عدم تحمل عدم قطعیت و اضطراب اجتماعی

Research has shown that intolerance of uncertainty (IU) – the tendency to react negatively to situations that are uncertain – is involved in generalized anxiety disorder (GAD). There is uncertainty about the specificity of IU. Some studies have shown that IU is specific for GAD. Other studies have shown that IU is also involved in obsessive compulsive disorder (OCD). No studies have yet examined IU in social anxiety, although it is possible that IU plays a role in anxiety responses that can be experienced in social-evaluative situations. This study examined the relationship between IU and social anxiety among 126 adults. Findings revealed that IU explained a significant amount of variance in social anxiety severity when controlling for established cognitive correlates of social anxiety (e.g., fear of negative evaluation) and for neuroticism. Furthermore, it was found that IU was related with symptom levels of GAD, OCD, and social anxiety, but not depression, when controlling the shared variance among these symptoms.

Anxiety disorders are among the most prevalent of all psychiatric disorders (Kessler, Berglund, Demler, Jin, & Walters, 2005). The recent decades have seen advancement of our understanding of the etiology of anxiety disorders. An important premise in theories about anxiety disorders is that they contain both common and unique components (Brown & Barlow, 2002; Mineka, Watson, & Clark, 1998). Specifically, theorists have proposed and research has confirmed that all anxiety disorders (as well as mood disorders) involve elevated levels of negative affectivity or neuroticism (Mineka et al., 1998), whereas specific cognitive factors are responsible for the development of specific anxiety disorders. Examples of such specific factors include anxiety sensitivity in panic disorder, fear of negative evaluation in social phobia, excessive responsibility beliefs in obsessive compulsive disorder (OCD), and intolerance of uncertainty in generalized anxiety disorder (GAD) (cf. Starcevic & Berle, 2006). Identifying factors that are unique to specific anxiety disorders is important for understanding and treatment of these disorders. In recent years, there is growing interest in one of such specific factors, namely intolerance of uncertainty (IU). IU has been defined as “a cognitive bias that affects how a person perceives, interprets, and responds to uncertain situations on a cognitive, emotional, and behavioral level” (Dugas, Schwarzt, & Francis, 2004, p. 835). People high in IU experience the possible occurrence of future negative events as stressful, believe that uncertainty is negative, reflects badly on a person, and should be avoided, and have difficulties functioning well in uncertain situations (Buhr & Dugas, 2002). In studies with non-clinical samples (e.g., Holaway, Heimberg, & Coles, 2006) and clinical samples (e.g., Dugas & Ladouceur, 2000) IU has consistently been found to be correlated with GAD. Nevertheless, studies examining specificity of IU to GAD have yielded mixed results (Starcevic & Berle, 2006). On the one hand, there is evidence that IU is a relatively unique component of GAD. For instance, studies have shown that high levels of IU distinguish patients with GAD from patients with panic disorder (Dugas, Marchand, & Ladouceur, 2005) and from a mixed group of patients with other anxiety disorders (Ladouceur et al., 1999). Moreover, IU has been found to be more strongly related with pathological worry – which is a key symptom of GAD – than with depression (Dugas et al., 2004). On the other hand, there are studies suggesting that IU is critical to both GAD and OCD. For instance, in a study among undergraduate students, Holaway et al. (2006) found that people with clinical significant levels of GAD and OCD reported higher levels of IU than controls, but did not differ significantly from each other in terms of IU levels (also see Steketee, Frost, & Cohen, 1998; Tolin, Abramowitz, Brigidi, & Foa, 2003). To our knowledge, no studies have yet examined the relationship of IU with social anxiety. Yet, it is possible that IU contributes to the severity of social anxiety symptoms. People with elevated social anxiety experience a marked and persistent fear in social situations in which they are exposed to possible scrutiny by others (Hofmann & Barlow, 2002). Clearly, uncertainty, ambiguity, and unpredictable change are inherent to such social-evaluative situations. Thus, it seems plausible that intolerance of such uncertainty, ambiguity, and unpredictable change – in the form of finding that uncertainty is stressful, reflects badly on a person, and blocks constructive action (i.e., IU) – is associated with the fear (e.g., of being criticized), avoidance (e.g., of talking to strangers), and physical discomfort (e.g., blushing, trembling) that some people experience in such situations. The present study, conducted in The Netherlands, addressed several interrelated issues, the overarching aim of which was to improve our understanding of the role of IU in social anxiety. Specifically, this study had two goals. The first goal was to examine the degree to which IU was related to social anxiety severity, when taking into account a number of cognitive variables that have been found to be associated with social anxiety. Cognitive behavioral models of social anxiety have proposed (Clark & Wells, 1995; Rapee & Heimberg, 1997) and research has confirmed (Weeks et al., 2005) that fear of negative evaluation (FNE), defined as fear of being judged disparagingly, critically, or hostilely by others, is strongly linked with social anxiety. Furthermore, social anxiety has been found to be associated with anxiety sensitivity ( Orsillo, Lilienfeld, & Heimberg, 1994), low self-esteem ( Kocovski & Endler, 2000), various dimensions of perfectionism ( Juster et al., 1996), and with pathological worry ( Starcevic et al., 2007). Our first goal was to examine if IU explained variance in social anxiety severity, above and beyond the variance explained by these established cognitive correlates of social anxiety. Because we wished to examine the contribution of IU and the other cognitive correlates to the explained variance in social anxiety independent of neuroticism, this variable was controlled for as well. The second goal of this study was to further our understanding of the generality vs. specificity of IU by examining the specificity of the relationship between IU and GAD, with regards to social anxiety. For comparative reasons, we also included measures of OCD and depression symptoms, expecting that IU would be related with symptom levels of GAD, social anxiety, and OCD, but not depression (Dugas et al., 2004), when controlling for the shared variance between symptoms.