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 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?”
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?
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.