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Behavioral assessment of risk-taking under uncertain threat: Associations with affect and pain tolerance
Personality and Individual Differences 87 (2015) 256–260
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Personality and Individual Differences journal homepage: www.elsevier.com/locate/paid
Behavioral assessment of risk-taking under uncertain threat: Associations with affect and pain tolerance Richard J. Macatee a, Shivali Sarawgi a, Aaron M. Norr a, Mary E. Oglesby a, Carl W. Lejuez b, Jesse R. Cougle a,⁎ a b
Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, USA Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, USA
a r t i c l e
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Article history: Received 21 April 2015 Received in revised form 4 August 2015 Accepted 10 August 2015 Available online 25 August 2015 Keywords: Risk-taking Intolerance of uncertainty Distress intolerance Behavioral task Anxiety disorder vulnerabilities
a b s t r a c t Low levels of risk-taking behavior have been associated with anxiety, but variables that influence risk-averse decision-making are not well-understood. Given that uncertainty is inherent to risk-taking behavior, individual differences in the appraisal of uncertainty (e.g., intolerance of uncertainty (IU)) may affect risk-taking behavior. However, nuanced behavioral assessments of risk-taking that allow for the simultaneous examination of uncertainty avoidance, risk-averse, and high-risk behavior are lacking. To address this gap in the literature, a computerized courage task was developed and the associations between task behavior and IU were examined. An unselected student sample completed measures of IU and other distress intolerance constructs before completing a cold pressor task to behaviorally assess pain tolerance and the courage task in which they were asked to win money under threat of possible shock. Selecting larger amounts of money was associated with greater risk of shock; a ‘pass’ option to avoid choosing entirely, ensuring no shock or money, was provided every trial. Selfreported anxious reactivity was related to lower-risk monetary choices, whereas greater IU was incrementally related specifically to pass choices; IU was unrelated to pain tolerance. Results support IU's construct validity and suggest that it may have incremental utility for understanding risk-taking behavior in anxiety disorders. © 2015 Elsevier Ltd. All rights reserved.
1. Introduction Risk-taking behavior is an important personality and clinical phenomenon with relevance to disorders across a spectrum of psychopathology. Risk-taking behavior has been defined as decision-making behavior occurring in contexts characterized by the simultaneous presence of potential reward and potential harm/danger (Leigh, 1999). Excessive levels of risk-taking (i.e., pursuing a possible reward despite disproportionately high levels of possible harm) may result in negative consequences and have been linked to a number of externalizing problems, including substance use (e.g., Bornovalova, Daughters, Hernandez, Richards, & Lejuez, 2005; Chitwood et al., 2000). However, some have suggested that levels of risk taking behavior can also be dysfunctionally low, as observed in pathological anxiety (Barlow, 2002; Maner et al., 2007). Dysfunctionally low levels of risk-taking behavior have been specifically linked to pathological anxiety. Raghunathan and Pham (1999) found that anxious individuals tend to prefer small rewards accompanied by low threat probability (i.e., low risk behavior) compared to larger rewards accompanied by greater threat probability (i.e., high risk behavior). Further, this propensity for risk-averse behavior has ⁎ Corresponding author at: Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA. E-mail address: [email protected] (J.R. Cougle).
http://dx.doi.org/10.1016/j.paid.2015.08.019 0191-8869/© 2015 Elsevier Ltd. All rights reserved.
also been found to be specific to clinically anxious individuals compared to non-clinical controls and other clinical individuals with non-anxious psychopathology (Maner et al., 2007). Anxious individuals may demonstrate avoidance of risk due to the inherent uncertainty involved in risk-taking behavior, particularly with regard to the possibility of a negative outcome (Leigh, 1999). Anxious individuals appear to overestimate personal risk (Butler & Mathews, 1983) and have pessimistic appraisals of risk (Maner & Schmidt, 2006), which indirectly suggests that risk avoidance behavior may be linked to individual differences in appraisals of uncertainty. Indeed, individual differences in intolerance of uncertainty (IU; Buhr & Dugas, 2002), a vulnerability factor that has been conceptualized as a form of distress intolerance (Zvolensky, Vujanovic, Bernstein, & Leyro, 2010) reflective of the propensity to negatively appraise and respond avoidantly to uncertainty, have consistently been linked to anxiety pathology (Buhr & Dugas, 2009; Carleton, Collimore, & Asmundson, 2010; Dugas & Ladouceur, 2000; Sarawgi, Oglesby, & Cougle, 2013). Further, IU has been found to be uniquely associated with generalized anxiety/worry, obsessive–compulsive, and social anxiety symptoms across two separate samples above and beyond other distress intolerance variables (Norr et al., 2013), suggesting that IU may be the form of distress intolerance most relevant to anxiety pathology and dysfunctional risk-averse behavior. Despite the relevance of uncertainty appraisal processes to risktaking behavior, there is a surprising lack of research explicitly
R.J. Macatee et al. / Personality and Individual Differences 87 (2015) 256–260
