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A review of the relationship between intolerance of uncertainty and threat appraisal in anxiety

Lookup NU author(s): Sara Milne, Professor Claire Lomax, Professor Mark FreestonORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© British Association for Behavioural and Cognitive Psychotherapies 2019.The development and conceptual relationship of the constructs of threat appraisal (TA) and intolerance of uncertainty (IU) are explored in the context of anxiety disorders. A narrative review tracking the development of these constructs and their relationship is undertaken. There is some evidence to suggest that the interaction between the components of threat appraisal (probability × cost) may partially account for or provide a theoretical framework which explains presenting levels of anxiety. Furthermore, research suggested that IU is a construct which contributes to a broad range of anxiety disorders. It was concluded that distinctive cognitive biases linked with IU - such as interpreting ambiguous and uncertain (both positive and negative) information as highly concerning - suggests that IU is interpreted negatively independent of threat appraisal. These findings mean a number of issues remain unclear, including whether IU in anxiety-provoking situations is sufficient in itself - independent of threat appraisal - in eliciting high levels of anxiety. Additionally, it is unclear whether threat appraisal and IU act as independent constructs, or more in an interactive manner in anxiety. To achieve further clarity on these issues, methodological recommendations for future research are made.Key learning aims (1)To understand the conceptual foundations of TA and IU in the cognitive model of anxiety.(2)To understand the empirical evidence supporting the role of both TA and IU in anxiety.(3)To appreciate the potential relationship between these concepts in anxiety.

Publication metadata

Author(s): Milne S, Lomax C, Freeston MH

Publication type: Review

Publication status: Published

Journal: Cognitive Behaviour Therapist

Year: 2019

Volume: 12

Online publication date: 09/08/2019

Acceptance date: 15/05/2019

ISSN (electronic): 1754-470X

Publisher: Cambridge University Press


DOI: 10.1017/S1754470X19000230