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Uncertainty as a Mechanism in Obsessive-Compulsive Disorder and its Treatment

dc.creatorKnowles, Kelly A 2022
dc.description.abstractIntolerance of uncertainty (IU) is the tendency to react negatively to uncertain situations due to negative beliefs about uncertainty. IU demonstrates robust associations with symptoms of obsessive-compulsive disorder (OCD). In addition, IU can be considered a causal risk factor for OCD, as changes in IU precede changes in OCD symptoms during cognitive-behavioral treatments for OCD. IU can also be experimentally induced, and experimentally induced IU impacts OCD symptoms. To further determine if IU meets criteria to be considered a cognitive vulnerability for OCD, longitudinal investigations must demonstrate that IU is stable and trait-like. After fitting a latent trait-state model to six waves of data collected from a community sample, most of the variance in IU was attributable to a stable, time-invariant component. Furthermore, time-invariant IU predicted OCD symptoms across each of the six waves, providing evidence for IU as a cognitive vulnerability for OCD. Given that IU is a cognitive vulnerability for OCD, a subsequent question is whether increased tolerance of uncertainty is a mechanism for effective OCD treatment. Using an analogue sample of contamination-fearful individuals, changes in state uncertainty during a single-session exposure-based intervention were examined as one such potential mechanism. Although a random, variable exposure intervention designed to maximize state uncertainty did not improve outcomes compared to a standard, hierarchical exposure approach, lower variability in state uncertainty during exposure predicted superior exposure intervention outcomes, contrary to study hypotheses. Thus, while state uncertainty is malleable within an exposure intervention, additional research is necessary to determine if increasing tolerance for uncertainty is a mechanism of effective OCD treatment. Future research that establishes reliable physiological and behavioral correlates of IU to expand the nomological network of IU will inform models of the development of and evidence-based treatment for OCD.
dc.subjectintolerance of uncertainty
dc.subjectobsessive-compulsive disorder
dc.subjectexposure therapy
dc.titleUncertainty as a Mechanism in Obsessive-Compulsive Disorder and its Treatment
dc.type.materialtext University Graduate School
dc.contributor.committeeChairOlatunji, Bunmi O

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