Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T20:12:04.309Z Has data issue: false hasContentIssue false

Does intolerance of uncertainty mediate improvement in anger during group CBT for GAD? A preliminary investigation

Published online by Cambridge University Press:  27 March 2019

Judith M. Laposa*
Affiliation:
Centre for Addiction and Mental Health University of Toronto, Toronto, Canada
Katie Fracalanza
Affiliation:
Stanford University School of Medicine, Stanford, USA
*
*Corresponding author. Email: Judith.Laposa@camh.ca

Abstract

Background:

Individuals with generalized anxiety disorder (GAD) have elevated intolerance of uncertainty (IU) and anger, and IU mediates the relationship between GAD symptoms and anger.

Aims:

The current pilot study examined whether group cognitive behavioural therapy (CBT) improves anger in people with GAD, and the degree to which change in IU mediates improved anger.

Method:

Individuals diagnosed with GAD completed measures of worry, IU, and facets of anger, before and at the end of group CBT for GAD.

Results:

Worry, IU, and internally felt and outwardly expressed anger, reduced significantly over treatment, but anger control (inwardly and outwardly) did not. CBT for GAD led to improvement in both internally felt and outwardly expressed anger, even though anger is not directly targeted in this treatment. Improvement in IU significantly mediated improvement in internally felt and outwardly expressed anger.

Conclusions:

This preliminary study contributes to the literature on the importance of IU in understanding worry and other symptoms such as elevated anger, experienced by people with excessive worry.

