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listas de contenidos ofrecidos en ScienceDirect

Journal of Anxiety Disorders

La intolerancia de la incertidumbre como predictor de síntomas de estrés postraumático siguiendo


un evento traumatico

María MI. Oglesby, José W. Boffa, Nicole A. corto, Amanda M. Raines, Norman SI. Schmidt *

Florida Estado Universidad, Estados Unidos

información del artículo resumen

Artículo historia: Intolerancia a la incertidumbre (IU) se ha asociado con síntomas elevados de estrés postraumático (PTSS) en la literatura existente. Sin embargo, ninguna
recibido el 27 de Recibido en el año 2015 de
investigación hasta la fecha ha investigado si la pre-trauma IU predice PTS tras la exposición al trauma. El presente estudio examinó prospectivamente la
agosto de forma 15 revisada Aceptado 11 de
relación entre IU y PTS dentro de una muestra de individuos con diferentes niveles de exposición a un tiroteo en el campus universitario. La hipótesis de que el
diciembre de el año 2015 Disponible de enero de
trauma pre-IU predeciría PTS elevada tras un tiroteo campus, incluso después de covarying para la sensibilidad a la ansiedad (AS), un correlato conocida de
el año 2016 xxx en línea
STP. Entre los participantes estudiantes ( n = 77) que completaron una batería de auto-informe de introducción a la psicología. Después de un tiroteo campus,
fueron invitados a completar las medidas de los síntomas de TEPT y el nivel de exposición a los disparos. Como se preveía, los resultados revelaron
pre-trauma IU como un predictor significativo del PTS elevada después de los disparos del campus. Estos resultados permanecieron significativos después
palabras clave:
covarying para los niveles pre-trauma de AS. Nuestros resultados son los primeros en demostrar que los niveles elevados de pre-trauma de IU predicen más
La intolerancia de la incertidumbre del

trauma TEPT Riesgo factor


adelante PTS tras la exposición a un acontecimiento traumático. Este hallazgo se discute en términos de direcciones prometedoras para futuras estrategias de
investigación y tratamiento.

© 2016 Publicado por Elsevier Ltd.

1. Introducción ( Kilpatrick y Resnick, 1993 ). Sin embargo, una minoría signi fi cativo continúan experimentando PTS, con
un poco de desarrollo fi malestar clínicamente significativo o deterioro criterios y reuniones para el TEPT.
La exposición a una acontecimiento traumático es común entre la población en general, con las Tanto la gravedad PTS elevada y trastorno de estrés postraumático se asocian con una serie de
tasas de prevalencia de la exposición al trauma estimados en aproximadamente 70-80% de individuos ( Frans,
resultados negativos, incluyendo la angustia signi fi cativa, interpersonal y la disfunción ocupacional, así
Rimmö, Aberg, y Fredrikson, 2005 ; Resnick, Kilpatrick, Dansky, Saunders, y el mejor de 1993 ). Mientras responde
como el riesgo para las enfermedades mentales comórbidos y las tendencias suicidas ( Kessler, 2000 ; Marshall
a eventos traumáticos varían, la mayoría de los individuos experimentan algunos grado de síntomas de et al., 2001 ). Dada la angustia y deterioro asociado con PTS, la identificación de factores de riesgo que
estrés postraumático (STP) del de el agudo después de un trauma ( Kilpatrick y Resnick, 1993 ), cual, cuandopueden contribuir al aumento de la sintomatología es importante. Kraemer, Lowe y Kupfer (2005) proporcionar
elevado, puede ser un factor de riesgo para un futuro post-traumático estrés trastorno (TEPT) diagnóstico una delineación útil de riesgo. Específicamente, un verdadero factor de riesgo debe estar relacionado con
( Ullman y Filipas, 2001 ). Específicamente, PTS incluir volver a experimentar el evento a través de un resultado no deseado, temporalmente anteceder el resultado deseado, y sea maleable ( Kraemer et al.,
pesadillas, flashbacks, y intruso recuerdos; evitación de recordatorios del evento; entumecimiento síntomas 2005 ). Varios factores se han implicado para poner a una persona en riesgo de trastorno de estrés
tales como la incapacidad de sentir emociones positivas y la pérdida de interés en antes otorgada postraumático, como la edad y el sexo ( Brewin, Andrews, y Valentine, 2000 ). Sin embargo, estos factores
actividades; y la hiperactivación síntomas, tales como hipervigilancia y problemas para dormir ( Ballenger no se pueden cambiar y se consideran fijos los marcadores de riesgo de Kraemer et al. (2005) . Aunque los
et al., 2000 ). La mayoría de los individuos expuestos a una traumática evento recuperarse de estos marcadores fijos son importantes para entender el riesgo de trastorno de estrés postraumático, sólo los
síntomas dentro de unos meses verdaderos factores de riesgo pueden ser mitigados a través de intervenciones preventivas.

