In a State of Flux
COPING WITH UNCERTAINTY.
If offered a new, more challenging position, some people will jump at the opportunity despite the possibility of failure, while others will cling to the comfort of their current, familiar job.
One factor that influences decisions like these is an individual’s ability to live with not knowing how a situation will unfold.
Over the past 30 years, researchers have learned that a high degree of difficulty coping with unpredictable, novel, or ambiguous situations is a risk factor common to a range of different mental health challenges.
What’s more, over the past decades, levels of this trait – known as intolerance to uncertainty (IU) – have climbed in the population as a whole, while arguably, the future seems more uncertain than ever before.
And many of the strategies people use to alleviate the distress of not knowing can worsen IU. On the other hand, it’s possible to dial down IU levels by learning healthier ways of handling uncertainty,, which in turn can improve your mental health and quality of life.
Researchers unexpectedly hit upon the concept of IU while studying generalized anxiety disorder (GAD). “The hallmark of GAD is excessive, uncontrolled worrying,” said Dr. Michel Dugas, one of the scientists who coined the term IU and developed a tool to measure it. (Dr. Dugas is currently Director of the Anxiety Disorders Laboratory and a professor of psychology at the Université du Québec en Outaouais.)
In trying to understand why people worry, Dr. Dugas and his collaborators initially wondered if it might be problem-solving run amok or a problem-solving deficit. However, their experience working with clients hinted at something else.
‘ALLERGY’ TO UNCERTAINTY
“Research in social psychology has shown that, given a choice between a clear outcome and an ambiguous outcome, just about everybody prefers one that’s clear,” Dr. Dugas said.
“But what we noticed in our clinical work, and later on studied more systematically, is that some people have a much higher level of difficulty dealing with uncertainty. So while most people don’t like it, really some people are almost allergic to it.”
People with very high IU, “can’t stand sitting with not knowing – it’s very uncomfortable for them,” added Dr. Dugas. “That’s what we’re interested in, in terms of how that contributes to our understanding of worry and anxiety.”
According to Dr. Dugas’ definition, “it’s important to distinguish uncertainty from threat, because I think that’s something that’s confused now in the literature,” he said. While the two often go hand-in-hand (for instance, a student’s distress at not knowing whether they’ll pass an important exam, plus fear that a failing grade will derail their career aspirations), that’s not always true.
“What we noticed in people with generalized anxiety disorder is this idea that even positive uncertainty is bad.”
“They might tell their spouse no surprise birthday parties ever,” Dr. Dugas continued. That said, perceived threat can exacerbate IU-related stress and anxiety, particularly in the case of “unknowable” unknowns.
“The more threat we imbue those with, the more concerned we are about those outcomes, the more problems they’re likely to cause us,” explained Dr. R. Nicholas Carleton, a professor of clinical psychology at the University of Regina, and author of several papers on uncertainty.
MISGUIDED CERTAINTY-SEEKING STRATEGIES
One of the drawbacks of experiencing high levels of discomfort in the face of uncertainty is that it can push people to make choices that are unhelpful in the long term.
“In the experimental research that’s been done, as people’s intolerance of uncertainty goes up, they’re more likely to choose a known negative outcome,” over a more delayed, positive one, said Dr. Carleton, “because they think at least then, they can build a plan.”
This kind of decision is just one example of something that’s referred to in the literature as a safety behaviour. Since people with high IU find not knowing intolerable, “they’ll indulge in these safety behaviours to try to decrease their feelings of uncertainty,” Dr. Dugas explained.
Other such strategies include procrastination, distraction, over-researching, constant double-checking or list-making, and seeking excessive reassurance from others.
“An example is a client who asks their spouse, ‘You’re not smiling much, is anything wrong? Did I do something?’” said Dr. Dugas. “And the spouse says everything’s fine don’t worry.” This only temporarily provides relief, so the cycle repeats over and over again.
