December 16, 2021

Living with Uncertainty

The psychological difficulties that have arisen from the pandemic seem to have appeared in every aspect of our lives. Little did the entire world know that a new level of anxiety and worry would take over globally, as we were thrown into an overwhelming and confusing situation and feeling stuck in limbo. A challenge for many of us, especially among patients and healthcare workers, has definitely been handling uncertainty.

Intolerance of Uncertainty

Developed in the 1990s by a group of Canadian researchers (Freeston et al, 1994), the construct of Intolerance of Uncertainty (IU) has been defined as “a dispositional characteristic that results from a set of negative beliefs about uncertainty and its implications and involves the tendency to react negatively on an emotional, cognitive, and behavioral level to uncertain situations and events” (Buhr & Dugas, 2009, p.216)

And while IU was initially associated with generalized anxiety (GAD) and obsessive-compulsive disorder (OCD), it’s now more widely considered to be a contributing or sometimes even a causal factor for several psychological disorders. For clients seeking certainty to relieve a negative emotional state, it’s not uncommon to find their symptoms worsening as time goes by, since their coping strategies could be a bit unhealthy, and they haven’t reached out to a professional to help them out.

Read More: What is the Difference Between OCD and BFRBs and How Are They Related?

Complete Certainty as Illusory

Consider this: Assuming you are not with them, can you be 100% sure that your loved one is alive and well at this very second? Now imagine calling your loved one to check in and the phone goes unanswered. Do you feel more anxious or less anxious?  

Seeking certainty can certainly exacerbate anxiety. Your loved one eventually calls you back and your anxiety decreases, which is negative reinforcement by definition, but now, you routinely call your loved one to check in on them. The need to engage in this safety behaviour increases, leading to a temporary relief in anxiety, and ultimately leading to other problems (e.g., increased attention to threats, marital problems especially if you’re dealing with your spouse, and the like)

Uncertainty as an allergy…Being intolerant of uncertainty is a lot like having an allergy. If you are allergic to pollen for example, you will sneeze and cough, and your eyes may get red and teary when you are exposed to even a small amount of pollen. When people who are intolerant of uncertainty are exposed to a little bit of uncertainty, they also have a strong reaction: they worry, and do everything they can think of to get away from, avoid, or eliminate the uncertainty. (Anxiety Canada, 2019)

Uncertainty in the Face of the Pandemic

Considered novel, ambiguous, and unpredictable, the changing pandemic is a worldwide stressor that brings us an alarming level of uncertainty. We may experience a high level of anxiety and at the same time, worry for those who are essentially intolerant of uncertainty.  

The anxiety and worry that we have often leads to time-consuming activities such as practicing safety behaviours aimed at increasing certainty. Some specific examples of this include information-seeking (which is news overload), checking on family/friends (which is increasing attention to risk), or avoidance. Further stress, anxiety, and worry is experienced, leading to more safety behaviours, and so a feedback loop develops.


Is Living with Uncertainty in the Pandemic Normal?

Living with uncertainty, especially a pandemic, has not been the norm for most of history. However, it has become a new normal for people worldwide. The constant change in guidelines, evolving nature of the virus, and unpredictability of its spread have created an atmosphere of uncertainty that affects various aspects of our daily lives.  

Stemming from numerous factors such as vaccine availability and efficacy, government response and decision-making, and the emergence of new variants, professionals across industries have had to adapt their strategies constantly to navigate uncertainty especially during the peak of COVID 19.

From healthcare workers on the frontlines battling the virus to business owners trying to sustain their operations amidst fluctuating restrictions, everyone grappled with an unprecedented level of ambiguity. Psychological effects such as anxiety, stress, and fatigue are common consequences resulting from this prolonged period of uncertainty.  

There are also coping mechanisms like seeking accurate information sources, creating routines within the limitations imposed by safety measures, maintaining social connections virtually, and adopting resilience-building practices, which helped a lot to address uncertainty systematically while safeguarding everyone’s mental well-being.  

It is crucial to acknowledge that living with uncertainty and how it increased during the pandemic is not easy especially on our collective mental and emotional health, and it’s good to recognize it as a shared global experience can provide us a sense of solidarity and perhaps even comfort. It is important that we seek the right resources like a trusted therapist and a good intervention program so that we hold up well and healthily cope with uncertainty.

Targeting IU in Therapy

We help patients increase their tolerance for uncertainty, rather than increasing certainty itself. We use strategies based in cognitive-behaviour therapy (CBT) and a new wave of CBT called acceptance and commitment therapy (ACT):

  • Shifting attitude to uncertainty – accepting certainty as a part of life
  • Gradual exposure to situations associated with uncertainty – systematic desensitization
  • Behavioural experiments – to test the hypothesis “I can’t cope if I don’t know for sure”
  • Reducing safety behaviours – to break a vicious cycle
  • Reducing avoidance of situations associated with greater certainty
  • Acting in line with one’s values – “acting as if” tolerant of uncertainty
  • Mindful curiosity of a certainty thought vs avoidance or thought control

Levels of IU can be measured using the Intolerance for Uncertainty Scale (IUS). It is a valid and reliable 27-item self-report measure (Buhr & Dugas, 2002).

IU self-help resources:

Anxiety Canada:

Centre for Clinical Interventions:—09—Accepting-Uncertainty.pdf


  • Buhr K & Dugas MJ (2002). The Intolerance of Uncertainty Scale: psychometric properties of the English version.  Behaviour Research and Therapy 40(8):931-45
  • Buhr K, Dugas MJ (2009). The role of fear of anxiety and intolerance of uncertainty in worry: an experimental manipulation. Behaviour Research and Therapy 47(3):215-23
  • Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences,17, 791–802