바로가기메뉴

본문 바로가기 주메뉴 바로가기

The Korean Journal of Health Psychology

  • KOREAN
  • P-ISSN1229-070X
  • E-ISSN2713-9581
  • KCI

The Relationship Between Intolerance of Uncertainty, and Anxiety and Depression: Mediating Effects of Common (Repetitive Negative Thinking) and Unique Factors of Worry and Rumination

The Korean Journal of Health Psychology / The Korean Journal of Health Psychology, (P)1229-070X; (E)2713-9581
2019, v.24 no.3, pp.709-734
https://doi.org/10.17315/kjhp.2019.24.3.010


Abstract

The purpose of this study was to examine the role of mediating effects of Repetitive Negative Thinking (RNT), worry, and rumination on the relationship between Intolerance of Uncertainty (IU), and anxiety and depression among Korean adults. Specifically, it was hypothesized that RNT would mediate the association between IU and anxiety and depression, whereas worry was expected to mediate the relationship between IU and anxiety, and rumination was anticipated to mediate the relationship between IU and depression. Participants were 300 Korean adults (188 males, and 112 females) who completed a series of self-report questionnaires assessing IU, worry, rumination, anxiety, and depressive symptoms. Data were analyzed using structural equation models in Mplus7. Results indicate that RNT fully mediated the relationship between IU and anxiety, whereas in contrast, RNT partially mediated the relationship between IU and depression. Worry mediated the relationship between IU and anxiety, However, worry did not mediate the relationship between IU and depression, whereas, interestingly, rumination did not mediate the effects of IU on either anxiety or depression. Theoretical and clinical implications and limitations of the study are discussed.

keywords
불확실성에 대한 인내력 부족, 반복적 부정적 사고, 걱정, 반추, 불안, 우울, Intolerance of uncertainty, Repetitive Negative Thinking, Worry, Rumination, Anxiety, Depression

Reference

1.

김가희 (2014). 불확실성에 대한 인내력 부족이 우울에미치는 영향: 자기자비의 매개효과를 중심으로. 건양대학교 대학원 석사학위 청구논문.

2.

김소정, 김지혜, 윤세창 (2010). 한국판 반추적 반응 척도 (KRRS) 의 타당화 연구. 한국심리학회지: 임상, 29(1), 1-19.

3.

김소정, 권정혜, 양은주, 김지혜, 유범희, 이동수 (2013). 한국판 반추적 반응 척도 (K-RRS) 의 확인적 요인분석: 우울장애 환자를 대상으로. 인지행동치료, 13(1), 133-147.

4.

김수영 (2016). 구조방정식 모형의 기본과 확장:Mplus 예제와 함께. 서울 : 학지사.

5.

김순희 (2010). 부정적 및 긍정적 평가에 대한 두려움, 불확실성에 대한 인내력 부족과 사회 불안의 관계. 이화여자대학교 석사학위 청구 논문.

6.

김정원, 민병배 (1998). 걱정과 불확실성에 대한 인내력부족 및 문제해결 방식의 관계. 한국심리학회 학술대회 자료집, 1998(1), 83-92.

7.

보건복지부 (2016). 정신질환실태 역학조사. http://www.mohw.go.kr/index.jsp에서 2018년 06월 10일검색.

8.

백인철 (2016). 불확실성에 대한 대처방식이 우울과 불안에 미치는 영향. 서울대학교 대학원 석사학위 청구논문.

9.

서은철 (2015). 다차원 요인구조 검증을 위한 bifactor 모형의 소개와 적용: second-order 모형과의 비교. 한국체육학회지, 54(3), 573-587.

10.

신은경 (2012). 불확실성에 대한 인내력 부족이 우울, 불안에 미치는 영향: 경험회피의 매개효과. 아주대학교 대학원 석사학위 청구 논문.

11.

이지현 (2016). 구조방정식 모형에서의 문항묶음 – 통합과 제안. 이화여자대학교 석사학위 청구 논문.

12.

전겸구, 최상진, 양병창 (2001). 통합적 한국판 CES-D 개발. 한국심리학회지: 건강, 6(1), 59-76.

13.

조맹제, 김계희 (1993). 주요 우울증환자 예비평가에서CES-D의 진단적 타당성 연구. 신경정신의학, 32. 381-399.

14.

