Embracing Uncertainty
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 one's 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.
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Introduction & Theoretical Background
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
Therapist Guidance
Clinicians can consider 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
References And Further Reading
- 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.