Factor structure of the intolerance of uncertainty scale for children.

Intolerance of uncertainty (IU), a dispositional negative orientation toward uncertainty and its consequences, has been studied in adults, but research has only recently examined IU in youth. Despite some advances, little is known about the factor structure of measures of IU in youth. The present study used confirmatory factor analysis to examine the structure of IU as measured by the Intolerance of Uncertainty Scale for Children (IUSC; Comer et al., 2009) in a sample of youth (N=368) 9-18 years of age (Mage=12.47) with and without anxiety disorders and their mothers. Findings demonstrated multiple acceptable factor structures: a correlated factors 2-factor structure and a bifactor model where a general factor underlies all items. While the bifactor model provides better fit and reliability to the data, multivariate analyses indicated that the 2-factor structure distinguishes apprehensive anxiety regarding future events (prospective IU) from present-focused inhibition of behavior due to uncertainty and negative reactions to the presence of uncertainty (inhibitory IU); a total IU score predicted all anxiety domains for self- and parent-reports except for parent-report harm avoidance. Findings are discussed in terms of consistency of IU across adult and youth samples, and how results can inform treatment efforts and etiologic models of IU and anxiety.

Content and correlates of checking related to symptoms of obsessive compulsive disorder and generalized anxiety disorder.

In addition to the central role of compulsive behaviors in obsessive compulsive disorder (OCD), recent data have documented the presence of compulsive behaviors in individuals with generalized anxiety disorder (GAD). However, there is a lack of information about potential similarities and differences with regard to the quality, or content, of checking associated with worry and obsessions. The two studies presented herein are an initial step towards gathering this information. Findings of Study 1, from a large unselected undergraduate sample, showed that symptoms of OCD and GAD were both significantly associated with checking behaviors. However, while OCD symptoms were associated with checking related to both objects and interpersonal situations, GAD symptoms were only significantly associated with interpersonal checking. Findings of Study 2, using a separate sample, suggest links between interpersonal checking and features characteristic of GAD, namely emotion regulation difficulties, and between object checking and a cognitive feature of OCD, namely thought-action fusion. In summary, the current studies add to a growing body of literature suggesting that checking may be important in numerous forms of psychopathology, while also suggesting that the nature and function of checking may differ for various symptom profiles.

The factor structure and dimensional scoring of the generalized anxiety disorder questionnaire for DSM-IV.

Despite favorable psychometric properties, the Generalized Anxiety Disorder Questionnaire for the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (GAD-Q-IV) does not have a known factor structure, which calls into question use of its original weighted scoring system (usually referred to as the dimensional score). Analyses appropriate to categorical item responses in a large sample of undergraduates were used to establish the scale's factor structure. Analyses indicated that a one-factor structure resulted in good fit. A scoring method based on this one-factor structure was compared with a variety of alternative scoring procedures, and it was found that a method based on factor scores did relatively well but that the previously suggested dimensional score failed to perform better than a simple sum of items. Results support the general unity of the measure but raise doubts regarding its scoring and response options.

Delineating components of emotion and its dysregulation in anxiety and mood psychopathology.

Two studies sought to elucidate the components of emotion and its dysregulation and examine their role in both the overlap and distinctness of the symptoms of 3 highly comorbid anxiety and mood disorders (i.e., generalized anxiety disorder, major depression, and social anxiety disorder). In Study 1, exploratory factor analyses demonstrated that 4 factors--heightened intensity of emotions, poor understanding of emotions, negative reactivity to emotions, and maladaptive management of emotions--best reflected the structure of 4 commonly used measures of emotion function and dysregulation. In Study 2, a separate sample provided support for this 4-factor model of emotion dysregulation. Poor understanding, negative reactivity, and maladaptive management were found to relate to a latent factor of emotion dysregulation. In contrast, heightened intensity of emotions was better characterized separately, suggesting it may relate more strongly to dispositional emotion generation or emotionality. Finally, the 4 components demonstrated both common and specific relationships to self-reported symptoms of generalized anxiety disorder, major depression, and social anxiety disorder.

Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3.

