See

discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/257552386

Intolerance of Uncertainty and PTSD

Symptoms: Exploring the Construct
Relationship in a Community Sample with a
Heterogeneous Trauma History
Article in Cognitive Therapy and Research August 2013
Impact Factor: 1.7 DOI: 10.1007/s10608-013-9531-6

CITATIONS

READS

22

179

4 authors:
Mathew Fetzner

Samantha C. Horswill

Royal Ottawa Mental Health Centre

University of Regina

15 PUBLICATIONS 221 CITATIONS

7 PUBLICATIONS 36 CITATIONS

SEE PROFILE

SEE PROFILE

P.A. Boelen

R. Nicholas Carleton

Utrecht University

University of Regina

149 PUBLICATIONS 2,631 CITATIONS

110 PUBLICATIONS 1,929 CITATIONS

SEE PROFILE

All in-text references underlined in blue are linked to publications on ResearchGate,

letting you access and read them immediately.

SEE PROFILE

Available from: R. Nicholas Carleton

Retrieved on: 30 June 2016

Cogn Ther Res (2013) 37:725734

DOI 10.1007/s10608-013-9531-6

ORIGINAL ARTICLE

Intolerance of Uncertainty and PTSD Symptoms: Exploring

the Construct Relationship in a Community Sample
with a Heterogeneous Trauma History
Mathew G. Fetzner Samantha C. Horswill
Paul A. Boelen R. Nicholas Carleton

Published online: 9 March 2013

Springer Science+Business Media New York 2013

Abstract Intolerance of uncertainty has received substantial empirical attention in recent years. The contribution of intolerance of uncertainty to the development and
maintenance of anxiety disorders has become increasingly
recognized by researchers; however, relationships between
intolerance of uncertainty and symptoms of posttraumatic
stress disorder remain largely unexplored. As part of a
larger study, North American community members
(n = 122, 81 % women) with a heterogeneous trauma
history completed self-report measures assessing intolerance of uncertainty and its dimensions (inhibitory and
prospective intolerance of uncertainty) and posttraumatic
stress disorder symptoms (re-experiencing, avoidance,
numbing, hyperarousal). Intolerance of uncertainty total
scores accounted for statistically significant variance in
each posttraumatic stress disorder symptom score except
re-experiencing. Inhibitory intolerance of uncertainty
scores accounted for statistically significant variance in
each posttraumatic stress disorder symptom score except
re-experiencing. Prospective intolerance of uncertainty
scores did not account for statistically significant variance
in any of the posttraumatic stress disorder symptom scores.
Results suggest that intolerance of uncertainty relates differentially to posttraumatic stress disorder symptom clusters and inhibitory intolerance of uncertainty appears to be
the main component of the relationship.

M. G. Fetzner (&)
S. C. Horswill
R. N. Carleton

Anxiety and Illness Behaviours Laboratory, Department of
Psychology, University of Regina, Regina, SK S4S 0A2, Canada
e-mail: fetznerm@gmail.com
P. A. Boelen
Utrecht University, Utrecht, The Netherlands

Keywords Posttraumatic stress disorder symptoms

Intolerance of uncertainty
Trauma
Anxiety sensitivity
neuroticism
Introduction
The relationship between anxiety disorders and intolerance
of uncertainty (IU)the tendency for a person to consider
the possibility of a negative event occurring as unacceptable and threatening, irrespective of the probability of its
occurrence (Carleton et al. 2007b)has received increasing
attention in recent years (e.g., Boelen and Carleton 2012;
Carleton et al. 2012; McEvoy and Mahoney 2012).
Researchers hypothesize that the experience of uncertainty
and tendency to avoid situations containing elements of
uncertainty is an important transdiagnotic feature contributing to the development and maintenance of anxiety
psychopathology (Carleton 2012; Carleton et al. 2012;
Riskind et al. 2007). Early research suggested IU may be
specific to generalized anxiety disorder (Dugas et al. 2004);
however, recent cross-sectional studies have identified IU
as being important to the maintenance of a number of
anxiety disorders including obsessive compulsive disorder
(Carleton et al. 2012; Holaway et al. 2006; Tolin et al.
2003), social anxiety disorder (Boelen and Reijntjes 2009;
Carleton et al. 2010; Carleton et al. 2012), and panic disorder (Carleton et al. 2012; McEvoy and Mahoney 2012).
IU has been conceptualized as being represented by two
dimensions (Carleton et al. 2007a; McEvoy and Mahoney
2011), specifically: cognitive perceptions of threat pertaining
to future uncertainty (i.e., prospective IU; e.g., being overly
concerned with organization in order to avoid disaster)
and behavioural symptoms indicating apprehension due to
uncertainty (i.e., inhibitory IU; e.g., being unable to act
effectively or function properly in the face of uncertainty).

123

726

The two dimensions of IU differentiate between distress

arising from uncertainty over future events and impediment in
current functioning as a result of uncertainty, and have been
differentially related to psychopathological symptoms. Specifically, prospective IU appears more strongly associated
with worry and obsessive compulsive symptoms, possibly as a
function of focus on the future; in contrast, inhibitory IU
appears more related to social anxiety, panic, agoraphobia,
and depression, possibly as a function of current behavioral
responses to uncertainty (Boelen 2010; Carleton et al. 2012;
Carleton et al. 2007a; McEvoy and Mahoney 2012).The
inhibitory IU dimension also appears to be specifically related
to the startle response under threat conditions (Nelson and
Shankman 2011).
Despite increased attention in extant literature for IU
and anxiety disorders (e.g., Boelen 2010; Boelen and
Carleton 2012; Carleton 2012; Carleton et al. 2012;
McEvoy and Mahoney 2011), the relationship between IU
and posttraumatic stress disorder (PTSD) symptoms
remains largely unexplored. Intuitively, IU and PTSD
symptoms may have a direct linkages given the propensity
for uncertainty to cause distress if it were to pertain to the
traumatic experience itself (e.g., uncertainty regarding
others perceptions of their actions during the event) or
ones future safety (e.g., uncertainty regarding ones ability
to avoid similar traumas). Recently, Boelen (2010) began
to address this gap by investigating the unique variance
accounted for by IU to grief and PTSD symptoms with data
from a sample of people who had lost a loved one. The
results provided preliminary evidence of a relationship
between IU and PTSD beyond the influence of worry, the
time since the death, and neuroticism. Prior research by
White and Gumley (2009) indicated higher IU in persons
with schizophrenia and PTSD symptoms following a distressing psychotic experience relative to those with
schizophrenia but no PTSD symptoms; however, the
research was limited to a single, very specific, trauma type.
Researchers have previously identified several key
constructs facilitating the development and maintenance of
PTSD symptoms which require consideration when
investigating novel constructs. Neuroticisma broad factor
describing general anxiety (Thompson 2008)has been
associated with PTSD symptoms (e.g., Boelen 2010;
Engelhard and van den Hout 2007) and studied across
several trauma types (e.g., Engelhard et al. 2007). A related
construct, anxiety sensitivity (fear of anxiety-related
symptoms for fear of catastrophic consequences; Reiss and
McNally 1985), has also received considerable attention
for consistent positive independent associations with PTSD
(e.g., Asmundson and Stapleton 2008; Collimore et al.
2008; Fetzner et al. 2011). Recent theory has suggested that
IU represents a core, if not necessary, feature of anxiety

123

Cogn Ther Res (2013) 37:725734

and anxiety sensitivity (Carleton 2012; Carleton et al.

