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Research is now suggesting that intolerance of uncertainty may be very important in understanding worry and may play a key role in the etiology and maintenance of worry. The present study attempted to further our understanding of intolerance of uncertainty by examining the psychometric properties of the English version of the Intolerance of Uncertainty Scale (IUS), which has already been validated in French. Factor analysis indicated that the IUS has a four-factor structure that represents the idea that uncertainty is stressful and upsetting, uncertainty leads to the inability to act, uncertain events are negative and should be avoided, and being uncertain is unfair. The IUS has excellent internal consistency, good test-retest reliability over a five-week period, and convergent and divergent validity when assessed with symptom measures of worry, depression, and anxiety. Overall, this study suggests that the IUS is a sound measure of intolerance of uncertainty and supports the idea that intolerance of uncertainty is an important construct involved in worry.

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The present study establishes an ecologically-valid point of reference for generalized anxiety disorder (GAD) treatment outcome studies. Although worry is the main diagnostic criterion for GAD, it is also a common and everyday cognition. Few studies have investigated the normal manifestation of worry in a non-clinical population. For this research, time spent worrying and the tendency to worry were measured in a non-clinical sample (n = 36), where GAD was screened-out, and results were compared to those obtained from a GAD sample (n = 60). Participants recorded the time spent worrying in self-monitoring notebooks for two consecutive weeks and completed the French version of the Penn State Worry Questionnaire (PSWQ). It was found that the non-GAD group reported less time spent worrying on a daily basis as well as a lower tendency to worry than the GAD group. Results are discussed in terms of treatment implications.

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UNLABELLED: Excessive worry, which is the central feature of Generalized Anxiety Disorder (GAD), is recognized as an important clinical phenomenon with many negative consequences on people's health. For example, studies report that excessive worry is associated with higher frequencies of work absenteeism and medical consultations, increased risk of other anxiety disorders, depression, heart disease, diabetes and cancer. It is thus imperative to develop effective measures to assess worry among adult. Until now, no measures were available in French for the practitioners and researchers to evaluate the tendency to engage in excessive and uncontrollable worry. One of the most frequently used questionnaires to assess worry in English is The Penn State Worry Questionnaire (PSWQ). This self-report measure has been widely studied and has shown excellent psychometric properties among the non-clinical and clinical populations. This manuscript presents the results of three studies evaluating the psychometric properties of a French Translation of the PSWQ, the Questionnaire sur les Inquiétudes de Penn State (QIPS). The first study includes the translation procedures used to create the French version of the questionnaire, the factorial structure, the internal consistency, the quality of the items, and the convergent validity among non-clinical participants. The second study examines the temporal stability, and the convergent and divergent validity of the questionnaire. Finally, the third study investigates the internal consistency, the quality of the items, and the convergent and divergent validity of the questionnaire among GAD patients. Study 1. This study describes the translation procedures used to create the QIPS, the factorial structure, the internal consistency, the quality of the items, and the convergent validity among non-clinical participants. The French version was translated by a group of clinical psychologists with the assistance of a professional translator and a linguist. A back translation procedure was also conducted. Finally, a pilot study confirmed the intelligibility of the questionnaire. French-speaking university students (N = 352) completed a battery of questionnaires during a lecture. The questionnaires were: The Questionnaires sur les Inquiétudes de Penn State, the Intolerance of Uncertainty Questionnaire, the Cognitive Avoidance Questionnaire, the Why Worry Questionnaire-Revised, and the Social Problem-Solving Inventory-Revised. The statistical analyses reveal that the QIPS shows an appropriate factorial structure, an excellent internal consistency and a very good convergent validity. This French Questionnaire thus seems to be suitable to assess the tendency to worry among the nonclinical population. Study 2. This second study examines the temporal stability, and the convergent and divergent validity of the QIPS. The sample includes 95 French-speaking University students who volunteered to complete the QIPS and the Beck anxiety Inventory. Two self-rating questions were also asked to evaluate the percentage of time spent worrying and to what extent does worrying causes a problem. Eighty-six students participated at the second administration of the questionnaires, four weeks later. The results indicate that the QIPS is very stable over time, thus supporting its temporal stability. Different correlations confirm its convergent and divergent validity. It is concluded that the QIPS is a suitable measure of worry in a non-clinical population. Study 3. This study investigates the internal consistency, the quality of the items, and the convergent and divergent validity of the questionnaire among GAD patients. Seventy-seven GAD patients, as defined by the Diagnostic and Statistical Manual of Mental disorders, fourth edition (DSM IV), participated in this study. They completed the QIPS, the Worry Domains Questionnaire, The Worry and Anxiety Questionnaire, the Intolerance of Uncertainty Questionnaire, the Beck Anxiety Inventory, the Beck Depression Inventory, and a daily diary of differents aspects of worry. The results reveal that the QIPS has an excellent internal consistency, a very good convergent and divergent validity. The QIPS thus seems to be suitable to assess the tendency to worry among GAD patients. CONCLUSION: The overall results presented in these studies confirm the excellent psychometric properties of the QIPS. This French questionnaire is a useful tool for clinicians and researchers to assess the tendency to worry among non-clinical and clinical populations.

