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Cognitive Behaviour Therapy

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Trait Versus Situation-Specific

Intolerance of Uncertainty in a Clinical
Sample with Anxiety and Depressive
Disorders
a b c
Alison E. J. Mahoney & Peter M. McEvoy
a
Clinical Research Unit for Anxiety and Depression, St Vincent's
Hospital , Sydney , Australia
b
Centre for Clinical Interventions , Perth , Australia
c
School of Psychology, University of Western Australia , Perth ,
Australia
Published online: 28 Oct 2011.

To cite this article: Alison E. J. Mahoney & Peter M. McEvoy (2012) Trait Versus Situation-Specific
Intolerance of Uncertainty in a Clinical Sample with Anxiety and Depressive Disorders, Cognitive
Behaviour Therapy, 41:1, 26-39, DOI: 10.1080/16506073.2011.622131

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 Cognitive Behaviour Therapy Vol 41, No 1, pp. 26–39, 2012

Trait Versus Situation-Specific Intolerance of

Uncertainty in a Clinical Sample with Anxiety and
Depressive Disorders

Alison E. J. Mahoney1 and Peter M. McEvoy2,3

1
Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Sydney,
Australia; 2Centre for Clinical Interventions, Perth, Australia; 3School of Psychology,
University of Western Australia, Perth, Australia
Downloaded by [Ondokuz Mayis Universitesine] at 01:56 11 November 2014

Abstract. Intolerance of uncertainty (IU) has been most heavily implicated in the development and
maintenance of generalised anxiety disorder; however, recent research has supported the
transdiagnostic conceptualisation of IU by demonstrating that IU contributes to a broad array of
symptoms associated with multiple anxiety and depressive disorders. The aim of this study was to
examine IU firstly as a trait variable and secondly in reference to a regularly occurring, diagnostically
relevant situation in a large clinical sample (N ¼ 218). A measure of situation-specific IU (the
Intolerance of Uncertainty Scale– Situation-Specific Version; IUS-SS) is presented. The IUS-SS was
found to have a unitary factor structure and high internal consistency. Participants reported
significantly more situation-specific IU compared to trait IU. Discriminant validity was indicated by
lack of significant relationships with measures of extraversion and alcohol use. Supporting the
convergent validity and transdiagnostic nature of the scale, the IUS-SS was positively associated with
neuroticism and symptoms of generalised anxiety disorder and social phobia, and explained unique
variance in symptoms of depression and panic disorder above and beyond trait IU. Theoretical and
clinical implications are discussed. Key words: intolerance of uncertainty; transdiagnostic; anxiety;
depression; cognitive behaviour therapy

Received 2 February, 2011; Accepted 18 August, 2011

Correspondence address: Alison E. J. Mahoney, Clinical Research Unit for Anxiety and Depression, St
Vincent’s Hospital, Level 4 O’Brien Centre, 394-404 Victoria Street, Darlinghurst, Sydney, New South
Wales 2010, Australia. Tel: þ 612 8382 1407. Fax: þ 612 8382 1402. E-mail: amahoney@
stvincents.com.au

Introduction Evidence is accumulating that IU contributes

Individuals who are intolerant of uncertainty
appraise uncertain or ambiguous situations as
threatening and typically respond negatively
to them on a cognitive, emotional, and
behavioural level (Dugas, Buhr, & Ladouceur,
2004). Previous research has tended to
examine intolerance of uncertainty (IU) within
specific internalising disorders, with the
majority of studies focussing on the role of
IU in excessive worry and generalised anxiety
disorder (Dugas, Gagnon, Ladouceur, &
Freeston, 1998; Sexton, Norton, Walker, &
Norton, 2003; van de Heiden et al., 2010).
to the symptoms of multiple internalising
disorders, and thus may be better understood
as a transdiagnostic construct (McEvoy &
Mahoney, 2011; Starcevic & Berle, 2006). IU
has been shown to predict symptoms of
obsessive compulsive disorder (OCD; Steke-
tee, Frost, & Cohen., 1998), social phobia
(Boelen & Reijntjes, 2009; Carleton, Colli-
more, & Asmundson, 2010), depression (de
Jong-Meyer, Beck, & Riede, 2009; Miranda,
Fontes, & Marroquı́n, 2008), panic disorder,
and agoraphobia (McEvoy & Mahoney,
2011). In a recent meta-analysis of 58 studies,
Gentes and Ruscio (2011) found that IU was