Accumulating evidence suggests that anxiety sensitivity (fear of arousal-related sensations) plays an important role in many clinical conditions, particularly anxiety disorders. Research has increasingly focused on how the basic dimensions of anxiety sensitivity are related to various forms of psychopathology. Such work has been hampered because the original measure--the Anxiety Sensitivity Index (ASI)--was not designed to be multidimensional. Subsequently developed multidimensional measures have unstable factor structures or measure only a subset of the most widely replicated factors. Therefore, the authors developed, via factor analysis of responses from U.S. and Canadian nonclinical participants (n=2,361), an 18-item measure, the ASI-3, which assesses the 3 factors best replicated in previous research: Physical, Cognitive, and Social Concerns. Factorial validity of the ASI-3 was supported by confirmatory factor analyses of 6 replication samples, including nonclinical samples from the United States and Canada, France, Mexico, the Netherlands, and Spain (n=4,494) and a clinical sample from the United States and Canada (n=390). The ASI-3 displayed generally good performance on other indices of reliability and validity, along with evidence of improved psychometric properties over the original ASI.

Examination of the known-groups validity of the Liebowitz Social Anxiety Scale.

We examined the known-groups validity of the Liebowitz Social Anxiety Scale (LSAS) by comparing the scores of patients with social anxiety disorder (n=46), generalized anxiety disorder plus an additional diagnosis of social anxiety disorder (n=15), generalized anxiety disorder without social anxiety disorder (n=12), and nonanxious controls (n=34). The LSAS total score discriminated significantly among all pairs of groups. Similar analyses were conducted on the original LSAS subscales and additional subscales derived from the factor-analytic work of Safren et al. [1999]. Original subscales showed a pattern substantially similar to that of the total score, but subscale intercorrelations and total score-subscale correlations were extremely high, suggesting that these subscales do not provide much unique information beyond that provided by the total score. Factor-analytically derived subscales were less highly correlated with each other or with the LSAS total score. Although the pattern of differences was more variable across subscales, the factor-analytically derived subscales, in conjunction with the total score, may provide more nonredundant information of clinical relevance than the original subscales. Limitations and future directions for research on the LSAS are discussed.

A comparison of intolerance of uncertainty in analogue obsessive-compulsive disorder and generalized anxiety disorder.

Intolerance of uncertainty has been defined as the unwillingness to tolerate the possibility that negative events may occur in the future, no matter how low the probability [Personality Individual Differences 17 (1994), 791-802]. Previous research suggests that intolerance of uncertainty may be more specific to worry and generalized anxiety disorder (GAD) than to other anxiety disorders [e.g., Dugas, M. J., Buhr, K., & Ladouceur, R. (2004). The role of intolerance of uncertainty in the etiology and maintenance of generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 143-163). New York: Guilford Press]. However, Tolin et al. [J. Anxiety Disorders 17 (2003), 233-242] argued that intolerance of uncertainty may also play a central role in obsessive-compulsive disorder (OCD). Therefore, the current study compared intolerance of uncertainty in individuals with analogue GAD and/or OCD. Intolerance of uncertainty was strongly related to pathological worry, GAD symptoms, and OCD symptoms; however, neither worry nor GAD was found to be more strongly associated with intolerance of uncertainty than OCD. Further, individuals with analogue GAD or OCD reported more intolerance of uncertainty than controls, but they did not differ significantly from each other. These findings suggest that intolerance of uncertainty may be a central theme in a number of the anxiety disorders.

The treatment of social anxiety disorder.

We review the available treatments for social anxiety disorder, focusing primarily on psychotherapeutic interventions for adults, but also giving briefer summaries of pharmacological treatments and treatments for children and adolescents. The most well-researched psychosocial treatments for social anxiety disorder are cognitive-behavioral therapies (CBTs), and meta-analyses indicate that all forms of CBT appear likely to provide some benefit for adults. In addition, there are several pharmacological treatments with demonstrated efficacy, and cognitive-behavioral interventions have some demonstrated efficacy for children and adolescents. We outline a number of concerns regarding this literature, including the questions of what influences treatment response and what role combinations of CBT and medication might have. Clearly, although a number of treatments appear well-established in regard to their effects on social anxiety disorder, a number of opportunities for future research remain, including the search for predictors of who will benefit from which treatment.

Scoring error of social avoidance and distress scale and its psychometric implications.

An error in the scoring instructions of the Social Avoidance and Distress Scale (SAD), one of the most popular instruments to measure social anxiety, is discussed.