Intolerance of Uncertainty as a Transdiagnostic Factor

Abstract

With the rapidly changing world and the impact of life conditions, uncertainty has become one of the concepts that we encounter in all areas of life. Uncertainty, which makes its presence felt almost every moment of time in daily life, is a disturbing and anxious situation for most people in the face of events or situations. Intolerance to uncertainty is the cognitive, emotional and behavioral response generated by the biased information process, which leads to high threat level, misconception and difficult to deal with. Intolerance to uncertainty is a concept developed against the backdrop of widespread anxiety disorder, after which its relationship with many mental disorders is revealed. Researches; it shows that people with depression, post-traumatic stress disorder, generalized anxiety disorder, obsessive-compulsive disorder, and social anxiety disorder have higher UI levels than healthy controls. For many mental disorders, it is considered as a transdiagnostic factor, because it is a revealing and sustaining factor. Recently, the importance of transdiagnostic factors in mental disorders is emphasized. The literature on the intolerance of uncertainty is increasing. In this review, intolerance to uncertainty is examined with a general perspective in line with the current literature, and the findings will be discussed both conceptually, measurement methods and clinical results will be evaluated. As a transdiagnostic factor, intolerance to uncertainty should be considered in the clinical approach because of its cognitive, emotional and behavioral structure.

Keywords

• Intolerance of uncertainty
• anxiety disorders
• obsesive compulsive disorder
• review

Transdiagnostik Faktör Olarak Belirsizliğe Tahammülsüzlük

Öz

Günümüzde hızla değişen dünya ve hayat şartlarının etkisi ile birlikte belirsizlik, hayatın her alanında karşımıza çıkan kavramlardan birisi haline gelmiştir. Günlük hayatta zamanın neredeyse her anında varlığını hissettiren belirsizlik, olaylar veya durumlar karşısında çoğu kişi için rahatsız edici ve kaygı verici bir durumdur. Belirsizliğe tahammülsüzlük, tehdit düzeyi yüksek, hatalı algılamaya yol açan ve başa çıkmanın güç olduğu, önyargılı bilgi işleminin oluşturduğu bilişsel, duygusal ve davranışsal tepkidir. Belirsizliğe tahammülsüzlük , yaygın anksiyete bozukluğu zemininde geliştirilen, sonrasında birçok ruhsal bozukluk ile ilişkisi ortaya konan bir kavramdır. Yapılan araştırmalar; depresyon, travma sonrası stres bozukluğu, yaygın anksiyete bozukluğu, obsesif kompulsif bozukluk ve sosyal anksiyete bozukluğu olan kişilerin sağlıklı kontrollerden daha yüksek belirsizliğe tahammülsüzlük düzeylerine sahip olduklarını göstermektedir. Birçok ruhsal bozukluk için, ortaya çıkarıcı, sürdürücü bir faktör olması sebebiyle de transdiagnostik bir faktör olarak ele alınmaktadır. Son zamanlarda ruhsal bozukluklarda transdiganostik faktörlerin önemine dikkat çekilmektedir. Belirsizliğe tahammülsüzlük ile ilgili yazın giderek artmaktadır. Bu gözden geçirmede belirsizliğe tahammülsüzlük genel bir bakış açısı ile güncel yazın doğrultusunda incelenmiş olup, bulgular hem kavramsal olarak ele alınacak, hem de ölçüm yöntemleri ve klinik sonuçları değerlendirilecektir. Transdiagnostik bir faktör olarak belirsizliğe tahammülsüzlük bilişsel, duygusal ve davranışsal bir yapı olmasından dolayı klinik yaklaşımda göz önünde bulundurulması gerekir.