examining the role of IU in pathological risk-avoidance, particularly with regard to risk behavior measured in the lab. We know of only three studies to assess the relationship between IU and behavior on laboratory tasks. Ladouceur, Talbot, and Dugas (1997) assessed the predictive association between IU and information-seeking behavior on an ambiguous inference task, and found that higher IU was associated with more information-seeking behavior in moderately ambiguous conditions, suggesting that IU is associated with a higher threshold for certainty in problem-solving situations. Similarly, Thibodeau, Carleton, Gomez-Perez, and Asmundson (2013) found that higher IU was associated with slower typing speed on a task in which participants believed they would be judged on their typing performance, suggesting that under threat individuals with high IU may behave in a more deliberative and risk-averse fashion. Finally, Luhmann, Ishida, and Hajcak (2011) found that individuals with greater IU were more likely to choose less rewarding outcomes in order to avoid the uncertain delay period associated with choosing more rewarding outcomes. Although these studies are suggestive of a relationship between IU and avoidance of risk, none utilized tasks involving a continuum of uncertain threat and reward (i.e., low threat/low reward, medium threat/medium reward, high threat/high reward) in conjunction with an option to avoid making a decision at all (i.e., achieving certainty of no threat, but also no reward). Such a task would be more ecologically valid in that most real-world decisions involve varying levels of uncertain threat/reward probabilities as well as the option to avoid uncertainty altogether (e.g., via inaction). Further, this task would allow for a determination of IU's contribution to general risk-averse behavior (i.e., more low threat/low reward choices compared to high threat/ high reward choices) and uncertainty avoidance behavior specifically (i.e., avoiding making any decision), a distinction important to IU's construct validity that has not been explored in the extant IU literature. Lastly, studies examining IU's role in risk-taking behavior have not assessed whether any observed association may be better accounted for by other distress intolerance variables or simply by heightened anxiety itself. Indeed, given that anxious affect elicits a risk-avoidance decision-making bias (Lerner & Keltner, 2000) and IU is considered to be one of multiple forms of distress intolerance (Zvolensky et al., 2010), it may be that heightened anxious emotional reactivity, or individual differences in general negative emotional or pain tolerance, may more parsimoniously explain the association between IU and avoidance of behavior involving the possibility of threat/harm. In order to address these limitations, a behavioral task was developed to assess risk-taking behavior in a decision-making context characterized by varying levels of reward and threat probabilities together with an option to avoid uncertainty entirely. The primary aim of the current study was to assess IU's association with risk-taking behavior on this task and determine if IU would not be associated with general risk-averse behavior (i.e., a preference for low-risk choices) when given the option to avoid risk altogether, and whether the association between IU and choices guaranteeing punishment avoidance is specific to IU or better accounted for by heightened anxious reactivity or other distress intolerance variables. Based upon prior findings demonstrating that individuals high in IU are intolerant of future threat regardless of the probability of its occurrence (Carleton, Norton, & Asmundson, 2007), we hypothesized that: 1) IU would only be positively associated with choices guaranteeing punishment avoidance; and 2) this association would be significant for IU, but not other distress intolerance variables, and would remain significant after controlling for the effects of anxious reactivity on the task; and 3) IU would specifically predict uncertainty avoidance behavior (i.e., via greater choices that guarantee no punishment) on the novel risk-taking task developed for the current study, but would be unrelated to avoidance behavior on a separate, validated behavioral index of pain tolerance, a construct that, like IU, is thought to be a form of distress tolerance (Zvolensky et al., 2010).
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2. Material and methods 2.1. Participants Participants (N = 57) were recruited through introductory psychology classes at a large southeastern university and completed the study for class credit. The majority of participants were female (n = 41; 71.9%) and college-aged (M = 18.79, SD = 1.08). The sample consisted of diverse racial/ethnic groups, with 70.2% identifying as Caucasian, 14% African-American, 10.5% Hispanic, 8.8% Asian, and 1.8% identifying as another ethnicity not specified.
2.2. Materials 2.2.1. Balloon courage task A novel computerized risk-taking task was developed involving a continuum of uncertain threat/reward probabilities and an option allowing the participant to escape uncertainty, differentiating it from prior risk-taking tasks that have only used reward omission punishers (Lejuez et al., 2002). Participants were told that they would be winning money for a charity of their choice under threat of electric shock. Electric shock stimuli were chosen given their greater aversiveness relative to other aversive stimuli (Glenn, Lieberman, & Hajcak, 2012), which was an important consideration for ensuring choice behavior variability on the task. The task consisted of 80 trials. During each trial, three balloons of increasing size (i.e., small, medium, large) were presented on the computer screen. The participant's task was to select a balloon on each trial. Larger balloons had a higher probability of being accompanied by an electric shock (i.e., small (low-risk): 20%, medium (medium-risk): 25%, large (high-risk): 35%), but were also associated with greater potential winnings (i.e., small: 5 cents, medium: 15 cents, large: 25 cents). Additionally, a pass option was presented during each trial that allowed the participant to skip that trial, guaranteeing no shock or money. After the participant selected a balloon, an image of the balloon expanding would appear on the screen. If the balloon exploded, a loud explosion sound was played and the participant was shocked. On fifty percent of the trials the participant did not win any money (i.e., no reward trials), regardless of the size of the balloon chosen, whereas on the other fifty percent of the trials the participant did win money (i.e., rewarded trials), again regardless of the size of the balloon chosen. The administration of shock was not contingent upon receipt of a reward; rather, probability of shock was determined based upon the participant's balloon choice (see above for percentages). The visual arrangement of balloon/pass options on the screen was randomized as was the order of reward/no reward trials. Participants were not informed of the reward or shock probabilities. Participants were only told that the risk of shock and balloon reward value increased with balloon size. Finally, participants were not told the relative likelihood of receiving versus not receiving a reward each trial. Instead, participants were only told that they would not win money every time, and that shock administration could occur on both rewarded and nonrewarded trials. Split-half reliability for choice behavior across the first and second half of the task indicates excellent internal consistency (rs N .81, ps b .001).
