1Department of General Psychology, University of Padova (Italy); 2Servizio di Psicologia Clinica, "Mater Salutis" Hospital, Legnago (Italy); 3School of.
Is Intolerance of Uncertainty transdiagnostic? Exploring the associations between Intolerance of Uncertainty and symptom severity in Italian clinical samples Gioia Bottesi1, Marta Ghisi1, Veronica Tesini1, Paola Schiavi2, Enrico Razzetti1, & Mark H. Freeston3 1Department
of General Psychology, University of Padova (Italy); 2Servizio di Psicologia Clinica, "Mater Salutis" Hospital, Legnago (Italy) ; 3School of Psychology, Institute of Neuroscience, Newcastle University (UK)
BACKGROUND • Intolerance of Uncertainty (IU): set of nega4ve beliefs about uncertainty and its consequences (Koerner & Dugas, 2008) comprising two dis4nct components (Birrell et al., 2011; Carleton et al., 2012): § §
Prospec4ve IU: future-‐oriented strategy employed to gain certainty; Inhibitory IU: avoidance strategy preven4ng individuals from ac4ng when they found themselves in ambiguous situa4ons.
• Transdiagnos4c nature: specific associa4ons between these dimensions and different disorders (e.g. Carleton et al., 2012; McEvoy & Mahoney, 2011, 2012):
§ Generalised Anxiety Disorder (GAD): more future-‐oriented, greater involvement of the Prospec4ve IU; § Panic Disorder (PD) and Major Depressive Disorder (MDD): more avoidance-‐based, greater involvement of the Inhibitory IU;
• Although there is a significant evidence base in English-‐speaking samples, there is liVle aVen4on in the Italian context to date.
AIMS OF THE STUDY 1) Examining associa4ons between IU and symptom severity in Italian clinical samples; 2) Tes4ng whether the two IU components are differen4ally involved in different psychological disorders. METHOD
Par7cipants Three DSM-‐5 diagnosed clinical groups: • GAD group (N = 13), 76.9% female (age: 47.38±14.12) • PD pa4ents (N = 12), 75% female (age: 43.25±9.64) • MDD pa4ents (N = 15), 93% female (age: 52±13.54) One healthy control (HC) group (N = 14), 71.43% female (age: 45.50±10.79). No differences between groups as regards gender and age (ps >.05). Self report measures • The Intolerance of Uncertainty Scale-‐12 (IUS-‐12) (Carleton et al., 2007; Walker et al., 2010)
• The Penn State Worry Ques;onnaire (PSWQ) (Meyer et al., 1990) • The Beck Anxiety Inventory (BAI) (Beck et al., 1998) • The Beck Depression Inventory-‐II (BDI-‐II) (Beck et al., 1996) Procedure • Clinical par4cipants were outpa4ents consecu4vely referred to the Servizio di Psicologia Clinica, "Mater Salu4s" Hospital (Legnago, Italy). • Individuals in the HC group were recruited through adver4sements reques4ng poten4al volunteers for psychological studies. • All par4cipants provided their wriVen consent before entering the study. • Self report measures were administered in counterbalanced order in order to avoid order effects. References Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric proper4es. Journal of Consul;ng and Clinical Psychology, 56, 893-‐897. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory Second Edi;on Manual. San Antonio, TX: The Psychological Corpora4on Harcourt Brace & Company. Birrell, L., Meares, K., Wilkinson, A., & Freeston, M. H. (2011). Toward a defini4on of intolerance of uncertainty: A review of factor analy4cal studies of the Intolerance of Uncertainty Scale. Clinical Psychology Review, 31, 1198-‐1208. Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., & Asmundson, G. J. G. (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26, 468-‐479. Carleton, R. N., Norton, P. J., & Asmundson, G. J. G. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21, 105-‐117. Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: a preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215-‐226. Koerner, N., & Dugas, M. J. (2008). An inves4ga4on of appraisals in individuals vulnerable to excessive worry: The role of intolerance of uncertainty. Cogni;ve Therapy and Research, 32, 619-‐638. McEvoy, P. M., & Mahoney, A. E. J. (2011). Achieving certainty about the structure of intolerance of uncertainty in a treatment-‐seeking sample with anxiety and depression. Journal of Anxiety Disorders, 25, 112-‐122. McEvoy, P. M., & Mahoney, A. E. J (2012). To be sure, to be sure: intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behaviour Therapy, 43, 533-‐545. Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and valida4on of the Penn State Worry Ques4onnaire. Behavior Research and Therapy, 28, 487-‐495. Walker, S., Birrell, J., L. Rogers, J. Leekam, S., and Freeston, M. H., (2010). Intolerance of Uncertainty Scale – Revised (Unpublished Document, Newcastle University).
