Exploring the role of contrast avoidance, worry, and rumination in the relationship between intolerance of uncertainty, generalized anxiety disorder, and panic disorder symptoms in a clinical sample

Abstract The contrast avoidance model (CAM) proposes that worry and rumination are employed to prolong and sustain a negative emotional state in generalized anxiety disorder (GAD), thereby avoiding unexpected emotional shifts. However, there is a need, both clinically and in terms of the literature, to investigate/examine the role of contrast avoidance (CA) in various psychopathologies beyond GAD, and to understand the relationships among intolerance of uncertainty (IU), rumination, worry, CA, and symptomatology. This study examined the serial-parallel mediating roles of worry, rumination, and CA in the relationship between IU and symptom severity in a sample of individuals with GAD and panic disorder (PD) within a structural model. The study was conducted with 411 voluntary participants followed up with a diagnosis of GAD (n=241) and PD (n=170). According to the serial-parallel mediation results, there was an indirect relationship between IU and GAD and PD symptoms fully mediated by worry, rumination, and CA. The tested alternative mediation models also indicated that the main model was the better fitted. The findings have demonstrated that individuals with GAD and PD, as they experience difficulty tolerating uncertainty, engage more in strategies of worry and rumination to avoid emotional contrasts, and thus experiencing more symptoms. The transdiagnostic nature of CA is supported, and it is shown that CA is also a significant predictor in PD. These results indicate that CA is a fundamental clinical variable in anxiety-related disorders. The clinical implications of these findings are discussed.