2.2.2. Cold pressor task The cold-pressor task is a widely used method of pain induction (Tousignant-Laflamme, Page, Goffaux, & Marchand, 2008) and has been used to behaviorally assess pain tolerance in prior work (McHugh & Otto, 2011). Participants are asked to submerge their nondominant hand in an ice water bath (between 0 and 5 °C) for as long as possible. Pain tolerance is operationalized as the time the participant removed their hand from the water minus the time the participant indicated they first started to experience pain.
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2.3. Measures 2.3.1. Intolerance of uncertainty (IUS-12; Carleton et al., 2007) The IUS-12 is a 12-item self-report measure that assesses the ability to tolerate uncertainty. Higher scores indicate greater intolerance of uncertainty. The IUS-12 demonstrated excellent internal consistency in the present sample (α = .91). 2.3.2. Distress Tolerance Scale (DTS; Simons & Gaher, 2005) The DTS is a 15-item self-report measure that assesses the ability to tolerate negative emotions in general. Higher scores indicate greater tolerance. The DTS demonstrated excellent internal consistency in the present sample (α = .90). 2.3.3. Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986) The ASI is a 16-item self-report measure that assesses the fear of anxious arousal and has been empirically shown to be a type of distress intolerance (Mitchell, Riccardi, Keough, Timpano, & Schmidt, 2013). Higher scores indicate greater fear of arousal. The ASI demonstrated good internal consistency in the present sample (α = .84). 2.3.4. Pain Anxiety Symptoms Scale (PASS-20; McCracken & Dhingra, 2002) The PASS-20 is a 20-item self-report measure that assesses intolerance of pain, with higher scores indicating greater anxious and avoidant reactions to pain. The PASS-20 demonstrated good internal consistency in the present sample (α = .89). 2.3.5. Physiological recording To prepare participants for the psychophysiological assessment, they were asked to wash their hands with Ivory soap and warm water. Electrode placement locations (middle/ring fingers on nondominant hand) were swabbed lightly with alcohol. Skin-conductance response (SCR) data were collected using a PsychLab recording system. Silver–silver chloride (Ag–AgCl) electrodes fitted with collars were filled with electrode paste and placed on the participants' distal phalanx of the middle and ring fingers of the non-dominant hand. Skin conductance (SC) was recorded through a DC amp connected to a 24-bit digitizing skin conductance coupler from Contact Precision Instruments. The SC data were scored using the PSYLAB 8 software program from Contact Precision Instruments via automated procedures. SCR data were recorded during a three minute relaxation period and again during the courage task itself. Mean SCR amplitude during relaxation and task engagement was calculated, with task reactivity calculated by subtracting the mean SCR amplitude during relaxation from the mean SCR amplitude during task engagement. 2.4. Procedure All participants provided written informed consent before beginning the IRB-approved study. After completing baseline questionnaires, participants completed the cold pressor task. Upon completion, skinconductance electrodes were connected to the distal phalanx of the participants' middle and ring fingers. Next, shock gel was used to lubricate a metal conductor connected to a shock generator. The metal conductor was then wrapped around the participant's pinky finger. Following the placement of the skin-conductance electrodes and shock conductor, the research assistant calibrated the shock generator to a shock intensity reported by the participant to be maximally uncomfortable without being painful. This calibration procedure is consistent with prior research using shock stimuli (Glenn et al., 2012). After calibration, the participant was instructed to relax for three minutes during which time skin-conductance was recorded. After the baseline relaxation period, the research assistant provided instructions on how to complete the
courage task, and then the participant completed the task while skinconductance was recorded.
3. Results 3.1. Courage and cold pressor task validity checks Current self-reported anxiety before the courage task was assessed with a 1 (‘No anxiety at all’) to 11 (‘Extremely anxious’) scale (M = 3.93, SD = 2.43), with peak anxiety during the task also assessed using the same scale following task completion (M = 6.51, SD = 2.87). Paired-sample t-tests revealed a significant increase in selfreported anxiety from pre-task to task engagement, t(56) = − 6.72, p b .001, suggesting that the courage task successfully increased anxiety. To ensure that the task also increased physiological arousal, pairedsample t-tests on average SCR indicated increases in SCR from relaxation (M = 2.78, SD = 1.74) to task engagement (M = 3.47, SD = 1.98; t(56) =−8.18, p b .001), suggesting that the courage task successfully induced sympathetic arousal. To obtain a measure of baseline pain during the cold pressor task, after immersing their hand in the water participants were asked to inform the experimenter when they began to experience pain and indicate the intensity of the pain on a 0 (‘No pain at all’) to 10 (‘Worst pain you can imagine’) scale (M = 5.96, SD = 1.80). After participants removed their hand, they were asked to indicate the peak intensity of pain they experienced during immersion (M = 8.26, SD = 1.36). Paired-sample t-tests indicated that pain significantly increased during the task, t(56) =−13.12, p b .001. Pain and anxious reactivity were computed using residualized change scores. Please see Table 1 for descriptives and bivariate correlations for self-report, courage task, cold pressor task, and psychophysiological data.
3.2. Hypothesis 1: IU will be positively associated with uncertainty avoidance behavior, but not general risk-averse behavior Although self-reported, but not physiological, anxious reactivity during the courage task predicted risk-averse task behavior, with greater anxious reactivity positively associated with pass choices (r = .32, p b .05), low (r = .39, p b .01) and medium-risk choices (r = .30, p b .05), and negatively associated with high risk choices (r = − .47, p b .001), IU was only significantly associated with pass choices (r = .32, p b .05).
