Intolerance of Uncertainty: Should I Stay Or Should I Go?

Imagine the following scenario: You are on the subway, headed to an important work meeting, and have no time to spare. All is good until, one stop away from your destination, the train just sits there in the station — doors open, engine idling. 

Then you hear the familiar announcement, “Ladies and Gentlemen: We are being held momentarily by the train’s dispatcher. Thank you for your patience.” After a small eternity, you think to yourself indignantly, “Really?” You check the time and immediately know you have a decision to make: you can get off the train, sprint up the stairs and hail a cab, but there is no guarantee you will find one and what if you end up having to run the whole way there? Or, you can stay on the train and wait for it to move but there is no guarantee that it ever will and what if you have wasted all that time waiting? 

While you feverishly consider the endless “what-ifs,” you remain stuck in place, impatiently fretting, unable to commit to one course of action or another. And then you hear it, “Stand clear of the closing doors!” You let out a sigh of relief as the subway lurches forward. Your decision has been made! Your torturous ordeal is over. Bottom line: You arrive, slightly sweaty, 10 minutes late — not at all what you wanted to happen, but also not the catastrophe you had predicted. You promise yourself you will leave for work ten minutes earlier from now on.

What you have just experienced is something CBT therapists refer to as “intolerance of uncertainty” – the anxious feeling brought on by the irrational demand that you MUST know what is going to happen and if you don’t know, that means it is probably going to turn out bad. 

Uncertainty is an unavoidable fact of daily life, yet people vary greatly in their ability to tolerate it. Some are relatively okay with not knowing, while others can barely stand it. Research has shown that people who are excessive worriers tend to equate uncertainty with negative predictions about the future, regardless of the probability of a negative consequence actually occurring. 

Just the possibility, alone, is so uncomfortable to some, that they may engage in behaviors designed to eliminate the uncertainty, such as procrastination, reassurance-seeking, distraction, list-making, excessive research, endless editing, etc. Despite their best efforts to avoid it, the uncertainty lingers and discomfort may even increase as unhelpful thoughts begin to intrude e.g., “I can’t stand this!” “This is awful.” “I should know what to do.” “What’s wrong with me?”

Understanding Intolerance of Uncertainty

Intolerance of uncertainty is often described as a “dispositional characteristic” that results from underlying negative beliefs about the state of uncertainty and how it will affect your life. In the world of psychology, intolerance of uncertainty is frequently connected to both generalized anxiety disorders and obsessive-compulsive disorders.

For people with generalized anxiety disorder, uncontrollable worry about the future and the fear of the unknown are two of the key defining characteristics. This worry can be paralyzing and may interfere with your ability to work, maintain relationships, or pursue meaningful activities in your life.

Often, people living with anxiety disorders feel as though their worry is adaptive, helping them to make the right choice. It’s a desire for control: by analyzing every potential situation, you may be able to minimize the risk of potential consequences.

In reality, the excessive worry and intolerance of uncertainty becomes the consequence itself. While you may feel more mentally prepared should an exceptionally rare but catastrophic outcome occur, you guarantee yourself undue stress in the much more likely scenario that the result is not as bad as you think.

People living with obsessive-compulsive disorder (OCD) have a similar fear of unknown events and a common pattern of seeking control. The rituals, compulsions, and obsessions that are characteristic of OCD are typically done to prepare for future consequences that may or may not ever occur. 

For example, a person may feel a strong uncertainty over whether they have left the stove on at home. Rather than continue to live with the worry and anxiety about the potential consequences, they rush to the stove to check that it is off. Only by learning to become tolerant of uncertainty can anxiety in decision-making be relieved.

The Impact of Anxiety and Decision Making

When you’re stuck between two bad options, your anxiety can amplify the negative outcomes of both scenarios. This makes it difficult for people to make quick and accurate assessments, as the outcome of any particular course of action can be perceived as being much worse than it truly is.

This often results in a phenomenon known as decision anxiety. In the example on the train, the anxiety about decisions pins you in place, unable to determine whether you should stay or go. You may run through countless potential scenarios, make extensive pros and cons lists, or ruminate on all the bad things that may happen if you make one choice or another.

For many, this simply leads to inaction rather than correct action. Past a certain point, worry loses its protective properties and makes the decision of inaction for you. 

Decision-making and anxiety are poor companions. When you need to make a decision and act, you are overwhelmed with a fear of uncertainty. And when you need to simply be present and accept your circumstances, you are overcome with negative thoughts and future scenarios. Neither truly helps you accomplish your goals but only adds to your stress.

Many of my clients come in with anxiety related to decisions they need to make. Whether or not to stay at a job, leave a relationship, move to a new city, become a single parent, or change a career path are just a few examples. etc. In these cases, it is often helpful to begin by exploring the individual’s relationship with uncertainty and what “not knowing” means to them. We look at the what-ifs embedded in the worry and consider the likelihood that any particular outcome will, in fact, be catastrophic. 