Uno de los factores de vulnerabilidad psicológica que pueden transmitir riesgo de aumento de PTS es

intolerancia a la incertidumbre (UI). Los individuos con alto contenido de IU muestran una tendencia a
* El primer autor en: Departamento de Psicología, Universidad del Estado de Florida, 1107W. llame a St Tallahassee, responder negativamente a situaciones inciertas o ambiguas en un cognitiva, emocional y comporta-
FL 32306, Estados Unidos. Fax: 1 850 644 7739.
Email habla a: schmidt@psy.fsu.edu (NB Schmidt).

http://dx.doi.org/10.1016/j.janxdis.2016.01.005
0887-6185 / © 2016 Publicado por Elsevier Ltd.

Por favor citar este artículo de prensa como: Oglesby, METRO. E., et al. Intolerancia a la incertidumbre como un predictor de los síntomas de estrés postraumático después de una evento traumatico. Journal of
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oral nivel ( Dugas, Schwartz, y Francis, 2004 ). Además, consideran el posibilidad de una evento negativo under review ). Consistent with theories of AS ( Taylor, Koch, & McNally, 1992 ) we expected and found
que ocurre como inaceptable y amenazante, independientemente de la probabilidad de su ocurrencia ( Carleton,
data consistent with the idea that high AS in the context of higher trauma exposure resulted in higher
Norton, y Asmundson de 2007 ). Como tal, los individuos alta en IU intentar evitar situaciones ambiguas, rates of PTSS. However, we considered that IU would likely be differentially related to trauma.
lo que puede Conducir a aumentado la ansiedad con el tiempo. Investigaciones anteriores han Whereas AS amplifies responses to stress, IU is most likely to contribute to anxiety in the anticipation
of a future threat versus a known or prior stressor ( Carleton et al., 2012 ; Dugas et al., 2005 ; Epstein,
encontrado que IU maleable, con reducciones estudios hallazgo en UI a pre postoperatorio ( Boswell, Thompson-Hollands,
Farchione, y Barlow, 2013 ; Dugas y Ladouceur, 2000 ). Además, el existente literatura tiene se muestra 1972 ; Holaway, Heimberg, & Coles, 2006 ; Krohne, 1993 ). Accordingly, we did not hypothesize that
robusta asociaciones entre IU y varios la ansiedad relacionada trastornos, lo que lleva a los pre-trauma IU would interact with level of exposure to a traumatic event to produce increased PTSS.
investigadores conceptualizan como una UI importante transdiagnóstico variable de diferencia
individual dentro ansiedad (trastornos Carleton et al, 2012.; Mahoney y McEvoy, 2012; McEvoy y Mahoney,
2012 ). A pesar de esto conceptualización, la relación entre IU y trastorno de estrés postraumático es understudied.
De hecho, sólo dos estudios realizados hasta la fecha han examinado el relación entre IU y STP. Por
ejemplo, Fetzner, Horswill, Boelen, y Carleton (2013) investigado la relación entre IU y PTSS la
utilización de los individuos expuestos al trauma de la comunidad. Dentro de este muestra, los autores
2. Methods
encontraron UI ser significativamente relacionado con el trastorno de estrés postraumático síntomas
de evitación, embotamiento, y hiperexcitación, pero no reexperimentación. En un estudio separado, Bardeen,
2.1. Participants
Fergus, y Wu (2013) examinado el relación entre IU, preocupación, y STP. resultados IU se indica como
moderador significantes en el relación entre la preocupación y la síntoma de dominio de hiperexcitación trastorno
Participants consisted of 50 undergraduate students recruited from a large southern university.
de estrés postraumático dentro de una muestra de estudiantes universitarios que respaldan una evento
The sample was primarily female (78%), with ages ranging from 17 to 20 ( M = 18.22, SD = .58). The
de vida traumática. Estos hallazgos proporcionan apoyo inicial para una relación entre IU y aumento de
majority of the sample identified as Caucasian (82%) followed by African American (8%) and Asian
PTS, pero una brecha crucial en el literatura todavía permanece. Específicamente, ninguna
(2%), with 8% declining to respond.
investigación hasta la fecha ha examinado si es IU prospectivamente relacionado con un aumento en
PTSS siguiente exposición a una evento traumatico. Este conocimiento es fundamental, dado el importancia
de temporal antecedente al determinar si una variable transmite riesgo de un resultado específico ( Kraemer
et Alabama., 2005 ). Teniendo en cuenta esta brecha en el la literatura, el estudio investigó si IU antes de acontecimiento