Anahtar Kelimeler

• belirsizliğe tahammülsüzlük
• anksiyete bozuklukları
• obsesif kompulsif bozukluk
• derleme

Kaynakça

1. Badia P, McBane B and Suter S (1966) Preference behavior in an immediate versus variably delayed shock situation with and without a warning signal. J Exp Psychol Gen, 72(6): 847.
2. Bar-Anan Y, Wilson TD and Gilbert DT (2009) The feeling of uncertainty intensifies affective reactions. Emotion, 9(1): 123.
3. Berenbaum H, Bredemeier K and Thompson RJ (2008) Intolerance of uncertainty: Exploring its dimensionality and associations with need for cognitive closure, psychopathology, and personality. J Anxiety Disord, 22(1): 117-125.
4. Birrell J, Meares K, Wilkinson A and Freeston M (2011) Toward a definition of intolerance of uncertainty: A review of factor analytical studies of the Intolerance of Uncertainty Scale. Clin Psychol Rev, 31(7): 1198-1208.
5. Boelen P. (2010) Intolerance of uncertainty and emotional distress following the death of a loved one. Anxiety Stress Coping, 23(4): 471-478.
6. Boelen PA and Reijntjes A (2009) Intolerance of uncertainty and social anxiety. J Anxiety Disord, 23(1): 130-135.
7. Boelen PA, Reijntjes A and Carleton RN (2014) Intolerance of uncertainty and adult separation anxiety. Cogn Behav Ther, 43(2): 133-144.
8. Boelen PA, Reijntjes A and Smid GE (2016) Concurrent and prospective associations of intolerance of uncertainty with symptoms of prolonged grief, posttraumatic stress, and depression after bereavement. J Anxiety Disord, 41: 65-72.

