A Practical Evidence-Based Self-Help Program for COVID-19-Related Worry and Anxiety
Session Three: On Uncertainty
Prepared by Nicole Carter, MSW, RSW
Please do not copy or distribute this material without permission.
Intolerance of Uncertainty
What Does it Mean to be “Intolerant of Uncertainty”?
While we all vary in terms of how much uncertainty we feel comfortable with in our lives, those of us who worry a lot can sometimes find ourselves to be more “intolerant of uncertainty” than those who worry less. Of course, uncertainty is something most of us dislike to some extent, especially during the COVID-19 pandemic. We want to know that our hospitals and governments are equipped to manage COVID-19-related issues effectively, and that our employers or teachers/professors have clear plans for us, and that we are doing everything in our power to maintain good health for ourselves and others. However, too much intolerance of uncertainty can create unnecessary feelings of anxiety and fear, and behaviours that can exhaust us. Tolerating uncertainty more can help reduce worry and feelings of anxiety and improve sleep, among other things.
“Uncertainty can be exciting. Known negative outcomes could eliminate risk, romance, wonder, and joy.”
Uncertainty as an Unavoidable Part of Life
As uncomfortable and at-times scary as it can be to admit, uncertainty is an unavoidable and unpreventable part of life. COVID-19 is certainly a good example of this, as very few of us would have ever predicted that in March 2020 the world would be locked down, sports cancelled, makeshift hospitals being built, and a pandemic raging across the globe.
Because uncertainty is so uncomfortable for many of us, engaging in behaviours to try to increase our feelings of certainty makes sense. But is uncertainty really something we have control over? Is it truly possible to attain certainty in our life? Many argue no, as we cannot see into the future.
Instead, it can be helpful to build our tolerance to uncertainty – especially during times of increased stress. When it comes to intolerance of uncertainty, we have two options - but only one is actually possible and/or arguably effective. Can you guess which one that is from the diagram below?
If you guessed option one, you are correct.
Increasing our Tolerance of Uncertainty
Shifting Our Thinking
As mentioned in the previous two sessions, shifting how you think can change how you feel and behave. If we think “as if” we are tolerant of uncertainty, we can start to feel more comfortable with it and experience less anxiety and worry as a result. Consider the following questions:
Is it truly possible to control the outcome of an event?
How often have I been right in the past when I have predicted a disaster?
What could I do to cope if the worst-case scenario did happen?
What are at least three other possible outcomes?
What is the most likely case scenario?
What can I do about this right now?
If the feared outcome does occur, how will I feel about this in two years? Ten years?
Self-help Exercises
Consider trying to think and behave “as if” you were tolerant of uncertainty this week. Ask yourself, “If I was tolerant of uncertainty, how would I be thinking? What would I be doing?”
Consider trying to gradually reduce behaviours that nurture an intolerance of uncertainty, such as excessive research, high expectations on yourself or others, procrastination, perfectionism, avoidance, seeking reassurance from others or the internet, checking behaviours, or excessive media intake. Make a list of behaviours you engage in to avoid uncertainty, rating them in terms of how difficult it would be to start reducing them. Choose one behaviour each week to focus on, starting with the easiest for you, paying attention to your level of distress and anxiety. Your distress, while it might feel greater at first, should slowly reduce over time.
Shifting Our Behaviours
Changing the way we behave can have a direct impact on our feelings and thoughts - sometimes right away, and sometimes gradually over time. Feelings can take awhile to catch up to our changed behaviour patterns - for example, if you quit smoking, chances are you won’t experience changes in your feelings right away. If you decide to consciously change some of your behaviour patterns with the intent to reduce anxiety and it doesn’t happen right away, don’t don’t give up! Sometimes it can take longer than we think.
Shifting how we act in relation to uncertainty can directly impact how anxious we feel. When we begin to act “as if” we are tolerant of uncertainty, we start to feel more comfortable with it and experience less anxiety and worry as a result.
There are two ways to shift our behaviours in order to become more comfortable with uncertainty:
Someone struggling with an intolerance of uncertainty might decide to experiment with the following behaviours, rated in order of difficulty (10 being the hardest):
Instead of asking multiple times a day, ask my partner only once every two days if he/she has been in less than 6 feet of contact with another person on a given day (10)
Text my loved ones for reassurance once a week instead of daily to ensure they do not have symptoms (8)
Check the news once per day, at the end of the day, for 15 minutes maximum (8)
Allow my partner to wash grocery packaging without intervening and doing it myself (7)
Go for a walk in the neighbourhood keeping a safe distance from others who might be on the street (6)
Stop checking my oximeter readings at night and get back in touch with how my body feels instead (5)
Check my son’s temperature once per day instead of 3+ times per day (4)
Open an amazon box right away and wash my hands instead of leaving it on the doorstep for multiple days out of fear (2)
How Shifting Our Behaviours Reduces Anxiety
Over time, with repeated practicing of these experiments, our anxiety levels go down and we become more comfortable with uncertainty. Consider what might happen if you watch a scary movie once, and then 50 times: your arousal will be much lower on the 50th viewing. The stimuli in our brain becomes bored and our brain eventually habituates to the stimuli that once made us afraid or worried.
Just like watching a scary movie multiple times, tolerating uncertainty will become more and more comfortable with repeated practice that is frequent, spaced close together, and completed gradually. Below is an example of how these experiments might look over time.
Before making behavioural changes, we might be used to experiencing a high level of anxiety quickly, and with a behaviour aimed at reducing distress, the anxiety comes down quite quickly.
After deciding to experiment with reducing a behaviour or exposing to an uncertain situation, our anxiety might be slightly higher, and come down at a slower pace. However, with increased practice and trials, our anxiety begins to come down and fizzle out quicker than before.