2.2. Procedure
traumático se asocia de forma prospectiva con aumento PTS después de un evento traumático. La
hipótesis de que IU antes de una acontecimiento traumático podría predecir PTS siguiente exposición
Students enrolled in introductory psychology courses are required to gain exposure to research
a una trauma. Teniendo en cuenta la investigación anterior resaltado el importante papel de la
by either writing a research paper or participating in research experiments conducted within the
ansiedad sensibilidad (AS) en relación con PTSS ( Bernstein et al., 2005 ; Naragon-Gainey, 2010 ; Olatunji
psychology department. As a part of a screening process to determine eligibility for individual
y Wolitzky-Taylor, 2009 ), Y el trabajo más reciente demostrando AS como una futuro predictor de PTS
experiments, 813 students enrolled in Introductory to Psychology in fall 2014 completed a large
después de un evento traumático ( Boffa et Alabama., debajo revisión ), También se han interesado en
battery of self-report questionnaires at the beginning of the semester. The entire battery took
el estudio de la relación Entre pre-trauma IU y postraumático PTS después de considerar los niveles de
approximately one hour to complete and participants received 1 course credit for their participation.
pre-trauma de la EA. AS se cree que actúa como un catión de fi cador factor en el contexto de
On November 21, 2014, a gunman opened fire in the campus library, leaving three students wounded
factores de estrés ( Boffa et al., En revisión ). por lo tanto, nosotros la hipótesis de que la relación entre
before being fatally shot by police. In the weeks following this incident, students who completed the
el pre-trauma IU y post-trauma PTSS would remain significant even after covarying for pre-trauma AS.
mass screening at the beginning of the fall 2014 semester were emailed a brief survey regarding their
To further examine the relationship between pre-trauma IU and PTSS following a traumatic event, we examined
experiences with the adverse event. Eighty individuals completed this follow-up survey which took
how IU related to the four DSM-IV PTSD symptom domains (i.e., hyperarousal, re-experiencing,
approximately 20 min to complete, with an average response time of 17.19 days (SD = 6.36) after the
numbing, and avoidance), after covarying for pre-trauma levels of AS. We hypothesized that pre-trauma levels
shooting occurred. Of the 80 individuals who completed the follow-up assessment, 25 reported no
of IU would be significantly associated with the post-trauma hyperarousal symptom domain after
direct exposure (i.e., did not directly experience, witness, or learn about the event occurring to
covarying for pre-trauma AS, given the consensus in regards to IU and this symptom cluster in previous research
someone they were close to) and thus were excluded from the current analyses. In addition, data
( Bardeen et al., 2013 ; Fetzner et al., 2013 ). No a priori hypotheses were made regarding pre-trauma IU
were missing from another 5 individuals bringing the final sample size to 50. As compensation for
and the remaining PTSD symptom domains (i.e., re-experiencing, numbing, and avoidance) due to
participation, all individuals who completed the follow-up assessment were entered into a drawing for
limited previous research investigating these relationships.
the chance to win one of three $50 Visa gift cards. All procedures for the study were approved by the
university’s Institutional Review Board and informed consent was obtained prior to data collection.

2.3. Measures

2.3.1. Anxiety sensitivity index (ASI)


The ASI is a 16-item self-report questionnaire measuring the feared physical, cognitive, and
social consequences associated with anxious arousal ( Reiss, Peterson, Gursky, & McNally, 1986 ).
Participants were asked to rate how much they agreed with each item on a 5-point Likert-type scale
ranging from 0 ( very little) to 4 ( very much). The ASI has previously demonstrated good psychometric
We were also interested in an exploratory analysis focused on whether IU would interact with properties ( Taylor et al., 1992 ). The ASI was administered initially at screening and during the
trauma exposure. In this sample, we found that AS interacted with level of exposure to a traumatic event follow-up assessment. In the
to predict increased PTSS following a trauma ( Boffa et al.,

