04) on the Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990). One hundred and fifteen participants (41% of the sample) scored above the PSWQ cut-off of 50, which has been suggested to discriminate individuals with GAD from non-clinical samples (Stanley et al., 2003), indicating that the sample included individuals with clinical and non-clinical levels of worry. Of the participants who completed the study, 70% identified that they were currently in a relationship. Participants reported an average current relationship duration of 4.45 years, with a range from one to 13 years (M = 4.45, SD = 2.52). 2.2. Materials Participants' IOU was examined using the Intolerance of Uncertainty Scale (IUS; Freestone et al., 1994). The IUS is a 27-item measure that assesses how individuals react to uncertainty through rating statements related to uncertainty on a five-point likert scale from 1 (not at all characteristic of me) to 5 (entirely characteristic of me). Scores are summed to produce a total score ranging from 27 to 135, with higher scores indicating greater IOU. The scale has good test-retest reliability

Collection of data proceeded after gaining approval from the University of New England Human Research Ethics Committee. Potential participants were invited to participate in the study through a study advertisement being posted in a number of locations on social media (Facebook, Twitter). These adverts were posted throughout a number of community Facebook sites with the aim of maximising the number of individuals reading the study invite. Interested individuals were required to click on the study link in the invitation in order to access the study information page and complete the online consent form prior to participating. Psychology students from the University were also invited to participate through posting the study invite on an online learning platform, with students given course credit for participation. The sample therefore reflects a convenience sample.

3. Results Bivariate correlations were performed to test H1 and H2, with two mediation analyses performed to test H3 and H4. The statistical assumptions for each test were satisfied and no data transformations were performed. Table 1 displays the means, standard deviations, range, and intercorrelations of all study variables. Across each of the study variables there was no significant difference in scores between males and females, with the exception of PSWQ scores, where females (M = 47.96, SD = 8.62) demonstrated significantly greater worry scores than males (M = 41.80, SD = 8.89), t(279) = 4.925, p b 0.001.

Table 1 Intercorrelations, means and standard deviations. Variable

1

2

1. Age 2. Worry (PSWQ) 3. Intolerance of uncertainty (IUS) 4. Attachment avoidance (ECR-R) 5. Attachment anxiety (ECR-R) M SD Minimum-maximum

– −0.16⁎⁎ −0.17⁎⁎ 0.01⁎ −0.16⁎⁎

– 0.65⁎⁎⁎ 0.20⁎⁎⁎ 0.37⁎⁎⁎

31.21 11.992 18–74

46.60 9.04 22–67

⁎ p b 0.05. ⁎⁎ p b 0.01. ⁎⁎⁎ p b 0.001.

3

4

5

– 0.29⁎⁎⁎ 0.47⁎⁎⁎ 65.09 18.95 29–113

– 0.51⁎⁎⁎ 3.06 1.30 1–6.28

– 3.04 1.35 1–6.50

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3.1. Hypotheses 1 and 2 As predicted, bivariate correlations revealed that attachment anxiety was positively associated with IOU (r = 0.472, N = 281, p b 0.001) and also with worry (r = 0.365, N = 281, p b 0.001), thus, supporting H1. Similarly, bivariate correlations revealed that attachment avoidance was positively associated with IOU (r = 0.290, N = 281, p b 0.001) and worry (r = 0.204, N = 281, p = 0.001), thus, supporting H2.

3.2. Hypotheses 3 and 4 A mediation analysis was conducted to examine whether IOU mediated the relationship between attachment anxiety and worry. Preacher and Hayes' (2004) bootstrapping method for mediation was performed using model 4 of Hayes' (2013) PROCESS macro for SPSS (version 2.041). As recommended by Hayes (2013), 5000 bootstrap samples were used in the mediation analysis. Intolerance of uncertainty was found to mediate the relationship between attachment anxiety and worry (see Fig. 1). Participants reporting higher levels of attachment anxiety reported higher levels of IOU, which was associated, in turn, with higher reported levels of worry. The model accounted for a statistically significant 42% of the variability in worry and the indirect effect of attachment anxiety on worry via IOU was statistically significant, F(2, 278) = 101.04, p b 0.001. The bias-corrected 99% confidence intervals (CI) for the indirect effect based on 5000 bootstrap samples (ab = 1.93) did not include zero [1.31, 2.66]. This result supported H3 and indicated that attachment anxiety did not act directly on worry (as the direct effect was nonsignificant, i.e., p = 0.13), but indirectly through IOU. A second mediation analysis examined whether IOU mediated the relationship between attachment avoidance and worry. In this mediation the independent variable was attachment avoidance, the proposed mediator was IOU, and the dependent variable was worry. IOU was found to mediate the relationship between attachment avoidance and worry (see Fig. 2). Participants reporting higher levels of attachment avoidance reported higher levels of IOU, which was associated, in turn, with higher reported levels of worry. The model accounted for a statistically significant 42% of the variability in worry and the indirect effect of attachment avoidance on worry via IOU was statistically significant, F(2, 278) = 99.20, p b 0.001. The bias-corrected 99% CI for the indirect effect based on 5000 bootstrap samples (ab = 1.15) did not include zero [0.49, 1.79]. This result supported H4 and suggests that attachment avoidance did not act directly on worry (as the direct effect was nonsignificant, i.e., p = 0.71), but indirectly through IOU.