2007b); in addition, there is evidence that both anxiety
sensitivity and IU can be reduced with specific directed
treatments (Dugas and Robichaud 2007; Taylor 2000),
whereas neuroticism is considered more intransigent and is
typically treated with more general tools (e.g., relaxation
therapy). After establishing relationships between anxiety
sensitivity and PTSD, researchers had sufficient reason to
explore treating PTSD by reducing anxiety sensitivity
(Wald and Taylor 2007). Similarly, reductions in IU have
led to reductions in symptoms of disorders with established
IU relationships (e.g., generalized anxiety disorder; Dugas
and Robichaud 2007). Accordingly, a significant relationship between PTSD and IUindependent of anxiety sensitivitywould support research exploring IU as an
additional treatment target for PTSD. A relationship that
existed independently of the relationship between anxiety
sensitivity, neuroticism, and PTSD would underscore the
potential of IU as a treatment target for PTSD. Exploring
the possibility of differential relationships between PTSD
symptoms and each of the IU dimensions may further
refine such subsequent research.
The preliminary relationship between PTSD and IU
demonstrated by Boelens (2010) and White and Gumleys
(2009) studies can be extended in several ways. First, the
relationship between PTSD and IU was demonstrated
among participants with a homogeneous trauma history;
whether the results generalize to a broader spectrum of
traumatic events remains to be explored. Second, PTSD
symptoms were assessed globally; as such, relationships
between the dimensions of IU (i.e., inhibitory and prospective IU) and PTSD symptom clusters remain to be
explored. Given that past studies assessing associations
between cognitive vulnerability factors and PTSD symptoms have suggested differential relations (e.g., Fetzner
et al. 2011), the relationship between IU dimensions and
PTSD subscales should also be assessed. Third, IU was
assessed with the 27-item Intolerance of Uncertainty Scale
(IUS), rather than the revised 12-item version (Carleton
et al. 2007a). Use of the IUS-12 may be important given
evidence that the original IUS may overlap with worry and
generalized anxiety disorder (Buhr and Dugas 2006),
whereas the IUS-12 appears to focus more on the core IU
construct (Carleton 2012; Gentes and Ruscio 2011).
Finally, examination of the relationship beyond previously
established empirical and theoretical associations (e.g.,
anxiety sensitivity, neuroticism, and time since index
trauma) may enhance understanding of the unique contribution of IU to PTSD symptoms. IU and each of the related
dimensions (i.e., prospective and inhibitory IU) were
expected to contribute significant unique amounts of variance to each of the PTSD symptom clusters above and

Cogn Ther Res (2013) 37:725734

beyond anxiety sensitivity, neuroticism, and time since

index trauma.

Method

727

validity was assessed using two check questions placed

randomly within study measures (During the traumatic
event I smelled almonds; My favorite singer is Marty
Bumble). Participants who responded to the check questions with anything other than not at all would have been
excluded; however, no such participants were identified.

Participants
Measures
Participants included 122 trauma-exposed community
members (81 % women), ranging in age from 18 to
60 years old (Mage = 33.83 years; SD = 14.41 years). The
most prevalent demographics endorsed by study participants were Caucasian (82 %), single/never married (46 %),
had at least partial college/university education (53 %),
were either a student (31 %) or employed full-time (34 %),
and had a household income less than $19,999 (23 %).
Participants were excluded from the current study based on
age restrictions (i.e., participant had to have been between
the ages of 18 and 65 years old) and if they did not complete at least 95 % of study measure items.
Procedure
Participants were recruited from across North America
through online social media advertisements calling for
individuals who currently experience anxiety or have in the
past. As a consequence, the current sample likely includes
a disproportionately high number of people experiencing
higher-than-average levels of anxiety. Respondents were
asked to voluntarily and anonymously complete an Internet-based survey as part of a larger ongoing study investigating risk factors and symptoms of anxiety disorders.
Permission to conduct the present study was obtained from
the local University research ethics board. A total of 1,075
participants logged on to complete the survey and were
presented with measures assessing anxiety disorder risk
factors (including AS, IU, and neuroticism). Of these participants, 357 (33 %) chose to answer additional questions
and were each randomized to one of three different sets of
questionnaires assessing specific anxiety disorder symptoms. Only 112 of 357 participants (11 %) were randomized to receive questionnaires containing items relevant to
the current study (focusing on trauma and PTSD symptoms); 83 of the 112 participants (74 %) completed the
questionnaires. A further 39 participants were initially
randomized to one of the two other sets of questionnaires
(focusing on either social/generalized anxiety or health
anxiety/physical health). Following completion of this
initial questionnaire set, these 39 participants chose to
complete another set of questionnaires, were randomized to
the trauma-focused questionnaire set, and completed the
questionnaires necessary for the current study, resulting in
a total study population of 122 participants. Response

The list of traumatic experiences (Carleton et al. 2006)

assesses for exposure to 16 types of traumatic events
commonly reported by community members, and is based
on the authors research and clinical experience. Participants were asked to provide the year in which each
endorsed event was experienced and indicate the worst
event endorsed (index trauma). In addition to traumatic
events meeting diagnostic and statistical manual of mental
disorders 4th edition text revision (DSM-IV-TR; American
Psychiatric Association [APA] 2000) Criterion A1, three
negative social events were included (i.e., being publicly
humiliated [worse than others], being severely bullied
[worse than others], and being ridiculed [worse than
others]) based on previous reports describing salient
PTSD symptoms arising from such experiences (e.g.,
Collimore et al. 2010). The current debate regarding the
differentiation between Criterion A events constituting
death or threats to bodily integrity and subsequent PTSD
diagnosis is beyond the scope of this paper (for review see
Friedman et al. 2011). Notwithstanding, the focus of the
current paper was on PTSD symptomatology and related
cognitive mechanisms, not precipitating events, which
were included in the current study for descriptive purposes.
The measure, including event outside the current conceptualization of Criterion A events, has been utilized previously by our research group in studies assessing PTSD
symptoms (e.g., Carleton et al. 2011; Fetzner et al. 2011).
The posttraumatic stress disorder check listcivilian
(PCL-C; Weathers et al. 1993) is a 17-item self-report
measure corresponding to PTSD symptoms as described in
DSMIV (APA 2000; e.g., Feeling jumpy/easily startled). Participants were asked to complete each item with
regards to their reaction to their index trauma provided by
the List of Traumatic Experiences measure. The current
study employed a subscale structure consistent with the
emotional numbing model of PTSD and anticipated DSMV PTSD diagnostic criteria (i.e., re-experiencing, avoidance, numbing, and hyperarousal; for review see Friedman
et al. 2011). The PCL-C was broken into the four subscales (i.e., one per cluster), despite being designed to
have three subscales (i.e., one for each of the previously
posited clusters), because the bulk of the extant literature
supporting the four factors has been completed using the
PCL-C (Asmundson et al. 2000; King et al. 1998; Shelby