Por favor citar este artículo de prensa como: Oglesby, METRO. E., et al. Intolerancia a la incertidumbre como un predictor de los síntomas de estrés postraumático después de una evento traumatico. Journal of
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present investigation only the screening total score was included as a covariate. Internal consistency Table 1
Zero-order correlation, means, and standard deviations.
was good at screening ( ˛ = . 89).
Measure 1 2 3 4 5 6 7M (SD)

2.3.2. Intolerance of uncertainty scale (IUS) 1. ASI – 23.20 11.59

The IUS is a 27-item self-report questionnaire assessing the degree to which individuals are able to 2. IUS-3 . 61 ** – 8.00 3.43
3. PCL total . 50 ** . 51 ** – 27.94 12.91
tolerate uncertainty of ambiguous situations, the cognitive and behavioral responses to uncertainty, perceived
4. PCL re-exp . 49 ** . 51 ** . 94 ** – 8.10 3.76
implications of uncertainty, and attempts to control the future ( Freeston, Rhéaume, Letarte, Dugas, & 5. PCL hyper . 42 * . 50 ** . 93 ** . 82 ** – 9.50 4.90
Ladouceur, 1994 ). Items are rated on a 5-point Likert-type scale ranging from 0 ( Not at all characteristic 6. PCL avoid . 40 * . 39 * . 80 ** . 74 ** . 62 ** – 3.34 1.94

of me) to 5 ( Entirely characteristic of me). 7. PCL numb . 50 ** . 42 * . 94 ** . 87 ** . 83 ** . 73 ** – 7.00 3.44

Note. ASI = anxiety sensitivity index; IUS–3 = intolerance of uncertainty scale. 3-item total score (items 5, 6, 26); PCL-C =
posttraumatic checklist, civilian version; PCL reexp = PCL-C re-experiencing symptoms; PCL hyper = PCL-C
hyperarousal symptoms; PCL avoid = PCL-C avoidance symptoms; PCL numb = PCL-C numbing symptoms.
Due to space constraints in the mass screening, only three items of the IUS-27 were administered in the
initial screening battery (item 5 “My mind can’t be relaxed if I don’t know what will happen tomorrow,” *
p < . 01.
item 6 “Uncertainty makes me uneasy, anxious, or stressed,” and item 26 “The ambiguities in life stress **
p < . 001.
me out”). However, correlation analyses found our abbreviated index of IU to be highly associated with
the IUS-27 total score in various clinical, undergraduate, and community samples ( r ’ s range from .87 to
excellent internal consistency within the present investigation ( ˛ ’s ranged from .82 to .95).

. 90). Therefore, we believe that our abbreviated IUS total score is representative of the overall construct
3. Results
of IU and permissible to use. The IUS has demonstrated good psychometric properties including high internal
consistency, retest reliability, and convergent and divergent validity ( Buhr and Dugas, 2002 ). In the
3.1. Preliminary analyses
current sample, the three IUS items (IUS-3) demonstrated excellent internal consistency ( ˛ = . 91).

The means, standard deviations, and zero-order correlations for all variables of interest in the
current sample are described in Table 1 . As hypothesized, total post-trauma PCL-C scores were
significantly correlated with pre-trauma IUS-3 scores. In addition, post-trauma PCL-C scores were
significantly associated with pre-trauma ASI scores. The IUS-3 and ASI were both significantly
2.3.3. Physical exposure questionnaire (PEQ) correlated with each of the four PCL-C symptom clusters (i.e., hyperarousal, re-experiencing,
The PEQ is a 15-item self-report questionnaire designed to assess level of exposure to the shooting avoidance, and numbing). Finally, pre-trauma ASI and IUS-3 scores were also significantly correlated
as it occurred. This measure was adapted from previous research examining trauma exposure ( Littleton, with one another.
Grills-Taquechel, & Axsom, 2009 ; Stephenson, Valentiner, Kumpula, & Orcutt, 2009 ). Specifically,
participants were asked to respond “Yes” or “No” to various questions designed to determine ones proximity
to the event. Furthermore, responses to specific questions are summed to create a “moderate” and
“high” exposure level score. From this measure, participants were selected if they endorsed moderate or
high exposure to the shooting. Of the final sample, 50% ( n = 25) individuals reported being in a campus building
3.2. Primary analyses
that was locked-down, or saw police surround the building, but did not report any other experiences,
and were categorized as ‘moderate’ exposure. The other 50% ( n = 25) of the sample endorsed experiencing
To test our primary hypothesis, a linear regression analysis was conducted to assess the
‘high’ exposure to the shooting, such as being in the building where the shooting occurred, hearing
relationship between pre-trauma IU and post-trauma PTSS after covarying for pre-trauma AS (i.e.,
gunfire, seeing the gunman or the gunman fire upon anyone, seeing individuals wounded, or knowing
ASI total score). Pre-trauma AS and pre-trauma IU scores were entered into Step 1 of the model. The
someone who was wounded.
overall model was significant [ F ( 2, 47) = 10.64, p < . 001, r 2 = . 312]. Consistent with hypotheses,
pre-trauma IU [ ˇ = . 32, t = 2.12, p = . 04, sr 2 = . 07] significantly predicted post-trauma PTSS above and
beyond pre-trauma AS [ ˇ = . 30,