q 2012 Swedish Association for Behaviour Therapy ISSN 1650-6073

http://dx.doi.org/10.1080/16506073.2011.622131
 VOL 41, NO 1, 2012
significantly associated with symptoms of
generalised anxiety disorder (GAD), major
depressive disorder (MDD), and OCD.
Additionally, reductions in IU reportedly
precede or occur concurrently with symptom
reduction during cognitive behavioural
therapy for GAD (Dugas & Ladouceur, 2000;
Dugas et al., 2003) and OCD (Overton &
Menzies, 2005). Preliminary data also suggest
that IU-based treatments may significantly
reduce symptoms of social phobia (Hewitt,
Egan, & Rees, 2009) and hypochondriasis
(Langlois & Ladouceur, 2004). Thus, IU
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appears to be associated with a broad range
of emotional disorders.
Existing research examines IU as a trait or
trans-situational variable. That is, IU has
previously been explored as a general tendency
to appraise and respond to uncertain situations
in particular ways, for example, general beliefs
such as ‘uncertainty makes me uneasy,
anxious, or stressed’ or ‘when it’s time to act
uncertainty paralyses me’ (Buhr & Dugas,
2002). An additional avenue of investigation is
the potential difference between trait IU and
IU that is associated with specific situations
that distress people with emotional disorders
(e.g., uncertainty about the cause of physical
symptoms of anxiety for panic disorder or
uncertainty about the meaning of ambiguous
social cues for those with social phobia).
Tolin, Abramowitz, Brigidi, and Foa (2003)
suggested that general experiences of uncer-
tainty may or may not reflect how anxious
patients feel about uncertainty associated with
specific situations that cause them distress.
Tolin et al. (2003) were writing in reference to
OCD; however, Carleton et al. (2010) made a
similar point about those with social phobia.
They speculated that the degree to which
people with social phobia can tolerate
uncertainty associated with social situations
may affect their level of social anxiety. The
question arises, how strongly is IU associated
with symptoms of emotional disorders when
we examine IU specifically in relation to areas
of primary clinical concern? It is possible that
the relevance of IU may be most apparent
when we examine it in relation to areas of core
concern for patients.
Previous research has typically examined IU
as a unitary construct; however, recent
research has found that certain components
of IU are differentially associated with
Situation-Specific Intolerance of Uncertainty 27
symptoms of internalising disorders (Carleton
et al., 2010; McEvoy & Mahoney, 2011).
Carleton, Norton, and Asmundson (2007)
identified two factors within IU, namely,
prospective anxiety and inhibitory anxiety.
Prospective anxiety relates to fear and anxiety
in anticipation of uncertainty, whereas inhibi-
tory anxiety relates to inaction in the face of
uncertainty. In a treatment-seeking sample,
McEvoy and Mahoney (2011) found that
prospective anxiety was uniquely associated
with symptoms of GAD and OCD, whereas
inhibitory anxiety was uniquely associated
with symptoms relating to social phobia, panic
disorder, agoraphobia, and depression. Given
that the prospective and inhibitory anxiety
scales were uniquely associated with both
anxiety and depression, McEvoy and Maho-
ney (2011) suggested that these factors be
relabelled prospective and inhibitory IU. This
relabeling was subsequently supported by the
authors of the IUS-12 (R. N. Carleton,
personal communication, January 11, 2011).
McEvoy and Mahoney (in press) further
demonstrated that prospective IU (P-IU)
partially mediated the relationship between
neuroticism and symptoms of GAD and
OCD, whereas inhibitory IU (I-IU) partially
mediated the relationship between neuroticism
and symptoms of social phobia, panic
disorder, agoraphobia, and depression, even
when controlling for symptoms of other
internalising disorders. It is noteworthy that
the meditational pathway explained a higher
proportion of variance in GAD symptoms
(i.e., worry) than symptoms of the other disor-
ders. In a community sample, Carleton et al.
(2010) also found that I-IU, but not P-IU, was
uniquely associated with social anxiety symp-
toms. This study sought to examine whether
different components of IU, namely, P-IU and
I-IU, were also evident within the construct of
situation-specific IU.
The aim of this study was to develop a
measure of IU that indexed IU in relation to
diagnostically pertinent situations: the Intol-
erance of Uncertainty Scale – Situation-
Specific version (IUS-SS). In order to examine
the psychometric properties of the IUS-SS
and draw comparisons between trait and
situation-specific IU, we sought to examine
(a) the factor structure of the IUS-SS, (b) the
instrument’s internal reliability and norms, (c)
gender differences, and (d) relationships
 28 Mahoney and McEvoy
between the IUS-SS and measures of person-
ality dimensions, alcohol use, and symptoms
of anxiety and depressive disorders. First, we
hypothesised that the factor structure of the
IUS-SS would replicate previous findings
(Carleton et al., 2007; McEvoy & Mahoney,
2011) and comprise two factors: P-IU and I-
IU. We also predicted that the IUS-SS will be
internally reliable. Second, we hypothesised
that situation-specific IU would be positively
correlated with trait IU and neuroticism, thus
providing evidence for the scale’s convergent
validity. We also expected that the IUS-SS
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would demonstrate acceptable discriminant
validity as indicated by a lack of relationships
with measures of extraversion and alcohol
use. Previous studies have shown a lack of
relationship between trait IU and extraver-
sion (Berenbaum, Bredemeier, & Thompson,
2008; McEvoy & Mahoney, 2011), and
although it is plausible that IU is associated
with alcohol use, this association was
expected to be substantially weaker than the
hypothesised associations with symptoms of
emotional disorders. Third, we expected that
participants would report more situation-
specific IU compared to trait IU. Lastly, we
hypothesised that, consistent with studies of
trait IU (McEvoy & Mahoney, 2011),
situation-specific IU would explain unique
variance in symptoms of anxiety and depress-