123

728

et al. 2005). Items are rated on a 5-point Likert scale

ranging from 1 (not at all) to 5 (extremely). Probable
PTSD caseness were defined for participants whose PCLC scores met or exceeded 50 (Weathers et al. 1993), and
endorsed at least 1 item from criterion B, 3 items from
Criterion C, and 2 items from criterion D. Although this
cut-score is typically associated with military samples,
and a cut-score of 44 is typically used in community
samples (Blanchard et al. 1996), we elected to use a more
conservative cut-score due to the fact that our PTSD
symptom measurement was based on self-report and to
avoid Type II error. The internal consistencies for PCL-C
subscale scores (i.e., reexperiencing, a = .90; avoidance
a = .88; numbing a = .80; hyperarousal a = .80) were
acceptable in the current sample.
The Anxiety Sensitivity Index3 (ASI-3; Taylor et al.
2007) is a self-report measure assessing the tendency to
fear anxiety symptoms based on the belief that they have
harmful consequences (e.g., It scares me when my heart
beats rapidly). Items are rated on a 5-point Likert scale
ranging from 0 (agree very little) to 4 (agree very much).
Previous research has indicated positive significant relationships between the higher-order anxiety sensitivity
construct and symptoms of PTSD (Collimore et al. 2008);
as such, the current study assessed the relationship between
IU, PTSD, and the ASI-3 total scores. The internal consistency for the total score (a = .91) was acceptable in the
current sample.
The Big 5 Mini-Markers Neuroticism Scale (Saucier
1994) includes 8 items (e.g., jealous, moody) as part of a
40-items scale assessing five constructs of personality (i.e.,
conscientiousness, extraversion, openness, neuroticism,
and agreeableness). Items are rated on a 5-point Likert
scale ranging from 1 (inaccurate) to 5 (accurate).
Respondents rate themselves on each item compared to
other people they know of the same age and sex. The
internal consistency for the Neuroticism scale was
acceptable (a = .79) in the current sample.
The Intolerance of Uncertainty Scale, Short Form (IUS12; Carleton et al. 2007a) is a 12-item questionnaire that
measures responses to uncertainty, ambiguous situations,
and the future. Items are rated on a 5-point Likert scale
ranging from 1 (not at all characteristic of me) to 5
(entirely characteristic of me). The IUS-12 has a continuous latent structure (Carleton et al. 2012b) and has been
shown to have two factors (Carleton et al. 2007a; McEvoy
and Mahoney 2011), prospective IU (7 items; e.g., I cant
stand being taken by surprise) and inhibitory IU (5 items;
e.g., When its time to act, uncertainty paralyses me).
The internal consistencies for the IUS-12 total score
(a = .93) and subscale scores (i.e., prospective IU
a = .89; inhibitory IU a = .90) were acceptable in the
current sample.

123

Cogn Ther Res (2013) 37:725734

Analytic Procedure
To begin, prevalence of probable PTSD in the current
sample was established based on the aforementioned cutoff score. Thereafter, to assess for potential differences in
IU between PTSD and other anxiety disorders, IU total and
subscale scores from those meeting criteria for probable
PTSD in the current sample were compared against those
meeting criteria for other mental disorders in previous
research conducted by our research team (Carleton et al.
2012). A power analysis to determine necessary sample
size, descriptive statistics, skewness and kurtosis, and
correlation analyses were performed to characterize the
data and initial interrelationships. Next, a series of four
hierarchical regression analyses were run to examine if IU
total scores accounted for statistically significant unique
variance in PCL-C subscale scores above and beyond time
since index trauma, neuroticism, and anxiety sensitivity.
The four dependent variables included (1) PCL-C reexperiencing, (2) PCL-C avoidance, (3) PCL-C numbing, and
(4) PCL-C hyperarousal. Independent variables included
the time since index trauma, ASI-3 total score, and Big 5
Mini-markers neuroticism subscale in step one, and then
IUS-12 total score in step two. Input of independent variables into steps one and two was based on the temporal
nature of time since index trauma in relation to the
development of PTSD, and neuroticism as being a consistent trait preceding the development of anxiety disorders
(Goldberg and Huxley 1991). No studies specifically outline the temporal etiology of anxiety sensitivity in respect
to IU; however, the established relationship between anxiety sensitivity and PTSD made anxiety sensitivity an
appropriate choice to input in step 1.
Evidence supports IU as an important, possibly necessary component of anxiety and anxiety sensitivity (Carleton 2012; Carleton et al. 2012, 2007b), suggesting primacy
of placement in a regression model (Tabachnick and Fidell
2001); however, the current study was designed to determine whether IU would account for statistically significant
and substantial variance beyond that accounted for by other
independent variables. As such, in the interest of thoroughness and paralleling prior research (Carleton et al.
2010), the four hierarchal regression analyses were also run
reversing the order of entry described above.
A third and fourth series of four analyses investigated
the unique contributions of the two IU subscales (i.e.,
prospective and inhibitory IU) to PTSD subscale scores.
The third and fourth series utilized the same dependent and
independent variable placement as the first and second
series respectively; however, each analysis included IUS12 inhibitory IU and IUS-12 prospective IU scores instead
of IUS-12 total scores. In an effort to maximize statistical
variance and power, while also being consistent with the

Cogn Ther Res (2013) 37:725734

proposed dimensional nature of PTSD (Forbes et al. 2005),

all participants, were included in the analyses for the current study. Assessing PTSD symptoms continuously is
consistent with contemporary correlational studies investigating PTSD symptoms and associated cognitive risk
factors (e.g., Fetzner et al. 2011; Vujanovic et al. 2011).
Due to the large number of analyses being conducted,
statistical significance was adjusted from p \ .05 to
p \ .01 to reduce the possibility of Type 1 error. Casespecific mean replacement was employed (less than 5 % of
cases) to address missing data points in participants who
filled out at least 95 % of the specific study measure.