Fig. 1. Intolerance of uncertainty as mediator of the relationship between attachment anxiety and worry. Statistically significant pathways are represented by solid arrowed line. Statistically non-significant pathways are represented by dotted arrowed lines. b = unstandardised regression coefficient, β = completely standardised regression coefficient of the indirect effect, CI = bias-corrected and accelerated bootstrapped confidence intervals based on 5000 samples.

Fig. 2. Intolerance of uncertainty as mediator of the relationship between attachment avoidance and worry. Statistically significant pathways are represented by solid arrowed line. Statistically non-significant pathways are represented by dotted arrowed lines. b = unstandardised regression coefficient, β = completely standardised regression coefficient of the indirect effect, CI = bias-corrected and accelerated bootstrapped confidence intervals based on 5000 samples.

Given the two sub-scales of attachment, attachment avoidance and attachment anxiety, are correlated (r = 0.51), we re-ran the mediations to assess whether the above mediation findings remained after controlling for the other subscale and age. Age was not a significant covariate. As shown in Fig. 3, in the mediation with attachment anxiety as the independent variable, covarying out attachment avoidance had little impact on the mediation. By contrast, with attachment avoidance as the independent variable, when attachment anxiety was covaried out the indirect path became negligible and not significant. This suggested the mediation effect observed for attachment avoidance was driven by the portion of attachment avoidance that was correlated with attachment anxiety, and with this removed there was no mediation resulting from the portion of attachment avoidance that was independent of attachment anxiety. By contrast, for attachment anxiety, the mediation was largely due to variance specific to attachment anxiety and not to variance shared with it and attachment avoidance. In short, we ultimately observed mediation for attachment anxiety but not for attachment

Fig. 3. The relative sizes of the direct and indirect effects as indicated by the standardised beta weights when presented as absolute values (they were only negative for βdirect of the right-most bar). The figure shows four mediations, all had intolerance of uncertainty as the mediator and worry as the dependent variable. The independent variable (IV) was either attachment anxiety (Att Anx) or attachment avoidance (Att Avoi), as indicated, and the covariates, when included, were age and either attachment anxiety or attachment avoidance. Significance levels: * = p b 0.05, ** = p b 0.01, n.s. = not significant.


