Where does my anxiety come from?

Anxiety is one of the most frequently identified mental health problems among Canadians. Despite this, it is often very difficult to understand where anxiety comes from, and why it seems to affect some people more than others. One of the most important things affecting how anxious we are is how well we tolerate uncertainty. Intolerance of uncertainty (IU) is strongly associated with higher anxiety, and helps explain why we get anxious.

Many times, if people feel certain of the future, they may not feel anxious about it – whether that future is good or bad. However, people may feel highly anxious thinking about things that might happen. Predicting the future and achieving certainty is usually impossible. Working on tolerating uncertainty is possible. We can respond to negative thoughts about the future in healthy ways, or unhealthy ways.

Research shows that IU is one of the things at the root of our anxiety. I will talk about the key things you need to understand about IU. We can use some practical strategies to help deal with IU, as well as anxiety in general. By responding to IU differently, you can overcome the obstacles it tries to put in your way. Psychologists can also use cognitive-behavioural therapy to help you with IU in particular.

What is IU?

In plain language, IU involves feeling anxiety when we think about the possibility of bad things happening. Being uncertain can keep us feeling anxious, and make it hard to take action. A more accurate definition of IU is as follows: “an individual’s dispositional incapacity to endure the aversive response triggered by the perceived absence of salient, key, or sufficient information, and sustained by the associated perception of uncertainty” (Carleton, 2016, p. 31).

Some people are not very bothered by the possibility of negative future events. You might hate not knowing whether an upcoming date is going to go poorly, but you might know someone who hardly worries about such things. They must look at uncertainty differently. Similarly, not all experiences of uncertainty are unpleasant. You might feel excited not knowing what kind of prize you’re going to get with a winning raffle ticket.

Is Everybody Equally Affected by IU?

Not everyone is very troubled by experiences of uncertainty. There are average amounts of IU that we observe in the general population, and different averages among people with specific mental health difficulties. Research shows that IU may contribute to various mental health difficulties, particularly anxiety.

While not everybody finds uncertainty especially distressing, everybody falls somewhere on the IU graph. Even among persons who don’t experience much anxiety, any given person might be a little higher in IU than another person. Some people have very low IU, but probably nobody has zero IU.

You can compare IU to an allergy. People higher in IU might react strongly to experiences of uncertainty and worries about even very unlikely events. For example, someone with very high IU may be extremely worried about their plane crashing, even though plane crashes are tremendously rare. Just like someone who is allergic to cats sneezing when a small amount of dander enters their nose, someone with high IU may have an anxious response to even small possibilities of things going badly. Unlike allergies, uncertainty can bother us all from time to time. Higher IU takes it to an unreasonable level that can be very hard to manage without help.

IU in Action

People with high IU may find it hard to function and make decisions in moments of uncertainty. They often try to avoid experiences of uncertainty. Unexpected events can be quite upsetting for such people. High IU, therefore, interferes with life functioning and can contribute to significant distress.

If you have trouble dealing with uncertainty, you may use avoidance as a coping strategy. This might mean avoiding situations where you think bad things could happen. What people sometimes fail to realize is that avoiding certain scenarios can also prevent good things from happening. Let’s use an example:

In the future, when the COVID-19 pandemic is over and everyone has received effective vaccinations to protect their health, more people will start getting together in person again. It may have been a while since you have spent time with people in person – maybe you think your social skills are a little rusty.

A couple of friends invite you to spend time with them. You might worry about it going poorly. What if you say something embarrassing, what if the conversation is awkward, what if you aren’t very much fun? Maybe they won’t want to be your friends anymore. Perhaps you decline the invite, and seemingly avoid the possibility of those bad outcomes.

What about good outcomes, though? Maybe spending time together will be fun, maybe it will strengthen your friendships, maybe you will learn that your friends are happy to be with you, even without you being an endless, superhuman fountain of wit, fun, energy and fascinating conversation. By avoiding experiences that might go poorly, you cut yourself off from the possibility of some good things happening, too.

Through avoidance, you also strengthen an inaccurate belief that uncertain situations are just too dangerous to step into. That will make you miss out on good experiences, because you have not put your worries to the test. Avoidance keeps anxiety going in the long run.

Here, your friends thinking poorly of you is not what’s driving your anxiety – it’s the uncertainty and your lack of ability to tolerate it. If you knew what they thought, you could do something about it. If you knew they didn’t think poorly of you at all, you wouldn’t worry. If you knew they did think poorly of you, you could talk to them about it directly, or decide to look for new friends. Something unpleasant could happen, but you aren’t sure. You are left in an anxious state, with your thoughts going in circles – lots of questions, but no real answers or solutions. The state of not knowing can be quite distressing. Avoiding your friends might make you feel a little less anxious for a moment or a day, but it will ensure that your anxiety keeps coming up again. Avoidance allows our worries to go unchallenged, and it keeps us believing that the worries are always true, or too scary to deal with if they are true.

If a worry tells you that things are going to go horribly, and that you have to make sure you’re more certain of the future, you can say this to your worry: “prove it”. Go see what happens. Try something 10 times, and write down what happens each time. Does the good end up outweighing the bad?

Psychological Treatments Focused on IU

There are IU-focused treatment protocols, under the umbrella of cognitive-behavioural therapy, that have been supported in clinical research. Cognitive-behavioural therapy (CBT) addresses inaccurate and unhelpful beliefs about worrying, learning when problem solving is possible and when problems cannot be directly solved, and replacing unhelpful avoidance strategies with better ways of responding to thoughts. Evidence shows that reducing IU through therapy leads to benefits in other areas.

