May 24, 2022

Dear Colleagues,

The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s research summary is written by Annika Okamoto, PhD, representing our Regional Clinic of NSAC Santa Barbara, CA. The article, entitled Social anxiety and negative interpretations of positive social events: What role does intolerance of uncertainty play?, was written by Yasunori Nishikawa, Katie Fracalanza, Neil A. Rector, and Judith M. Laposa, and is published in the Journal of Clinical Psychology, April 18, 2022.

People diagnosed with social anxiety disorder (SAD) are less likely to enjoy social events and report less frequent and intense positive emotions. The higher symptom level is correlated to more negative appraisals of social events. This study focused on exploring how intolerance of uncertainty may mediate this relationship. Just as a recap, the intolerance of uncertainty is the tendency to react negatively to situations that are uncertain and has been associated with various other anxiety disorders such as generalized anxiety and obsessive-compulsive disorder.

165 participants diagnosed with SAD completed four types of measures. First, the participants filled in a social interaction anxiety symptom severity questionnaire (SIAS) that measured anxiety related to social interactions. Second, they filled in the measure for intolerance of uncertainty (IUS-12) that measures negative beliefs and reactions to uncertainty in terms of prospective anxiety (e.g., “I can’t stand being taken by surprise”) and inhibitory anxiety (e.g., “I must get away from all uncertain situations”). Third, they filled in a measure of the tendency to interpret positive social events negatively, making negative future predictions after positive social events (IPES). Sample items include “when a social event goes well, it means that next interaction will usually go less well” and “when I am open and friendly with people, they expect more from me the next time we meet.” Last, the participants filled in a measure for negative affective states of depression (DASS-D).

The results showed that intolerance of uncertainty, particularly the inhibitory subscale scores, significantly mediated the relationship between social interaction anxiety and negative interpretations of positive events. The takeaway is that socially anxious people with elevated intolerance of uncertainty may make the negative future interpretations mainly to reduce uncertainty. They may prefer a bad outcome versus the possibility of a bad outcome, because not knowing for sure feels paralyzing. If you think about it, uncertainty is inherent and omnipresent in social interactions and inference. The researchers found mixed results regarding the role of depression. The results were true both for those with and without comorbid mood disorders. The core of intolerance of uncertainty is being bothered by uncertainty independent of estimated threat, even regarding positive social experiences devoid of threat.

For therapists, these results suggest that striving to increase tolerance for uncertainty and decreasing general distress symptoms may be relevant to reducing negative appraisals of positive social events.

What are some examples of how you could discuss intolerance of uncertainty with your patients?

Since intolerance of uncertainty seems to be a contributing factor, consider treatments that modify negative beliefs about uncertainty; build tolerance for uncertainty; and use behavioral experiments targeting inhibitory intolerance of uncertainty such as testing specific beliefs about uncertainty in social interactions, and reducing avoidance of social interactions.

Annika Okamoto, PhD
Board member representing NSAC Santa Barbara
Director of Clinical Training and Group Programs, California Counseling Clinics