The Role of Intolerance of Uncertainty in the Treatment of Anxious Youth

Abstract

Background: Intolerance of uncertainty (IU) is a cognitive vulnerability implicated in the etiology and maintenance of pathological anxiety. Research has yet to examine IU during the course of treatment for anxious youth to inform whether IU may be an important construct to target to improve the effectiveness of available interventions. The current study evaluated whether IU mediates the relationship between anxiety severity pre- to post-treatment while controlling for levels of IU at pre-treatment. Methods: Participants were 69 youth aged 7 to 17 who participated in cognitive behavioral therapy (CBT) for anxiety. Youth and their caregiver(s) completed a diagnostic interview administered by an Independent Evaluator (IE) and self- and parent-report measures pre- and post-treatment. Multiple regression mediation analyses examined the degree to which mid-treatment IU mediates the relationship between anxiety severity pre- to post-treatment while controlling for pre-treatment IU. Multiple regression mediation analyses also examined the degree to which post-treatment IU mediates the relationship between anxiety severity pre- to post-treatment while controlling for pre-treatment IU. For both analyses, three separate models were estimated to measure anxiety severity (a) by IE-report, (b) by youth self-report and (c) by parent-report. Results: There were no significant indirect effects for IE-, youth-, or parent-report models when mid-treatment IU or post-treatment IU were tested as potential mediators. Discussion: Additional work is needed to explore other potential mediators of CBT outcomes as well as the role of IU before attempts are made to target IU directly to improve current interventions. Study limitations and future directions are discussed.