Intolerance of uncertainty and emotional processing in a mixed psychiatric sample: distinct but related transdiagnostic factors

Introduction. Both intolerance of uncertainty (IU) and emotional processing (EP) are cognitive constructs involved in the onset and course of mental disorders. With the refinement of clinical assessment, there is evidence that each construct is represented by a hierarchical arrangement of facets. Avoidance of uncertainty, doubting, overestimation of threat, worry, control of uncertainty, and seeking reassurance are the facets of IU. Suppression, signs of unprocessed emotions, control of the emotional experience, avoidance, and impoverished emotional experience are the facets of the EP model. We aim to test the degree to which the general factors underlying each construct are overlapping. Method: One-hundred and eighty-five patients (100 women, 85 men; mean age 43.5 years, SD=13.6 years) with mixed psychiatric conditions were recruited from mental health facilities (n=65) and residential therapeutic communities or day centers (n=120). Inclusion criteria for the study were age > 18, a diagnosed psychiatric condition, ability to fill in personality questionnaires. The patients, classified as psychotics (n=74), neurotics (n=62), or other conditions (n=54), completed the Intolerance of Uncertainty Inventory (Lauriola et al., 2018) and the Emotional Processing Scale (Baker et al., 2010). Structural Equation Modeling was applied to parse general and specific variance components in patient ratings. Results: A bifactor model had an acceptable fit to the data of both scales. The proportion of common variance explained by the general factor was .70 for the IUI and .64 for the EPS. Compared to reference data for the Italian population the broad diagnostic groups were all high on the general factor of IU and EP. A joint factor model also yielded an acceptable fit (CFI=.90, TLI=.89, RMSEA=.04, p-close =.998; SRMR=.07). The latent variable correlation between the general factors underlying IU and EP (r=.64) was not so large to support a complete overlap of the two constructs. Discussion. The findings of the present study are consistent with the transdiagnostic hypothesis for both constructs. Although the general factors underlying IU and EP were elevated in all diagnostic groups, they cannot be equated. The latent variable correlation was below the recommended threshold for establishing discriminant validity. Future studies should explore clinical hypothesis concerning with the common and the distinct aspects of the constructs. We speculate that the relationships between IU and EP might lie in the high distressing value of uncertainty for patients, which might be unable to fully elaborate the negative emotions triggered by uncertainty.