“Paradoxically, the solutions people use to help themselves feel less anxious end up contributing to their anxiety and worry in the long term.”
Say someone has a panic attack and can’t bear not knowing when the next one might strike, “they might rarely, if ever leave the house,” Dr. Carleton noted. This kind of behaviour may cause strained relationships, which could further exacerbate their anxiety.
But what determines an individual’s ability to tolerate uncertainty in the first place? “The more we started to dig into it, the more evidence there was to suggest that we have different levels inherently with which we can tolerate unknowns,” Dr. Carleton said.
“Some of that is going to be biologically based, some is going to be socially based, and some of that is environmentally based.”
“For example, if you had a very safe childhood, and you weren’t worried about love, money, or basic needs, you may be more tolerant of uncertainty because your body basically accepted that the world was, in general, a safe, knowable place. In contrast, if you had a lot more difficulties, that might make you less able to tolerate uncertainty.”
“To put this in a larger context, there are theories that we come into the world needing certainty because from a survival of the species point of view, it might be a good idea not to like novel and unpredictable situations too much,” continued Dr. Dugas. “So the default position may be to be intolerant of what is novel, ambiguous, or unpredictable, and we need to learn to tolerate uncertainty.”
That idea, he explained, suggests we need to be able to identify cues in our environment that tell us, “I’m safe.”
‘IMMUNOTHERAPY’ FOR IU
Returning to the allergy metaphor, kids with a peanut allergy can become less sensitive to peanut protein by consuming it in small, gradually increasing doses. The same approach has been found to be effective in treating IU.
“In therapy, we help people provoke situations where they don’t know how things will turn out,” Dr. Dugas explains. “We have them identify where they feel that uneasiness – often people will say they feel it in their stomach – and habituate to that feeling.”
“By provoking uncertainty in your life and helping you gradually learn to deal with that, you may be able to worry less and feel less anxiety.”
So-called behavioural experiments are one of the main tools used in this process. These involve carrying out a prescribed activity that brings on a mild to moderate amount of distress.
“For a client who is glued to their cellphone because they’re so worried they’ll miss an important call, or that someone will be upset with them if they don’t answer, we’ll have them leave their cellphone at home,” Dr. Dugas explained. “In an ideal situation, the person will get home, see that a friend called to reschedule a get-together and everything’s fine – the friend’s not upset.”
He noted that the ideal behavioural experiment is one where things don’t go well, and people learn that it’s not catastrophic even if things don’t go to plan.
SELF-HELP STRATEGIES
People whose struggles with uncertainty aren’t sufficiently severe to require a mental health professional’s help can try devising behavioural experiments to target their own individual areas of difficulty, increasing the level of challenge with each step. For example, someone who feels compelled to go to the same restaurant all the time might try going to an unfamiliar one.
“You can add skills and increase confidence by practicing with uncertainty,” suggested Dr. Carleton.
Dr. Carleton believes that a ubiquitous aspect of modern living has robbed us of opportunities to routinely engage in this type of exercise in our day-to-day routine.
“Before cellphones, there were all kinds of little things we got used to accepting that we didn’t know. You couldn’t know where your loved one was at that exact moment or resolve a barroom debate,” he said. “Over the past 20 or 30 years, we’ve systematically removed these tiny opportunities to practice dealing with being uncertain.”
“The argument we made in a paper that we authored was that we’re seeing this increase in difficulties with uncertainty, and it maps onto the increase in the penetration of cellphones.”
“Putting down the smartphone could help a lot,” to build the average person’s tolerance for uncertainty, Dr. Carleton said.
A more novel approach to shifting comfort levels with the unknown was tested in a March 2020 study published in the journal Thinking Skills and Creativity. It involved two experiments: in each, half of the participants engaged in 20 minutes of collaborative improv thinking exercises or a matched control condition including social interactions.
