Uncertainty distress: Theoretical underpinnings and clinical implications

Uncertainty distress is a psychological state defined as the set of negative emotions elicited by the unknown aspects of a given situation. The Uncertainty Distress Model (UDM;Freeston et al., 2020) highlights the role of threat, uncertainty, and intolerance of uncertainty in determining such distress in everyday life. Theoretically, the formulation of the UDM was inspired by three different research backgrounds, referring to threat models of anxiety and the concepts of <<perceived uncertainty and <<intolerance of uncertainty. In addition, clinical experiences in contexts characterized by high levels of uncertainty and threat (i.e., chronic diseases, dementia) and clinical considerations related to the current Coronavirus (Covid-19) pandemic have significantly contributed to this conceptualization. The current manuscript reviews the theoretical underpinnings and the clinical implications of the UDM. The main implications are not exclusively related to the field of psychopathology, since this model aims to provide an explanation for the <<normal responses to events that can impact people's lives. Future studies should empirically test its conceptual and applicative validity. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Italian) L'uncertainty distress e uno stato psicologico che viene definito come l'insieme delle emozioni negative che sono elicitate da aspetti non noti di una determinata situazione. Il modello dell'uncertainty distress (Uncertainty Distress Model, UDM;Freeston et al., 2020) analizza il ruolo che minaccia, incertezza e intolleranza all'incertezza esercitano nel determinare tale distress nella vita quotidiana. A livello teorico, la formulazione dell'UDM e stata ispirata da tre differenti filoni di ricerca, che fanno riferimento ai modelli relativi all'ansia basati sul costrutto di minaccia, il costrutto di <<incertezza percepita e quello di <<intolleranza all'incertezza. Un forte contributo concettuale e inoltre stato fornito da esperienze cliniche in contesti caratterizzati da alti livelli di incertezza e minaccia (ad esempio, malattie croniche, demenze) e da considerazioni cliniche emergenti nell'ambito dell'attuale pandemia di Coronavirus (Covid-19). Il presente lavoro si propone di passare in rassegna le basi teoriche e le implicazioni cliniche dell'Uncertainty Distress Model. Le principali implicazioni derivabili dall'Uncertainty Distress Model non riguardano esclusivamente l'ambito della psicopatologia, dal momento che tale modello fornisce una chiave di lettura delle <<normali risposte psicologiche che possono manifestarsi a seguito di eventi in grado di esercitare un forte impatto sulla vita delle persone. Studi futuri dovranno testarne empiricamente la validita concettuale e applicativa. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Uncertainty distress: Theoretical underpinnings and clinical implications

(Italian) L'uncertainty distress e uno stato psicologico che viene definito come l'insieme delle emozioni negative che sono elicitate da aspetti non noti di una determinata situazione. Il modello dell'uncertainty distress (Uncertainty Distress Model, UDM;Freeston et al., 2020) analizza il ruolo che minaccia, incertezza e intolleranza all'incertezza esercitano nel determinare tale distress nella vita quotidiana. A livello teorico, la formulazione dell'UDM e stata ispirata da tre differenti filoni di ricerca, che fanno riferimento ai modelli relativi all'ansia basati sul costrutto di minaccia, il costrutto di <<incertezza percepita e quello di <<intolleranza all'incertezza. Un forte contributo concettuale e inoltre stato fornito da esperienze cliniche in contesti caratterizzati da alti livelli di incertezza e minaccia (ad esempio, malattie croniche, demenze) e da considerazioni cliniche emergenti nell'ambito dell'attuale pandemia di Coronavirus (Covid-19). Il presente lavoro si propone di passare in rassegna le basi teoriche e le implicazioni cliniche dell'Uncertainty Distress Model. Le principali implicazioni derivabili dall'Uncertainty Distress Model non riguardano esclusivamente l'ambito della psicopatologia, dal momento che tale modello fornisce una chiave di lettura delle <<normali risposte psicologiche che possono manifestarsi a seguito di eventi in grado di esercitare un forte impatto sulla vita delle persone. Studi futuri dovranno testarne empiricamente la validita concettuale e applicativa. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The Trap of the COVID-19 Pandemic: Italian Adolescents Fare Well at First, Maybe Thanks to Protective Trait Expression.