ive disorders.
Method
Participants
Participants (N ¼ 218 and 51% women) were
recruited from a specialist anxiety disorders
treatment service. Participants had a mean age
of 35.73 years (SD ¼ 11.59) and 73% had
completed high school. Regarding relationship
status, 32% reported that they were married or
were in de facto relationships, 59% were never
married, 9% were separated or divorced, and
1% were widowed. Prior to treatment, partici-
pants completed the Anxiety Disorders Inter-
view Schedule for DSM-IV (ADIS-IV; Brown,
DiNardo, & Barlow, 1994). The principal
diagnoses of the sample included social phobia
(45%), GAD (19%), panic disorder with or
without agoraphobia (19%), OCD (7%),
MDD (5%), dysthymic disorder (1%), specific
phobia (2%), posttraumatic stress disorder
(2%), and somatisation disorder (1%). The
COGNITIVE BEHAVIOUR THERAPY
majority of the sample experienced comorbid
disorders; 23% of the sample met criteria for
one diagnosis, 31% with two diagnoses, 26%
with three diagnoses, 13% with four diagnoses,
6% with five diagnoses, and 1% met criteria for
six diagnoses. Comorbid diagnoses included
GAD (28%), social phobia (18%), OCD (8%),
panic disorder with or without agoraphobia
(7%), depressive disorder (40%), alcohol use
disorder (13%), and drug use disorder (4%).
Measures
Anxiety Disorders Interview Schedule for
DSM-IV (ADIS-IV). The ADIS-IV (Brown
et al., 1994) is a structured diagnostic inter-
view for the anxiety, mood, somatoform, and
substance use disorders according to criteria in
DSM-IV (American Psychiatric Association,
1994). Brown, Di Nardo, Lehman, and
Campbell (2001) provide evidence of good
inter-rater reliability for the anxiety disorders
investigated in the present study (k ¼ .65 –
.79). Inter-rater reliability (k ¼ .63) for the
combined depressive disorders group (MDD
and dysthymia) was also acceptable (Brown
et al., 2001). Evidence of construct validity,
including discriminant and convergent val-
idity, has been demonstrated (Brown, Chor-
pita, & Barlow, 1998).
Diagnosticians in this study were four
clinical psychologists and four psychiatric
registrars. Training involved (a) thorough
reading of the ADIS-IV protocol, (b) obser-
vation of an experienced interviewer conduct-
ing an ADIS-IV, and (c) administration of an
ADIS-IV while being observed by an experi-
enced interviewer. After the training inter-
views, diagnosticians compared and reviewed
diagnoses. All clinicians had extensive experi-
ence in the assessment and treatment of
internalising disorders. Principal diagnoses
were determined collaboratively by assessing
clinicians and participants as the most
distressing and life-interfering disorder at the
time of interview.
Intolerance of Uncertainty Scale-12 (IUS-12).
The 12-item IUS-12 (Carleton et al., 2007) was
our trait measure of IU and consists of two
subscales: prospective IU (P-IU) and inhibitory
IU (I-IU). P-IU assesses anxiety in anticipation
of uncertainty (e.g., ‘One should always look
ahead so as to avoid surprises’), whereas I-IU
measures inhibition of action or experience
(e.g., ‘The smallest doubt can stop me from
 VOL 41, NO 1, 2012
acting’). Evidence of internal consistency
(a ¼ .91 for total score), convergent validity,
discriminant validity, and factorial stability has
been demonstrated (Carleton et al., 2007;
McEvoy & Mahoney, 2011). In this study, the
IUS-12 demonstrated acceptable levels of
skewness (total score 2.26, P-IU 2.24, I-IU
2.23), kurtosis (total score 2.49, P-IU 2.56, I-
IU 2.56), and internal consistency (IUS-12
total a ¼ .94, average inter-item correlation
¼ .55; P-IU a ¼ .91, average inter-item corre-
lation ¼ .58; I-IU a ¼ .88, average inter-item
correlation ¼ .59).
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Intolerance of Uncertainty Scale –Situation-
Specific Version (IUS-SS). The 12-item IUS-
SS is an adaptation of the IUS-12 and was
developed for the purposes of this study in
order to examine IU in relation to specific
situations that were diagnostically pertinent to
the sampled anxiety disorders. When complet-
ing the IUS-SS, participants selected their area
of primary concern from a list (e.g., social
interactions or performance situations, places
or situations that may lead to panic sen-
sations, excessive worries about everyday
concerns, or intrusive distressing thoughts
that lead to repetitive behaviours), and then
described a situation related to this concern
that was regularly occurring and distressing
(e.g., conversations with a colleague, catching
trains, watching the evening news, or touching
door knobs). The items from the IUS-12 were
then completed in reference to that situation
(item wording was altered to reference the
situation, e.g., the IUS-12 item ‘I can’t stand
being taken by surprise’ became ‘I can’t stand
being taken by surprise in this situation’).
Penn State Worry Questionnaire (PSWQ).
The PSWQ (Meyer, Miller, Metzger, &
Borkovec, 1990) is a 16-item measure of
worry, which is the core symptom of GAD.
The PSWQ has good internal consistency
(a ¼ .86–.95) and temporal stability (r ¼ .92
over 8–10 weeks and r ¼ .74–.93 over 4 weeks;
Meyer et al., 1990; Molina & Borkovec, 1994).
Evidence of construct validity, including dis-
criminant and convergent validity, has been
demonstrated in clinical and community popu-
lations (e.g., Brown, Antony, & Barlow, 1992;
Meyer et al., 1990; van Rijsoort, Emmelkamp,
& Vervaeke, 1999). In this sample, levels of
skewness (2.74), kutosis (2.10), and internal
consistency (a ¼ .77, average inter-item corre-
lation ¼ .32) were acceptable.
Situation-Specific Intolerance of Uncertainty 29
Body Sensations Questionnaire (BSQ) and
Agoraphobic Cognitions Questionnaire (ACQ).
The 17-item BSQ and 14-item ACQ (Chamb-
less, Caputo, Bright, & Gallagher, 1984) are
established measures of panic disorder and
agoraphobia symptoms. The scales measure
physical sensations and thoughts respondents
typically experience when they are nervous or
frightened. Internal consistency is good
(a ¼ .80 and .87 for ACQ and BSQ, respect-
ively), and evidence of temporal stability
(r ¼ .86 and .67 for ACQ and BSQ, respectively,
over 31 days) and construct validity has been
provided (Chambless et al., 1984; Chambless,
Beck, Gracely, & Grisham, 2000; Chambless &