Results
Participants reported experiencing an index trauma
153 months before the time of data collection. Frequencies of traumatic events endorsed and index traumas are
presented in Table 1. A total of 49 (40 %) participants in
the current sample exceeded the aforementioned cut-off
score on the PCL-C indicating probable PTSD. Participants
meeting criteria for probable PTSD in the current study had
a mean IUS-12 score of 42.04 (SD = 11.35), as well as
mean prospective and inhibitory IU scores of 24.66
(SD = 6.88) and 17.38 (5.17) respectively. As such, after a
Bonferroni correction, the IUS-12 total and subscale scores
in the probable PTSD subsample were not statistically
significantly different (all ps [ .05) from scores reported
by individuals with other mental disorders (i.e., social
anxiety disorder [n = 120], panic disorder with or without
agoraphobia [n = 89], generalized anxiety disorder
[n = 63], obsessive compulsive disorder [n = 60], and
major depressive disorder [n = 26]) previously reported by
Carleton, Mulvogue, and colleagues (2012). Specific
description of the demographic information from the clinical sample compared against is available in the original
manuscript.
A power analysis (f2 = .2, a = .05, number of predictors = 5) suggested that the number of participants available for the current study was sufficient to conduct the
proposed analyses. Table 2 includes the total and subscale
score correlational analyses, as well as measurements of
central tendencies. Pearson correlation analyses revealed
IUS-12 total scores and IUS-12 subscale scores (i.e., prospective IU and inhibitory IU) to be significantly associated
with PCL-C subscale scores, AS, and neuroticism. No
indices of univariate skewness and kurtosis were sufficiently out of range to preclude the planned analyses (i.e.,
had positive standardized skewness values that exceeded 2
or positive standardized kurtosis values that exceeded 7;
Tabachnick and Fidell 2001); nevertheless, bootstrapping
(2000 samplings) was used on all variables (Byrne 2001;

729
Table 1 Trauma reference and endorsement frequency
Type of trauma

Natural disaster

Index
trauma
Frequency (%)

Trauma
endorsement
Frequency (%)

2 (1.6)

38 (30.4)

Motor vehicle accident

11 (8.8)

92 (73.6)

Other serious accident

Serious fire

3 (2.4)
0 (0)

20 (16.0)
13 (10.4)

Seeing someone badly injured

3 (2.4)

31 (24.8)

27 (22.1)

49 (39.2)

Physical assault

8 (6.4)

45 (36.0)

Military combat or peacekeeping

0 (0)

1 (0.8)

Civilian living in a warzone

0 (0)

3 (2.4)

Terrorist attack

1 (0.8)

5 (4.0)

Torture

0 (0)

Sexual assault

Unexpected death of a loved one

27 (22.1)

2 (1.6)
80 (64.0)

Armed robbery

1 (.8)

2 (1.6)

Serious illness

3 (2.4)

31 (24.8)

Public humiliation

8 (6.4)

50 (40.0)

16 (12.8)

68 (54.4)

Being ridiculed

6 (4.8)

71 (56.8)

Other trauma

6 (4.8)

16 (12.8)

Being severely bullied

Trauma endorsement refers to whether the individual has ever

encountered the event regardless of their subjective response to the
event. Index trauma refers to the participants assessment of the worst
event that they have experienced out of all events encountered

Davison and Hinkley 2006) to maximize adherence to

normality requirements.
When time since index trauma, ASI-3, and Big-5 mini
markers neuroticism scale were entered into step 1 the
model accounted for 16 % of variance in re-experiencing,
17 % in avoidance, 25 % in numbing, and 34 % in PCL-C
hyperarousal. Time since index trauma accounted for significant unique variance in PCLC re-experiencing only.
ASI-3 scores accounted for significant unique variance in
each PCL-C subscale. Big-5 mini markers neuroticism
scale accounted for significant unique variance in PCL-C
numbing and hyperarousal. When IUS-12 scores were
entered into step 1, they accounted for significant amounts
of variance; 9 % in PCL-C re-experiencing, 9 % in PCL-C
avoidance, 9 % in PCL-C numbing, and 15 % in PCL-C
hyperarousal. When IUS-12 subscale scores were entered
into step 1, inhibitory IU but not prospective IU accounted
for significant amounts of unique variance. Variance
accounted for by the model included 11 % for PCL-C
re-experiencing, 20 % for PCL-C avoidance, 24 % for
PCL-C numbing, and 28 % for PCL-C hyperarousal.
The first and second series of four hierarchal regression
analyses are presented in Table 3. When IUS-12 total
scores were entered in step 2 along with time since index
trauma, ASI-3, and Big-5 mini markers neuroticism scale,

123

730

Cogn Ther Res (2013) 37:725734

Table 2 Means, standard deviations, skewness and kurtosis, and pearson correlations
S (SES)

K (SEK)

Variable

M (SD)

1. PCL-C rxp

12.50 (5.33)

.42 (.22)

-.71 (.41)

2. PCL-C avd

5.56 (2.68)

.19 (.22)

-1.19 (.41)

.76**

3. PCL-C nmb

13.05 (5.30)

.08 (.22)

-1.14 (.41)

.56**

.62**

-.73 (.41)

.52

**

**

.73**

**

**

.47**

4. PCL-C hyp

14.74 (5.08)

-.15 (.22)

.53

.56**

.02

-.06

5. ASI-3

30.04 (15.78)

-.17 (.22)

-.97 (.42)

.36

6. Time since
trauma

12.10 (12.56)

1.30(.22)

1.01 (.41)

-.15

7. Neuroticism
8. IUS-12 pro

20.60 (5.69)
21.88 (7.04)

.22 (.22)
.01 (.22)

.03 (.41)
-.85 (.43)

.26**
.28**

.17
.29**

.36**
.37**

.40**
.44**

.44**
.38**

-.02
.16 -.40**

9. IUS-12 inh

14.16 (5.84)

.11 (.22)

-1.10 (.43)

.34**

.44**

.49**

.53**

.46**

.04 -.46**

.75**

-.92 (.44)

**

**

**

**

**

**

.95**

10. IUS-12 tot

35.92 (12.00)

.07 (.22)

.32

.40

-.07

-.02

.38

.45

.50

.44

.12 -.46

.92**

Time since index trauma rated in months; ASI-3 Anxiety Sensitivity Index 3; IUS-12 Intolerance of Uncertainty Scale, Short Form; pro
prospective anxiety; inh inhibitory anxiety; Neuroticism Big 5 mini-markers neuroticism subscale; PCL-C Posttraumatic Checklist Civilian
version; hyp hyperarousal; avd avoidance; nmb numbing; rxp re-experiencing; SE Standard Error; S Skewness; K Kurtosis; *p \ .05; **p \ .01