avoidance. The mediation we initially observed for attachment avoidance may be seen to be an artefact caused by attachment anxiety. 4. Discussion The present study examined the relationship between IOU, worry, attachment anxiety and attachment avoidance. The first hypothesis was supported, as attachment anxiety was positively associated with IOU and with worry. Additionally, the second hypothesis was supported as attachment avoidance was positively associated with IOU and with worry. This finding is consistent with the proposal that individuals with insecure attachment styles (i.e., with higher levels of attachment anxiety and attachment avoidance) develop heightened IOU relative to those who are more securely attached (Dugas et al., 2004). These findings also align with empirical research suggesting that worry is associated with both attachment anxiety and attachment avoidance (e.g., Simonelli et al., 2004). Consistent with findings from a variety of studies, the present study also found that higher levels of IOU were associated with higher levels of worry (Dugas & Landouceur, 2000). More notably, the present study found that IOU mediated the relationship between attachment anxiety and worry, thus, supporting H3. The indirect effect was three to four times larger than the direct effect (see Fig. 3). This suggests that, contrary to the relationship implied by previous studies concerning attachment and worry (e.g., Simonelli et al., 2004), attachment anxiety may not act directly on level of worry, but indirectly through its impact upon IOU. By contrast, for the relationship between attachment avoidance and worry, intolerance only mediated the association if attachment anxiety was ignored. Once these effects were covaried out, the mediation effect disappeared, failing to support H4. These findings, therefore, partially support our proposed hypothetical causal chain suggesting that heightened attachment anxiety, at least, contributes to maladaptive emotional regulation and the perceived inability to tolerate distress and uncertainty (i.e., IOU), which, in turn, promotes fluctuations in level of worry. As the first study to evaluate the mediating effect of IOU on the relationship between attachment and worry, this finding may be of significant clinical and theoretical interest. The results of the study may be conceptualised within the model of the activation and dynamics of the attachment system, as described by Mikulincer et al., (2003). When the attachment system is activated, uncertainty, which is inherent within social interactions and interpersonal relationships, may be perceived as threatening (Campbell et al., 2005; Collins, 1996; Dugas et al., 1997). This would be expected to lead to worry and further activation of the attachment system including the use of proximity-seeking strategies in response to attachment insecurity. For individuals with high attachment anxiety this may involve the use of hyperactivating strategies where an individual becomes hypervigilant regarding threat and attachment-related cues, seeking reassurance and close proximity with significant others (Mikulincer et al., 2003). Such behaviours may, paradoxically, impact negatively upon their relationships and increase perceived uncertainty within such relationships. It may, therefore, be hypothesised that individuals with high attachment anxiety may be predisposed to experience uncertainty as a sign of threat which reactivates the attachment system and creates a vicious cycle of maintenance of attachment-related distress and worry.

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choosing to opt into participating in response to online advertisements the sample must be considered a convenience sample and, consequently, the possibility of selection bias must be considered. This is further highlighted by the fact that a greater number of females than males chose to participate in the study. Exploring potential gender differences in the relationships evaluated within this study would be an important avenue for future research. A further limitation of the study sample is that the nature of the data collection does not allow us to analyse the responses of students who participated in the study to obtain course credit relative to the rest of the sample. Given that these participants were taking part on the basis of an incentive this may limit the generalisability of the data. This study included participants who fell within both the clinical and non-clinical population for worry, with the mean score for worry being below the clinical cut-off score. Consequently, the present study's findings may not be replicated within a sample of individuals suffering from chronic worry. When scrutinizing the results of the present study, a concern regarding measurement contamination may arise, wherein seven items on the ECR-R (the IV) directly assess aspects of worry concerning relationships, which may bear conceptual overlap with worry as measured by the PSWQ (the DV). However, when removing these seven items from the analysis, the results were found to be almost identical (not reported here due to space constraints), indicating that the results are not a function of the measurement of worry in the ECR-R. The use of mediation analyses within a cross-sectional design is considered an appropriate first step in assessing a proposed hypothetical causal chains (e.g., Salthouse, 2011). However, cross-sectional designs do not allow for definitive conclusions to be drawn regarding temporal sequences (e.g., Maxwell & Cole, 2007). Future extensions of this research should, therefore, evaluate the study variables by employing a longitudinal design. Attachment difficulties are associated with significant distress and a variety of psychological difficulties (Mikulincer & Shaver, 2012). It would appear that existing attachment-focussed psychological interventions (e.g., Stuart, 2008) do not actively conceptualise and target IOU within treatment. Evaluating whether targeting IOU within treatment could alleviate the worry and psychological distress associated with attachment difficulties would also be an important avenue for future research. 4.2. Conclusion This study investigated the relationships between attachment anxiety, attachment avoidance, IOU, and worry in the general population. Attachment anxiety and attachment avoidance were found to positively correlate with IOU. Additionally, attachment anxiety and attachment avoidance were found to positively correlate with worry. This study is the first to demonstrate that IOU mediates the relationship between attachment anxiety and worry. These results may have significant implications for how adult attachment difficulties and worry are understood and treated in clinical settings. Acknowledgements There was no funding source for this study.

4.1. Limitations and future directions Whilst the above discussion highlights the potential role of uncertainty within the interpersonal context it must be cautioned that the IOU scale is not a measure which specifically assesses intolerance of uncertainty in relationships but is, instead, a global measure of IOU. Therefore, it is not possible to discern the degree to which IOU within, and concerning, interpersonal relationships mediates the relationship between attachment and worry, versus a more global difficulty in tolerating uncertainty. As an online study which involved participants

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