3.3. Hypothesis 2: IU will be the only tolerance variable associated with uncertainty avoidance behavior, and the association will remain significant after controlling for anxious reactivity Scores on the DTS, ASI, and the PASS-20 were not associated with behavior on the courage task (ps N .23). Because of the nature and distribution of the choice data, negative binomial link regression was used to examine the independent effects of IU and anxious reactivity given that this approach is well-suited to count data that are overdispersed (Gardner, Mulvey, & Shaw, 1995). Negative binomial link regression analyses revealed that after controlling for the effect of anxious reactivity during the task (B = .48, SE = .16, p b .01), IU remained positively predictive of the number of pass choices (B = .03, SE = .01, p b .05).
3.4. Hypothesis 3: IU will not predict behaviorally-indexed pain tolerance IU was not significantly associated with cold pressor immersion duration (r = −.24, p = .08).
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Table 1 Descriptive statistics and bivariate correlations. Measures M (SD) Self-Report 1. IUS-12 14.88 (9.44) 2. DTS 50.84 (11.65) 3. ASI 18.91 (9.20) 4. PASS-20 36.32 (14.44) 5. ΔAnxiety 1.93 (3.17) 6. ΔPain 2.30 (1.32) Behavior 7. Pass 2.93 (5.56) 8. Low Risk 10.14 (14.86) 9. Medium Risk 15.00 (17.26) 10. High Risk 51.46 (28.13) 11. Immersion 29.38 (28.91) Physiology 12. ΔSCR 0.76 (0.70)
1
2
3
4
5
6
7
8
9
10
11
12
1 −.40⁎⁎
1
.42⁎⁎
−.54⁎⁎⁎
.38⁎⁎
−.31⁎
1 .31⁎
1
.05
.04
.03
.00
.09
.16
.10
−.04
−.16
−.12
−.09
.18
−.03
.32⁎ .16
1 −.07
1
.32⁎
.06
.02
.39⁎⁎
.10
.39⁎⁎
.30⁎
.23
.11
.23
1 1
−.06
−.05
.00
.11
−.16
−.03
.03
−.07
−.47⁎⁎⁎
−.20
−.54⁎⁎⁎
−.77⁎⁎⁎
−.74⁎⁎⁎
−.24
.20
−.11
−.27⁎
−.08
−.24
−.20
−.13
−.20
.24
−.05
.02
.04
−.21
.23
−.11
.19
−.11
−.01
.07
1 1 1
.13
1
Note. IUS-12 = Intolerance of Uncertainty Scale; DTS = Distress Tolerance Scale; ASI = Anxiety Sensitivity Index — 3; PASS-20 = Pain Anxiety Symptoms Scale-20; pass/low risk/medium risk/high risk = # of choices on balloon task; immersion = cold pressor duration time (in seconds) after first pain; SCR = Skin Conductance Response. ⁎ p b .05. ⁎⁎ p b .01. ⁎⁎⁎ p b .001.
4. Discussion The results of the present study were consistent with our hypotheses. IU, but not other affect or pain tolerance variables, uniquely predicted uncertainty avoidance behavior on the balloon courage task, and this relationship remained significant after controlling for anxious reactivity, which was robustly related to general risk-averse task behavior. Further, IU did not significantly predict cold pressor immersion duration, suggesting the dissociability of behavioral indices of uncertainty and pain tolerance. The courage task represents a novel behavioral assessment of risktaking involving variable threat/reward contingencies together with an escape option that reflects an ecologically valid decision-making context. The present results are consistent with studies demonstrating state anxiety's association with risk-averse behavior (Raghunathan & Pham, 1999), and suggest that IU may have incremental utility in understanding risk-taking behavior in anxiety disorders. The significant association between IU, but not other distress intolerance variables, and uncertainty avoidance behavior, is suggestive of IU's construct validity and the importance of domain specificity to understanding individual differences in distress intolerance. However, although not significant, the correlation coefficients observed between cold pressor immersion duration and uncertainty avoidance behavior, and between the former and IUS/DTS/PASS-20 scores, suggest that affect/pain tolerance variables share common variance (McHugh & Otto, 2011). Finally, the null associations between IU and emotional reactivity are consistent with previous findings on distress tolerance task behavior and emotional reactivity (Daughters, Sargeant, Bornovalova, Gratz, & Lejuez, 2008). This study has limitations that should be mentioned. First, all observed associations are correlational in nature. Future studies utilizing experimental designs are required to determine whether IU causally affects risk-taking behavior. Second, data were collected from a small,
predominantly female high-functioning student sample and the highrisk choice mean was quite large. Future research should assess IU and courage task behavior in community and clinical samples to ensure that the task is sensitive to expected risk-taking differences across samples. Additionally, given the robust gender differences in anxiety and risk-taking behavior (Byrnes, Miller, & Schafer, 1999; Feingold, 1994), future work should utilize larger samples with more equitable gender representation to examine if courage task behavior is associated with relevant individual differences for both males and females. Relatedly, future work should examine the utility of the courage task in adolescent and older adult samples given the relevance of these developmental periods to risk-taking (Steinberg, 2007). 5. Conclusion The present study represents, to our knowledge, the first test of a risk-taking task incorporating a continuum of threat/reward contingencies capable of distinguishing risk-averse and uncertainty avoidance behavior. The incremental utility of IU and its specific relationship with uncertainty avoidance, but not general risk-averse behavior suggest that IU may be valuable in understanding risk-taking behavior in nonclinical and clinical populations. Future studies may consider utilizing the courage task to assess the role of IU and other relevant decisionmaking variables in risk-taking behavior. Acknowledgments, declaration of interests, and funding organizations We have none to declare. References Barlow, D. H. (2002). Anxiety and its disorder: The nature and treatment of anxiety and panic (2nd ed.). New York: The Guilford Press.