t = 1.95, p = . 06, sr 2 = . 06], which was only marginally significant in relation to post-trauma PTSS.

Next, a series of linear regression analyses were conducted to assess the relationships between
2.3.4. Posttraumatic stress disorder checklist (PCL-C) pre-trauma IU and each of the four post-trauma PTSS clusters (i.e., hyperarousal, re-experiencing,
The PCL-C is a 17-item self-report measure assessing various symptoms of PTSD ( Weathers, Litz, emotional numbing, and avoidance) after covarying for pre-trauma AS. Pre-trauma AS and pre-trauma
IU scores were entered into Step 1 of the models. In each of these analyses, the overall model was
Herman, Huska, & Keane, 1994 ). In the current study, the PCL-C was administered only at follow-up and was
modified to specifically index symptoms related to the recent campus shooting. In particular, participants significant (all p ’s < .01). As hypothesized, pre-trauma IU was significantly related to the hyperarousal
were asked to indicate the degree to which they had been bothered by each problem on a 5-point Likert-type PTSS cluster [ ˇ = . 38, t = 2.41, p = . 02, sr 2 = . 09]; however, pre-trauma AS was not significantly related to
scale ranging from 1 ( Not at all) to 5 ( Extremely) since the shooting occurred, and as a direct result of the hyperarousal PTSS cluster [ ˇ = . 19,
their experience with the shooting with the following prompt: “The following questions will now focus on
your direct experience with the shooting that occurred at Strozier Library on the FSU campus in
November. Please answer all questions as they relate to your experiences since that time.” In addition to
t = 1.23, p = . 23, sr 2 = . 02]. Though not originally hypothesized, pretrauma IU was significantly related to
a total score, the PCLC yields four subscales including hyperarousal, re-experiencing, numbing, and avoidance.
The PCL-C has demonstrated good psychometric properties in prior research ( Wilkins, Lang, & the re-experiencing PTSS cluster [ ˇ = . 33, t = 2.17, p = . 04, sr 2 = . 07], but pre-trauma AS was only
Norman, 2011 ). Likewise, the PCL-C total score and subscale scores demonstrated good marginally significant in relation to the re-experiencing PTSS cluster [ ˇ = . 29, t = 1.90, p = . 06, sr 2 = . 05].
Pre-trauma IU was not significantly related to the avoidance PTSS cluster [ ˇ = . 23, t = 1.38,

p = . 17, sr 2 = . 03], nor was pre-trauma AS [ ˇ = . 26, t = 1.54, p = . 13, sr 2 = . 04]. Pre-trauma IU was not
significantly related to the emotional numbing PTSS cluster [ ˇ = . 19, t = 1.17, p = . 25, sr 2 = . 02].

Please cite this article in press as: Oglesby, M. E., et al. Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event. Journal of Anxiety Disorders ( 2016), http://dx.doi.org/10.1016/j.janxdis.2016.01.0
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However, pre-trauma AS was significantly related to the emotional numbing PTSS cluster [ ˇ = . 38, t = 2.43, pre-experiencing symptoms with results demonstrating a trend towards significance in a regression
= . 02, sr 2 = . 09]. analysis. Given that the current study and Fetzner et al. (2013) utilized non-clinical samples, time since
We also evaluated whether pre-trauma IU and level of trauma exposure would interact to produce the experience of the traumatic event may explain our somewhat disparate findings. Specifically, in
elevated post-event PTSS. Level of exposure (moderate vs high; as measured by the PEQ), the the Fetzner et al. (2013)
centered predictor variable of pre-trauma IU, and the centered interaction term of level of exposure by pre-trauma
IU were entered into Step 1 of a linear regression analysis with post-trauma PTSS as the dependent outcomesample, participants reported experiencing a traumatic event 1–53 months prior to data collection.
variable. Consistent with expectation, the interaction between level of trauma exposure and pre-trauma However, data collection in our sample was much closer to the experience of the trauma, with
IU did not significantly predict post-trauma PTSS [ ˇ = . 62, t = 1.43, participant response approximately 18 days after the event. Therefore, we would expect a larger
amount of fearful intrusive images (i.e., re-experiencing) directly following the traumatic event versus
years after the experience of a trauma, particularly for non-clinical individuals.

p = . 16, sr 2 = . 03].