Table 3 Summary of hierarchal regression analyses utilizing IU total scores as independent variables
DV

PCL-C rxp

Step

1(2)

Constant

Time since trauma

ASI-3

PCL-C avd

PCL-C nmb

PCL-C hyp

Coefficient statistics

Model step statistics

DR2

p
.30(.24)

.03(.04)

-.14(-.16)

.03(.03)
.17(.56)

Neuroticism

.13(.06)

2(1)

IUS-12 total

.21(.32)

1(2)

Time since index trauma

ASI-3

.41(.31)
-.05(-.10)

DF

f2

\.01(.04)

.19 (.04)

.16(.03)

7.53(4.49)

.05(\.01)

.10(.09)

13.82(4.27)

\.01(\.01)

.11 (.04)

.50(.24)
\.01(\.01)

.17(.07)

7.75(9.93)

\.01(\.01)

.17 (.08)

Neuroticism

-.01(-.11)

2(1)

IUS-12 total

.31(.38)

.01(\.01)

.91(.24)
.15(.09)

20.39(4.29)

\.01(\.01)

.18 (.08)

1(2)

Time since trauma

.38(.30)

.86(.76)

.25(.07)

13.25(8.20)

\.01(\.01)

.33 (.07)

ASI-3

.01(-.02)

\.01(\.01)

Neuroticism

.20(.11)

.05(.29)

2(1)

IUS-12 total

.26(.45)

\.01(\.01)

.24(.09)

29.77(5.70)

\.01(\.01)

.45 (.07)

1(2)

Time since trauma

.47(.38)

.52(.95)

.34(.06)

20.49(10.96)

\.01(\.01)

.51 (.01)

.04(.01)

\.01(\.01)
.25(.15)

40.43(9.52)

\.01(\.01)

.33 (.01)

ASI-3
Neuroticism
2(1)

IUS-12 total

-20(.11)
.28(.50)

.03(.24)
\.01(\.01)

DV Dependent variable; Time since trauma rated in months; PCL-C rxp Posttraumatic checklist civilian version re-experiencing subscale; PCL-C
avd Posttraumatic checklist civilian version avoidance subscale; PCL-C nmb Posttraumatic checklist civilian version numbing subscale; PCL-C
hyp Posttraumatic checklist civilian version hyperarousal subscale; ASI-3 Anxiety sensitivity index version 3; Neuroticism Big 5 mini-markers
neuroticism subscale; IUS-12 Intolerance of uncertainty scale12 items

the models accounted for 19 % of variance in PCL-C

re-experiencing, 24 % in PCL-C avoidance, 33 % in
PCL-C numbing, and 40 % in PCL-C hyperarousal. Time
since index trauma accounted for significant unique variance in PCL-C re-experiencing scores only. ASI-3 total
scores accounted for significant unique variance in each
PCL-C subscale score. Big-5 mini markers neuroticism
scale did not account for significant unique variance in any
PCL-C subscale score. IUS-12 total scores accounted for

123

significant unique variance in each PCL-C subscale score

except PCL-C re-experiencing.
The third and fourth hierarchal regression analyses are
presented in Table 4.When IUS-12 subscale scores were
entered into step 2 along with time since index trauma,
ASI-3, and Big-5 mini markers neuroticism scale, the
modes accounted for 19 % in PCL-C re-experiencing,
26 % in PCL-C avoidance, 34 % in PCL-C numbing, and
41 % in PCL-C hyperarousal. Time since index trauma

Cogn Ther Res (2013) 37:725734

731

Table 4 Summary of hierarchal regression analyses utilizing IU subscale scores as independent variables
DV

PCL-C rxp

Constant

Time since trauma

Step

1(2)

DR2

-.14(-.16)

.06(.04)
\.01(.03)

Neuroticism

.13(.06)

.15(.55)

2(1)

Time since trauma

1(2)

ASI-3
Neuroticism
IUS-12 pro

2(1)

IUS-12 inh
Time since trauma

1(2)

.08(.05)

.60(.74)

.15(.30)

.27(.02)

-.05(-.06)

.46(.42)

.41(.29)
-.01(-.12)

\.01(\.01)
.90(.20)

-.09(-.11)

.50(.40)

.44(.53)

\.01(\ .01)

.01(.00)

.85(.94)

ASI-3

.38(.28)

\.01(\.01)

Neuroticism

.20(.11)

.06(.34)

IUS-12 pro

2(1)

IUS-12 inh
PCL-C hyp

.30(.23)

IUS-12 pro

PCL-C nmb

Model step statistics

ASI-3

IUS-12 inh
PCL-C avd

Coefficient statistics

Time since trauma

1(2)

ASI-3
Neuroticism
IUS-12 pro
IUS-12 inh

2(1)

-.04(-.01)

.69(.93)

.34(.49)

\.01(\.01)

.04(.02)

.52(.710)

.47(.37)

\.01 \ (.01)

.20(.11)

.01(.22)

.02(.07)

.82(.50)

.29(.48)

.01(\.01)

DF

f2

\.01(.01)

.19 (.04)

.16 (.3)

7.53(3.80)

.08 (.11)

2.30(7.61)

.17 (.10)

7.75(3.38)

\.01 (.02)

.17 (.14)

.06 (.20)

8.00(15.04)

\.01 (\.01)

.25 (.14)

\.01 (\.01)

.25 (.10)

\.01 (\.01)

.31 (.10)

\.01 (\.01)

.52 (.12)

\.01 (\.01)

.39 (.12)

.25 (.09)

.07 (.24)
.34 (.07)

.13 (.28)

13.25(4.81)

5.83(18.35)
20.49(8.58)

6.51(22.88)

.11 (\.01)

.12 (.04)

DV dependent variable; Time since trauma rated in months; PCL-C rxp Posttraumatic checklist civilian version re-experiencing subscale; PCL-C
avd Posttraumatic checklist civilian version avoidance subscale; PCL-C nmb Posttraumatic checklist civilian version numbing subscale; PCL-C
hyp Posttraumatic checklist civilian version hyperarousal subscale; ASI-3 Anxiety sensitivity index version 3; Neuroticism Big 5 mini-markers
neuroticism subscale; IUS-12 Intolerance of uncertainty scale12 items; pro prospective anxiety subscale; inh inhibitory anxiety subscale

accounted for significant unique variance in PCL-C

re-experiencing only. ASI-3 total scores accounted for
significant unique variance in each PCL-C subscale. Big-5
mini markers neuroticism and IUS-12 prospective IU
subscales did not account for significant unique variance in
any PCL-C subscale. IUS-12 inhibitory IU accounted for
significant unique variance in each PCL-C subscale except
PCL-C re-experiencing.
In order to assess the relationship between IU and PTSD
symptoms as fully compliant with the current DSM-IV-TR
conceptualization of trauma, analyses were run without
individuals endorsing a social trauma (i.e., public humiliation, being severely bullied, and being ridiculed) as their
index trauma. Results suggested that IUS total scores
remained a significant predictor of PCL-C numbing
(p = .01), trended towards significance for PCL-C avoidance (p = .09), and was a non-significant predictor of
PCL-C re-experiencing and hyperarousal. In terms of IU
dimensions, IUS prospective remained a non-significant
predictor of each PCL-C subscale. IUS inhibitory remained
a significant predictor of PCL-C avoidance and numbing,
and was a non-significant predictor of PCL-C re-experiencing (p = .01) and hyperarousal (p = .01). Non-significant

results were likely a product of lack of power given the

reduction in numbers and demonstrated significance among
the full sample.