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Personality and Individual Differences journal homepage: www.elsevier.com/locate/paid
Behavioral assessment of risk-taking under uncertain threat: Associations with affect and pain tolerance Richard J. Macatee a, Shivali Sarawgi a, Aaron M. Norr a, Mary E. Oglesby a, Carl W. Lejuez b, Jesse R. Cougle a,⁎ a b
Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, USA Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, USA
a r t i c l e
i n f o
Article history: Received 21 April 2015 Received in revised form 4 August 2015 Accepted 10 August 2015 Available online 25 August 2015 Keywords: Risk-taking Intolerance of uncertainty Distress intolerance Behavioral task Anxiety disorder vulnerabilities
a b s t r a c t Low levels of risk-taking behavior have been associated with anxiety, but variables that influence risk-averse decision-making are not well-understood. Given that uncertainty is inherent to risk-taking behavior, individual differences in the appraisal of uncertainty (e.g., intolerance of uncertainty (IU)) may affect risk-taking behavior. However, nuanced behavioral assessments of risk-taking that allow for the simultaneous examination of uncertainty avoidance, risk-averse, and high-risk behavior are lacking. To address this gap in the literature, a computerized courage task was developed and the associations between task behavior and IU were examined. An unselected student sample completed measures of IU and other distress intolerance constructs before completing a cold pressor task to behaviorally assess pain tolerance and the courage task in which they were asked to win money under threat of possible shock. Selecting larger amounts of money was associated with greater risk of shock; a ‘pass’ option to avoid choosing entirely, ensuring no shock or money, was provided every trial. Selfreported anxious reactivity was related to lower-risk monetary choices, whereas greater IU was incrementally related specifically to pass choices; IU was unrelated to pain tolerance. Results support IU's construct validity and suggest that it may have incremental utility for understanding risk-taking behavior in anxiety disorders. © 2015 Elsevier Ltd. All rights reserved.
1. Introduction Risk-taking behavior is an important personality and clinical phenomenon with relevance to disorders across a spectrum of psychopathology. Risk-taking behavior has been defined as decision-making behavior occurring in contexts characterized by the simultaneous presence of potential reward and potential harm/danger (Leigh, 1999). Excessive levels of risk-taking (i.e., pursuing a possible reward despite disproportionately high levels of possible harm) may result in negative consequences and have been linked to a number of externalizing problems, including substance use (e.g., Bornovalova, Daughters, Hernandez, Richards, & Lejuez, 2005; Chitwood et al., 2000). However, some have suggested that levels of risk taking behavior can also be dysfunctionally low, as observed in pathological anxiety (Barlow, 2002; Maner et al., 2007). Dysfunctionally low levels of risk-taking behavior have been specifically linked to pathological anxiety. Raghunathan and Pham (1999) found that anxious individuals tend to prefer small rewards accompanied by low threat probability (i.e., low risk behavior) compared to larger rewards accompanied by greater threat probability (i.e., high risk behavior). Further, this propensity for risk-averse behavior has ⁎ Corresponding author at: Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA. E-mail address: [email protected] (J.R. Cougle).
http://dx.doi.org/10.1016/j.paid.2015.08.019 0191-8869/© 2015 Elsevier Ltd. All rights reserved.
also been found to be specific to clinically anxious individuals compared to non-clinical controls and other clinical individuals with non-anxious psychopathology (Maner et al., 2007). Anxious individuals may demonstrate avoidance of risk due to the inherent uncertainty involved in risk-taking behavior, particularly with regard to the possibility of a negative outcome (Leigh, 1999). Anxious individuals appear to overestimate personal risk (Butler & Mathews, 1983) and have pessimistic appraisals of risk (Maner & Schmidt, 2006), which indirectly suggests that risk avoidance behavior may be linked to individual differences in appraisals of uncertainty. Indeed, individual differences in intolerance of uncertainty (IU; Buhr & Dugas, 2002), a vulnerability factor that has been conceptualized as a form of distress intolerance (Zvolensky, Vujanovic, Bernstein, & Leyro, 2010) reflective of the propensity to negatively appraise and respond avoidantly to uncertainty, have consistently been linked to anxiety pathology (Buhr & Dugas, 2009; Carleton, Collimore, & Asmundson, 2010; Dugas & Ladouceur, 2000; Sarawgi, Oglesby, & Cougle, 2013). Further, IU has been found to be uniquely associated with generalized anxiety/worry, obsessive–compulsive, and social anxiety symptoms across two separate samples above and beyond other distress intolerance variables (Norr et al., 2013), suggesting that IU may be the form of distress intolerance most relevant to anxiety pathology and dysfunctional risk-averse behavior. Despite the relevance of uncertainty appraisal processes to risktaking behavior, there is a surprising lack of research explicitly
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examining the role of IU in pathological risk-avoidance, particularly with regard to risk behavior measured in the lab. We know of only three studies to assess the relationship between IU and behavior on laboratory tasks. Ladouceur, Talbot, and Dugas (1997) assessed the predictive association between IU and information-seeking behavior on an ambiguous inference task, and found that higher IU was associated with more information-seeking behavior in moderately ambiguous conditions, suggesting that IU is associated with a higher threshold for certainty in problem-solving situations. Similarly, Thibodeau, Carleton, Gomez-Perez, and Asmundson (2013) found that higher IU was associated with slower typing speed on a task in which participants believed they would be judged on their typing performance, suggesting that under threat individuals with high IU may behave in a more deliberative and risk-averse fashion. Finally, Luhmann, Ishida, and Hajcak (2011) found that individuals with greater IU were more likely to choose less rewarding outcomes in order to avoid the uncertain delay period associated with choosing more