The literature suggests that level of exposure may play an important role in the relationship
4. Discussion between AS and PTSS. Within our same sample, Boffa et al. (2015) found the interaction between
pretrauma levels of AS and level of exposure to the traumatic event to predict increased post-trauma
Consistent with initial prediction, pre-trauma levels of IU were significantly associated with elevated PTSS. These findings are consistent with previous research suggesting that physiological arousal
PTSS following exposure to a traumatic event. These results were significant even after covarying for AS, during exposure to a traumatic film moderates the relationship between AS and elevated PTSS
a well-established risk factor for increased PTSS. Our findings are consistent with previous research following film exposure ( Olatunji and Fan, 2015 ). However, we did not expect similar interactive
suggesting that IU plays an important role in the development of PTSS ( Bardeen et al., 2013 ; Fetzner et effects in terms of IU. Whereas exposure level is likely to yield greater stress responses that are
al., 2013 ). Furthermore, our results corroborate IU as an important transdiagnostic individual difference relevant to the amplification effects of AS, in the case of IU, individuals primarily fear the
variable for various anxiety-related disorders ( Carleton et al., 2012 ; Mahoney and McEvoy, 2012 ). Our findings
repercussions associated with future uncertainty, regardless of the intensity of stressful events that
are particularly novel for two reasons. First, the current study is the first to investigate whether IU predicts have occurred. Consistent with this, we did not find a significant interaction between level of trauma
PTSS following a trauma within a longitudinal framework. Furthermore, our results found a prospective exposure and pretrauma IU when predicting post-trauma PTSS.
association between pre-trauma IU and post-trauma PTSS above and beyond the relationship between pre-trauma
AS. Given previous research suggesting the important role of AS in the development and maintenance
of PTSS ( Bomyea, Risbrough, & Lang, 2012 ; Elwood, Hahn, Olatunji, & Williams, 2009 ), our findings
provide an important addition to the literature by identifying a potentially more important risk factor for increased
PTSS.
Taken together, the results of the current study are promising when considered in light of
treatment implications. The extant literature supports the notion of IU as a central transdiagnostic
individual difference variable in the development and maintenance of various anxiety-related and
mood disorders, including symptoms of PTSD ( Carleton et al., 2012 ; Fetzner et al., 2013 ; McEvoy and
Mahoney, 2012 ). Given that previous research has shown IU to be malleable and amenable to
treatment ( Boswell et al., 2013 ;