Gracely, 1989). In the current study, levels of
skewness (ACQ .88 and BSQ .41), kutosis (ACQ
.58 and BSQ 2.55), and internal consistency
were acceptable (ACQ a ¼ .86 and average
inter-item correlation ¼ .30; BSQ a ¼ .94 and
average inter-item correlation ¼ .46).
Social Interaction Phobia Scale (SIPS). The
SIPS (Carleton et al., 2009) is a 14-item
measure of social phobia symptoms, specifi-
cally social interaction anxiety, fear of overt
evaluation, and fear of attracting attention.
The SIPS items were derived from factor
analyses of the Social Phobia Scale and Social
Interaction Anxiety Scale (Mattick & Clarke,
1998). Internal consistency in clinical and
undergraduate samples is high (a ¼ .92), and
evidence of factorial stability, convergent
validity, and discriminant validity has been
provided (Carleton et al., 2009). In this study,
the total score was employed rather than
subscale scores in order to be consistent with
previous research (Carleton et al., 2010).
Current skew was 2 .24 and kurtosis was
2 .87. Current internal reliability a ¼ .94
(average inter-item correlation ¼ .52).
Padua Inventory – Washington State University
Revision (PI). The PI (Burns, 1995) is a widely
used 39-item self-report measure of OCD
symptoms (e.g., ‘I feel my hands are dirty
when I touch money’). Evidence for conver-
gent and discriminant validity, as well as
factor structure, has been demonstrated
(Burns, Keortge, Formea, & Sternberger,
1996; Jónsdóttir & Smári, 2000). Internal
consistency (a ¼ .92) and temporal stability
(r ¼ .61 – .84 across subscales over 6 – 7
months) are good (Burns et al., 1996). In this
study, the total score was used and a was .93
(average inter-tem correlation ¼ .25). Skew
 30 Mahoney and McEvoy
was 1.05 and kurtosis was .59; however, a
square-root transformation reduced these
values to .18 and 2 .44, respectively. All
subsequent analyses were conducted with the
transformed variable (PIsqrt).
Beck Depression Inventory (BDI-II). The
BDI-II (Beck, Steer, & Brown, 1996) is a 21-
item measure of depression symptoms experi-
enced during the previous fortnight. Internal
consistency (a ¼ .92) and test – retest
reliability (r ¼ .93 over 1 week) are established
(Beck et al., 1996), and evidence for construct
validity has been demonstrated (e.g., Dozois,
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Dobson, & Ahnberg, 1998; Osman, Kopper,
Barrios, Gutierrez, & Bagge, 2004). Support
for convergent and discriminant validity has
also been reported (Osman et al., 1997; Steer,
Ball, Ranieri, & Beck, 1997). In this study,
skewness (2 .06), kutosis (2 .78), and internal
reliability (a ¼ .94, average inter-item corre-
lation was .41) were acceptable.
Eysenck Personality Questionnaire (EPQ).
The 23-item neuroticism subscale (EPQ-N)
and 21-item extraversion subscale (EPQ-E) of
the EPQ were used (Eysenck & Eysenck,
1975). Internal consistency (a ¼ .82 for both
subscales; Loo, 1979) and test – retest
reliability (r ¼ .82 and .92 over 1 month for
neuroticism and extraversion, respectively;
Eysenck & Eysenck, 1975) are good, and
data demonstrating construct validity, includ-
ing convergent and discriminant validity, are
extensive (e.g., Barrett, Petrides, Eysenck, &
Eysenck, 1998; Caruso, Witkiewitz, Belcourt-
Dittloff, & Gottlieb, 2001; Steele & Kelly,
1976). In this study, skew was 2 1.09 and .66
and kurtosis was .92 and 2 .15 for the EPQ-N
and EPQ-E, respectively. Internal consist-
encies were a ¼ .84 (average inter-item corre-
lation ¼ .19) and a ¼ .76 (average inter-item
correlation ¼ .23) for neuroticism and extra-
version, respectively.
Alcohol Use Disorders Identification Test. The
10-item AUDIT (Saunders, Aasland, Babor,
de le Fuente, & Grant, 1993) is a widely used
screening measure that identifies hazardous
and harmful alcohol consumption. Evidence
of internal consistency (a ¼ .75 – .94), conver-
gent validity, and discriminant validity is
extensive (Allen, Litten, Fertig, & Babor,
1997). Internal consistency was a ¼ .88 in this
sample (average inter-item correlation ¼ .45).
Levels of skewness (1.80) and kurtosis (3.38)
were problematic; however, a square-root
COGNITIVE BEHAVIOUR THERAPY
transformation reduced these values to .45
and 2 .19, respectively. All subsequent ana-
lyses were conducted with the transformed
variable (AUDITsqrt).
Procedure
Participants completed the ADIS-IV and a
battery of questionnaires (including the IUS-
12, IUS-SS, PSWQ, ACQ, BSQ, SIPS, PI,
BDI-II, EPQ-N, EPQ-E, and AUDIT) prior
to treatment at a specialist anxiety disorders
clinic. Participants consented for their data to
be used for research purposes. The use of the
data was approved by the Hospital’s Human
Research Ethics Committee.
Results
Situations reported in the IUS-SS
The majority of the sample (n ¼ 187) com-
pleted the IUS-SS; 159 participants described a
situation that matched their principal diag-
nosis and 20 described a situation that
matched a comorbid diagnosis. A match was
defined as a situation or experience that
appeared or was likely to appear as an item
on the relevant symptom measure described
above (e.g., ‘mixing in a group’ from the SIPS).
When the relevance of situations was unclear,
qualitative data from participants’ ADIS-IV
responses were consulted. A small number of
participants (n ¼ 5) did not complete a
description, and three participants described
recent financial or relationship stressors that
were unrelated to their diagnoses. Situations
were coded by one researcher (AM), although
a subsample (n ¼ 106) was coded by an
additional clinical psychologist as a measure
of reliability. Agreement between coders was
good (k ¼ .64) and discrepancies were
resolved via discussion and consensus. Partici-
pants who completed the IUS-SS were not
significantly different from non-completers
with respect to age, gender, number of
diagnoses, or IUS-12 total score (all ps . .05).
IUS-SS factor analysis
Table 1 shows the means, standard deviations,
skewness, kurtosis, and corrected item-total
correlations for each item of the IUS-SS.
Common factor analysis (i.e., principal axis
factor analysis) was used to analyse the 12
IUS-SS items. Oblique rotation was used
because if multiple factors were derived it was
 VOL 41, NO 1, 2012 Situation-Specific Intolerance of Uncertainty 31