Type
Main
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn). Arlington, VA: American Psychiatric Publishing.Google Scholar
Anderson, K. G., Deschênes, S. S. and Dugas, M. J. (2016). Experimental manipulation of avoidable feelings of uncertainty: effects on anger and anxiety. Journal of Anxiety Disorders, 41, 5058. doi: 10.1016/j.janxdis.2016.03.007 CrossRefGoogle ScholarPubMed
Barlow, D. H. (2002). Anxiety and its Disorders: The Nature and Treatment of Anxiety and Panic (2nd edn). New York, NY, USA: Guilford Press.Google Scholar
Bauer, I., Wilansky-Traynor, P. and Rector, N. A. (2012). Cognitive-behavioral therapy for anxiety disorders with comorbid depression: a review. International Journal of Cognitive Therapy, 5, 118156. doi: 10.1521/ijct.2012.5.2.118 CrossRefGoogle Scholar
Beck, R. and Fernandez, E. (1998). Cognitive-behavioral therapy in the treatment of anger: a meta-analysis. Cognitive Therapy and Research, 22, 6374. doi: 10.1023/A:1018763902991 CrossRefGoogle Scholar
Bomyea, J., Ramsawh, H., Ball, T. M., Taylor, C.T., Paulus, M. P., Lang, A. J. and Stein, M. B. (2015). Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder. Journal of Anxiety Disorders, 33, 9094. doi: 10.1016/j.janxdis.2015.05.004 CrossRefGoogle Scholar
Boswell, J. F., Thompson-Hollands, J., Farchione, T. J. and Barlow, D. H. (2013). Intolerance of uncertainty: a common factor in the treatment of emotional disorders. Journal of Clinical Psychology, 69, 630645. doi: 10.1002/jclp.21965 CrossRefGoogle ScholarPubMed
Brown, T. A., Antony, M. M. and Barlow, D. H. (1992). Psychometric properties of the penn state worry questionnaire in a clinical anxiety disorders sample. Behaviour Research and Therapy, 30, 3337. doi: 10.1016/0005-7967(92)90093-V CrossRefGoogle Scholar
Carleton, N. (2016). Into the unknown: a review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 3043. doi: 10.1016/j.janxdis.2016.02.007 CrossRefGoogle ScholarPubMed
Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M. and Asmundson, G. J. G. (2012). Increasingly certain about uncertainty: intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26, 468479. doi: 10.1016/j.janxdis.2012.01.011 CrossRefGoogle ScholarPubMed
Carleton, R. N., Norton, M. A. P. and Asmundson, G. J. G. (2007). Fearing the unknown: a short version of the intolerance of uncertainty scale. Journal of Anxiety Disorders, 21, 105117. doi: 10.1016/j.janxdis.2006.03 CrossRefGoogle Scholar
Del Vecchio, T. and O’Leary, K. D. (2004). Effectiveness of anger treatments for specific anger problems: a meta-analytic review. Clinical Psychology Review, 24, 1534. doi: 10.1016/j.cpr.2003.09.006 CrossRefGoogle ScholarPubMed
Deschênes, S., Dugas, M., Fracalanza, K. and Koerner, N. (2012). The role of anger in generalized anxiety disorder. Cognitive Behaviour Therapy, 41, 261271. doi: 10.1080/16506073.2012.666564 CrossRefGoogle ScholarPubMed
Deschênes, S. S., Dugas, M. J., Anderson, K. G. and Gouin, J. (2015). Effects of anger on interpretation bias, negative beliefs about uncertainty, and worry catastrophizing: an experimental study. Journal of Experimental Psychopathology, 6, 138148. doi: 10.5127/jep.042814 CrossRefGoogle Scholar
Dugas, M. J., Brillon, P., Savard, P., Turcotte, J., Gaudet, A., Ladouceur, R., Leblanc, R. and Gervais, N. J. (2010). A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Behavior Therapy, 41, 4658. doi: 10.1016/j.beth.2008.12.004 CrossRefGoogle ScholarPubMed
Dugas, M. J., Freeston, M. H. and Ladouceur, R. (1997). Intolerance of uncertainty and problem orientation in worry. Cognitive Therapy and Research, 21, 593606. doi: 10.1023/A:1021890322153 CrossRefGoogle Scholar
Dugas, M. J., Ladouceur, R., Léger, E., Freeston, M. H., Langolis, F., Provencher, M. D. and Boisvert, J. M. (2003). Group cognitive behavioral therapy for generalized anxiety disorder: treatment outcome and long-term follow-up. Journal of Consulting and Clinical Psychology, 71, 821825. doi: 10.1037/0022-006X.71.4.821 CrossRefGoogle ScholarPubMed
Dugas, M. J., Marchand, A. and Ladouceur, R. (2005). Further validation of a cognitive behavioral model of generalized anxiety disorder: diagnostic and symptom specificity. Journal of Anxiety Disorders, 19, 329343. doi: 10.1016/j.janxdis.2004.02.002 CrossRefGoogle ScholarPubMed
Einstein, D. A. (2014). Extension of the transdiagnostic model to focus on intolerance of uncertainty: a review of the literature and implications for treatment. Clinical Psychology: Science and Practice, 21, 280300. doi: 10.1111/cpsp.12077 Google ScholarPubMed
Einstein, D. A. and Mansell, W. (2016). The relevance of uncertainty and goal conflict to mental disorders, their prevention and management: a unifying approach. The Cognitive Behaviour Therapist, 9, 9.CrossRefGoogle Scholar
Erdem, M., Çelik, C., Yetkin, S. and Özgen, F. (2008). Yaygın anksiyete bozukluğunda öfke düzeyi ve öfke ifade tarzi. Anadolu Psikiyatri Dergisi, 9, 203207.Google Scholar
Erwin, B. A., Heimberg, R. G., Schneier, F. R. and Liebowitz, M. R. (2003). Anger experience and expression in social anxiety disorder: pretreatment profile and predictors of attrition and response to cognitive-behavioral treatment. Behavior Therapy, 34, 331350. doi: 10.1016/S0005-7894(03)80004-7 CrossRefGoogle Scholar
Fracalanza, K., Koerner, N., Deschênes, S. S. and Dugas, M. J. (2014). Intolerance of uncertainty mediates the relation between generalized anxiety disorder symptoms and anger. Cognitive Behaviour Therapy, 43, 122132. doi: 10.1080/16506073.2014.888754 CrossRefGoogle ScholarPubMed
Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J. and Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791802. doi: 10.1016/0191-8869(94)90048-5 CrossRefGoogle Scholar
Gentes, E. L. and Ruscio, A. M. (2011). A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive-compulsive disorder. Clinical Psychology Review, 31, 923933. doi: 10.1016/j.cpr.2011.05.001 CrossRefGoogle ScholarPubMed
