As a general rule, most people prefer certainty to uncertainty. However, we’ve all heard that the only things we can be certain about are death and taxes. So what about everything else? How do most people cope with uncertainty? When is fear of the unknown too much? And when can it become a risk factor for an anxiety disorder? Below we delve into the term “intolerance of uncertainty” and ask an expert in this field, Dr. Keith Bredemeier, to share ways to identify and combat this characteristic.
What is Intolerance of Uncertainty & How to Measure It
In 1994, a team of researchers in Quebec developed the Intolerance of Uncertainty Scale (IUS). The scale assesses how much people seek out predictability and how they react in ambiguous situations. The IUS evaluates emotional, cognitive, and behavioral reactions to uncertain situations, implications of being uncertain, and attempts to control the future. A higher level of intolerance of uncertainty (IU) is considered a “cognitive vulnerability,” according to Michel Dugas, a professor of psychology at the University of Quebec and one of the originators of the IUS. He and his team have linked high IU to several anxiety disorders, eating disorders, and depression. However, most of his research has been done on generalized anxiety disorder (GAD), for which he feels IU seems to be a risk factor.
So what’s happening in the brain during these feelings? Dan Grupe and Jack Nitschke of the University of Wisconsin-Madison have developed a theory of what brain mechanisms might play in IU, which they revealed in Nature Reviews Neuroscience. Grupe tells The Atlantic, “It’s complicated. There’s not a part of your brain that’s the IU part. Instead, IU is likely linked to several brain processes, including emotional regulation, safety detection, and threat detection. These processes are so intertwined.” Some key brain regions implicated in IU include the amygdala, prefrontal cortex, orbitofrontal cortex, and the anterior insula.
How to Distinguish Between “Worry” & Intolerance of Uncertainty
To gain a deeper understanding of intolerance of uncertainty, Endominance spoke with Dr. Keith Bredemeier, an Assistant Professor and Director of Research at the University of Pennsylvania’s Center for the Treatment and Study of Anxiety. When asked how someone can distinguish between IU and just “a tendency to worry,” Bredemeier states, “While intolerance of uncertainty and the tendency to worry are strongly correlated, they are distinct from one another. Not all people who struggle with one will struggle with the other. Conceptually, we think intolerance of uncertainty is one important factor contributing to excessive worrying (i.e., it is thought to be a risk factor). This concept may be because of the various things it leads people to do to cope with their discomfort with uncertainty – including worrying about the future, avoidance, and so on. As such, elevated intolerance of uncertainty may precede the development of excessive worry and also may be more consistent/stable. But I think this warrants more research to confirm.”
Bredemeier goes on to suggest, “Importantly, IU may be a risk factor for several other mental health problems, from depression to disordered eating to delusional thinking – in other words, intolerance of uncertainty is increasingly considered a “transdiagnostic” problem. As I articulated in a Scientific Americanarticle, no one likes to feel uncertain. People who score higher on intolerance of uncertainty dislike feeling uncertain even more than others.” He also notes that the tendency to worry is a trait everyone “has” to varying degrees. Hence, people who worry excessively are just those who fall at the high end of that continuum.
How to See Uncertainty in New Ways
So how can people address IU? We asked Dr. Bredemeier to give a few examples of how he would treat someone experiencing intolerance of uncertainty. He reveals, “Like various anxiety problems/disorders, treatment approaches to address IU primarily utilize exposure therapy techniques. However, rather than focusing on situations or stimuli that will elicit feelings of anxiety, the overarching aim of these “behavioral experiments with uncertainty” is to bring on strong feelings of uncertainty – with the end goal to increase one’s tolerance of those feelings. I like to identify feelings that bring on uncertainty but not other unpleasant feelings like anxiety.” He gives examples of ways to achieve this goal, such as:
- Purchasing items or ordering from a new restaurant without reading reviews.
- Taking a new route to work.
- Not checking messages repeatedly (especially when waiting on some information or response).
- Responding to emails or phone messages promptly (without re-reading them or scripting what you will say).
- Delegating a task to a family member or coworker.
Bredemeier also notes, “It can be effective to focus on challenging the client to do things they don’t typically do. For example, if someone usually does everything themselves, then delegating would be a great challenge for them. Or, if someone tends to procrastinate, they can challenge themselves to start/complete tasks promptly. This treatment approach was initially developed and tested by Michel Dugas and colleagues as part of a cognitive-behavioral therapy protocol for generalized anxiety. It has been shown to help with symptoms. But this approach has also clearly been shown to improve uncertainty tolerance. It may even work as a standalone intervention.”