Abundant research indicates that the COVID-19 pandemic has been negatively affecting mental health in adolescence. Few works, however, benefit from data from the same sample before and after the onset of the pandemic. The present longitudinal study involved a non-clinical group of 136 Italian adolescents (Mage = 16.3 years ± 1.08, 67% girls) to investigate their psychological response to the first lockdown and explore the role of a protective trait (i.e., Positivity) in moderating the effect of Intolerance of Uncertainty (IU) on internalizing symptoms before and during the COVID-19 outbreak. Participants completed self-report questionnaires assessing psychopathological symptoms, psychological well-being, IU, and Positivity on three separate occasions: October 2019 (T1), January 2020 (T2), and April 2020 (T3). The results showed that internalizing and externalizing symptoms as well as psychological well-being did not vary significantly over time. Positivity was found to significantly moderate the relationship between IU and internalizing symptoms at T3 (i.e., during the COVID-19 lockdown) only. Overall, our findings suggest that the teenagers' good adjustment to the initial phase of the pandemic might have been associated with the enhanced weight of the Positivity trait, which may have encouraged a positive attitude towards self, life, and the future.

Assessment of perceived support in the context of emergency: Development and validation of the psycho-social support scale

In research and clinical contexts, it is important to briefly evaluate perceived Psychological and Social Support (PSS) to plan psychological interventions and allocate efforts and resources. However, an appropriate brief assessment tool for PSS was lacking. This study aimed at developing a brief and accurate scale to specifically measure PSS in clinical and emergency contexts, with specific, relevant, targeted, and irredundant items. Experienced clinicians developed the perceived Psycho-Social Support Scale (PSSS) and administered it to a clinical sample (N = 112) seeking psychological help during the COVID-19 emergency. A Confirmatory Factor Analysis examined the PSSS internal structure, and a Multiple Indicator and Multiple Causes model investigated its association with the number of sessions and emotional symptoms. The PSSS showed good psychometric properties and the Confirmatory Factor Analysis provided acceptable fit indexes for a unidimensional structure. The Multiple Indicators and Multiple Causes revealed that more sessions and emotional symptoms were associated with lower PSSS scores. The PSSS is a reliable brief tool to measure PS and could be useful to individualize treatments (i.e., number of sessions) to efficiently allocate efforts and resources in clinical contexts and emergencies (e.g., earthquake, COVID-19 pandemic). Supplementary Information The online version contains supplementary material available at 10.1007/s12144-022-03344-z.

Psychological distress in the context of the COVID-19 pandemic: the joint contribution of intolerance of uncertainty and cyberchondria.

OBJECTIVE: To explore the direct and indirect associations between intolerance of uncertainty, health anxiety (HA), and psychological distress through problematic internet use (PIU) and cyberchondria, both before and during the first months of the COVID-19 pandemic. DESIGN: Two Italian samples were enrolled via an online questionnaire. Sample 1 (N = 556; 69.3% females, Mage 29.6 years, SD = 13.2) was recruited in non-pandemic times, whereas Sample 2 (N = 575; 74% females, Mage 31.9 years, SD = 13.4) was recruited during the COVID-19 lockdown. MAIN OUTCOME MEASURES: Self-report measures assessing HA and psychological distress. RESULTS: Two distinct path analyses showed that intolerance of uncertainty was directly associated with HA and psychological distress in both samples. Moreover, cyberchondria partially mediated the relationship between intolerance of uncertainty and HA and PIU partially mediated the relationship between intolerance of uncertainty and psychological distress in both samples. The link between cyberchondria and psychological distress was significant in Sample 2 but non-significant in Sample 1. The model accounted for a substantial variance of HA and psychological distress in both samples. CONCLUSION: Our findings suggest that problematic online behaviors might exacerbate the negative consequences of intolerance of uncertainty in terms of higher levels of HA and psychological distress both in pandemic and non-pandemic contexts.

Towards a model of uncertainty distress in the context of Coronavirus (COVID-19).