Discussion
The current study examined IU in terms of total and subscale scores (i.e., prospective and inhibitory IU), assessed
the individual PTSD symptom clusters (i.e., re-experiencing, avoidance, numbing, hyperarousal), utilized a contemporary measure of IU (i.e., the IUS-12), assessed
relationships among a community sample with a heterogeneous trauma history, and examined the role of IU relative to three theoretically relevant and empirically
established variables (i.e., time since index trauma, neuroticism, and anxiety sensitivity). Three key results
emerged. First, IUS-12 total scores accounted for significant unique variance in each of the PCL-C avoidance,
numbing, and hyperarousal subscale scores, but not in the
re-experiencing subscale scores. Second, inhibitory IU
scores accounted for significant unique variance in each of
the PCL-C avoidance, numbing, and hyperarousal subscale

123

732

scores, but not in the re-experiencing subscale scores.

Third, prospective IU did not account for significant unique
variance in PCL-C subscale scores. Differences in the
aforementioned findings between those who met strict
DSM-TR-IV Criterion A definitions of traumatic experiences and the full combined sample comprised in part by
individuals who had endured a social trauma (i.e., public
humiliation, severely bullied, being ridiculed) were minimal. Given that statistical artifacts (i.e., lack of power due
to small sample size) were likely the cause of the differences between samples, these findings speak to the generalizability of the current resultsparticularly with regards to
IUacross trauma types.
As predicted, IU total scores were associated with
avoidant responses, emotional numbness, and hyperarousal
symptoms of PTSD; however, contrary to predictions, IU
total scores did not account for significant variance in fearbased intrusive images (i.e., re-experiencing scores).
Despite IU total scores not accounting for statistically
significant variance in the re-experiencing symptom cluster, the relationship demonstrated a trend towards significance in the hierarchal regression analysis. Furthermore,
re-experiencing and IU were significantly correlated,
indicating the presence of a relationship albeit a smaller
one than demonstrated among other symptom clusters.
In line with prior research investigating IU and other
anxiety disorders (e.g., Carleton et al. 2012; McEvoy and
Mahoney 2011), the prospective and inhibitory IU subscales
accounted for different amounts of variance in PTSD
symptoms. Specifically, inhibitory IU accounted for significant unique variance, whereas prospective IU did not. A
similar pattern has been found in relationships between IU
and panic disorder, social anxiety disorder, and depression
(Carleton et al. 2010, 2012; McEvoy and Mahoney 2011,
2012). The relationship suggests that PTSD symptoms may
be related more to uncertainty causing inaction than uncertainty causing worry about the future. For example, individuals with salient PTSD symptoms may be concerned
about their inability to react effectively to current threats or
withstand the stress of being faced with trauma-related cues
or memories more so than the cognitive anxiety involved
with the potential for future uncertainty. Such speculation is
reasonable given the propensity for PTSD symptoms to
include a sense of foreshortened future (APA 2000) and to be
highly comorbid with depression (Beck et al. 2009).
The specific relationship between inhibitory IU and
PTSD symptoms may be further exemplified and explained
by examining the relationship with specific symptom
clusters. For example, numbing symptoms such as a sense
of foreshortened future (Criterion 7; APA 2000) may relate
to uncertainty regarding a perceived lack of future safety
and inhibition brought on by fear of future trauma. Higher
levels of IU may facilitate avoidance behaviours because of

123

Cogn Ther Res (2013) 37:725734

uncertainty regarding future traumatic exposures and

uncertainty regarding the presence of symptom triggers.
The association between inhibitory IU and PTSD symptoms may be more pronounced in cases where the peritraumatic reaction was one of uncertainty leading to
inhibition and the individual views themselves as having
contributed to the trauma in some way. Consequently,
future inhibition when faced with trauma-related cues may
precipitate strong physiological and emotional reactions
(e.g., hyperarousal symptoms) for fear of recurrence of a
similar trauma.
The current study also added to previous research
regarding three other variables with theoretical relevance
for PTSD (i.e., neuroticism, time since index trauma, and
anxiety sensitivity). First, in line with Boelen (2010)
assessing PTSD total scores, neuroticism was not substantively related to PTSD symptom cluster scores once IU
was entered into the second step of the model. Given that
neuroticism correlated significantly, albeit weakly, with
PTSD symptom cluster scores, results from the hierarchal
regression analyses suggest that neuroticism may have
shared variance with other variables in the analyses.
Indeed, neuroticism may better be accounted for by other
variables, such as IU and anxiety sensitivity (Thibodeau
et al. 2012), which may have stronger direct relationships
with PTSD (Taylor 2006). Second, extending Boelens
(2010) results assessing PTSD total scores, time since
index trauma only contributed significant amounts of variance to PTSD reexperiencing scores, but not PTSD
avoidance, numbing, or hyperarousal scores. The differences may have resulted from the current sample having a
heterogeneous trauma type history; specifically, 78 % of
the current sample referenced another trauma besides the
loss of a loved one as the most significant trauma
encountered. Alternatively, the differences may have
resulted from differences in time since the referenced
event. In Boelens (2010) study, the time since the loss of a
loved one ranged from 1 to 120 months, whereas in the
current study the time since the traumatic event ranged
only from 1 to 53 months. Third, the current results support
previous research indicating a strong and consistent relationship between anxiety sensitivity and PTSD (Asmundson and Stapleton 2008; Collimore et al. 2008; Fetzner
et al. 2011); despite the strength of this relationship, IU
remained significant beyond anxiety sensitivity in each
PTSD symptom cluster, except re-experiencing.
There were several limitations in the current study
providing direction for future research. First, the current
sample included a high proportion of women, and may not
generalize to samples composed entirely of men. Second,
the current sample was a community-based convenience
sample, and may not generalize to a clinical population.
That said, PTSD (Forbes et al. 2005) and IU (Carleton et al.