Dealing With IU

Often, we might temporarily stop feeling anxious if we could achieve certainty about the future – good or bad. However, achieving certainty is often not a practical solution. We generally have two options when faced with uncertainty: 1) increase certainty, or 2) increase tolerance to uncertainty. Increasing certainty is often impossible, so it is generally not an effective go-to strategy. Working to decrease IU – to better tolerate uncertainty – is always possible.

Here is a basic concept you can apply to work on IU in your own life: don’t stop yourself from doing things just because you don’t know what will happen. Exposing yourself to the possibility of things going poorly is part of opening yourself up to possibilities. You also gain opportunities to experience things going well. Importantly, you will learn that you can live with things going poorly sometimes. A worry coming true is not the end of the world, and you will get better at coping with unexpected setbacks if you don’t avoid them like the plague.

Take going on a date as an example. It is IMPOSSIBLE to see the future. The date might be unpleasant in a hundred different ways. You can’t achieve certainty about whether something bad will happen. So, do you never go on a date, even though you want to have a romantic relationship? That would be a radical and ultimately self-defeating decision. Sure, your date might be a jerk. Perhaps you will spill soup on your leg and get a second-degree burn. Maybe the date will be fun, a little awkward, but with bright moments of warmth and laughter. It’s possible the date will go so well that you have 79 follow-up dates, and then 51 years of happy marriage to someone you learn, grow and love with. It could be that it leads to 12 years of marriage that ends in a bitter and difficult divorce. To twist a cliché, IU encourages us to never get on a horse in the first place, because we might fall off or have something bad happen that we can’t even predict.

I expect you are seeing a pattern to my examples; almost nothing in life is certain. Does that mean it is not worth seeing what happens, and opening yourself up to learning from the bad, and rejoicing in the good? Do what you can to prepare yourself for realistic possibilities, but try to accept that no one can be prepared for everything. Not even Batman.

Takeaway: Reduce Constant Efforts to Achieve Certainty

One handy way to challenge IU is by designing behavioural experiments for yourself. You might be someone who takes great care to plan everything out in advance, and you feel uncomfortable with not being sure of what might happen. This might mean checking the weather every day before you drive, because you don’t want to be caught in an unexpected rainfall. Maybe you never drive when it’s supposed to rain.

As long as your car is in good working order (e.g., windshield is clean, wipers work properly, tires are appropriate and in good shape), skip the weather forecast. For an experiment, take a drive when you don’t know what the weather is going to be like. We’re only just getting in to October – you won’t get caught in a blizzard or hit black ice if you’re here in Nova Scotia at this time of year.

Write down how you expect to feel and what you expect to happen. Then, go for the drive. Maybe it stays clear, maybe it rains. Do it again the next day, and the day after. An experiment is not tremendously useful if it isn’t repeated.

You will likely discover that it’s okay to not know what is going to happen. You can be uncertain and still end up okay. You might start to enjoy your drives a lot more! In this case, you’ll probably also learn that driving in the rain is more manageable than you thought. This may sound simple, but our beliefs and our relationship with anxiety and IU won’t change if we don’t take action by putting anxiety to the test in the real world. Merely understanding our anxiety is not enough.

If You Need Help

Our own best efforts might still end up with us feeling stuck. In life, we all need help sometimes. It’s okay to ask someone else for help. If anxiety and IU are contributing to significant distress or difficulties in your life, you will probably benefit from speaking with a psychologist.

Psychologists can use their expertise to work with you and plan effective interventions tailored to your unique circumstances. CBT offers effective methods for overcoming anxiety and reducing IU in particular. There are also many ineffective approaches for attempting to overcome anxiety that have not been tested through the scientific process we use to develop good methods of therapy. Psychological techniques with demonstrated effectiveness for anxiety have been developed through rigorous scientific research. Each person’s needs in therapy are unique, and a registered psychologist can help you to find methods that work.

References

Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Intolerance of uncertainty: A common factor in the treatment of emotional disorders. Journal of Clinical Psychology, 69, 630-645. doi: 10.1002/jclp.21965

Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30-43. doi: 10.1016/j.janxdis.2016.02.007

Dugas, M. J., & Ladouceur, R. (2000). Treatment of GAD: Targeting intolerance of uncertainty in two types of worry. Behavior Modification, 24(5), 635–657. doi:10.1177/0145445500245002

McEvoy, P. M., & Erceg-Hurn, D. M. (2016). The search for universal transdiagnostic and trans- therapy change processes: Evidence for intolerance of uncertainty. Journal of Anxiety Disorders, 41, 96-107. doi: 10.1016/j.janxdis.2016.02.002

Patten, S. B., Lin, E., Martens, P. J., Stiff, D., Smetanin, P., & Adair, C. E. (2012). Synthesis through simulation: Insights on the epidemiology of mood and anxiety disorders in Canada. The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie, 57, 765–771.

Stevens, K., Rogers, T., Campbell, M., Björgvinsson, T., & Kertz, S. (2018). A transdiagnostic examination of decreased intolerance of uncertainty and treatment outcome. Cognitive Behaviour Therapy, 47, 19-33. doi:10.1080/16506073.2017.1338311

Talkovsky, A. M., & Norton, P. J. (2016). Intolerance of uncertainty and transdiagnostic group cognitive behavioral therapy for anxiety. Journal of Anxiety Disorders, 41, 108-114. doi:10.1016/j.janxdis.2016.05.002

van der Heiden, C., Muris, P., & van der Molen, H. T. (2012). Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behaviour Research and Therapy, 50, 100-109. doi:10.1016/j.brat.2011.12.005

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