Review
Intolerance of uncertainty and emotion regulation: A meta-analytic and systematic review

https://doi.org/10.1016/j.cpr.2023.102270Get rights and content

Highlights

  • Positive association between uncertainty and maladaptive emotion regulation.

  • Negative association between uncertainty and adaptive emotion regulation.

  • No moderator was found for the relationship between uncertainty and emotion regulation.

  • Cognitive avoidance was the strategy most strongly related to intolerance of uncertainty.

  • Expressive suppression was the strategy less strongly related to intolerance of uncertainty.

Abstract

Intolerance of uncertainty, a transdiagnostic factor manifested across emotional disorders, has been associated with difficulties in regulating emotions. This meta-analysis addresses the lack of synthesis of this relationship. PsycInfo, PubMed, Scopus, and ProQuest were systematically searched for relevant articles published up to and during November 2022. We combined 161 effect sizes from 91 studies (N = 30,239), separating the analysis into maladaptive and adaptive emotion regulation strategies and their association with intolerance of uncertainty. We found a moderate positive relationship between maladaptive, and a moderate inverse relationship between adaptive emotion regulation and intolerance of uncertainty. Analysing the magnitude of relationships revealed that cognitive avoidance and mindfulness were the maladaptive and adaptive strategies respectively which had the largest effect sizes and thus strongest relationships with intolerance of uncertainty. Combining all strategies, cognitive avoidance remained the largest effect size, while expressive suppression had the smallest effect size and was non-significant in its relationship. Further analyses testing study sample, design, and age as moderators found no significant moderator for the relationships between intolerance of uncertainty and emotion regulation strategies. These findings have implications for future intolerance of uncertainty interventions, with emotion regulation as a potential target of change.

Section snippets

Protocol and registration

The protocol for this study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on the 3rd of October 2021 (registration number CRD42021269128). One additional moderator (i.e., study design) was identified during the data extraction stage, and thus the protocol was updated on 17th of March 2022 to reflect this change. We reported the meta-analysis according to the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Descriptive characteristics

We had 161 independent correlations based on 91 studies, with a total number of participants of N = 30,239 (34 correlations/data points were missing3). More than half of the sample were women (66.71%; four studies did not report gender) and the mean age

Discussion

The aim of this meta-analysis was to investigate the relationship between intolerance of uncertainty and strategies of emotion regulation. Specifically, we assessed the strength of the association between maladaptive and adaptive emotion regulation strategies and intolerance of uncertainty, respectively. We then examined both maladaptive and adaptive strategies together by comparing the strength of the relationships between all these strategies and intolerance of uncertainty. Furthermore, we

Conclusions

This meta-analysis was the first to investigate the relationship between intolerance of uncertainty and emotion regulation, looking at both maladaptive and adaptive strategies. Our results demonstrated that maladaptive strategies have a stronger relationship with intolerance of uncertainty than adaptive strategies. These results provide evidence for the proposal of maladaptive emotion regulation strategies in the theoretical models of intolerance of uncertainty. Furthermore, the results

Role of funding sources

Alison Calear is supported by a National Health and Medical Research Council (NHMRC) Fellowship (1173146). No funding body had a role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Contributors

Aseel Sahib and Junwen Chen designed the study and wrote the protocol, with Diana Cárdenas and Alison Calear providing edits on the final version of the protocol. Aseel Sahib conducted the literature searches and provided summaries of previous research studies. Aseel Sahib and Diana Cárdenas conducted the statistical analysis. Aseel Sahib wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript. All authors contributed to the revise and

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgements

The authors wish to thank Ms. Mila Knezovic, Ms. Alysia Robertson, Ms. Amy Cheng, Ms. Kelly Ferber, Ms. Sarah Brocklehurst, Ms. Jessica Nguyen, and Mr. William Whitecross for their help in abstract and full-texting screening, and Ms. Cheng for help with data extraction.

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