rewarding outcomes. Although these studies are suggestive of a relationship between IU and avoidance of risk, none utilized tasks involving a continuum of uncertain threat and reward (i.e., low threat/low reward, medium threat/medium reward, high threat/high reward) in conjunction with an option to avoid making a decision at all (i.e., achieving certainty of no threat, but also no reward). Such a task would be more ecologically valid in that most real-world decisions involve varying levels of uncertain threat/reward probabilities as well as the option to avoid uncertainty altogether (e.g., via inaction). Further, this task would allow for a determination of IU's contribution to general risk-averse behavior (i.e., more low threat/low reward choices compared to high threat/ high reward choices) and uncertainty avoidance behavior specifically (i.e., avoiding making any decision), a distinction important to IU's construct validity that has not been explored in the extant IU literature. Lastly, studies examining IU's role in risk-taking behavior have not assessed whether any observed association may be better accounted for by other distress intolerance variables or simply by heightened anxiety itself. Indeed, given that anxious affect elicits a risk-avoidance decision-making bias (Lerner & Keltner, 2000) and IU is considered to be one of multiple forms of distress intolerance (Zvolensky et al., 2010), it may be that heightened anxious emotional reactivity, or individual differences in general negative emotional or pain tolerance, may more parsimoniously explain the association between IU and avoidance of behavior involving the possibility of threat/harm. In order to address these limitations, a behavioral task was developed to assess risk-taking behavior in a decision-making context characterized by varying levels of reward and threat probabilities together with an option to avoid uncertainty entirely. The primary aim of the current study was to assess IU's association with risk-taking behavior on this task and determine if IU would not be associated with general risk-averse behavior (i.e., a preference for low-risk choices) when given the option to avoid risk altogether, and whether the association between IU and choices guaranteeing punishment avoidance is specific to IU or better accounted for by heightened anxious reactivity or other distress intolerance variables. Based upon prior findings demonstrating that individuals high in IU are intolerant of future threat regardless of the probability of its occurrence (Carleton, Norton, & Asmundson, 2007), we hypothesized that: 1) IU would only be positively associated with choices guaranteeing punishment avoidance; and 2) this association would be significant for IU, but not other distress intolerance variables, and would remain significant after controlling for the effects of anxious reactivity on the task; and 3) IU would specifically predict uncertainty avoidance behavior (i.e., via greater choices that guarantee no punishment) on the novel risk-taking task developed for the current study, but would be unrelated to avoidance behavior on a separate, validated behavioral index of pain tolerance, a construct that, like IU, is thought to be a form of distress tolerance (Zvolensky et al., 2010).
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2. Material and methods 2.1. Participants Participants (N = 57) were recruited through introductory psychology classes at a large southeastern university and completed the study for class credit. The majority of participants were female (n = 41; 71.9%) and college-aged (M = 18.79, SD = 1.08). The sample consisted of diverse racial/ethnic groups, with 70.2% identifying as Caucasian, 14% African-American, 10.5% Hispanic, 8.8% Asian, and 1.8% identifying as another ethnicity not specified.
2.2. Materials 2.2.1. Balloon courage task A novel computerized risk-taking task was developed involving a continuum of uncertain threat/reward probabilities and an option allowing the participant to escape uncertainty, differentiating it from prior risk-taking tasks that have only used reward omission punishers (Lejuez et al., 2002). Participants were told that they would be winning money for a charity of their choice under threat of electric shock. Electric shock stimuli were chosen given their greater aversiveness relative to other aversive stimuli (Glenn, Lieberman, & Hajcak, 2012), which was an important consideration for ensuring choice behavior variability on the task. The task consisted of 80 trials. During each trial, three balloons of increasing size (i.e., small, medium, large) were presented on the computer screen. The participant's task was to select a balloon on each trial. Larger balloons had a higher probability of being accompanied by an electric shock (i.e., small (low-risk): 20%, medium (medium-risk): 25%, large (high-risk): 35%), but were also associated with greater potential winnings (i.e., small: 5 cents, medium: 15 cents, large: 25 cents). Additionally, a pass option was presented during each trial that allowed the participant to skip that trial, guaranteeing no shock or money. After the participant selected a balloon, an image of the balloon expanding would appear on the screen. If the balloon exploded, a loud explosion sound was played and the participant was shocked. On fifty percent of the trials the participant did not win any money (i.e., no reward trials), regardless of the size of the balloon chosen, whereas on the other fifty percent of the trials the participant did win money (i.e., rewarded trials), again regardless of the size of the balloon chosen. The administration of shock was not contingent upon receipt of a reward; rather, probability of shock was determined based upon the participant's balloon choice (see above for percentages). The visual arrangement of balloon/pass options on the screen was randomized as was the order of reward/no reward trials. Participants were not informed of the reward or shock probabilities. Participants were only told that the risk of shock and balloon reward value increased with balloon size. Finally, participants were not told the relative likelihood of receiving versus not receiving a reward each trial. Instead, participants were only told that they would not win money every time, and that shock administration could occur on both rewarded and nonrewarded trials. Split-half reliability for choice behavior across the first and second half of the task indicates excellent internal consistency (rs N .81, ps b .001).