As hypothesized, results also indicated that pre-trauma levels of IU were significantly related to the post-trauma
hyperarousal symptom domain after covarying for pre-trauma levels of AS. These findings are in line Ladouceur, Gosselin, & Dugas, 2000 ), developing prevention and intervention protocols aimed at
with prior research finding IU to be significantly associated with the hyperarousal PTSD symptom reducing IU would be important. Furthermore, the results of this study suggest that IU may be a
domain ( Fetzner et al., 2013 ). In addition, this finding is consistent with valuable focus of treatment for individuals at risk for developing PTSD given the shortcomings often
associated with traditional PTSD treatment. Specifically, PTSD treatment is often associated with high
dropout rates and many individuals remain symptomatic following treatment ( Hendriks, De Kleine, &
Bardeen et al. (2013) in which IU was found to significantly moderate the relationship between worry and Van Minnen, 2015 ;
the PTSS hyperarousal cluster. Taken together with previous work, our findings suggest that for individuals
high in IU hyperarousal may play a particularly important role following a trauma. Specifically, individuals
with elevated IU may be hypervigilant in order to reduce future danger by eliminating uncertainty ( Bardeen Schnurr et al., 2015 ; Schnurr et al., 2007 ). In addition, existing prevention and intervention protocols
et al., 2013 ). In addition, these individuals may fear the uncertainty regarding the reoccurrence of such for individuals with PTSD may benefit from the inclusion of techniques aimed at reducing IU (e.g.,
a trauma, resulting in increased hyperarousal symptoms (e.g., jumpy, on guard; Fetzner et al., 2013 ). This behavioral exposure to uncertain scenarios). Future work should develop and test the effectiveness of
finding is crucial, given previous research finding poor outcomes in relation to the hyperarousal symptom IU-specific treatments in regards to individuals with PTSD/elevated PTSS.
domain. Specifically, previous work has suggested that for individuals with PTSS, hyperarousal
symptoms are associated with increased symptomology, reduced recovery, and the development of clinically
significant symptoms following a traumatic event ( Bardeen et al., 2013 ; Marshall, Schell, Glynn, & Limitations of the current study should be considered in light of future work. Although scores from
Shetty, 2006 ; Schell, Marshall, & Jaycox, 2004 ). Unexpectedly, we found a significant association the full IUS were unavailable prior to the shooting, our abbreviated measure of IU correlated highly
between pretrauma IU and post-trauma symptoms of re-experiencing above and beyond pre-trauma with the full scale in three independent samples. Furthermore, the abbreviated measure did not allow
levels of AS. Although Fetzner et al. (2013) us to assess for differential relationships between the prospective and inhibitory IU subscales and
PTSS. Due to the unpredictable nature of our data we do not have information regarding PTSS levels
prior to the event, and therefore cannot account for baseline PTSD symptoms in the current analyses.
Furthermore, diagnostic information was not collected, thus we can only look at post-trauma symptom
level data as an outcome variable. Future work should aim to replicate these findings within a clinical
sample while covarying for baseline PTSS. On average, PTSS (PCL-C means) were lower than the
suggested clinical cut-off ( Weathers and Ford, 1996 ), however several indi-

did not find a significant association between IU and PTSD reexperiencing symptoms after accounting for
the other symptom clusters (i.e., hyperarousal, emotional numbing, and avoidance), the authors did note
a significant correlation between IU and

Please cite this article in press as: Oglesby, M. E., et al. Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event. Journal of Anxiety Disorders ( 2016), http://dx.doi.org/10.1016/j.janxdis.2016.01.005
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viduals in the current sample reported symptom levels that have demonstrated stability from one-week Bomyea, J., Risbrough, V., & Lang, A. J. (2012). A consideration of select pre-trauma

to 12-months post-trauma in prior studies, resulting in a likely PTSD diagnosis ( O’Donnell, Elliott, Lau, & Creamer,factors as key vulnerabilities in PTSD. Clinical Psychology Review, 32( 7), 630–641. http://dx.doi.org/10.1016/j.cpr.2012.06.008
, 2006-09167-010 Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013).
2007 ). Lastly, given the relatively small sample at follow-up, it is possible that these results may not be
representative of the overall population. Future investigations should attempt to replicate these results in Intolerance of uncertainty: a common factor in the treatment of emotional disorders. Journal of clinical

larger samples. psychology, 69( 6), 630–645. http://dx.doi.org/10. 1002/jclp.21965

Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for
posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68( 5),
Despite these limitations, the current study provides valuable information regarding the relationship 748–766. http://dx.doi.org/10.1037/0022-006X.
68.5.748
between IU and PTSS. As previously noted, this investigation is the first to find IU as a prospective predictor
Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: psychometric
of increased PTSS following a traumatic event. Although previous research has found associations properties of the English version. Behaviour research and therapy, 40( 8), 931–945.
between IU and symptoms of PTSD, no research to date has looked at this relationship within a longitudinal
Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., &
framework. Given the significant negative outcomes associated with elevated PTSS and PTSD, our
Asmundson, G. J. (2012). Increasingly certain about uncertainty: intolerance of uncertainty across anxiety and
findings provide a crucial addition to the literature by highlighting an important individual difference factor depression. Journal of Anxiety Disorders, 26( 3), 468–479.
that may be contributing to increased symptoms. Given the malleable nature of IU ( Boswell et al., 2013 ; Ladouceur
Carleton, R. N., Norton, M., & Asmundson, G. J. (2007). Fearing the unknown: a
et al., 2000 ), the creation and utilization of IU-specific treatments aimed at reducing symptoms of
short version of the intolerance of uncertainty scale. Journal of Anxiety Disorders, 21( 1), 105–117.
PTSD could be beneficial. Future work investigating the relations between IU and elevated PTSS within
clinical samples and the effectiveness of IU-based protocols is critical for these findings to generalize. Dugas, M. J., Hedayati, M., Karavidas, A., Buhr, K., Francis, K., & Phillips, N. A. (2005).
Intolerance of uncertainty and information processing: evidence of biased recall and interpretations. Cognitive
Therapy and Research, 29( 1), 57–70. http://
dx.doi.org/10.1007/s10608-005-1648-9
Dugas, M. J., & Ladouceur, R. (2000). Treatment of GAD targeting intolerance of
uncertainty in two types of worry. Behavior Modification, 24( 5), 635–657.
Dugas, M. J., Schwartz, A., & Francis, K. (2004). Brief report: intolerance of
uncertainty, worry, and depression. Cognitive Therapy and Research, 28( 6), 835–842.