RESULTS
Descrip7on of par7cipants Scores obtained by the 4 groups on the psychopathological measures and the IUS-‐12 Total score are reported in Table 1. Self GAD PD MDD HC par*al report F p Bonferroni post hocs group group group group η measure 60.92 56.95 57.91 39.64 8.65 < .001 .34 GAD = PD = MDD > HC PSWQ (9.86) (9.94) (14.50) (13.00) 19.16 24.41 26.39 9.35 PD = MDD > HC 6.00 .002 .28 BAI (14.82) (15.27) (10,14) (7.73) GAD = PD, GAD = HC MDD > GAD = HC 14.46 20.07 28.41 5.64 PD = GAD, PD = MDD, 12.19 HC 37.85 33.09 36.08 23.36 IUS-‐12 5.62 .002 .26 PD = GAD = MDD (11.51) (10.87) (10.59) (7.11) Total PD = HC Table 1: Mean (SDs) scores obtained by the 4 groups on the PWSQ, BAI, BDI-‐II, And IUS-‐12 Total scores. Associa7ons between IU and symptom severity Pearson’s correla4ons were performed on the whole clinical sample (Table 2). Posi4ve medium-‐range correla4ons between the IUS-‐12 (Total and subscales) and the PSWQ emerged. On the other hand, no associa4ons with the BAI and the BDI-‐II scores were found. PSWQ BAI BDI-‐II IUS-‐12 .45** .31 .18 Total IUS-‐12 .44** .25 .10 Prospec7ve IUS-‐12 .45** .32 .25 Inhibitory Table 2. Note: N = 40. ** = p < .001. Differences between clinical groups on the IU dimensions Clinical groups were compared on the IUS-‐12 Prospec4ve and Inhibitory subscales controlling for the PSWQ scores (Table 3). No differences between groups emerged. PSWQ was a significant covariate in both the ANCOVAs (p = .009, par;al η2 = .18; p = .006, par;al η2 = .21, respec4vely). 3,47
2
GAD
PD
MDD
F2,37
group
group
group
IUS-‐12
24.31
20.00
22.07
Prospec7ve
(6.34)
(5.90)
(5.24)
IUS-‐12
13.54
13.09
14.38
Inhibitory
(6.19)
(5.79)
(6.24)
p
1.32
.28
.25
.78
Table 3. Mean (SDs) scores obtained by the 3 clinical groups on the IUS-‐12 Prospec4ve and Inhibitory subscales.
DISCUSSION • Overall, IU was moderately associated with worry and unrelated to p h y s i o l o g i c a l a n x i e t y a n d d e p r e s s i v e s y m p t o m s correla4onal findings suggest a preferen4al rela4onship between IU and worry (in line with the Laval model; Dugas et al., 1998). To note: worry was a highly shared feature across groups. • Higher levels of IU in GAD and MDD pa4ents than in HCs AND similar levels of Prospec4ve and Inhibitory IU across clinical groups. support to the transdiagnos4city of IU but no specific paVerns characterising different disorders cross-‐cultural similari4es and differences? • Main limita4ons: small sample size (low power), assessment of comorbidity, unrepresenta4veness of Italian clinical popula4on. • Further inves4ga4on is needed since replica4ng that IU has transdiagnos4c rela4onships across cultures and would increase support for the need of transdiagnos4c interven4ons that target IU.