한덕웅, 이장호, 전겸구 (1996). Spielberger 의 상태-특성 불안검사 Y 형의 개발. 한국심리학회지: 건강, 1(1), 1-14.

15.

홍세희 (2000). 구조 방정식 모형의 적합도 지수 선정기준과 그 근거. Korean Journal of Clinical Psychology, 19(1), 161-177.

16.

Bandalos, D. L. (2002). The effects of item parceling on goodness-of-fit and parameter estimate bias in structural equation modeling. Structural Equation Modeling, 9(1), 78-102.

17.

Behar, E., Dimarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M (2009). Current theoretical models of generalized anxiety disorder(GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011-1023.

18.

Boelen, P. A., & Reijntjes, A. (2009). Intolerance of uncertainty and social anxiety. Journal of Aanxiety Disorders, 23(1), 130-135.

19.

Boomsma, A. (2000). Reporting analyses of covariance structures. Structural Equation Modeling: A Multidisciplinary Journal, 7(3), 461-481.

20.

Borkovec, T. D., Lyonfields, J. D., Wiser, S. L., & , Deihl, L. (1993). The role of worrisome thinking in the suppression of cardiovascular response to phovic imagery. Behavior Research and Therapy, 31(3), 321-324.

21.

Borkovec, T. D., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy, 21(1), 9-16.

22.

Borkovec, T. D., & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: distraction from more emotionally distressing topics? Journal of Behavior Therapy and Experimental Psychiatry, 26(1), 25-30.

23.

Boswell, J. F., Thompson‐Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Intolerance of uncertainty: A common factor in the treatment of emotional disorders. Journal of Clinical Psychology, 69(6), 630-645.

24.

Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110(4), 585.

25.

Brown, S. L., & Schiraldi, G. R. (2004). Reducing Subclinical Symptoms of Anxiety and Depression:A Comparison of Two College Courses. American Journal of Health Education, 2004, 35(3), 168-164.

26.

Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. Sage Focus Editions, 154, 136-136.

27.

Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: psychometric properties of the English version. Behaviour Research and Therapy, 40(8), 931-945.

28.

Bullis, J. R., Fortune, M. R., Farchione, T. J., & Barlow, D. H. (2014). A Preliminary Investigation of the Long-Term Outcome of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Comprehensive Psychiatry, 55(8), 1920-1927.

29.

Byrne, B. M., Shavelson, R. J., & Muthén, B. (1989). Testing for the equivalence of factor covariance and mean structures: The issue of partial measurement invariance. Psychological Bulletin, 105(3), 456.

30.

Calmes, C. A., & Roberts, J. E. (2007). Repetitive Thought and Emotional Distress: Rumination and Worry as Prospective Predictors of Depressive and Anxious Symptomatology. Cognitive Therapy and Research, 31(3), 343-356.

31.

Carleton, R. N., Duranceau, S., Freeston, M. H., Boelen, P. A., McCabe, R. E., & Antony, M. M., (2014). “But it might be a heart attack":Intolerance of uncertainty and panic disorder symptoms. Journal of Anxiety Disorders, 28(5), 463-470.

32.

Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCave, R. E., Antony, M. M., & Asmundson, G. J. (2012). Increasingly certain about uncertainty:Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders. 26(3), 468-479.

33.

Carleton, R. N., Norton, M. A., & Asmundson, G. J. G. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21(1), 105-117.

34.

Chen, F. F., West, S. G., & Sousa, K. H. (2006). A comparison of bifactor and second-order models of quality of life. Multivariate Behavioral Research, 41(2), 189-225.

35.

Cuijpers, P., Koole, S. L., van Dijke, A., Roca, M., Li, J., & Reynolds, C. F. (2014). Psychotherapy for subclinical depression: meta-analysis. The British Journal of Psychiatry, 205(4), 268-274.

36.

Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1(1), 16-29.

37.

de Jong-Meyer, R., Beck, B., & Riede, K. (2009). Relationships between rumination, worry, intolerance of uncertainty and metacognitive beliefs. Personality and Individual Differences, 46(4), 547-551.

38.

Drost, J., Van der Does, W., van Hemert, A. M., Penninx, B. W., & Spinhoven, P. (2014). Repetitive negative thinking as a transdiagnostic factor in depression and anxiety: A conceptual replication. Behaviour Research and Therapy, 63, 177-183.

39.

Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215-226.