2.2.2. Cold pressor task The cold-pressor task is a widely used method of pain induction (Tousignant-Laflamme, Page, Goffaux, & Marchand, 2008) and has been used to behaviorally assess pain tolerance in prior work (McHugh & Otto, 2011). Participants are asked to submerge their nondominant hand in an ice water bath (between 0 and 5 °C) for as long as possible. Pain tolerance is operationalized as the time the participant removed their hand from the water minus the time the participant indicated they first started to experience pain.
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2.3. Measures 2.3.1. Intolerance of uncertainty (IUS-12; Carleton et al., 2007) The IUS-12 is a 12-item self-report measure that assesses the ability to tolerate uncertainty. Higher scores indicate greater intolerance of uncertainty. The IUS-12 demonstrated excellent internal consistency in the present sample (α = .91). 2.3.2. Distress Tolerance Scale (DTS; Simons & Gaher, 2005) The DTS is a 15-item self-report measure that assesses the ability to tolerate negative emotions in general. Higher scores indicate greater tolerance. The DTS demonstrated excellent internal consistency in the present sample (α = .90). 2.3.3. Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986) The ASI is a 16-item self-report measure that assesses the fear of anxious arousal and has been empirically shown to be a type of distress intolerance (Mitchell, Riccardi, Keough, Timpano, & Schmidt, 2013). Higher scores indicate greater fear of arousal. The ASI demonstrated good internal consistency in the present sample (α = .84). 2.3.4. Pain Anxiety Symptoms Scale (PASS-20; McCracken & Dhingra, 2002) The PASS-20 is a 20-item self-report measure that assesses intolerance of pain, with higher scores indicating greater anxious and avoidant reactions to pain. The PASS-20 demonstrated good internal consistency in the present sample (α = .89). 2.3.5. Physiological recording To prepare participants for the psychophysiological assessment, they were asked to wash their hands with Ivory soap and warm water. Electrode placement locations (middle/ring fingers on nondominant hand) were swabbed lightly with alcohol. Skin-conductance response (SCR) data were collected using a PsychLab recording system. Silver–silver chloride (Ag–AgCl) electrodes fitted with collars were filled with electrode paste and placed on the participants' distal phalanx of the middle and ring fingers of the non-dominant hand. Skin conductance (SC) was recorded through a DC amp connected to a 24-bit digitizing skin conductance coupler from Contact Precision Instruments. The SC data were scored using the PSYLAB 8 software program from Contact Precision Instruments via automated procedures. SCR data were recorded during a three minute relaxation period and again during the courage task itself. Mean SCR amplitude during relaxation and task engagement was calculated, with task reactivity calculated by subtracting the mean SCR amplitude during relaxation from the mean SCR amplitude during task engagement. 2.4. Procedure All participants provided written informed consent before beginning the IRB-approved study. After completing baseline questionnaires, participants completed the cold pressor task. Upon completion, skinconductance electrodes were connected to the distal phalanx of the participants' middle and ring fingers. Next, shock gel was used to lubricate a metal conductor connected to a shock generator. The metal conductor was then wrapped around the participant's pinky finger. Following the placement of the skin-conductance electrodes and shock conductor, the research assistant calibrated the shock generator to a shock intensity reported by the participant to be maximally uncomfortable without being painful. This calibration procedure is consistent with prior research using shock stimuli (Glenn et al., 2012). After calibration, the participant was instructed to relax for three minutes during which time skin-conductance was recorded. After the baseline relaxation period, the research assistant provided instructions on how to complete the
courage task, and then the participant completed the task while skinconductance was recorded.
3. Results 3.1. Courage and cold pressor task validity checks Current self-reported anxiety before the courage task was assessed with a 1 (‘No anxiety at all’) to 11 (‘Extremely anxious’) scale (M = 3.93, SD = 2.43), with peak anxiety during the task also assessed using the same scale following task completion (M = 6.51, SD = 2.87). Paired-sample t-tests revealed a significant increase in selfreported anxiety from pre-task to task engagement, t(56) = − 6.72, p b .001, suggesting that the courage task successfully increased anxiety. To ensure that the task also increased physiological arousal, pairedsample t-tests on average SCR indicated increases in SCR from relaxation (M = 2.78, SD = 1.74) to task engagement (M = 3.47, SD = 1.98; t(56) =−8.18, p b .001), suggesting that the courage task successfully induced sympathetic arousal. To obtain a measure of baseline pain during the cold pressor task, after immersing their hand in the water participants were asked to inform the experimenter when they began to experience pain and indicate the intensity of the pain on a 0 (‘No pain at all’) to 10 (‘Worst pain you can imagine’) scale (M = 5.96, SD = 1.80). After participants removed their hand, they were asked to indicate the peak intensity of pain they experienced during immersion (M = 8.26, SD = 1.36). Paired-sample t-tests indicated that pain significantly increased during the task, t(56) =−13.12, p b .001. Pain and anxious reactivity were computed using residualized change scores. Please see Table 1 for descriptives and bivariate correlations for self-report, courage task, cold pressor task, and psychophysiological data.
3.2. Hypothesis 1: IU will be positively associated with uncertainty avoidance behavior, but not general risk-averse behavior Although self-reported, but not physiological, anxious reactivity during the courage task predicted risk-averse task behavior, with greater anxious reactivity positively associated with pass choices (r = .32, p b .05), low (r = .39, p b .01) and medium-risk choices (r = .30, p b .05), and negatively associated with high risk choices (r = − .47, p b .001), IU was only significantly associated with pass choices (r = .32, p b .05).
