Intolerance of Uncertainty, Cognitive Avoidance, Positive Beliefs About Worry and Negative Problem Orientation: Relevance to Anxiety Disorders, OCD and Depression in Youth

Intolerance of uncertainty (IU), cognitive avoidance (CA), positive beliefs about worry (PBW) and a tendency to view everyday problems as threats, termed negative problem orientation (NPO), are cognitive vulnerabilities associated with symptoms of anxiety and depression in adults, with fewer studies examining all four vulnerabilities in youth. In this study, validated measures of IU, CA, PBW and NPO were administered to clinically referred youth with a principal diagnosis of obsessive-compulsive disorder (OCD, n = 86), anxiety disorders (n = 80) or major depression (n = 18) and to non-clinical peers (n = 46). Group differences and the contribution of each vulnerability to internalizing symptom domains were examined. The OCD and anxiety groups did not differ significantly from each other on any vulnerability but had higher scores than non-clinical peers on all vulnerabilities except PBW. Alongside age and sex, IU, CA, PBW and NPO accounted for 52% of the variance in generalized anxiety symptoms, 51% in depression, 48% in panic, 31% in obsessions/compulsions, 29% in separation anxiety and 18% in social anxiety. Structural modelling revealed that IU was associated with all anxiety symptom domains and that NPO was most strongly associated with depression. These findings suggest that IU, CA, PBW and NPO are linked to various internalizing symptom domains in youth and that IU and NPO act as transdiagnostic vulnerabilities and may be important treatment targets.