‘‘What If I Make a Mistake?’’ Intolerance of Uncertainty Is Associated With Poor Behavioral Performance Michel A. Thibodeau, MA, R. Nicholas Carleton, PhD, Lydia Go ´mez-Pe ´rez, PhD, and Gordon J.G. Asmundson, PhD Abstract: Intolerance of uncertainty (IU) has been posited as ubiquitous across experiences of anxiety; however, studies testing how IU impacts be- havior remain scant. The current study examined the impact of IU on per- formance during a keyboard typing task, a relatively complex and common behavior. A total of 40 members of the university community completed the task and measures of IU, trait anxiety, negative affect, and state anxiety. Heart rate and skin conductance were also assessed during the task as indices of state anxiety. IU was independently and substantially associatedwith slower typing speed (part r = j0.68) beyond other measured psychological and physiolog- ical variables but was not associated with typing errors. Prospective and in- hibitory IU, as manifestations of IU, did not seemingly differ in their relationship with performance. IU may negatively impact day-to-day behav- iors and contribute to undesired consequences. Further research is needed to explore whether this relationship warrants consideration in models of anxiety disorders. Key Words: Intolerance of uncertainty, anxiety, behavioral consequences, performance, typing. (J Nerv Ment Dis 2013;201: 760Y766) A nxiety involves a sense of uncontrollability focused on an un- realized potential threat and, as such, is necessarily associated with uncertainty (Barlow, 2000). Theorists have posited that intoler- ance of uncertainty (IU), defined as the propensity to react negatively to uncertain circumstances (Buhr and Dugas, 2006), may play an important role in experiences of anxiety (Carleton, in press; Carleton et al., 2012a). Initial research focused primarily on IU as driving worry in the context of generalized anxiety disorder (Dugas et al., 1998, 2005), but subsequent research has demonstrated empirical associations between IU and several anxiety disorders (e.g., social anxiety disorder, obsessive-compulsive disorder, panic disorder; Boelen and Reijntjes, 2009; Gentes and Ruscio, 2011; McEvoy and Mahoney, 2011, 2012; Tolin et al., 2003). Research also demon- strates that IU is continuous across experiences of anxiety rather than circumscribed to clinical levels of anxiety (Carleton et al., 2012b) and is associated with anxiety and physiological arousal in ambigious circumstances (e.g., the possibility of an intense noise stimulus; Greco and Roger, 2001). These findings have led researchers to conclude that IU represents a crucial feature across all anxiety dis- orders (Carleton, in press; Carleton et al., 2012a; Mahoney and McEvoy, 2011). The majority of research exploring IU has focused on the cognitive facet of the construct (e.g., as underlying worry; Freeston et al., 1994); however, several definitions of IU highlight that the construct is also characterized by behavioral reactions to uncertain situations (Buhr and Dugas, 2002; Freeston et al., 1994). Changes in behavior associated with IU, either subtle (e.g., attentional biases) or overt (e.g., avoidance of uncertain situation, need to seek more in- formation), could conceivably lead to unfavorable outcomes and exacerbated negative beliefs (e.g., overidentifying uncertain situa- tions, believing that uncertain situations should be avoided; Dugas et al., 1997; Holaway et al., 2006). Accordingly, the impact of IU in the development and maintenance of anxiety disorders may go be- yond its influence as a cognitive bias (e.g., as underlying worry). Nevertheless, few investigations have empirically examined the re- lationship between IU and behavior. Ladouceur et al. (1997) conducted a study wherein partici- pants were asked to decide whether a small bag was filled with a majority (85/100) of black marbles or a majority of white marbles. Before deciding, the participants were allowed to draw as many in- dividual marbles from the bag as they wanted. The participants with higher IU withdrew significantly more marbles before deciding whether most of them were black or white. Another study, conducted by Luhmann et al. (2011), demonstrated that individuals with greater IU were more likely to repeatedly choose smaller ($0.04) and even fewer probable rewards (50%) if they were immediately made aware of the outcome, rather than choosing larger ($0.06) and even more probable rewards (70%) that would require a longer period of un- certainty (e.g., 12 seconds) regarding whether they had won. Fur- thermore, Rosen and Kna ¨uper (2009) conducted an experiment demonstrating that individuals with greater IU are more likely to acquire health-related brochures to reduce their health-related worries (e.g., concerned about the possibility that they may have contracted an illness). The findings from these studies suggest that IU results in a greater need for information and evidence and a greater need for immediate certainty regarding an outcome. Theoretical and factor analytic studies suggest that IU mani- fests in two dimensions, representing either prospective IU, a cog- nitive process focusing on future events (e.g., ‘‘Unforeseen events upset me greatly’’), or inhibitory IU, a behavioral hesitation resulting in inhibition of action (e.g., ‘‘The smallest doubt can stop me from acting’’; Carleton, in press; Carleton et al., 2007; McEvoy and Mahoney, 2011). Research supports the stability of prospective and inhibitory IU as representing manifestations of IU and demonstrates that these factors may be associated with different anxiety disorders (Birrell et al., 2011; Khawaja and Yu, 2010; McEvoy and Mahoney, 2011). For example, research demonstrates that prospective IU is independently associated with symptoms of generalized anxiety disorder and obsessive-compulsive disorder, whereas inhibitory IU is independently associated with symptoms of social anxiety disorder, panic disorder, and depression (McEvoy and Mahoney, 2011). These findings suggest that prospective IU and inhibitory IU stemming from IU may lead to different implications; however, the hypothesis that inhibitory IU may be more behaviorally focused (Carleton et al., 2007) remains relatively unexplored, and studies exploring how these constructs differ are few. The precedent empirical and theoretical work exploring asso- ciations between IU and behavior have provided crucial groundwork ORIGINAL ARTICLE 760 www.jonmd.com The Journal of Nervous and Mental Disease & Volume 201, Number 9, September 2013 Department of Psychology, University of Regina, Regina, Saskatchewan, Canada. Send reprint requests to Michel A. Thibodeau, MA, Department of Psychology, University of Regina, Regina, Saskatchewan, S4S 0A2 Canada. E-mail: mikethibodeau@gmail.com. Copyright * 2013 by Lippincott Williams & Wilkins ISSN: 0022-3018/13/20109Y0760 DOI: 10.1097/NMD.0b013e3182a21298 Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.