9. Boswell JF, Thompson‐Hollands J, Farchione TJ and Barlow DH (2013) Intolerance of uncertainty: A common factor in the treatment of emotional disorders. J Clin Psychol, 69(6): 630-645.
10. Boulter C, Freeston M, South M and Rodgers J (2014) Intolerance of uncertainty as a framework for understanding anxiety in children and adolescents with autism spectrum disorders. J Autism Dev Disord, 44(6): 1391-1402.
11. Brown M, Robinson L, Campione GC, Wuensch K, Hildebrandt T and Micali N (2017) Intolerance of uncertainty in eating disorders: A systematic review and meta‐analysis. Eur Eat Disord Rev, 25(5): 329-343.
12. Buhr K and Dugas MJ (2006) Investigating the construct validity of intolerance of uncertainty and its unique relationship with worry. J Anxiety Disord, 20(2): 222-236.
13. Buhr K and Dugas MJ (2009) The role of fear of anxiety and intolerance of uncertainty in worry: An experimental manipulation. Behav Res Ther, 47(3): 215-223.
14. Calleo JS, Hart J, Björgvinsson T and Stanley MA (2010) Obsessions and worry beliefs in an inpatient OCD population. J Anxiety Disord, 24(8): 903-908.
15. Carleton RN (2016) Into the unknown: A review and synthesis of contemporary models involving uncertainty. J Anxiety Disord, 39: 30-43.
16. Carleton RN, Duranceau S, Shulman EP, Zerff M, Gonzales J and Mishra S (2016) Self-reported intolerance of uncertainty and behavioural decisions. J Behav Ther Exp Psychiatry, 51: 58-65.
17. Carleton RN, Fetzner MG, Hackl JL and McEvoy P (2013) Intolerance of uncertainty as a contributor to fear and avoidance symptoms of panic attacks. Cogn Behav Ther, 42(4): 328-341.
18. Carleton RN, Gosselin P and Asmundson GJ (2010) The Intolerance of Uncertainty Index: Replication and extension with an English sample. Psychol Assess, 22(2): 396.
19. Carleton RN, Norton MPJ and Asmundson GJ (2007a) Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. J Anxiety Disord, 21(1): 105-117.
20. Carleton RN, Sharpe D and Asmundson GJ(2007b) Anxiety sensitivity and intolerance of uncertainty: Requisites of the fundamental fears? Behav Res, Ther 45(10): 2307-2316.
21. Castriotta N , Dozier ME, Taylor CT, Mayes T and Ayers CR (2019) Intolerance of uncertainty in hoarding disorder. J Obsessive Compuls Relat Disord, 21: 97-101.
22. Chorpita BF and Barlow DH (1998) The development of anxiety: the role of control in the early environment. Psychol Bull, 124(1): 3.
23. Comer JS, Roy AK, Furr JM, Gotimer K, Beidas RS, Dugas MJ et al. (2009) The intolerance of uncertainty scale for children: a psychometric evaluation. Psychol Assess, 21(3): 402.
24. Dar KA, Iqbal N and Mushtaq A (2017) Intolerance of uncertainty, depression, and anxiety: Examining the indirect and moderating effects of worry. Asian J Psychiatr, 29: 129-133.
25. Davey GC, Eldridge F, Drost J and MacDonald BA (2007) What ends a worry bout? An analysis of changes in mood and stop rule use across the catastrophising interview task. Behav Res Ther, 45(6): 1231-1243.
26. De Jong-Meyer, Beck RB and Riede K (2009) Relationships between rumination, worry, intolerance of uncertainty and metacognitive beliefs. Pers Individ Dif, 46(4): 547-551.
27. Denmark FL (2010) Zeigarnik effect. The Corsini encyclopedia of psychology: 1-1.
28. Dugas MJ, Gagnon F, Ladouceur R and Freeston MH (1998) Generalized anxiety disorder: A preliminary test of a conceptual model. Behav Res Ther, 36(2): 215-226.
29. Dugas MJ, Laugesen N and Bukowski WM (2012) Intolerance of uncertainty, fear of anxiety, and adolescent worry. J Abnorm Child Psychol, 40(6): 863-870.
30. Dugas MJ, Savard P, Gaudet A, Turcotte J, Laugesen N, Robichaud M et al. (2007) Can the components of a cognitive model predict the severity of generalized anxiety disorder? Behav Ther, 38(2): 169-178.
31. Dugas MJ, Schwartz A and Francis K (2004) Brief report: Intolerance of uncertainty, worry, and depression. Cognit Ther Res, 28(6): 835-842.
32. Dupuy JB and Ladouceur R (2008) Cognitive processes of generalized anxiety disorder in comorbid generalized anxiety disorder and major depressive disorder. J Anxiety Disord, 22(3): 505-514.
33. Ehring T and Watkins ER (2008) Repetitive negative thinking as a transdiagnostic process. Int J Cogn Ther, 1(3): 192-205.