40.

Dugas, M. J., Marchand, A., & Ladouceur, R. (2005). Further validation of a cognitive-behavioral model of generalized anxiety disorder: diagnostic and symptom specificity. Journal of Anxiety Disorders, 19(3), 329–343.

41.

Dupuy, J. B., & Ladouceur, R. (2008). Cognitive processes of generalized anxiety disorder in comorbid generalized anxiety disorder and major depressive disorder. Journal of Anxiety Disorder, 22(3), 505-514.

42.

Ehring, T., & Watkins, E. R. (2008). Repetitive Negative Thinking as a Transdiagnostic Process. International Journal of Cognitive Psychotherapy, 1(3), 192-205.

43.

Ellard, K. K., Farholme, C. P., Boisseau, C. L., Farchione, T. J., & Barlow, D. H. (2010). Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: Protocol Development and Initial Outcome Data. Cognitive and Behavioral Practice, 17(1), 88-101.

44.

Feldman, C., & Kuyken, W. (2011). Compassion in the Landscape of Suffering. Contemporary Buddhism. An Interdisciplinary Journal, 12(1), 143-155.

45.

Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17(6), 791-802.

46.

Fresco, D. M., Frankel, A. N., Mennin, D. S., Turk, C. L., & Heimberg, R. G. (2002). Distinct and Overlapping Features of Rumination and Worry:The Relationship of Cognitive Production to Negative Affective States. Cognitive Therapy and Research, 26(2), 179-188.

47.

Garber, J., & Weersing, V. R. (2010). Comorbidity of anxiety and depression in youth: Implications for treatment and prevention. Clinical Psychology:Science and Practice, 17(4), 293-306.

48.

Goring, H. J., & Papageorgiou, C. (2008). Rumination and Worry: Factor Analysis of Self-Report Measures in Depressed Participants. Cognitive Therapy and Research, 32(4), 554-566.

49.

Harvey, A. G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioral processes across psychological disorders. Oxford, UK: Oxford University Press.

50.

Hirschfeld, R. M. (2001). The comorbidity of major depression and anxiety disorders: recognition and management in primary care. Primary Care Companion to the Journal of Clinical Psychiatry, 3(6), 244.

51.

Hofmann, S. G., & Asmundson, G. J. (2008). Acceptance and mindfulness-based therapy: New wave or old hat?. Clinical Psychology Review, 28(1), 1-16.

52.

Hong, R. Y. (2007). Worry and rumination:Differential associations with anxious and depressive symptoms and coping behavior. Behaviour Research and Therapy, 45(2), 277-290.

53.

Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis:Conventional criteria versus new alternatives. Structural Equation Modeling: a Multidisciplinary Journal, 6(1), 1-55.

54.

Jeon, S. W., Han, C., Ko, Y. H., Yoon, S., Pae, C. U., Choi, J., Kim, J. M., Yoon, H. K., Lee, H., Patkar, A. A., & Zimmerman, M. (2017). A Korean validation study ofthe Clinically Useful Anxiety Outcome Scale: Comorbidity and differentiation of anxiety and depressive disorders. PLoS ONE 12(6): e0179247. https://doi.org/10.1371/journal.pone.0179247

55.

Joormann, J., Kosfelder, J., & Schulte, D. (2005). The Impact of Comorbidity of Depression on the Course of Anxiety Treatments. Cognitive Therapy and Research, 29(5), 569-591.

56.

Kessler, R. C., Chiu, W. T., Demle,r O., & Walters, E. E. (2005). Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 62(6), 617–627.

57.

Kline, R. B. (2011). Principles and practice of structural equation modeling. New York, NY:Guilford.

58.

Koerner, N., & Dugas, M. J. (2008). An investigation of appraisals in individuals vulnerable to excessive worry: The role of intolerance of uncertainty. Cognitive Therapy and Research, 32(5), 619-638.

59.

Kullback, S., & Leibler, R. A. (1951). On information and sufficiency. The Annals of Mathematical Statistics, 22(1), 79-86.

60.

Ladouceur, R., Blais, F., Freeston, M. H., & Dugas, M. J. (1998). Problem solving and problem orientation in generalized anxiety disorder. Journal of Anxiety Disorders, 12(2), 139-152.

61.