3.3. Hypothesis 2: IU will be the only tolerance variable associated with uncertainty avoidance behavior, and the association will remain significant after controlling for anxious reactivity Scores on the DTS, ASI, and the PASS-20 were not associated with behavior on the courage task (ps N .23). Because of the nature and distribution of the choice data, negative binomial link regression was used to examine the independent effects of IU and anxious reactivity given that this approach is well-suited to count data that are overdispersed (Gardner, Mulvey, & Shaw, 1995). Negative binomial link regression analyses revealed that after controlling for the effect of anxious reactivity during the task (B = .48, SE = .16, p b .01), IU remained positively predictive of the number of pass choices (B = .03, SE = .01, p b .05).
3.4. Hypothesis 3: IU will not predict behaviorally-indexed pain tolerance IU was not significantly associated with cold pressor immersion duration (r = −.24, p = .08).
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259
Table 1 Descriptive statistics and bivariate correlations. Measures M (SD) Self-Report 1. IUS-12 14.88 (9.44) 2. DTS 50.84 (11.65) 3. ASI 18.91 (9.20) 4. PASS-20 36.32 (14.44) 5. ΔAnxiety 1.93 (3.17) 6. ΔPain 2.30 (1.32) Behavior 7. Pass 2.93 (5.56) 8. Low Risk 10.14 (14.86) 9. Medium Risk 15.00 (17.26) 10. High Risk 51.46 (28.13) 11. Immersion 29.38 (28.91) Physiology 12. ΔSCR 0.76 (0.70)
1
2
3
4
5
6
7
8
9
10
11
12
1 −.40⁎⁎
1
.42⁎⁎
−.54⁎⁎⁎
.38⁎⁎
−.31⁎
1 .31⁎
1
.05
.04
.03
.00
.09
.16
.10
−.04
−.16
−.12
−.09
.18
−.03
.32⁎ .16
1 −.07
1
.32⁎
.06
.02
.39⁎⁎
.10
.39⁎⁎
.30⁎
.23
.11
.23
1 1
−.06
−.05
.00
.11
−.16
−.03
.03
−.07
−.47⁎⁎⁎
−.20
−.54⁎⁎⁎
−.77⁎⁎⁎
−.74⁎⁎⁎
−.24
.20
−.11
−.27⁎
−.08
−.24
−.20
−.13
−.20
.24
−.05
.02
.04
−.21
.23
−.11
.19
−.11
−.01
.07
1 1 1
.13
1
Note. IUS-12 = Intolerance of Uncertainty Scale; DTS = Distress Tolerance Scale; ASI = Anxiety Sensitivity Index — 3; PASS-20 = Pain Anxiety Symptoms Scale-20; pass/low risk/medium risk/high risk = # of choices on balloon task; immersion = cold pressor duration time (in seconds) after first pain; SCR = Skin Conductance Response. ⁎ p b .05. ⁎⁎ p b .01. ⁎⁎⁎ p b .001.
4. Discussion The results of the present study were consistent with our hypotheses. IU, but not other affect or pain tolerance variables, uniquely predicted uncertainty avoidance behavior on the balloon courage task, and this relationship remained significant after controlling for anxious reactivity, which was robustly related to general risk-averse task behavior. Further, IU did not significantly predict cold pressor immersion duration, suggesting the dissociability of behavioral indices of uncertainty and pain tolerance. The courage task represents a novel behavioral assessment of risktaking involving variable threat/reward contingencies together with an escape option that reflects an ecologically valid decision-making context. The present results are consistent with studies demonstrating state anxiety's association with risk-averse behavior (Raghunathan & Pham, 1999), and suggest that IU may have incremental utility in understanding risk-taking behavior in anxiety disorders. The significant association between IU, but not other distress intolerance variables, and uncertainty avoidance behavior, is suggestive of IU's construct validity and the importance of domain specificity to understanding individual differences in distress intolerance. However, although not significant, the correlation coefficients observed between cold pressor immersion duration and uncertainty avoidance behavior, and between the former and IUS/DTS/PASS-20 scores, suggest that affect/pain tolerance variables share common variance (McHugh & Otto, 2011). Finally, the null associations between IU and emotional reactivity are consistent with previous findings on distress tolerance task behavior and emotional reactivity (Daughters, Sargeant, Bornovalova, Gratz, & Lejuez, 2008). This study has limitations that should be mentioned. First, all observed associations are correlational in nature. Future studies utilizing experimental designs are required to determine whether IU causally affects risk-taking behavior. Second, data were collected from a small,
predominantly female high-functioning student sample and the highrisk choice mean was quite large. Future research should assess IU and courage task behavior in community and clinical samples to ensure that the task is sensitive to expected risk-taking differences across samples. Additionally, given the robust gender differences in anxiety and risk-taking behavior (Byrnes, Miller, & Schafer, 1999; Feingold, 1994), future work should utilize larger samples with more equitable gender representation to examine if courage task behavior is associated with relevant individual differences for both males and females. Relatedly, future work should examine the utility of the courage task in adolescent and older adult samples given the relevance of these developmental periods to risk-taking (Steinberg, 2007). 5. Conclusion The present study represents, to our knowledge, the first test of a risk-taking task incorporating a continuum of threat/reward contingencies capable of distinguishing risk-averse and uncertainty avoidance behavior. The incremental utility of IU and its specific relationship with uncertainty avoidance, but not general risk-averse behavior suggest that IU may be valuable in understanding risk-taking behavior in nonclinical and clinical populations. Future studies may consider utilizing the courage task to assess the role of IU and other relevant decisionmaking variables in risk-taking behavior. Acknowledgments, declaration of interests, and funding organizations We have none to declare. References Barlow, D. H. (2002). Anxiety and its disorder: The nature and treatment of anxiety and panic (2nd ed.). New York: The Guilford Press.
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