34. Einstein DA (2014) Extension of the transdiagnostic model to focus on intolerance of uncertainty: a review of the literature and implications for treatment. Clin Psychol, 21(3): 280-300.
35. Fetzner MG, Asmundson GJ, Carey C, Thibodeau MA, Brandt C, Zvolensky MJ et al. (2014) How do elements of a reduced capacity to withstand uncertainty relate to the severity of health anxiety? Cogn Behav Ther, 43(3): 262-274.
36. Fetzner MG, Horswill SC, Boelen PA and Carleton RN (2013) Intolerance of uncertainty and PTSD symptoms: Exploring the construct relationship in a community sample with a heterogeneous trauma history. Cognit Ther Res, 37(4): 725-734.
37. Fourtounas A and Thomas SJ (2016) Cognitive factors predicting checking, procrastination and other maladaptive behaviours: Prospective versus Inhibitory Intolerance of Uncertainty. J Obsessive Compuls Relat Disord, 9: 30-35.
38. Freeston MH, Rhéaume J, Letarte H, Dugas MJ and Ladouceur R (1994) Why do people worry? Pers Individ Dif, 17(6): 791-802.
39. Frenkel-Brunswik E (1949) Intolerance of ambiguity as an emotional and perceptual personality variable. J Pers.
40. Gentes EL and Ruscio AM (2011) A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive–compulsive disorder. Clin Psychol Rev, 31(6): 923-933.
41. Gray J and McNaughton N (2003) The neuropsychology of anxiety. Crossref Google Scholar Article Locations: Article Location Article Location More AR articles citing this reference The Neurocognitive Bases of Human Volition Patrick Haggard 1(2): 3.
42. Greco V and Roger D (2003) Uncertainty, stress, and health. Pers Individ Dif 34(6): 1057-1068.
43. Grupe DW and Nitschke JB (2011) Uncertainty is associated with biased expectancies and heightened responses to aversion. Emotion, 11(2): 413.
44. Grupe DW and Nitschke JB (2013) Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nat Rev Neurosci, 14(7): 488-501.
45. Gu Y, Gu S, Lei Y and Li H (2020) From Uncertainty to Anxiety: How Uncertainty Fuels Anxiety in a Process Mediated by Intolerance of Uncertainty. Neural Plast, 2020.
46. Harvey A, Watkins E, Mansell W and Shafran R (2004). A Transdiagnostic Approach to Research and Treatment, Oxford University Press.
47. Hebert EA and Dugas MJ (2019) Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder. Cogn Behav Pract, 26(2): 421-436.
48. Holaway RM, Heimberg RG and Coles ME (2006) A comparison of intolerance of uncertainty in analogue obsessive-compulsive disorder and generalized anxiety disorder. J Anxiety Disord, 20(2): 158-174.
49. Hong RY and Cheung MWL (2015) The structure of cognitive vulnerabilities to depression and anxiety: Evidence for a common core etiologic process based on a meta-analytic review. Clin Psychol Sci, 3(6): 892-912.
50. Hwang YI, Arnold S, Srasuebkul P and Trollor J (2020) Understanding anxiety in adults on the autism spectrum: An investigation of its relationship with intolerance of uncertainty, sensory sensitivities and repetitive behaviours. Autism, 24(2): 411-422.
51. Jacoby RJ (2020) Intolerance of uncertainty. Washington, DC : American Psychological Association
52. Jacoby RJ, Abramowitz JS, Buck BE and Fabricant LE (2014) How is the Beads Task related to intolerance of uncertainty in anxiety disorders? J Anxiety Disord, 28(6): 495-503.
53. Jacoby RJ, Abramowitz JS, Reuman L and Blakey SM (2016) Enhancing the ecological validity of the Beads Task as a behavioral measure of intolerance of uncertainty. J Anxiety Disord, 41: 43-49.
54. Jacoby RJ, Fabricant LE, Leonard RC, Riemann BC and Abramowitz JS (2013) Just to be certain: Confirming the factor structure of the Intolerance of Uncertainty Scale in patients with obsessive-compulsive disorder. J Anxiety Disord, 27(5): 535-542.
55. Jensen D and Heimberg RG (2015) Domain-specific intolerance of uncertainty in socially anxious and contamination-focused obsessive–compulsive individuals. Cogn Behav Ther, 44(1): 54-62.
56. Jensen D, Kind AJ, Morrison AS and Heimberg RG (2014) Intolerance of uncertainty and immediate decision-making in high-risk situations. J Exp Psychopathol, 5(2): 178-190.
57. Kertz SJ, Stevens KT, McHugh RK and Björgvinsson T (2015) Distress intolerance and worry: The mediating role of cognitive variables. Anxiety Stress Coping, 28(4): 408-424.
