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Intolerance of Uncertainty, Anxiety, and Worry in Children and Young People: Improving Assessment of Intolerance of Uncertainty in Preadolescent Children

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Intolerance of Uncertainty, Anxiety, and Worry in Children and Young People: Improving Assessment of Intolerance of Uncertainty in Preadolescent Children Intolerance of uncertainty, anxiety, and worry in children and young people: Improving assessment of intolerance of uncertainty in preadolescent children A thesis submitted in fulfilment of the requirements for the degree of: Doctor of Philosophy School of Psychology and Clinical Language Sciences University of Reading Nihan Osmanagaoglu May, 2018 Declaration of Original Authorship I confirm this is my own work and the use of all material from other sources has been properly and fully acknowledged. Nihan Osmanagaoglu May, 2018 v Acknowledgements I would like to begin by thanking the Turkish Ministry of National Education for funding my studies through a PhD scholarship. The research also would not have been possible without the children and parents who kindly participated. I also need to thank local schools for helping with the recruitment of children as well as parents. All of these processes would not have gone easier without the help from MSc placement students; Mariel Thottam and Charlie Lewis-Pryde. They have done an excellent job helping me run the study by undertaking research assessments, scoring, coding, entering, and checking the data as well as entertaining children. I feel quite fortunate to complete my PhD in University of Reading and getting to work with amazing people. I would like thank my PhD monitors, Dr. Graham Schafer and Dr. Bhismadev Chakrabarti for their helpful suggestions early on in the process. I am very thankful to Prof. Cathy Creswell for her guidance and support throughout the PhD as my second supervisor. I have learned a tremendous amount of critical thinking and analytic ability, which I will carry on for the rest of my life. The person I need to thank the most is my first supervisor Dr. Helen Dodd. I am more than thankful for all constructive criticism, which pushed my research and me to its possible best; and I am grateful for all academic and personal support. I am blessed to have both of them as my supervisors. My PhD cohorts also deserve huge thanks for incredible support; Suzannah Stuijfzand and Charlotte Goodwin, in particular. They have always been there for a cup of tea and for academic support. I am also thankful to my roommates, Jessi Godleman and Heather Plumpton who have seen and have been there for me at the worst. Finally, I would like to thank my mother, Guler who has always been there to hold a loving space for me even in the midst of all uncertainty. vii Table of Contents Declaration of Original Authorship iii Acknowledgements v Abstract xi Chapter 1 - General Introduction 1 1.1 Anxiety in young people 3 1.2 Models of Uncertainty-Related Anxiety 5 1.2.1 Anxiety as an epistemic emotion 6 1.2.2 Psychological entropy 6 1.2.3 Uncertainty and anticipation model of anxiety (UAMA) 8 1.2.4 Summary 8 1.3 Intolerance of uncertainty (IU) 9 1.3.1 Theory of IU and Initial Evidence 9 1.3.2 IU in the Treatment of Anxiety Disorders 11 1.3.3 IU Assessment in Adults 12 1.3.4 IU Assessment in Children and Young People 14 1.3.5 Developmental Changes 15 1.4 General aims of the thesis 17 1.5 References 18 Chapter 2 – Study 1: Intolerance of Uncertainty, Anxiety, and Worry in Children and Adolescents: A meta-analysis 31 Abstract 33 2.1 Introduction 34 2.2 Method 37 2.2.1 Eligibility criteria 37 2.2.2 Preliminary search strategy 38 2.2.3 Study selection 39 2.2.4 Quality assessment 39 2.2.5 Data extraction 40 2.2.6 Study sample 40 2.2.7 Meta-analytic method 43 2.3 Results 44 2.3.1 Meta-analysis of IU and anxiety 44 2.3.2 Meta-analysis of IU and worry 44 2.3.3 Publication bias 44 viii 2.4 Discussion 44 2.4.1 Strengths and limitations 48 2.5 Conclusion 49 2.6 Limitations 49 2.7 References 51 Chapter 3 - What Uncertainties Remain? 