There have been countless psychological difficulties that have arisen from the pandemic. In March 2020, individuals experienced a new level of anxiety and worry, as the world was thrown into a situation with unknown outcomes. A challenge for many of us (patients and healthcare workers) has been the difficulty with handling uncertainty.
Intolerance of Uncertainty
The construct of Intolerance of Uncertainty (IU) was developed in the 1990s by a group of Canadian researchers (Freeston et al, 1994). 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)
Although initially associated with generalized anxiety (GAD) and obsessive-compulsive disorder (OCD), IU is now more widely considered to be a contributing factor (arguably causal factor) for several psychological disorders. Individuals seeking certainty to relieve a negative emotional state can find their symptoms worsening in their quest to reach more certainty. Many situations (arguably all situations) have an element of uncertainty.
Complete certainty as illusive
Consider this: Can you be 100% sure that your loved one is alive and well at this very second (assuming you are not with them)? Now imagine you phone your loved one to check in and the phone goes unanswered. Do you feel more anxious or less anxious? Seeking certainty can exacerbate anxiety. Your loved one eventually calls you back and your anxiety decreases (negative reinforcement). However now you routinely call your loved one to check-in (safety behaviour) in case something bad has happened. 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 threat, marital problems etc.)
Uncertainty in the face of the Pandemic
The changing pandemic is a stressor that can be considered novel, ambiguous, and unpredictable. This high level of uncertainty may be associated with a high level of anxiety and worry for those who are essentially intolerant of uncertainty. Furthermore, anxiety and worry often leads to time-consuming behaviours (safety behaviours) aimed at increasing certainty. For example, information-seeking (news overload), checking on family/friends (increasing attention to risk), and avoidance. Further stress, anxiety, and worry is experienced, leading to more safety behaviours, and so a feedback loop develops.
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:
Centre for Clinical Interventions
– 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