Beyond self-report: a multi-method approach to characterising intolerance of uncertainty

On a daily basis we are confronted with uncertainty about the outcome of future events. In some uncertain situations we may be able to weigh up the options, predict the outcome, and make an informed choice, whilst in other uncertain situations we have very little information with which to make a judgement. Excessive stress in response to uncertainty is common in anxiety disorders. The term Intolerance of Uncertainty (IU) refers to individual differences in anticipating and reacting to uncertainty, with those high in IU having a more negative reaction to uncertainty than those low in IU. Recent work suggests that understanding IU may be important for the diagnosis and treatment of anxiety disorders. Despite these recent advances, very little is understood about exactly how the processing of uncertainty differs in individuals who are low and high in IU, and how this is related to anxiety.

The proposed programme of research will characterise how individuals high in IU differ from those low in IU when faced with uncertainty. Some of the questions that will be addressed are:

1. Do individuals with higher levels of IU have a broader threshold for detecting uncertainty in their environment than individuals low in IU?

2. Do individuals high in IU differ from those low in IU only when the uncertainty is associated with the potential for something bad to happen or is all uncertainty aversive?

3. Do individuals high in IU cope with uncertainty differently to those low in IU? Do they seek more information to enforce some certainty, or do they avoid uncertain situations altogether?

To address these questions, the research will make use of state of the art technologies which will allow us to measure what captures people's attention and how they feel whilst they complete computer based tasks that emulate uncertain situations.

This research has important implications for theories of anxiety and, importantly, by better understanding the nature of IU and how it is associated with anxiety, the research will help us to design new ways of intervening and treating people with anxiety disorders. This would improve the quality of life of the people in question and provide a benefit to society by decreasing the economic burden of long-term mental health problems.

In the UK, anxiety disorders are common, affecting over eight million people. Anxiety disorders place a significant financial burden on the suffering individual and society, costing the economy approximately £10 billion a year. In order to obtain cost-effective targeted treatment, better characterisation of psychological processes that underlie anxiety disorder pathology are needed. Recent theoretical and empirical work suggests that fear of the unknown, captured by individual differences in Intolerance of Uncertainty (IU), plays a central role in anxiety disorder pathology. The aim of the proposed project is to provide research outputs that directly inform the development of treatments for anxiety disorders that target IU-related mechanisms.

The most important potential impact of this research is in improving the quality of life of people with anxiety disorders via an enhanced understanding of IU-related psychological processes that give rise to anxiety. IU has a robust association with worry and anxiety and recent work suggests that it may have relevance for other mental health disorders that have an anxiety component (e.g. depression and obsessive compulsive disorder). Research has begun to examine whether IU can be targeted in treatment for anxiety disorders and initial findings show promise. On this basis the study of IU has gained substantial momentum in recent years and now sits at the forefront of anxiety research. Despite these recent advances, very little is understood about exactly how the processing of uncertainty differs in individuals who are low and high in IU, and how this is related to anxiety.

By providing insights into the characterisation of IU and how it contributes to anxiety, the research has clear potential to impact a range of beneficiaries. Academically, the research will inform theoretical understanding of IU's role in anxiety. In addition, the research will be of interest to academics and clinicians working to develop evidence-based treatments for anxiety disorders.

The outputs from the research have the potential to enhance treatment for people with anxiety, directly through the PIs own future work and indirectly, via the work of other academics and clinicians who may use the research. Thus, the project has the capacity to benefit:

1. People who are high in IU. The research could impact the quality of life for individuals displaying high levels of IU, by informing interventions that help to alleviate uncertainty-induced anxiety in these individuals.

2. Clinicians working with patients who have anxiety disorders and high levels of IU. This research will provide new ideas about ways of approaching the treatment of anxiety disorders for patients who have high levels of IU.

3. Other professionals working with people with high IU, such as educators, employers, carers or charity workers. For example, people with high IU may face anxiety with: (1) starting new courses or employment and (2) in occupations where uncertainty is common (e.g. finance, stock market). Therefore, people with high IU may benefit from available support from councillors or occupational psychologists to reduce stress. Such support may facilitate smooth transitions in education and employment, easing the burden off professionals in these institutions.

The final group of potential research users are public bodies such as the National Institute for Health and Care Excellence (NICE) who provide evidence-based guidance and advice for health practitioners. Before recommendations for guidelines and policy can be made however, potential interventions based on the outcomes of the proposed research would need to be developed and evaluated. Thus, impact for policy represents a long-term goal.