Cogn Ther Res (2013) 37:725734

2012b) are both dimensional constructs, which suggests

analogue samples may be ideal for exploring whether IU
represents a vulnerability factor for PTSD. Third, the current study was cross-sectional, making attributions of
causation impossible. Future research should explore the
relationship between IU, trauma, and PTSD using longitudinal designs. Fourth, the data from the current study
relied entirely on self-report measures; as such, confirmation of the presence of PTSD symptoms and comorbid
diagnoses within the current sample was unavailable. Fifth,
although past research has utilized negative social events as
index traumas (e.g., Fetzner et al. 2011), and the focus of
the current study was on symptomatology not index events,
25 % of the current sample referenced a negative social
event as an index trauma, which does not meet full criteria
for Criterion A and thus may limit generalizability to PTSD
diagnoses. Lastly, our measurement of IU involved a
general assessment of aversion to uncertainty; future
studies may benefit from assessing IU specific to a particular problem domain (i.e., IU specific to trauma and
PTSD symptoms).

Conclusions
Results regarding the relationships between IU and PTSD
symptoms may have important implications for therapy.
For example, it may be beneficial for clinicians to assess IU
when treating persons with PTSD, as a vulnerability factor
for, or a result of, traumatic exposure. Treatments targeting
IUespecially ones that target behavioural manifestations
of IU which the current study suggests as being most
strongly related to PTSD (e.g., behavioral exposures to
uncertain situations, Dugas and Robichaud 2007)may be
effective compliments to more trauma-focused interventions (e.g., prolonged exposure or processing of trauma
cognitions). Irrespective of the potential for direct treatment implications, recognizing that IU appears related to
PTSD symptoms independently of several established
constructs may provide beneficial insights for clinicians
and patients.

References
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed.). Washington, DC: Author.
Asmundson, G. J. G., Frombach, I., McQuaid, J., Pedrelli, P., Lenox,
R., & Stein, M. B. (2000). Dimensionality of posttraumatic stress
symptoms: A confirmatory factor analysis of DSM-IV symptom
clusters and other symptom models. Behaviour Research and
Therapy, 38, 203214.
Asmundson, G. J. G., & Stapleton, J. (2008). Associations between
dimensions of anxiety sensitivity and PTSD symptom clusters in

733
active-duty police officers. Cognitive Behaviour Therapy, 37,
6675. doi:10.1080/16506070801969005.
Beck, J., DeMond, G., Clapp, J., & Palyo, S. (2009). Understanding
the interpersonal impact of trauma: Contributions of PTSD and
depression. Journal of Anxiety Disorders, 23, 443450. doi:
10.10.16.
Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C.
A. (1996). Psychometric properties of the PTSD Checklist
(PCL). Behaviour Research and Therapy, 34, 669673. doi:
10.1016/0005-7967(96)00033-2.
Boelen, P. A. (2010). Intolerance of uncertainty and emotional
distress following the death of a loved one. Anxiety, Stress &
Coping, 23 (4) doi:10.1080/10615800903494135.
Boelen, P. A., & Carleton, R. N. (2012). Intolerance of uncertainty,
hypochondriacal concerns, obsessive compulsive symptoms, and
worry. Journal of Nervous and Mental Disease, 200, 208213.
doi:10.1097/NMD.0b013e318247cb17.
Boelen, P. A., & Reijntjes, A. (2009). Intolerance of uncertainty and
social anxiety. Journal of Anxiety Disorders, 23, 130135. doi:
10.1016/j.janxdis.2008.04.007.
Buhr, K., & Dugas, M. J. (2006). Investigating the construct validity
of intolerance of uncertainty and its unique relationship with
worry. Journal of Anxiety Disorders, 20, 222236. doi:10.1016/
j.janxdis.2004.12.004.
Byrne, B. (2001). Structural equation modeling with amos: Basic
concepts, applications, and programming. Mahwah, NJ:
Erlbaum.
Carleton, R. N. (2012). The intolerance of uncertainty construct in the
context of anxiety disorders: Theoretical and practical perspectives. Expert Reviews in Neurotheraputics, 12, 937947. doi:
10.1586/ERN.12.82.
Carleton, R. N., Brundin, P., Asmundson, G. J. G., & Taylor, S.
(2006). Traumatic life events questionnaire. Unpublished measure, Department of Psychology, University of Regina, Regina,
Canada.
Carleton, R. N., Collimore, K. C., & Asmundson, G. J. G. (2010).
Its not just the judgementsIts that I dont know: Intolerance of uncertainty as a predictor of social anxiety. Journal of
Anxiety Disorders, 24, 189195. doi:10.1016/j.janxdis.
2009.10.007.
Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E.,
Antony, M. M., & Asmundson, G. J. G. (2012a). 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.
Carleton, R. N., Norton, P. J., & Asmundson, G. J. G. (2007a).
Fearing the unknown: A short version of the intolerance of
uncertainty scale. Journal of Anxiety Disorders, 21, 105117.
doi:10.1016/j.janxdis.2006.03.01.
Carleton, R. N., Peluso, D. L., Collimore, K. C., & Asmundson, G.
J. G. (2011). Social anxiety and posttraumatic stress symptoms:
The impact of distressing social events. Journal of Anxiety
Disorders, 25(1), 4957.
Carleton, R. N., Sharpe, D., & Asmundson, G. J. G. (2007b). Anxiety
sensitivity and intolerance of uncertainty: Requisites of the
fundamental fears? Behaviour Research and Therapy, 45,
23072316. doi:10.1016/j.brat.2007.04.006.
Carleton, R. N., Weeks, J. W., Howell, A. N., Asmundson, G. J. G.,
Antony, M. M., & McCabe, R. E. (2012b). Assessing the latent
structure of the intolerance of uncertainty construct: An initial
taxometric analysis. Journal of Anxiety Disorders, 26, 150157.
doi:10.1016/j.janxdis.2011.10.006.
Collimore, C., Carleton, N., Hoffman, S., & Asmundson, G. (2010).
Posttraumatic stress and social anxiety: The interaction of
traumatic events and interpersonal fears. Depression and Anxiety, 27, 10171026. doi:10.1002/da.20728.