Table 1. Factor loadings, means, standard deviations, skewness, kurtosis and corrected item-total correlations
(CITC) for the IUS-SS items

Factor
Item loadings M SD Skewness Kurtosis CITC
1. I always want to know what the future .81 3.23 1.31 2 .38 2 .56 .77
has in store for me for this situation
2. Unforeseen events associated with this .81 3.43 1.33 2 .57 2 .45 .77
situation upset me greatly
3. I can’t stand being taken by surprise in .80 3.32 1.40 2 .51 2 .77 .77
this situation
4. The smallest doubt can stop me from .79 3.28 1.40 2 .55 2 .56 .77
acting in this situation
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5. A small unforeseen event in this situation .78 3.28 1.37 2 .42 2 .84 .75
can spoil everything, even with the best
planning
6. When I am uncertain I can’t function very .74 3.49 1.22 2 .54 2 .22 .72
well in this situation
7. One should always look ahead so as to .73 3.24 1.32 2 .35 2 .79 .71
avoid surprises in this situation
8. When it’s time to act, uncertainty will .72 3.02 1.40 2 .21 2 .99 .70
paralyse me in this situation
9. I should be able to organise everything .72 3.04 1.36 2 .24 2 .98 .69
in advance for this situation
10. I must get away from all uncertainty in .70 3.09 1.29 2 .23 2 .87 .67
this situation
11. It frustrates me not having all the .68 3.07 1.37 2 .25 2 .84 .66
information I need about this situation
12. Uncertainty in this situation keeps me .61 3.65 1.25 2 .75 2 .18 .60
from living a full life
Total 39.15 12.27 2 .45 2 .25 1.00

expected that they would be correlated with
one another. Common factor analysis was
used because estimates tend to replicate better
with confirmatory factor analysis and our
intention was to examine relationships among
manifest variables to latent variables (Floyd &
Widaman, 1995). The highest bivariate corre-
lation between items was .72, suggesting that
item redundancy was not a significant
problem. Several methods of estimating the
most appropriate number of factors were
used. First, Velicer’s minimum average partial
(MAP) and Horn’s parallel analysis (O’Con-
nor, 2000) were used because they have
demonstrated robust estimations in the devel-
opment of health measures in samples of 100 –
300 subjects (Coste, Fermanian, & Venot,
1995). In addition, the eigenvalues and Scree
Test were examined. The MAP test, parallel
analysis, and Scree plot indicated the presence
of one factor with one eigenvalue greater than
1 (6.63). Consistent with previous research
(McEvoy & Mahoney 2011), criteria for
removing items were if the factor loading did
not exceed .40. Given the existence of only one
factor, cross-loadings were not relevant. All
items loaded above .40 (range ¼ .61 –.81, see
Table 1). The IU factor explained 55.23% of
the variance.
IUS-SS descriptive statistics and
internal consistency
Table 2 provides descriptive statistics for the
IUS-SS and IUS-12. Participants reported
significantly more situation-specific IU than
trait IU [t(167) ¼ 6.00, p , .001, h 2 ¼ .18].
IUS-SS internal consistency was excellent
(a ¼ .94, average inter-item correlation ¼ .55).
There were no significant differences in IUS-SS
mean for gender (men: M ¼ 38.77, SD ¼ 11.57;
women: M ¼ 39.51, SD ¼ 12.95) [t(185) ¼ .41,
p ¼ .68, h 2 ¼ .001]. The IUS-12 means also did
not differ across gender (men: M ¼ 33.47,
 32 Mahoney and McEvoy COGNITIVE BEHAVIOUR THERAPY

Table 2. Means and standard deviations for the IUS- those with the respective diagnosis compared
SS, IUS-12, personality dimensions, and symptom to those without the diagnosis (all ps , .01).
measures

Symptom measure M SD
IUS-SS convergent and divergent
validity
IUS-SS 38.71 12.34 We examined evidence of convergent validity
IUS-12 34.19 12.59 for the IUS-SS via relationships with neuroti-
SIPS 30.48 14.64 cism in order to be consistent with previous
ACQ 29.69 10.21
studies in trait IU (McEvoy & Mahoney,
BSQ 43.43 16.35
PSWQ 64.75 11.12 2011). Supporting convergent validity, there
PIsqrt 4.40 2.06 were significant positive bivariate Pearson
BDI-II 22.21 11.97 correlations between the IUS-SS and the IUS-
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EPQ-N 17.41 4.53 12 (r ¼ .69, p , .001) and the EPQ-N (r ¼ .46,

