“What if I make a mistake?”: Examining uncertainty-related distress when decisions may harm oneself vs. others

• Published in: Journal of obsessive-compulsive and related disorders 2019-01, Vol.20, p.50-58
• Main Authors: Jacoby, Ryan J., Reuman, Lillian, Blakey, Shannon M., Hartsock, Jeremiah, Abramowitz, Jonathan S.
• Format: Article
• Language: English
• Subjects: Behavioral assessment; Decision making; Obsessive compulsive disorder (OCD); Physiological Stress; Uncertainty
• ISSN: 2211-3649; 2211-3657
• DOI: 10.1016/j.jocrd.2017.11.003

Intolerance of Uncertainty (IU) is a key construct in the development and maintenance of obsessive-compulsive disorder (OCD). Recent research has examined the Beads Task as a behavioral measure of IU in which an incorrect decision is tied to an aversive outcome. The current study aimed to increase ecological validity of the Beads Task as an analog for decisional uncertainty in OCD. Specifically, we investigated whether the aversive outcome's “victim” impacted associations between IU and distress during decision-making. Undergraduates (N = 85) completed the Beads Task either alone or with a confederate partner. They were told that errors on the task would either lead to themselves (solo condition) or their “partner” (partner condition) having to complete the Cold Pressor Task (CPT). As hypothesized, participants in the partner condition experienced the Beads Task as significantly more distressing and important than those in the solo condition. Furthermore, self-report prospective IU was associated with distress about harm befalling oneself and perceived importance of the decision (solo condition), whereas inhibitory IU was associated with distress about harm befalling others (partner condition). Clinical implications for addressing uncertainty using exposure and response prevention, and future research of decision-making in the context of responsibility for harm are discussed. •Aimed to enhance Beads Task as an in vivo measure of uncertainty-related distress.•Investigated whether the task's “victim” impacted the decision-making process.•Group responsible for harm to their partner was more distressed than solo group.•Beads Task distress and importance correlated with prospective IU for solo group.•Beads Task distress was correlated with inhibitory IU for the partner group.