58. Khawaja NG and Yu LNH (2010) A comparison of the 27‐item and 12‐item intolerance of uncertainty scales. Clin Psychol, 14(3): 97-106.
59. Krain AL, Hefton S, Pine DS, Ernst M, Xavier Castellanos F, Klein RG et al. (2006) An fMRI examination of developmental differences in the neural correlates of uncertainty and decision‐making. J Child Psychol Psychiatry, 47(10): 1023-1030.
60. Lanzetta JT and Driscoll JM (1966) Preference for information about an uncertain but unavoidable outcome. J Pers Soc Psychol, 3(1): 96.
61. Laugesen N, Dugas MJ and Bukowski WM (2003) Understanding adolescent worry: The application of a cognitive model. J Abnorm Child Psychol, 31(1): 55-64.
62. Luhmann CC, Ishida K and Hajcak G (2011) Intolerance of uncertainty and decisions about delayed, probabilistic rewards. Behav Ther, 42(3): 378-386.
63. Mahoney AE and McEvoy PM (2012a) Trait versus situation-specific intolerance of uncertainty in a clinical sample with anxiety and depressive disorders. Cogn Behav Ther, 41(1): 26-39.
64. Mahoney AE and McEvoy PM (2012b) A transdiagnostic examination of intolerance of uncertainty across anxiety and depressive disorders. Cogn Behav Ther, 41(3): 212-222.
65. McEvoy PM and Erceg-Hurn DM (2016) The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty. J Anxiety Disord, 41: 96-107.
66. McEvoy PM, Hyett MP, Shihata S, Price JE and Strachan L (2019) The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: A meta-analysis. Clin Psychol Rev, 73: 101778.
67. McEvoy PM and Mahoney AE (2011) Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression. J Anxiety Disord, 25(1): 112-122.
68. McEvoy PM and Mahoney AE (2012) To be sure, to be sure: Intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behav Ther, 43(3): 533-545.
69. Motzkin JC, Philippi CL, Wolf RC, Baskaya MK and Koenigs M (2014) Ventromedial prefrontal cortex lesions alter neural and physiological correlates of anticipation. J Neurosci, 34(31): 10430-10437.
70. Norton PJ and Mehta PD (2007) Hierarchical model of vulnerabilities for emotional disorders. Cogn Behav Ther, 36(4): 240-254.
71. OCCWG (1997) Cognitive assessment of obsessive-compulsive disorder. Behav Res Ther, 35(7): 667-681.
72. Oglesby ME, Boffa JW, Short NA, Raines AM and Schmidt NB (2016) Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event. J Anxiety Disord, 41: 82-87.
73. Oglesby ME, Medley AN, Norr AM, Capron DW, Korte KJ and Schmidt NB (2013) Intolerance of uncertainty as a vulnerability factor for hoarding behaviors. J Affect Disord, 145(2): 227-231.
74. Osmanağaoğlu N, Creswell C and Dodd HF (2018) Intolerance of Uncertainty, anxiety, and worry in children and adolescents: A meta-analysis. J Affect Disord, 225: 80-90.
75. Ottaviani C, Borlimi R, Brighetti B, Caselli G, Favaretto E, Giardini I, Marzocchi C et al. (2014) Worry as an adaptive avoidance strategy in healthy controls but not in pathological worriers. Int J Psychophysiol, 93(3): 349-355.
76. Paula-Pérez I and Artigas-Pallarés J (2020) Intolerance to uncertainty in autism. Medicina, 80: 17-20.
77. Pleskac TJ, Diederich A and Wallsten TS (2015) Models of decision making under risk and uncertainty. The oxford handbook of computational and mathematical psychology: 209-231.
78. Renjan V, McEvoy PM, Handley AK and Fursland A (2016) Stomaching uncertainty: Relationships among intolerance of uncertainty, eating disorder pathology, and comorbid emotional symptoms. J Anxiety Disord, 41: 88-95.
79. Robichaud M (2013) Cognitive Behav Ther targeting intolerance of uncertainty: Application to a clinical case of generalized anxiety disorder. Cogn Behav Pract, 20(3): 251-263.
80. Rosen NO, Knäuper B, Di Dio P, Morrison E, Tabing R, Feldstain A et al. (2010) The impact of intolerance of uncertainty on anxiety after receiving an informational intervention about HPV: a randomised controlled study. Psychol Health, 25(6): 651-668.
81. Sadeh N. and Bredemeier K (2019) Engaging in risky and impulsive behaviors to alleviate distress mediates associations between intolerance of uncertainty and externalizing psychopathology. J Pers Disord, 1-16.
82. Sari S. and Dağ İ (2009) Belirsizliğe Tahammülsüzlük Ölçeği, Endişe ile İlgili Olumlu İnançlar Ölçeği ve Endişenin Sonuçları Ölçeği’nin Türkçeye uyarlanması, geçerliliği ve güvenilirliği. Anadolu Psikiyatri Derg, 10: 270.