EPQ-E 8.29 4.12
AUDITsqrt 2.09 1.41
Note. IUS-SS, Intolerance of Uncertainty Scale –
Situation-Specific version; IUS-12, Intolerance of
Uncertainty Scale-12; SIPS, Social Interaction
Phobia Scale; ACQ, Agoraphobic Cognitions Ques-
tionnaire; BSQ, Body Sensations Questionnaire;
PSWQ, Penn State Worry Questionnaire; PI,
Padua Inventory; BDI-II, Beck Depression Inven-
tory; EPQ-N, Eysenck Personality Questionnaire –
Neuroticism subscale; EPQ-E, Eysenck Personality
Questionnaire – Extraversion subscale; AUDIT,
Alcohol Use Disorders Identification Test.
SD ¼ 11.67; women: M ¼ 35.35, SD ¼ 13.25)
[t (197) ¼ 1.06, p ¼ .29, h 2 ¼ .01].
Descriptive statistics for personality
and symptom measures
Table 2 presents the means and standard
deviations for the personality dimensions and
symptom measures. Independent samples’ t
tests were conducted to compare mean scores
on symptom measures for participants with
and without each diagnosis. For all symptom
measures, scores were significantly higher for
p , .001). Evidence of divergent validity for
the IUS-12 has been previously examined via
relationships with extraversion (McEvoy &
Mahoney, 2011). Similarly, we found evidence
of divergent validity for the IUS-SS via a non-
significant correlation between the IUS-SS
and the EPQ-E (r ¼ 2 .14, p ¼ .08). The
relationship between IU and alcohol use was
used as an additional assessment of divergent
validity. The IUS-SS and IUS-12 did not
significantly correlate with the AUDITsqrt
(IUS-SS: r ¼ .01, p ¼ .94; IUS-12: r ¼ 2 .02,
p ¼ .83).
Transdiagnostic associations between
IU and symptoms
Bivariate Pearson correlation coefficients
indicated the strength of associations between
IU and symptom measures across the entire
sample regardless of diagnosis (see Table 3).
To reduce the number of analyses, a compo-
site index was calculated for panic disorder
and agoraphobic symptoms (BSQ þ ACQ/2).
The BSQ and ACQ were correlated at .73, and
the composite score correlated at .91 with the

Table 3. Pearson Bivariate correlations between IU (trait and situation-specific) and symptom measures

Symptom measure IUS-SS IUS-12 P-IU I-IU

SIPS .27** .47** .42** .46**
BSQ/ACQ composite .50** .39** .36** .36**
PSWQ .41** .50** .50** .42**
PIsqrt .29** .30** .31** .25*
BDI-II .38** .43** .37** .45**
Note. IUS-SS, Intolerance of Uncertainty Scale – Situation-Specific version; IUS-12, Intolerance of Uncertainty
Scale-12; P-IU, Prospective Intolerance of Uncertainty; I-IU, Inhibitory Intolerance of Uncertainty; SIPS, Social
Interaction Phobia Scale; BSQ, Body Sensations Questionnaire; ACQ, Agoraphobic Cognitions Questionnaire;
PSWQ, Penn State Worry Questionnaire; PI, Padua Inventory; BDI-II, Beck Depression Inventory.
*p , .05. **p , .01.
 VOL 41, NO 1, 2012 Situation-Specific Intolerance of Uncertainty 33

BSQ and .95 with the ACQ, suggesting that
the composite score reflected scores on both
measures. All correlations were positive and
statistically significant ( ps , .05), which
suggests that both trait and situation-specific
IU were associated with symptoms of inter-
nalising disorders.
Regression analyses examining unique
contributions of IU to symptoms
We employed a series of hierarchical multiple
linear regression analyses to explore if IU
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measures. For each regression, P-IU and
I-IU were entered in step 1, while the IUS-SS
was entered at step 2. Five separate models
were run for the following criterion variables:
SIPS, PSWQ, BSQ/ACQ composite, PIsqrt,
and BDI-II. As seen in Table 4, the IUS-12
subscales explained a significant proportion of
variance in all symptoms measures. I-IU
significantly predicted social anxiety and
depression symptoms at step 1, while P-IU
predicted symptoms of GAD, panic disorder,
and agoraphobia. Part rs indicated that P-IU

explained unique variance in symptom was also a stronger predictor of OCD

Table 4. Summary of hierarchical linear regressions for trait IU subscales and situation-specific IU predicting
symptom scores