Hawkins, K. A. and Cougle, J. R. (2010). Anger problems across the anxiety disorders: findings from a population-based study. Depression and Anxiety, 28, 145152. doi: 10.1002/da.20764 CrossRefGoogle ScholarPubMed
Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York, NY, USA: Guilford.Google Scholar
Hong, R. Y. and Lee, S. S. (2015). Further clarifying prospective and inhibitory intolerance of uncertainty: factorial and construct validity of test scores from the intolerance of uncertainty scale. Psychological Assessment, 27, 605620. doi: 10.1037/pas0000074 CrossRefGoogle ScholarPubMed
Horan, S. M., Chory, R. M. and Goodboy, A. K. (2010). Understanding students’ classroom justice experiences and responses. Communication Education, 59, 453474. doi: 10.1080/03634523.2010.48 CrossRefGoogle Scholar
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R. and Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593602. doi: 10.1001/archpsyc.62.6.593 CrossRefGoogle ScholarPubMed
Khawaja, N. G. and Yu, L. N. H. (2010). A comparison of the 27-item and 12-item intolerance of uncertainty scales. Clinical Psychologist, 14, 97106. doi: 10.1080/13284207.2010.502542 CrossRefGoogle Scholar
Koerner, N. and Dugas, M. J. (2008). An investigation of appraisals in individuals vulnerable to excessive worry: the role of intolerance of uncertainty. Cognitive Therapy and Research, 32, 619638. doi: 10.1007/s10608-007-9125-2 CrossRefGoogle Scholar
Ladouceur, R., Dugas, M. J., Freeston, M. H., Rhéaume, J., Blais, F., Boisvert, J., Gagnon, F. and Thibodeau, N. (1999). Specificity of generalized anxiety disorder symptoms and processes. Behavior Therapy, 30, 191207. doi: 10.1016/S0005-7894(99)80003-3 CrossRefGoogle Scholar
Ladouceur, R., Gosselin, P. and Dugas, M. J. (2000). Experimental manipulation of intolerance of uncertainty: a study of a theoretical model of worry. Behaviour Research and Therapy, 38, 933941. doi: 10.1016/S0005-7967(99)00133-3 CrossRefGoogle Scholar
Laposa, J. M., Collimore, K. C., Hawley, L. and Rector, N. A. (2015). Distress tolerance in OCD and the anxiety disorders and its relationship with anxiety sensitivity and intolerance of uncertainty. Journal of Anxiety Disorders, 33, 814. doi: 10.1016/j.janxdis.2015.04.003 CrossRefGoogle ScholarPubMed
Mahoney, A. E. and McEvoy, P. M. (2012). Changes in intolerance of uncertainty during cognitive behavior group therapy for social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 43, 849854. doi: 10.1016/j.jbtep.2011.12.004 CrossRefGoogle ScholarPubMed
McEvoy, P. M. and Erceg-Hurn, D. M. (2016). The search for universal transdiagnostic and trans-therapy change processes: evidence for intolerance of uncertainty. Journal of Anxiety Disorders, 41, 96107. doi: 10.1016/j.janxdis.2016.02.002 CrossRefGoogle ScholarPubMed
McEvoy, P. M. and Mahoney, A. E. (2013). Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediators of repetitive negative thinking in a clinical sample with anxiety disorders. Journal of Anxiety Disorders, 27, 216224. doi: 10.1016/j.janxdis.2013.01.006 CrossRefGoogle Scholar
McEvoy, P. M. and 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, 112122. doi: 10.1016/j.janxdis.2010.08.010 CrossRefGoogle Scholar
McEvoy, P. M. and Mahoney, A. E. J. (2012). To be sure, to be sure: intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behavior Therapy, 43, 533545. doi: 10.1016/j.beth.2011.02.007 CrossRefGoogle ScholarPubMed
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the penn state worry questionnaire. Behaviour Research and Therapy, 28, 487495. doi: 10.1016/0005-7967(90)90135-6 CrossRefGoogle ScholarPubMed
Montoya, A. K. and Hayes, A. F. (2017). Two-condition within-participant statistical mediation analysis: a path-analytic framework. Psychological Methods, 22, 627. doi: 10.1037/met0000086 CrossRefGoogle ScholarPubMed
Posternak, M. A. and Zimmerman, M. (2002). Anger and aggression in psychiatric outpatients. Journal of Clinical Psychiatry, 63, 665672. doi: 10.4088/JCP.v63n0803 CrossRefGoogle ScholarPubMed
Safran, J. D. and Segal, Z. V. (1990). Interpersonal Process in Cognitive Therapy. New York: Basic Books.Google Scholar
Sexton, K. A., Norton, P. J., Walker, J. R. and Norton, G. R. (2003). Hierarchical model of generalized and specific vulnerabilities in anxiety. Cognitive Behaviour Therapy, 32, 8294. doi: 10.1080/16506070302321 CrossRefGoogle ScholarPubMed
Spielberger, C. D. (1999). State-trait Anger Expression Inventory-2: STAXI-2 Professional Manual. Odessa, FL, USA: Psychological Assessment Resources.Google Scholar
Stöber, J. (1998). Reliability and validity of two widely used worry questionnaires: self-report and self-peer convergence. Personality and Individual Differences, 24, 887890. doi: 10.1016/S0191-8869(97)00232-8 CrossRefGoogle Scholar
Takebe, M., Takahashi, F. and Sato, H. (2017). The effects of anger rumination and cognitive reappraisal on anger-in and anger-control. Cognitive Therapy and Research, 41, 654661. doi: 10.1007/s10608-017-9837-x CrossRefGoogle Scholar
Torbit, L. and Laposa, J. M. (2016). Group CBT for GAD: the role of change in intolerance of uncertainty on treatment outcomes. International Journal of Cognitive Therapy, 9, 356368. doi: 10.1521/ijct_2016_09_17 CrossRefGoogle Scholar
van der Heiden, C., Melchior, K., Muris, P., Bouwmeester, S., Bos, A. E. R. and van der Molen, H. T. (2010). A hierarchical model for the relationships between general and specific vulnerability factors and symptom levels of generalized anxiety disorder. Journal of Anxiety Disorders, 24, 284289. doi: 10.1016/j.janxdis.2009.12 CrossRefGoogle ScholarPubMed
Van Rijsoort, S., Emmelkamp, P. and Vervaeke, G. (1999). The Penn State worry questionnaire and the worry domains questionnaire: structure, reliability, and validity. Clinical Psychology and Psychotherapy, 6, 297307. doi: 10.1002/(SICI)1099-0879(199910)6:4<297::AID-CPP206>3.0.CO;2-E 3.0.CO;2-E>CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.