Ladouceur, R., Dugas, M. J., Freeston, M. H., Léger, E., Gagnon, F., & Thibodeau, N. (2000). Efficacy of a cognitive–behavioral treatment for generalized anxiety disorder: Evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology, 68(6), 957.

62.

Ladouceur, R., Dugas, M. J., Freeston, M. H., Rhéaume, J., Blais, F., Boisvert, J. M., ..., & Thibodeau, N. (1999). Specificity of generalized anxiety disorder symptoms and processes. Behavior Therapy, 30(2), 191-207.

63.

Ladouceur, R., Gosselin, P., & Dugas, M. J. (2000). Experimental manipulation of intolerance of uncertainty: a study of a theoretical model of worry. Behavior Therapy and Research, 38(9), 933-41.

64.

Landis, R. S., Beal, D. J., & Tesluk, P. E. (2000). A comparison of approaches to forming composite measures in structural equation models. Organizational Research Methods, 3(2), 186-207.

65.

Liao, K. Y., & Wei, M. (2011). Intolerance of Uncertainty, Depression, and Anxiety: The Moderating and Mediating Roles of Rumination. Journal of Clinical Psychology, 67(12), 1220-1239.

66.

Lind, C., & Boschen, M. J. (2009). Intolerance of uncertainty mediates the relationship between responsibility beliefs and compulsive checking. Journal of Anxiety Disorders, 23(8), 1047–1052.

67.

Little, T. D., Rhemtulla, M., Gibson, K., & Schoemann, A. M. (2013). Why the items versus parcels controversy needn’t be one. Psychological Methods, 18(3), 285.

68.

MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7(1), 83-104.

69.

MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect:Distribution of the product and resampling methods. Multivariate Behavioral Research, 39(1), 99-128.

70.

Mansell, W., Harvey, A., Watkins, E. R., & Shafran, R. (2008). Cognitive behavioral processes across psychological disorders: A review of the utility and validity of the transdiagnostic approach. International Journal of Cognitive Therapy, 1(3), 181-191.

71.

Mansell, W., Harvey, A., Watkins, E., & Shafran, R. (2009). Conceptual Foundations of the Transdiagnostic Approach to CBT. Journal of Cognitive Psychotherapy: An International Quarterly, 23(1). 6-19.

72.

McDonald, R. P., & Ho, M. H. R. (2002). Principles and practice in reporting structural equation analyses. Psychological Methods, 7(1), 64-82.

73.

McEvoy, P. M., & Brans, S. (2013). Common Versus Unique Variance Across Measures of Worry and Rumination: Predictive Utility and Mediational Models for Anxiety and Depression. Cognitive Therapy and Research, 37(1), 183-196.

74.

McEvoy, P. M., & Erceg-Hurn, D. M. (2016). The search for universal transdiagnostic and trans-therapy change process: Evidence for intolerance of uncertainty. Journal of Anxiety Disorders, 41, 96-107.

75.

McEvoy, P. M., & Mahoney, A. E. (2011). Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression. Journal of Anxiety Disorders, 25(1), 112-122.

76.

McEvoy, P. M., & Mahoney, A. E. (2012). To be sure, To Be Sure: Intolerance of Uncertainty mediates symptoms of various anxiety disorders and depression. Behavior Therapy, 43(3), 533-545.

77.

McEvoy, P. M., & Mahoney, A. E. (2013). Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediators of repetitive negative thinking in a clinical sample with anxiety disorders. Journal of Anxiety Disorders, 27(2), 216-224.

78.

McEvoy, P. M., Mahoney, A. E., & Moulds, M. L. (2010). Are worry, rumination, and post-event processing one and the same?: Development of the Repetitive Thinking Questionnaire. Journal of anxiety disorders, 24(5), 509-519.

79.

McLaughlin, K. A., Borkovec, T. D., & Sibrava, N. J. (2007). The Effects of Worry and Rumination on Affect States and Cognitive Activity. Behavior Therapy, 38(1), 23-38.

80.

McLaughlin, K. A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy, 49(3), 186-193.

81.

Merikangas, K. R., Zhang, H., Avenevoli, S., Acharyya, S., Neuenschwander, M., & Angst, J.. (2003). Longitudinal Trajectories of Depression and Anxiety in a Prospective Community Study:The Zurich Cohort Study. Arch Gen Psychiatry. 60(10), 993–1000

82.