Criterion Predictors DR 2 B SEB Beta t Part r

SIPS Step 1: P-IU .17*** .28 .28 .13 1.01 .09
I-IU .90 .37 .31 2.42* .21
Step 2: P-IU .002 .23 .30 .10 .76 .07
I-IU .85 .38 .29 2.22* .19
IUS-SS .07 .14 .06 .51 .04
PSWQ Step 1: P-IU .23*** .61 .20 .38 3.07** .25
I-IU .30 .27 .13 1.09 .09
Step 2: P-IU .01 .54 .21 .33 2.57* .21
I-IU .23 .28 .11 .83 .07
IUS-SS .10 .10 .10 .96 .08
BSQ/ACQ composite Step 1: P-IU .18*** .64 .28 .29 2.27* .19
I-IU .47 .37 .17 1.29 .11
Step 2: P-IU .08*** .26 .29 .12 .92 .07
I-IU .18 .36 .06 .51 .04
IUS-SS .47 .13 .39 3.61*** .29
PIsqrt Step 1: P-IU .09* .08 .04 .26 1.92 .18
I-IU .02 .06 .06 .41 .04
Step 2: P-IU .02 .06 .04 .20 1.40 .13
I-IU .001 .06 .003 .02 .00
IUS-SS .03 .02 .17 1.49 .14
BDI-II Step 1: P-IU .24*** .16 .21 .09 .73 .05
I-IU 1.05 .30 .41 3.54** .25
Step 2: P-IU .04** 2 .06 .22 2.03 2.26 2 .02
I-IU .84 .30 .33 2.79** .19
IUS-SS .30 .11 .28 2.95** .20
Note. IUS-SS, Intolerance of Uncertainty Scale – Situation-Specific version; P-IU, Prospective Intolerance of
Uncertainty; I-IU, Inhibitory Intolerance of Uncertainty; SIPS, Social Interaction Phobia Scale; PSWQ, Penn
State Worry Questionnaire; BSQ, Body Sensations Questionnaire; ACQ, Agoraphobic Cognitions
Questionnaire; PI, Padua Inventory; BDI-II, Beck Depression Inventory.
*p , .05. **p , .01. ***p , .001.
 34 Mahoney and McEvoy
symptoms than I-IU was, although neither
was a significant independent predictor. At
step 2, trait IU scales continued to explain
variance in symptoms of social phobia and
GAD, whereas situation-specific IU failed to
explain an additional portion of variance in
these symptoms. Conversely, situation-
specific IU explained unique variance in
symptoms of depression, panic disorder, and
agoraphobia over and above trait IU scales.
VIFs for each regression did not indicate
problematic collinearity (O’Brien, 2007; SIPS:
1.77 – 2.56; PSWQ: 1.69 – 2.45; BSQ/ACQ
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composite: 1.79 – 2.67; PIsqrt: 1.65 – 2.48;
BDI-II: 1.92 – 3.05).
Discussion
IU has been most heavily implicated in the
development and maintenance of excessive
worry and GAD; however, recent research
suggests that IU contributes to a range of
symptoms across the emotional disorders
(Gentes & Ruscio, 2011; McEvoy & Mahoney,
2011). Existing research has examined trait or
trans-situational IU. This study is the first to
investigate IU associated with diagnosis-
specific situations that are particularly distres-
sing for individuals with anxiety and depress-
ive disorders. This study sought to compare
trait and situation-specific IU by developing a
measure of situation-specific IU (the IUS-SS)
and subsequently examining its factor struc-
ture, internal reliability, norms, differences
across gender, and relationships with
measures of personality dimensions and
symptoms associated with anxiety and
depressive disorders.
Recent research suggests that trait IU is not
a unitary construct; in student and treatment-
seeking samples, it has been shown to consist
of two factors, namely, P-IU and I-IU
(Carleton et al., 2007; McEvoy & Mahoney,
2011). Our first hypothesis was that situation-
specific IU would also comprise of these two
components; however, this hypothesis was not
supported. The IUS-SS had a unitary factor
structure that suggests that IU in relation to
diagnostically pertinent situations is more
homogeneous than trait IU. When considering
particularly distressing situations, the antici-
pation and avoidance of associated aversive
uncertainty (i.e., prospective and inhibitory
components, respectively) appear to be highly
COGNITIVE BEHAVIOUR THERAPY
related experiences for people with anxiety
and depressive disorders. Further psycho-
metric evaluation of the IUS-SS suggested
that the measure demonstrated excellent
internal reliability and good convergent
validity as indicated by positive relationships
with neuroticism and trait IU. As predicted,
this study also found evidence to support the
discriminant validity of the IUS-SS as shown
via non-significant associations with measures
of extraversion and alcohol use. We also
found additional evidence for the divergent
validity of the IUS-12 via its non-significant
association with alcohol use.
We predicted that participants would report
more situation-specific IU than trait IU. This
prediction was supported; mean IUS-SS
scores were significantly higher than those on
the IUS-12. This suggests that people with
anxiety disorders find uncertainty more
aversive when it is encountered in situations
that are particularly difficult for them (e.g.,
social interactions for individuals with social
phobia). Previous studies have demonstrated
associations between trait IU and symptoms
of internalising disorders (e.g., de Jong-Meyer
et al., 2009; McEvoy & Mahoney, 2011;
Steketee et al., 1998), and this study extends
existing research by finding significant, posi-
tive correlations between situation-specific IU
and an array of symptoms including those
associated with GAD, social anxiety,
depression, OCD, panic disorder, and agor-
aphobia. These results support the transdiag-
nostic nature of IU and enrich our
understanding of the relationships between
IU and symptoms of emotional disorders.
Our last hypothesis was that situation-
specific IU would explain unique variance in
symptoms of anxiety and depressive disorders.
P-IU was a unique predictor of excessive worry,
which concurs with previous research (Buhr &
Dugas, 2006; Laugesen, Dugas, & Bukowski,
2003; McEvoy & Mahoney, 2011). This finding
suggests that individuals with excessive worry
fear future uncertainty, which is consistent with
the fact that worry is generally future-oriented
or anticipatory in nature (Papageorgiou &
Wells, 1999; Watkins, Moulds, & Mackintosh,
2005). Situation-specific IU was not a unique
predictor of worry after taking trait IU into
account. This finding may be influenced by
measurement factors in that both the PSWQ
and the IUS-12 assess trait-like constructs.
 VOL 41, NO 1, 2012
Nevertheless, these results are consistent with
theoretical conceptualisations of worry and
current cognitive models of GAD, which
highlight the importance and relevance of trait
IU (Dugas et al., 1998; Sexton et al., 2003; van
de Heiden et al., 2010). Trait IU also predicted
symptoms of social phobia, specifically I-IU.
This replicates previous findings (Boelen &
Reijntes, 2009; Carleton et al., 2010; McEvoy &
Mahoney, 2011) and indicates that inaction or
avoidance in response to uncertainty may be
most predictive of social anxiety symptoms. I-
IU was also a significant predictor of depression
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symptoms and may suggest that depression is
more strongly related to restriction and
constraint in response to uncertainty. This
concurs with McEvoy and Mahoney’s (2011)
study and may reflect the fact that depression is
generally associated with withdrawal and