67 3.1 IU in Children and Young People 69 3.1.1 Recommendation 1: Focusing on Narrow Age Bands 69 3.1.2 Recommendation 2: The Psychometric Properties of the IUS-C 71 3.1.3 Recommendation 3: Behavioural Measures to Assess IU in Children 72 3.2 Aims of the thesis 74 3.3 Outline of the studies 74 3.3.1 Study 2: Evaluating the Psychometric Properties of the Intolerance of Uncertainty Scale for Children in a Preadolescent Sample 74 3.3.2 Study 3: Development of a Behavioural Measure of Intolerance of Uncertainty in Preadolescent Children: Adaptation of the Beads Task 75 3.3.3 Study 4: Reactions to uncertainty with and without potential threat: developing a behavioural measure of intolerance of uncertainty for preadolescent children 75 3.4 Summary 76 3.5 References 77 Chapter 4 – Study 2: Evaluating the Psychometric Properties of the Intolerance of Uncertainty Scale for Children in a Preadolescent Sample 81 Abstract 82 4.1 Introduction 83 4.2 Method 86 4.2.1 Participants 86 4.2.2 Measures 87 4.2.3 Procedure 88 4.2.4 Missing/Invalid Data 88 4.3 Results 89 4.3.1 Preliminary Analyses 89 4.3.2 Item Difficulty Ratings 90 4.3.3 Factor Analysis 91 4.3.4 Test-Retest Reliability 94 4.3.5 Agreement between child and parent reports of the IUS-C 95 4.3.6 Internal consistency and convergent validity across versions 96 4.4 Discussion 97 ix 4.4.1 Strengths and limitations 99 4.5 Conclusion and Future Directions 100 4.6 References 102 Chapter 5 – Study 3: Development of a Behavioural Measure to Assess Reactions to Uncertainty in Preadolescent Children: Adaptation of the Beads Task 115 Abstract 117 5.1 Introduction 118 5.2 Method 121 5.2.1 Participants 121 5.2.2 Measures 121 5.2.3 The Beads Task 123 5.2.4 Procedure 125 5.2.5 Preparing the Data for Analysis 125 5.3 Results 126 5.3.1 Preliminary analyses 126 5.3.2 The suitability of the task 126 5.3.3 The effect of uncertainty 127 5.3.4 Does the task capture self-reported IU, anxiety, and worry? 128 5.4 Discussion 131 5.5 Conclusion 134 5.6 References 136 Chapter 6 – Study 4: Reactions to Uncertainty with and without Potential Threat: Developing a Behavioural Measure to Assess Reactions to Uncertainty for Preadolescent Children 151 Abstract 153 6.1 Introduction 154 6.2 Method 157 6.2.1 Sample 157 6.2.2 Measures 157 6.2.3 Decision Making Tasks 159 6.2.4 Procedure 162 6.2.5 Preparing for Data Analysis 162 6.3 Results 164 6.3.1 Preliminary analyses 164 6.3.2 The suitability of the tasks 164 6.3.3 The effect of uncertainty 166 6.3.4 Are task responses affected by self-reported IU, anxiety, and worry? 167 6.4 Discussion 171 6.5 Conclusion 175 6.6 References 177 Chapter 7- General Discussion 191 7.1 Overview of Findings 193 7.1.1 Study 1: Intolerance of Uncertainty, anxiety, and worry in children and adolescents: A meta-analysis 193 7.1.2 Study 2: Evaluating the psychometric properties of the Intolerance of Uncertainty Scale for Children in a preadolescent sample 194 7.1.3 Study 3: Exploration of the Beads Task as a behavioural measure of Intolerance of Uncertainty in preadolescent children 195 7. 1.4 Study 4: Reactions to uncertainty with and without potential threat: developing a behavioural measure of intolerance of uncertainty for preadolescent children 196 7.2 The implications for Theoretical Models 196 7.3 Reflection on Thesis Aims 199 7.4 Strengths and Limitations 202 7.5 Directions for Future Research 205 7.5.1 The importance of Age and Development 205 7.5.2 Developing a better understanding of IU mechanisms in children and young people in the context of anxiety disorders 206 7.5.3 Examining associations with IU 207 7.5.4 Research with Clinical Samples 209 7.6 Conclusion 210 7.6 References 212 8. Appendices 217 8.1 Appendix 1: Information sheets used in study 2 217 8.2 Appendix2: Consent forms used in study 2 219 8.3 Appendix 3: Debriefing form used in study 2 221 8.4 Appendix 4: Information sheet used in studies 3 and 4 222 8.5 Appendix 5: Consent form used in studies 3 and 4 224 8.6 Appendix 6: Debriefing form used in studies 3 and 4 225 8.7 Appendix 7: Example of a reward chart used in studies 3 and 4 226 8.8 Appendix 8: Certificate given to children at the completion of behavioural tasks 227 8.9 Appendix 9: Example of faces used in image-rating and heightened threat HiLo tasks 228 xi Abstract Anxiety disorders are one of the most common mental health problems among children and adolescents. Studies in adults suggest that intolerance of uncertainty (IU) is closely linked to a range of anxiety disorders; however, there is a relative lack of research focusing on IU in children and young people. Four studies are presented in this thesis that together aim to: 1. review existing evidence for associations between IU, anxiety, and worry in children and adolescents; 2. begin addressing issues around the assessment of IU in preadolescent children. Study 1, a meta-analysis of the current literature on IU, anxiety, and worry in children and adolescents revealed robust relationships between IU and both anxiety and worry. Following this, study 2 assessed the psychometric properties of the current child IU questionnaire measure in a preadolescent sample.
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