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Embracing Uncertainty

Exercise

Intolerance of uncertainty (IU) was first described in individuals suffering from Generalized Anxiety Disorder (GAD). Many behaviors associated with GAD, such as worry and avoidance, can be framed as attempts to increase ones sense of certainty: worry is the attempt to look ahead and foresee potentially negative consequences, avoidance and ‘sticking to what is known and safe’ reduces exposure to the unknown. Recent research has recognized intolerance of uncertainty as a transdiagnostic risk factor for many clinical conditions including anxiety, depression, obsessive-compulsive disorder, and eating disorders. A behavioral approach for addressing intolerance of uncertainty is to encourage clients to introduce uncertain events into their lives gradually. Through a process of exposure and habituation clients, can be helped to behave in more flexible ways.

Embracing Uncertainty CBT Handout Embracing Uncertainty CBT Handout Embracing Uncertainty CBT Handout Embracing Uncertainty CBT Handout

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Description

Intolerance of uncertainty can be viewed as a dispositional characteristic that results from a set of negative beliefs about uncertainty and its implications. (Dugas & Robichaud, 2007)

Intolerance of uncertainty involves the tendency to react negatively on an emotional, cognitive, and behavioral level to uncertain situations and events. (Dugas, Buhr, & Ladouceur, 2004)

Intolerance of uncertainty was first described in individuals suffering from generalised anxiety disorder (GAD). Metaphors used to describe people who are intolerant of uncertainty talk about how they can behave almost as if they were ‘allergic to uncertainty’, or as though they have a ‘phobia of uncertainty’. Many behaviours associated with GAD, such as worry and avoidance, can be framed as attempts to increase one’s sense of certainty. Understood in this way, worry is the attempt to look ahead and foresee potentially negative consequences, and avoidance and ‘sticking to what is known and safe’ reduces exposure to the unknown.

Unfortunately, attempts to feel better by increasing one’s sense of certainty often result in unintended consequences. For example, attempting to ‘think ahead’ in order to foresee difficulties can result in worry that feels uncontrollable and actually generates more uncertain possibilities and anxiety. Attempting to stick to what is known and safe can result in feeling less confident when you inevitably encounter novelty and change. In the context of OCD, compulsive checking as a strategy to increase one’s sense of certainty actually leads to an increase in doubt (Radomsky et al, 2014).

Wilkinson, Meares & Freeston (2011) describe various strategies for overcoming intolerance of uncertainty. One cognitive approach is to understand an individual’s beliefs and rules about uncertainty (e.g. “If I go into an uncertain situation without preparing then I won’t be able to cope”) and then test these with behavioural experiments. A more behavioral approach for addressing intolerance of uncertainty is to encourage clients to introduce uncertain events into their lives gradually. Through a process of exposure and habituation clients, can be helped to behave in more flexible ways.

This Embracing Uncertainty exercise describes the continuum of intolerance of uncertainty, the rationale for exposing oneself to uncertain situations, and suggests ‘embracing uncertainty’ tasks that clients can be encouraged to try.

Instructions

Clinicians can condsider introducing this exercise in the following terms:

“When people find uncertain situations anxiety-provoking we sometimes say that they are ‘intolerant of uncertainty’. It’s almost as though they have an allergic reaction to situations where they don’t know what the outcome will be. In this way it is a bit like a phobia. Some people who are intolerant of uncertainty might avoid trying new activities, or might avoid situations that they can’t control or predict. Others try to reduce uncertainty wherever they can. For example, they might find out as much as they can before going somewhere new, order the same meal at a restaurant, or sit in the same place on a train. Does any of that sound familiar to you?

One good way that psychologists have found to help people to overcome fears like these is to use ‘graded exposure’. To help someone with a phobia overcome their fear of dogs they would be gradually introduced to dogs – perhaps to pictures, then to a puppy, and then to bigger dogs. We can do a similar thing when people are intolerant of uncertainty. By gradually introducing elements of uncertainty into your life we can help you to live more of the life that you want to lead. Would you be willing to explore how we might do this together?”.

References

  • Buscaglia, L. (1982). Living, Loving, and Learning. New York: Henry Holt & Company.
  • Dugas, M. J., Buhr, K., & Ladouceur, R. (2004). The role of intolerance of uncertainty in the etiology and maintenance of generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: advances in research and practice (pp. 143–163). New York: Guilford Press.
  • Dugas, M. J., & Robichaud, M. (2007). Cognitive-behavioural treatment for generalized anxiety disorder: from science to practice. New York: Routledge.
  • Radomsky, A. S., Dugas, M. J., Alcolado, G. M., & Lavoie, S. L. (2014). When more is less: Doubt, repetition, memory, metamemory, and compulsive checking in OCD. Behaviour Research and Therapy, 59, 30-39.
  • Wilkinson, A., Meares, K., Freeston, M. 2011. CBT for worry & generalised anxiety disorder. London: Sage.