Meyer, T., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of Penn state worry questionnaire. Behavior Research and Therapy, 28(6), 487-495.

83.

Moudling, R., & Kyrios, M., (2006). Anxiety disorders and control related belifs: the examplar of Obsessive-Compulsive Disorder(OCD). Clinical Psychology Review, 26(5), 573-583.

84.

Muris, P., Roelofs, J., Meesters, C., & Boomsma, P. (2004). Rumination and Worry in Nonclinical Adolescents. Cognitive Therapy and Research, 28(4), 539-554.

85.

Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569.

86.

Nolen-Hoeksema, S., & Morrow, J. (1993). Effects of rumination and distraction on naturally occurring depressed mood. Cognition & Emotion, 7(6), 561-570.

87.

Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for developing transdiagnostic models of psychopathology: Explaining multifinality and divergent trajectories. Perspectives on Psychological Science, 6(6), 589-609.

88.

Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400-424.

89.

Norr, A. M., Oglesby, M. E., Capron, D. W., Raines, A. M., Korte, K. J., & Schmidt, N. B. (2013). Evaluating the unique contribution of intolerance of uncertainty relative to other cognitive vulnerability factors in anxiety psychopathology. Journal of Affective Disorders, 151(1), 136-142.

90.

Papageorgiou, C., & Wells, A. (1999). Process and meta‐cognitive dimensions of depressive and anxious thoughts and relationships with emotional intensity. Clinical Psychology & Psychotherapy, 6(2), 156-162.

91.

Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879-891.

92.

Radloff, L. S. (1977). The CES-D scale a self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401.

93.

Reuther, E. T., Davis, T. E., Rudy, B. M., Jenkins, W. S., Whiting, S. E., & May, A. C. (2013). Intolerance of uncertainty as a mediator of the relationship between perfectionism and obsessive ‐compulsive symptom severity. Depression and Anxiety, 30(8), 773-777.

94.

Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6(2), 461-464.

95.

Segerstrom, S. C., Tsao, J. C. I., Alden, L. E., & Craske, M. G. (2000). Worry and Rumination:Repetitive Thought as a Concomitant and Predictor of Negative Mood. Cognitive Therapy and Research, 24(6). 671-688.

96.

Sexton, K. A., Norton, P. J., Walker, J. R., & Norton, G. R. (2003). Hierarchical model of generalized and specific vulnerabilities in anxiety. Cognitive Behaviour Therapy, 32(2), 82–94.

97.

Spinhoven, P., Drost, J., Hemert, B., & Pennix, B. W. (2015). Common rather than unique aspects of repetitive negative thinking are related to depressive and anxiety disorders and symptoms. Journal of Anxiety Disorders, 33, 45-52.

98.

Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for the state-trait anxiety inventory. Palo Alto, C.A.: Consulting Psychologists Press, Inc.

99.

Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27(3), 247-259.

100.

Watkins, E., Moulds, M., & Mackintosh, B. (2005). Comparison between rumination and worry in a non-clinical population. Behaviour Research and Therapy, 43(12), 1577-1585.

101.

Wenzlaff, R. M., & Wegner, D. M. (2000). Thought suppression. Annual Review of Psychology, 51(1), 59-91.

102.

West, S. G., Taylor, A. B., & Wu, W. (2012). Model fit and model selection in structural equation modeling. Handbook of Structural Equation Modeling, 1, 209-231.

103.

Wetherell, J. L., Gatz, M., & Pedersen, N. L. (2001). A longitudinal analysis of anxiety and depressive symptoms. Psychology and Aging, 16(2), 187-195.

104.

Whiting, S. E., Jenkins, W. S., May, A. C., Rudy, B. M., Davis Ⅲ, T. E., & Reuther, E. T. (2014). The Role of Intolerance of Uncertainty in Social Anxiety Subtypes. Journal of Clinical Psychology, 70(3), 260-272.

105.

Yook, K., Kim, K., Suh, S., & Lee, K. (2010). Intolerance of uncertainty, worry, and rumination in major depressive disorder and generalized anxiety disorder. Journal of Anxiety Disorders, 24(6), 623-628.

106.

Zvolensky, M. J., Lejuez, C. W., & Eifert, G. H. (2000). Prediction and Control: operational definitions for the experimental analysis of anxiety. Behaviour Research and Therapy, 38(7), 653-663.

The Korean Journal of Health Psychology