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This study evaluates the efficacy of a cognitive-behavioral treatment for generalized anxiety disorder (GAD) that addresses two types of worries: (a) those about situations that are amenable to problem solving, and (b) those about situations that are not. The treatment's goal is to help patients become more tolerant of uncertainty by discriminating between both types of worry and applying the correct strategy to each type. A multiple baseline design was used and subjects were 4 adults with a primary diagnosis of GAD. Treatment outcome was assessed with daily self-monitoring, self-report questionnaires, and standardized clinician ratings. At posttest and 6-month follow-up, 3 of 4 subjects no longer met diagnostic criteria for GAD and had attained high end-state functioning. At 12-month follow-up, none of the subjects met GAD diagnostic criteria but end-state functioning was variable. The results also show that treatment outcome was highly related to change in intolerance of uncertainty.

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Intolerance of uncertainty has been identified as an important variable related to worry and Generalized Anxiety Disorder (GAD) [Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: a preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215-226; Ladouceur, R., Dugas, M. J., Freeston, M. H., Rhéaume, J., Blais, F., Boisvert, J.-M., Gagnon, F., & Thibodeau, N. (1999). Specificity of Generalized Anxiety Disorder symptoms and processes. Behavior Therapy, 30, 197-207]. The goal of the present study was to clarify the relationship between this cognitive process and worry by experimentally manipulating intolerance of uncertainty. A gambling procedure was used to increase intolerance of uncertainty in one group (N = 21) and to decrease intolerance of uncertainty in another group (N = 21). The results indicate that participants whose level of intolerance of uncertainty was increased showed a higher level of worry, compared to participants whose level of intolerance of uncertainty was decreased. These results provide some initial clarifications as to the causal nature of the link between intolerance of uncertainty and worry. These results are coherent with our theoretical model of worry and GAD (Dugas et al., 1998), which stipulates that intolerance of uncertainty plays a key role in the acquisition and maintenance of excessive worry.

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Models of intrusive thoughts attribute a key role to strategies used by people to cope with their unwanted cognitions. In an extension of previous work, the authors conducted structured interviews with 38 people with obsessive-compulsive disorder, 38 people with another anxiety disorder, and 19 healthy volunteers. The interview identified the repertoire of strategies used with the participant's most troubling thought. The 2 clinical groups reported significantly more strategies than the nonclinical group. The clinical groups also reported significantly greater intensity of the thought and their emotional response and lower efficacy for the strategies. People with OCD reported a significantly higher proportion of strategies that were specifically linked to the thought content (as distinct from nonspecific strategies that were only linked sequentially in time). The results identify both common and differential characteristics of intrusive cognition in anxiety disorders.

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Although generalized anxiety disorder (GAD) has traditionally been understudied, several authors have stated that interest in GAD has recently increased. However, no data exist to confirm or refute this assertion. The present study investigates publication rates for the anxiety disorders from 1980 to 1997 in two extensive databases: PsycLIT and MEDLINE. GAD publications were examined in two ways. First, the annual percentage of anxiety disorder publications devoted to GAD was calculated. Second, GAD publications were classified into one of four categories: descriptive, process, treatment, and review. The results show that GAD is considerably less studied than panic disorder/agoraphobia, posttraumatic stress disorder and obsessive-compulsive disorder. Though the percentage of anxiety disorder publications devoted to GAD increased considerably during the 1980s, it has generally remained stable in the 1990s. The results also show that descriptive and treatment issues account for the vast majority of GAD publications. The author concludes that the paucity of research into process issues is unfortunate because intensified investigation of the specific processes involved in GAD may lead to new breakthroughs in our understanding and treatment of this anxiety disorder.

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Recent advances in the understanding of worry have led to the development of treatments for generalized anxiety disorder (GAD). The present study tested a GAD treatment that targeted intolerance of uncertainty, erroneous beliefs about worry, poor problem orientation, and cognitive avoidance. Twenty-six primary GAD patients were randomly allocated to a treatment condition (n = 14) or a delayed treatment control condition (n = 12). Self-report, clinician, and significant other ratings assessed GAD and associated symptoms. The results show that the treatment led to statistically and clinically significant change at posttest and that gains were maintained at 6- and 12-month follow-ups. Furthermore, 20 of 26 participants (77%) no longer met GAD diagnostic criteria following treatment. With regard to the treatment's underlying model, the results show that intolerance of uncertainty significantly decreased over treatment and that gains were maintained at both follow-ups. Although nonspecific factors were not significant predictors of treatment outcome, their role in the treatment of GAD requires further investigation.