83. Sarıçam H., Erguvan FM, Akın A and Akça MŞ (2014) The Turkish short version of the Intolerance of Uncertainty (IUS-12) Scale: The study of validity and reliability. Route Educational and Social Science Journal, 1(3): 148-157.
84. Sarinopoulos I, Grupe D, Mackiewicz K, Herrington J, Lor M, Steege E et al. (2010) Uncertainty during anticipation modulates neural responses to aversion in human insula and amygdala. Cereb Cortex, 20(4): 929-940.
85. Schienle A, Köchel A, Ebner F, Reishofer G and Schäfer A (2010) Neural correlates of intolerance of uncertainty. Neurosci Lett, 479(3): 272-276.
86. Shihata S, McEvoy PM and Mullan BA (2017) Pathways from uncertainty to anxiety: An evaluation of a hierarchical model of trait and disorder-specific intolerance of uncertainty on anxiety disorder symptoms. J Anxiety Disord, 45: 72-79.
87. Shihata S, McEvoy PM, Mullan BA and Carleton RN (2016) Intolerance of uncertainty in emotional disorders: What uncertainties remain? J Anxiety Disord, 41: 115-124.
88. Shin LM and Liberzon I (2010) The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology, 35(1): 169-191.
89. Simmons A, Matthews SC, Paulus MP and Stein MB (2008) Intolerance of uncertainty correlates with insula activation during affective ambiguity. Neurosci Lett, 430(2): 92-97.
90. Stanley Budner N (1962) Intolerance of ambiguity as a personality variable 1. J Pers 30(1): 29-50.
91. Summers BJ, Matheny NL, Sarawgi S and Cougle JR (2016) Intolerance of uncertainty in body dysmorphic disorder. Body image, 16: 45-53.
92. TDK (2019) Türk dil kurumu sözlükleri. Erişim Adresi: https://sozluk. gov. tr.
93. Thayer JF, Åhs F, Fredrikson M, Sollers JJ III and Wager TD (2012) A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev, 36(2): 747-756.
94. Thibodeau MA, Carleton RN, Gómez-Pérez L and Asmundson GJ (2013) “What if I make a mistake?”: Intolerance of uncertainty is associated with poor behavioral performance. J Nerv Ment Dis, 201(9): 760-766.
95. Thibodeau MA, Carleton RN, McEvoy PM, Zvolensky MJ, Brandt CP, Boelen PA et al. (2015) Developing scales measuring disorder-specific intolerance of uncertainty (DSIU): A new perspective on transdiagnostic. J Anxiety Disord, 31: 49-57.
96. Tolin DF, Abramowitz JS, Brigidi BD and Foa EB (2003) Intolerance of uncertainty in obsessive-compulsive disorder. J Anxiety Disord, 17(2): 233-242.
97. van der Heiden C, Muris P and van der Molen HT (2012) Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behav Res Ther, 50(2): 100-109.
98. Vansteenwegen D, Iberico C, Vervliet B, Marescau V and Hermans D (2008) Contextual fear induced by unpredictability in a human fear conditioning preparation is related to the chronic expectation of a threatening US. Biol Psychol, 77(1): 39-46.
99. Whalen PJ, L. Shin M, McInerney SC, Fischer H, Wright CI and Rauch SL (2001) A functional MRI study of human amygdala responses to facial expressions of fear versus anger. Emotion, 1(1): 70.
100. Wheaton MG, Abramowitz SJ, Jacoby RJ, Zwerling J and Rodriguez CI (2016) An investigation of the role of intolerance of uncertainty in hoarding symptoms. J Affect Disord, 193: 208-214.
101. Wheaton MG and Ward HE (2020) Intolerance of uncertainty and obsessive-compulsive personality disorder. Personality Disorders: Theory, Research, and Treatment, 11(5), 357–364
102. Whiting SE, Jenkins WS, May AC, Rudy BM, Davis TE III and Reuther ET (2014) The role of intolerance of uncertainty in social anxiety subtypes. J Clin Psychol, 70(3): 260-272.
103. Wright KD, Lebell MAA and Carleton RN (2016) Intolerance of uncertainty, anxiety sensitivity, health anxiety, and anxiety disorder symptoms in youth. J Anxiety Disord, 41: 35-42.
104. Yook K, Kim KH, Suh SY and Lee KS (2010) Intolerance of uncertainty, worry, and rumination in major depressive disorder and generalized anxiety disorder. J Anxiety Disord, 24(6): 623-628.
105. Zlomke KR and Jeter KM (2014) Stress and worry: examining intolerance of uncertainty's moderating effect. Anxiety Stress Coping, 27(2): 202-215.
106. Zlomke KR and Young JN (2009) A retrospective examination of the role of parental anxious rearing behaviors in contributing to intolerance of uncertainty. J Child Fam Stud, 18(6): 670-679.