Elwood, L. S., Hahn, K. S., Olatunji, B. O., & Williams, N. L. (2009). Cognitive
vulnerabilities to the development of PTSD: a review of four vulnerabilities and the proposal of an integrative
Conflict of interest vulnerability model. Clinical Psychology Review, 29( 1), 87–100. http://dx.doi.org/10.1016/j.cpr.2008.10.002

Epstein, S. (1972). The nature of anxiety with emphasis upon its relationship to
The authors of this manuscript do not have any actual or potential conflicts of interest to report or
expectancy. Anxiety: Current Trends in Theory and Research, 2, 291–337.
disclose. Fetzner, M. G., Horswill, S. C., Boelen, P. A., & Carleton, R. N. (2013). Intolerance of
uncertainty and PTSD symptoms: exploring the construct relationship in a community sample with a
heterogeneous trauma history. Cognitive Therapy and Research, 37( 4), 725–734.
Role of funding
Frans, Ö., Rimmö, P. A., Åberg, L., & Fredrikson, M. (2005). Trauma exposure and
post-traumatic stress disorder in the general population. Acta Psychiatrica Scandinavica, 111( 4), 291–299.
This research was not funded by any source.

Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why
do people worry? Personality and Individual Differences, 17( 6), 791–802.
Contributors
Hendriks, G.-J., De Kleine, R., & Van Minnen, A. (2015). Optimizing the efficacy of
exposure in PTSD treatment. European Journal of Psychotraumatology, 6. http://
Author one wrote the majority of the introduction and discussion sections, as well as assisted with dx.doi.org/10.3402/ejpt.v6.27628
Holaway, R. M., Heimberg, R. G., & Coles, M. E. (2006). A comparison of intolerance
the methods and results sections. Author two assisted with writing the results section as well as assisting
of uncertainty in analogue obsessive-compulsive disorder and generalized anxiety disorder. Journal of
with the introduction and discussion sections. Author three wrote the methods section and conducted Anxiety Disorders, 20( 2), 158–174.
literature searches. Author four assisted with the introduction and discussion sections as well as proof Kessler, R. C. (2000). Posttraumatic stress disorder: the burden to the individual
and to society. Journal of Clinical Psychiatry, 4, 4–14.
reading and writing assistance. Author five provided critical feedback on all drafts of the manuscript. All
Kilpatrick, D. G., & Resnick, H. S. (1993). Posttraumatic stress disorder associated
authors contributed significantly to the manuscript and approved the final version being submitted. with exposure to criminal victimization in clinical and community populations. Posttraumatic Stress
Disorder: DSM-IV and Beyond, 113–143.
Kraemer, H. C., Lowe, K. K., & Kupfer, D. J. (2005). To your health: how to understand
what research tells us about risk. Oxford University Press.
Krohne, H. W. (1993). Vigilance and cognitive avoidance as concepts in coping
research. In Attention and avoidance: strategies in coping with aversiveness. pp. 19–50. Ashland, OH: Hogrefe
& Huber Publishers.
Ladouceur, R., Gosselin, P., & Dugas, M. J. (2000). Experimental manipulation of
Acknowledgement intolerance of uncertainty: a study of a theoretical model of worry. Behaviour Research and Therapy, 38( 9),
933–941.
Littleton, H., Grills-Taquechel, A., & Axsom, D. (2009). Resource loss as a predictor
The authors of this manuscript do not have any acknowledgments. of posttrauma symptoms among college women following the mass shooting at Virginia Tech. Violence and
Victims, 24( 5), 669–686.
Mahoney, A. E., & McEvoy, P. M. (2012). A transdiagnostic examination of
intolerance of uncertainty across anxiety and depressive disorders. Cognitive Behaviour Therapy, 41( 3),
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Please cite this article in press as: Oglesby, M. E., et al. Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event. Journal of Anxiety Disorders ( 2016), http://dx.doi.org/10.1016/j.janxdis.2016.01.005

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