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This study examines worry themes among 87 anxiety disorder patients divided into three groups: (a) 24 primary generalized anxiety disorder (GAD) patients, (b) 25 secondary GAD patients, and (c) 38 other anxiety disorder patients (primarily obsessive-compulsive disorder, social phobia and panic disorder with agoraphobia). Structured and free-recall measures were used to measure five worry themes: relationships, work, finances, physical threat, and the future. Both types of measures revealed that GAD patients worry more about the future than non-GAD patients. Further, post hoc analyses testing for linear relationships indicated that primary GAD patients worry more about the future than secondary GAD patients who in turn worry more about the future than other anxiety disorder patients. The results suggest that although worry about immediate problems may not differentiate GAD patients from other anxiety disorder patients, high levels of worry about future events may be a distinguishing feature of GAD.

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This study presents a preliminary test of a conceptual model of Generalized Anxiety Disorder (GAD) which is theoretically driven and has clear clinical implications. The model's main features are intolerance of uncertainty, beliefs about worry, poor problem orientation and cognitive avoidance, Subjects were 24 GAD patients and 20 non clinical control subjects. The results show that all main components of the model were highly related to the discriminant function and that intolerance of uncertainty was pivotal in distinguishing GAD patients from non clinical subjects. Further, the discriminant function derived from these four process variables was very effective for classifying GAD patients and non clinical subjects into their respective groups. Overall, 82% of subjects were correctly classified as 18 of 24 subjects in the GAD group and 18 of 20 subjects in the non clinical group were properly identified. The results are discussed in terms of the proposed model of GAD and its clinical implications.

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The present study's main objective is to examine whether problem orientation and problem-solving skills differ according to generalized anxiety disorder (GAD) symptom level or clinical status (seeking help for GAD). Its secondary goal is to examine whether two cognitive variables (intolerance of uncertainty and beliefs about worry) vary according to GAD symptom level or clinical status. Three groups of subjects participated in the study: (a) nonclinical moderate worriers (N = 15), (b) nonclinical subjects meeting GAD criteria by questionnaire (N = 14), and (c) GAD patients (N = 14). Problem orientation and problem-solving skills were measured with the Social Problem-Solving Inventory (D'Zurilla & Nezu, 1990) and the Problem-Solving Inventory (Heppner & Petersen, 1982), whereas the cognitive variables were assessed with the Intolerance of Uncertainty questionnaire (Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994) and the Why Worry? questionnaire (Freeston, Rhéaume et al., 1994). The results show that problem orientation, intolerance of uncertainty, and beliefs about worry were similar in subjects meeting GAD criteria by questionnaire and GAD patients, whereas moderate worriers had different scores on these variables. Thus, these variables are more highly affected by GAD symptom level than by clinical status. The results also show that problem-solving skills were unaffected by symptom level and clinical status, thereby indicating that knowledge of problem-solving skills is unrelated to both GAD symptom level and GAD clinical status. The findings are discussed in terms of their theoretical and clinical implications.

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Intolerance of uncertainty has been related to increased worry in recent conceptual models of Generalized Anxiety Disorder (GAD). The present study examines the relationship between a measure of intolerance of uncertainty, the Intolerance of Uncertainty scale (IU), and behaviors associated with GAD, such as slowness of execution and amount of evidence required before decision making. A total of 49 individuals participated in the study. Three experimental tasks varying in level of ambiguity and difficulty were used. The analyses show a positive correlation between scores on the IU and number of cues required before responding in a moderately ambiguous inference task. However, scores on the IU were not significantly related to responses in an unambiguous task (regardless of the level of difficulty) or in a highly ambiguous task. The results suggest that high worriers have a lower threshold of tolerance of uncertainty for intermediate levels of ambiguity. The results are discussed in terms of theoretical models of GAD.

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Although both perfectionism and responsibility have been associated with OCD at a theoretical level, responsibility has been the focus of a number of recent articles. This study was conducted in order to empirically test the relative importance of perfectionism and responsibility in Obsessive-Compulsive symptoms. Perfectionism and two measures of responsibility showed moderate correlations with Obsessive-Compulsive symptoms. A hierarchical regression analysis revealed that although responsibility accounted for more variance, perfectionism was still a significant predictor of Obsessive-Compulsive symptoms, once responsibility had been partialled out. These results suggest that although responsibility is related to OC symptoms, perfectionism is also independently associated. While responsibility has received much attention lately from OCD theorists and clinicians, perfectionism may also play a significant if underestimated role in some OC patients. The results are discussed in terms of their implications for current cognitive models and treatment procedures that give responsibility a central role in OCD. A new definition of perfectionism is also proposed.

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