Among those in the improv group, measures of divergent thinking, tolerance of uncertainty, and affective well-being improved. According to the authors,
“Since improvisation involves encountering uncertainty in a non-judgmental, trusting, and mutually supportive environment, new associations developed through improv are likely non-threatening and even pleasant.”
Another body of research has looked at life circumstances where even people who might normally have little problem with the unknown often experience intense distress– high-stakes situations such as waiting for breast biopsy results or news about academic placements.
One study, published in Emotion in 2019, found that engaging in an activity that induced “flow” or complete immersion bolstered well-being during three types of anxiety-provoking periods – such as awaiting bar exam results. (People can achieve flow during a variety of activities, such as gardening and painting. In the study, participants either performed self-reported flow activities or played Tetris.)
Flow even appeared to help people cope during the early days of COVID-19, according to a November 2020 paper published in PLOS ONE . Researchers recruited 5,115 people living in major Chinese cities to fill out an online survey in February 2020, which included rating their well-being over the past week, as well as two questionnaires that gauged levels of flow and mindfulness during the same period.
One notable finding: participants who had been quarantined for long periods who also scored higher-than-average on the flow scale had levels of well-being on par with people who had not yet quarantined.
BENEFITS OF INCREASED TOLERANCE FOR UNCERTAINTY
However, the benefits of learning healthy strategies for coping with uncertainty likely aren’t limited to reduced distress when confronting the unknown.
Being able to maintain relative calm in specific types of uncertain situations may help facilitate learning. Dr. Joseph W. Kable, the Jean-Marie Kneeley President’s Distinguished Professor of Psychology and Director of MindCORE at the University of Pennsylvania, is a decision scientist.
He studies how people perform on tasks involving what’s known as epistemic uncertainty, which is, “uncertainty that comes from a lack of knowledge – so in theory you could know but you don’t,” Dr. Kable explained.
“We’re looking at how the brain registers that state of ‘there is something we could know that we don’t know’ and how it affects brain communication and behaviour,” Dr. Kable explained.
“The short story is that uncertainty is a big clue to our minds that we should pay attention, seek out information, and learn. It increases arousal and seems to make brain regions more connected with each other so information can flow in a way that makes you sensitive to incoming information, as opposed to what you’ve learned in the past. The behavioural impact is that people do pay more attention and update their behaviour more quickly when (epistemic) uncertainty is high.”
Perhaps the strongest argument for working toward greater comfort with uncertainty is that succumbing to IU is very limiting.
According to Dr. Dugas, “People don’t travel. They avoid opportunities and challenges. It interferes with pleasure across almost all life domains. In our therapy, we try to help our clients move from just tolerating uncertainty to embracing it, because one of the disadvantages of not embracing it is that people don’t fully live their lives.”
TEACH YOURSELF TO TOLERATE UNCERTAINTY
To work on improving your tolerance of uncertainty, Anxiety Canada offers the following tips:
Make a list of the behaviours you use to try avoid uncertainty, such as procrastinating, frequently seeking reassurance from others, or checking certain things over and over again.
Then rank these behaviours on a scale of zero (no anxiety) to 10 (extreme anxiety) according to how you would feel if you could not do them. Once you have a list, choose the lowest-stake tasks and start trying them without falling back on old habits.
Examples:
· let your teen hang out with friends without calling to check up on them; and
· go out with your partner and have them make all of the plans.
Finally, write down what happened following each of these experiments. For more detailed instructions, go to anxietycanada.com and search for “uncertainty.”
A 2023 paper by Dr. Fabiola Olivieri and colleagues reviewed sex-dependent differences related to inflammaging and found they are affected by hormones. In particular, they reported that women have an immune system advantage over men during their reproductive years, but reduced estrogen production post-menopause is associated with immune system changes that eliminate that advantage.
As a result, women tend to live longer but experience worse health in later life compared to men. (These findings were shared in Mechanisms of Ageing and Development.)
Source: Mind Over Matter V19