inactivity, the function of which may be to
imbue the individual with a sense of control and
certainty, albeit pessimistic and thus depresso-
genic (Dupuy & Ladouceur, 2008; Yook, Kim,
Suh, & Lee, 2010). Situation-specific IU was a
significant predictor of symptoms associated
with depression, panic disorder, and agorapho-
bia after trait IU was taken into account. That
is, IU specifically associated with diagnostically
pertinent situations contributed to the predic-
tion of symptoms of panic disorder and
depression over and above trait levels of IU.
Again, not only do these findings support the
transdiagnostic conceptualisation of IU but
also suggest that disorders may differ in the
degree to which IU is generalised or specific to
diagnosis-related situations.
Similar to previous studies, trait and
situation-specific IU correlated significantly
with OCD symptoms, and together the IUS-
12 subscales explained a significant albeit
relatively small proportion of variance in PI
scores (Holaway, Heimberg, & Coles, 2006;
Lind & Boschen, 2009; McEvoy & Mahoney,
2011; Steketee et al., 1998). P-IU was more
strongly associated with OCD symptoms than
I-IU, which is consistent with previous
findings (McEvoy & Mahoney, 2011),
although neither remained a significant unique
predictor in the model. Given that IU has been
found to be robustly associated with OCD
symptoms in previous studies (Gentes &
Ruscio, 2011), methodological differences
may have influenced our results. Previous
studies used considerably larger sample sizes
Situation-Specific Intolerance of Uncertainty 35
(particularly for those with clinically signifi-
cant OCD symptoms) and thus had greater
opportunity to detect associations than the
current study did. The OCD literature has also
generally used different measures of IU, and
the IUS has been found to be more strongly
associated with symptoms of GAD than OCD
(Gentes & Ruscio, 2011).
Our findings have several theoretical and
clinical implications. For instance, the fact
that trait IU predicted worry supports the
Intolerance of Uncertainty Model of GAD
(Dugas, Letarte, Rhéaume, Freeston, &
Ladouceur, 1995; Dugas et al., 1998) as well
as GAD treatments that target trait IU (see
Dugas et al., 2010). Replicating McEvoy and
Mahoney’s (2011) findings, this study found
that the P-IU was a more robust predictor of
worry than I-IU. This aspect of IU could be
addressed in GAD treatment by challenging
relevant unhelpful cognitions and behaviours,
such as restructuring the belief ‘one should
always look ahead so as to avoid surprises’
and reducing associated safety behaviours
including excessive contingency planning.
Behavioural experiments could be conducted
to test the true consequences of present-
focused attention in the face of uncertainty,
rather than pursuing the unachievable goal of
anticipating and controlling uncertain situ-
ations. Although excessive worry is the hall-
mark of GAD, elevated worry is a common
feature of many internalising disorders (Amer-
ican Psychiatric Association, 1994), and thus
trait IU may still need to be considered when
formulating difficulties for individuals with
other anxiety disorders and depression. Trait
IU, and I-IU in particular, also predicted
social phobia symptoms. Here, cognitive
interventions may address beliefs such as
‘when it’s time to act uncertainty paralyses
me’, whereas behavioural strategies could
reduce avoidance via graded exposure to
uncertain situations (e.g., impromptu speeches
or spontaneous social interactions). On the
other hand, situation-specific IU predicted
symptoms of depression, panic disorder,
and agoraphobia. Thus, to address these
symptoms it may be helpful in treatment to
assess and modify IU in relation to specific
distressing situations that are diagnostically
pertinent. Existing treatment protocols often
seek to modify distorted thinking and mala-
daptive behaviours in relation to specific
 36 Mahoney and McEvoy
situations of core concern (e.g., exposure to
crowded places in cognitive behavioural
group therapy for panic disorder and agor-
aphobia; Andrews et al., 2003). Addressing
IU-related fears and avoidance behaviours
may be a useful adjunct to these interventions.
The contribution of IU to internalising
disorders should not be overstated. Although
various aspects of IU predicted symptoms of
anxiety disorders and depression, the pro-
portion of variance explained was modest.
Moreover, additional constructs thought to
maintain anxiety and depressive symptoms
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were not taken into account (e.g., repetitive
negative thinking, anxiety sensitivity, or meta-
cognitive beliefs), and so interactions between
potential maintaining factors could not be
explored. For example, Yook et al. (2010)
found that rumination fully mediated the
relationship between IU and depression
symptoms and Sexton et al. (2003) found that
IU was not directly associated with symptoms
of panic disorder in a model that included both
IU and anxiety sensitivity. Thus, the mechan-
isms through which IU influences symptoms
require further clarification. In the clinic, it is
therefore likely that the relevance of IU may
vary across patients, and additional maintain-
ing factors such as behavioural avoidance will
continue to contribute heavily to clinical
conceptualisations. Future research is needed
to examine the comparative importance of IU
within existing diagnosis-specific and trans-
diagnostic cognitive models of anxiety and
depressive disorders as well as demonstrate
whether IU-based interventions increase the
effectiveness of current CBT treatments.
There are additional limitations to this
study. The cross-sectional nature of this study
precludes casual conclusions, and further
work with experimental paradigms is needed.
For example, although existing research has
shown that experimentally increasing IU leads
to increased worry (e.g., Grenier & Ladou-
ceur, 2004), future studies may explore
whether increasing trait or situation-specific
IU exacerbates symptoms of other internalis-
ing disorders. Also, the number of participants
in the current study with a primary depressive
disorder was small. Future research is needed
to investigate IU in relation to primary
depression and depressogenic situations.
This study found good evidence for the
reliability and validity for a situation-specific
COGNITIVE BEHAVIOUR THERAPY
measure of IU. The scale demonstrated a
unitary factor structure, excellent internal
consistency, and good convergent and diver-
gent validity. Situation-specific IU was found
to be associated with a broad array of anxiety
and depression symptoms supporting the
transdiagnostic nature of this construct.
Moreover, situation-specific IU predicted
symptoms of depression, panic disorder, and
agoraphobia over and above trait IU.
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