The paper forms part of a series of papers outlining the theoretical framework for a new model of uncertainty distress (this paper), treatment implications arising from the model, and empirical tests of the model. We define uncertainty distress as the subjective negative emotions experienced in response to the as yet unknown aspects of a given situation. In the first paper we draw on a robust body of research on distinct areas including: threat models of anxiety, perceived illness uncertainty and intolerance of uncertainty. We explore how threat and uncertainty are separable in anxiety and how we can understand behaviours in response to uncertainty. Finally, we propose a clinically, theoretically and empirically informed model for uncertainty distress, and outline how this model can be tested. Caveats, clinical applications and practitioner key points are briefly included, although these are more fully outlined in the treatment implications article. While we outline this model in the context of novel coronavirus (COVID-19), the model has broader applications to both mental and physical health care settings. KEY LEARNING AIMS: (1)To define the concept of uncertainty distress.(2)To understand the role of threat, over-estimation of threat, perceived uncertainty, actual uncertainty, and intolerance of uncertainty in distress maintenance.(3)To understand how people may behave in response to uncertainty distress.(4)To describe a model of uncertainty distress.

Facing distress in Coronavirus era: The role of maladaptive personality traits and coping strategies.

The aim of the current study was to investigate the intersecting roles of dysfunctional personality traits and coping styles in relation to psychological distress during the Italian national lockdown caused by the COVID-19 pandemic. Participants included 633 adults who completed questionnaires of maladaptive personality traits, coping styles, and psychological distress. Results indicated that all the maladaptive traits were associated with psychological distress with magnitude of associations strongest for Negative Affect and weakest for Antagonism. Maladaptive traits were also generally positively associated with avoidant/maladaptive and negatively associated with acceptance and positive reframing, forms of coping. A series of path analyses further demonstrated that coping strategies partially explained associations between maladaptive personality traits and psychological distress. All told, results suggest that during an unprecedented stressful time, associations between maladaptive personality traits and psychological distress may be, at least in part, explained by maladaptive coping strategies.

Health Anxiety Predicts the Perceived Dangerousness of COVID-19 over and above Intrusive Illness-Related Thoughts, Contamination Symptoms, and State and Trait Negative Affect.

This study sought to evaluate the specificity of health anxiety, relative to other forms of psychopathology, in perceptions of COVID-19 as dangerous. Measures of health anxiety, COVID-19 perceived dangerousness, negative affect, anxiety, depression, stress, contamination-related obsessions and compulsions, and intrusive illness-related thoughts were administered online to 742 community individuals during the Italian national lockdown. Results showed that, after controlling for demographic variables and other internalizing problems, health anxiety was the single most important factor associated with the perceived dangerousness of COVID-19. Moreover, a comparison between the current sample's scores on various symptom measures and scores from prepandemic Italian samples revealed that, whereas other internalizing symptoms increased by a large or very large magnitude during the pandemic, levels of health anxiety and negative affect increased by a medium amount. This result may indicate that health anxiety is relatively trait-like, increasing the likelihood that our correlational data support the model of health anxiety as a vulnerability rather than an outcome. Together, these results indicate that health anxiety may be a specific risk factor for COVID-related maladjustment and support the distinction of health anxiety from other psychological problems.

Psychopathy and COVID-19: Triarchic model traits as predictors of disease-risk perceptions and emotional well-being during a global pandemic.

This study extended recent research showing that perceptions of disease risk are associated with emotional well-being during COVID-19 by examining how psychopathic traits of boldness, meanness, and disinhibition influence these perceptions and psychological outcomes. During the Italian national lockdown, a large community sample (M age = 31.3 years) completed online questionnaire measures of the triarchic psychopathic traits, perceptions of disease susceptibility and danger, and recent well-being. Path analyses revealed differing roles for the triarchic traits: boldness and meanness predicted greater well-being (lower stress, higher positive affect) and disinhibition predicted lower well-being. Further, boldness and meanness were linked to well-being through distinct indirect pathways of low perceived susceptibility to infection (boldness) and low perceived dangerousness of COVID-19 (boldness and meanness). Findings speak to the triarchic model's utility in explaining socioemotional phenomena during times of crisis and support the distinct biobehavioral conceptualizations of boldness as low threat sensitivity, meanness as low affiliative capacity, and disinhibition as deficient affective and behavioral control.