123

734
Collimore, C., McCabe, R., Carleton, R. N., & Asmundson, G.
(2008). Media exposure and dimensions of anxiety sensitivity
Differential associations with PTSD symptom clusters. Journal
of Anxiety Disorders, 22, 10211028. doi:10.1016/j.janxdis.
2007.11.002.
Davison, A. C., & Hinkley, D. V. (2006). Bootstrap methods and their
application. Cambridge, UK: Cambridge University Press.
Dugas, M. J., & Robichaud, M. (2007). Cognitive-behavioral
treatment for generalized anxiety disorder: From science to
practice. New York: Routledge.
Dugas, M. J., Schwartz, A., & Francis, K. (2004). Intolerance of
uncertainty, worry, and depression. Cognitive Therapy and
Research, 28, 835842.
Engelhard, I. M., Huijding, J., van den Hout, M. A., & de Jong, P. J.
(2007). Vulnerability associations and symptoms of posttraumatic stress disorder in soldiers deployed to Iraq. Behaviour
Research and Therapy, 45, 23172325. doi:10.1016/j.brat.
2007.04.005.
Engelhard, I. M., & van den Hout, M. A. (2007). Preexisting
neuroticism, subjective stressor severity, and posttraumatic stress
in soldiers deployed to Iraq. Canadian Journal of Psychiatry, 52,
505509.
Fetzner, M. G., Collimore, K. C., Carleton, R. N., & Asmundson, G.
J. G. (2011). Clarifying the relationship between AS dimensions
and PTSD symptom clusters: Are negative and positive affectivity theoretically relevant constructs? Cognitive Behaviour
Therapy, 41, 1525. doi:10.1080/16506073.2011.621971.
Forbes, D., Haslam, N., Williams, B. J., & Creamer, M. (2005).
Testing the latent structure of posttraumatic stress disorder: A
taxometric study of combat veterans. Journal of Traumatic
Stress, 18, 647656. doi:10.1002/jts.20073.
Friedman, M. J., Resnick, P. A., Bryant, R. A., & Brewin, C. R.
(2011). Considering PTSD for DSM-5. Depression and Anxiety,
28, 750769. doi:10.1002/da.20767.
Gentes, E. L., & 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.
Goldberg, D. P., & Huxley, P. (1991). Common mental disorders: A
biosocial model. London: Routledge.
Holaway, R. M., Heimberg, R. G., & Coles, M. E. (2006). A comparison
of intolerance of uncertainty in analogue obsessive compulsive
disorder and generalized anxiety disorder. Journal of Anxiety
Disorders, 20, 158174. doi:10.1016/janxdis.2005.01.002.
King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998).
Confirmatory factor analysis of the clinician-administered PTSD
scale: Evidence for the dimensionality of posttraumatic stress
disorder. Psychological Assessment, 10, 9096. doi:10.1037/10403590.10.2.90.
McEvoy, P. M., & Mahoney, A. E. J. (2011). Achieving certainty
about the structure of intolerance of uncertainty in a treatmentseeking sample with anxiety and depression. Journal of Anxiety
Disorders, 25, 112122. doi:10.1016/j.janxdis.2010.08.010.
McEvoy, P. M., & Mahoney, A. E. J. (2012). To be sure, to be sure:
Intolerance of uncertainty mediates symptoms of variance
anxiety disorders and depression. Behavioral Therapy, 43,
533545. doi:10.1016/j.beth.2011.02.007.
Nelson, B. D., & Shankman, S. A. (2011). Does intolerance of
uncertainty predict anticipatory startle responses to uncertain

123

Cogn Ther Res (2013) 37:725734

threat? International Journal of Psychophysiology, 81, 107115.
doi:10.1016/j.ijpsycho.2011.05.003.
Reiss, S., & McNally, R. (1985). The expectancy model of fear. In R.
Reiss & R. R. Bootzin (Eds.), Theoretical issues in behaviour
therapy (pp. 107121). New York, NY: Academic Press.
Riskind, J. H., Tzur, D., Williams, N. L., Mann, B., & Shahar, G.
(2007). Short-term predictive effects of the looming cognitive
style on anxiety disorder symptoms under restrictive methodological conditions. Behaviour Research and Therapy, 45,
17651777. doi:10.1016/j.brat.2006.12.007.
Saucier, G. (1994). Effects of variable selection on the factor structure
of person descriptors. Journal of Personality and Social
Psychology, 73, 12961312. doi:10.1037/0022-3514.73.6.1296.
Shelby, R. A., Golden-Kreutz, D. M., & Anderson, B. L. (2005).
Mismatch of posttraumatic stress disorder (PTSD) symptoms
and DSM-IV symptom clusters in a cancer sample: Exploratory
factor analysis of the PTSD Checklist-Civilian version. Journal
of Traumatic Stress, 18, 347357. doi:10.1002/jts.20033.
Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate
statistics (4th ed.). New York: Harper and Row.
Taylor, S. (2000). Understanding and treating panic disorder:
Cognitive behavioural approaches. Hoboken NJ: John Wiley.
Taylor, S. (2006). Clinicians guide to PTSD: A cognitive-behavioral
approach. New York NY: The Guilford Press.
Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G.,
Ledley, D. R., et al. (2007). Robust dimensions of anxiety
sensitivity: Development and initial validation of the Anxiety
Sensitivity Index-3. Psychological Assessment, 19, 176188.
doi:10.1037/1040-3590.19.2.176.
Thibodeau, M. A., Carleton, R. N., Collimore, K. C., & Asmundson,
G. J. G. (2012). From higher-order to underlying constructs:
Examining the relationships between affect and fundamental
fears. Cognitive Therapy and Research. doi:10.1007/s10608012-9468-1.
Thompson, E. R. (2008). Development and validation of an international English big-five mini-markers. Personality and Individual
Differences, 45, 542548. doi:10.1016/j.paid.200806.013.
Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., & Foa, E. B. (2003).
Intolerance of uncertainty in obsessive-compulsive disorder.
Journal of Anxiety Disorders, 17, 233242. doi:
10.1016/S0887-6185(02)00182-2.
Vujanovic, A. A., Bonn-Miller, M. O., Potter, C. M., Marshall, E. C.,
& Zvolensky, M. J. (2011). An evaluation of the relation
between distress tolerance and posttraumatic stress within a
trauma-exposed sample. Journal of Psychopathology and
Behavioral Assessment, 33, 129135. doi:10.1007/s10862-0109209-2.
Wald, J., & Taylor, S. (2007). Efficacy of interoceptive exposure
therapy combined with trauma-related exposure therapy for
posttraumatic stress disorder: A pilot study. Journal of Anxiety
Disorders, 21(8), 10501060.
Weathers, F. W., Litz, B. T., Herman, D. S., Huska, H. R., & Keane,
T. M. (1993). The PTSD checklist (PCL-C): Reliability, validity,
and diagnostic utility. San Antonio, TX: International Society
for Traumatic Stress Studies.
White, R. G., & Gumley, A. I. (2009). Postpsychotic posttraumatic
stress disorder: Associations with fear of recurrence and
intolerance of uncertainty. Journal of Nervous and Mental
Disease, 197, 841849. doi:10.1097/NMD.0b013e3181bea625.