To become more tolerant of uncertainty, we must first learn to identify what we are telling ourselves about it. Are we focusing on the negative outcome more than the positive or neutral? Are we overestimating the risk of a negative outcome? Is there more than just a right or wrong decision? Most importantly, if a decision turns out to have a negative outcome, can we creatively cope with the fallout without putting ourselves down for making a disappointing choice?

Coping Strategies for Intolerance of Uncertainty

Building strategies to tolerate uncertainty can be difficult at first, but as you continue to work with a therapist and practice these strategies in your daily life, the process can start to feel natural and effortless. But remember that recovering from anxiety takes time. You must train yourself to become more tolerant of uncertainty, more comfortable in uncomfortability, and less prone to worry.

Scientists and clinical practitioners have dedicated years to developing treatment methods and coping strategies that work for the greatest number of individuals. Some of the more common strategies include:

Cognitive Reframing

Reframing is a technique used by cognitive behavioral therapists, who focus on helping their clients identify, challenge, and change the maladaptive thought patterns that lead to worry, fear, or rumination. 

In the case of the subway delay, a number of thoughts could be considered targets for cognitive reframing, such as:

• “I’m going to lose my job if I’m late.”
• “My friends will be so angry that I didn’t show up on time.”
• “This client will never want to work with me again.”
• “They’re going to think I’m untrustworthy after this.”

Cognitive-behavioral therapists have a number of terms for thoughts like these. Broadly, they are referred to as “cognitive distortions.” But they might also fit into subcategories, such as:

• Fortune Telling: When you make predictions about how future events will unfold.
• Mind Reading: When you predict how somebody is going to react.
• Magnification: When you focus on the importance of small problems rather than on overall qualities.

Cognitive reframing is a technique that can help you identify these thoughts as what they truly are: irrational, not based on fact, and a source of distress. Your therapist may then guide you towards challenging these thoughts and ultimately replacing them with healthier, more rational ways of thinking. You may reframe the situation with thoughts such as:

• “I might be late, but I won’t lose my job over five or ten minutes. Everyone on the team has dealt with transportation issues before, and nobody has lost their job over them.”
• “My friends might be bothered, but it’s not going to end our friendship. I can call them and let them know the subway is being delayed.”
• “My client might not be pleased with a slight delay, but it doesn’t mean we won’t work together again. We have a long working relationship, and they know that this isn’t the norm.”
• “Being late isn’t an indication of my trustworthiness. It happens to everyone, and they’ll understand.”

Over time, these techniques can become natural — to the point where the cognitive distortions get nipped in the bud before your anxiety starts to spin out of control.

Acceptance and Mindfulness Techniques

Sometimes, it can be difficult to replace distressing or anxious thoughts with more reasonable ones. Anxious thoughts and feelings can be invasive and often carry an inertia of their own.

Rather than trying to change every thought through reframing or other CBT techniques, many people have better success learning to accept their thoughts and emotions mindfully. Mindful acceptance may not remove the anxious thoughts, but it can help you to manage your reactions to them.

A common mindfulness technique that can be incredibly beneficial for people with anxiety is the five senses exercise:

• Notice five things you can see
• Notice four things you can touch
• Notice three things you can hear
• Notice two things you can smell
• Notice one thing you can taste

By drawing your attention to the here and now of sensory experience, you can disconnect from the flurry of anxious thoughts and bring your attention to the present moment. This can vastly improve your symptoms of anxiety and help you to address your challenge with a calm, stress-free approach.

Becoming comfortable with uncertainty inevitably means challenging our irrational demand for it. And it takes practice. When clients have a difficult decision to make, I suggest that they keep a log of their thoughts about the situation, including their needs, wants, predictions, fears, hopes, assumptions, previous experiences, etc. This will help us to identify, in session, what they are telling themselves about the problem. They can also make a list of unhelpful behaviors in which they may be engaging in an attempt to deal with the discomfort of the situation. Evidence shows that change is most likely to take place when we challenge our assumptions through active disputation of our thoughts as well as through behavioral experimentation. Avoidance is never a solution. Additionally, I encourage my clients to practice relaxation or mindfulness techniques which can be extremely beneficial towards decreasing anxiety by allowing a shift of focus from the future to the present.

In the case of the subway delay, not making a decision is still a decision. It just doesn’t feel as good. You might get through the ordeal with less stress if you remind yourself that there are no decisions that can guarantee a timely arrival at your meeting. You then accept the discomfort of being uncertain and choose “a” decision, rather than futilely demanding to know “the” decision. To do so requires telling yourself that you will be okay, you can cope with the outcome and, most importantly, you can learn from the experience.

Think about it this way. Every time you walk out your front door, you are already doing a good job of accepting the biggest uncertainty of all – life.