Obsessive compulsive disorder - OCD treatment and therapy from NOCD

How to deal with uncertainty – Advice from a therapist

By Elle Warren

Nov 30, 20237 min read minute read

Reviewed byApril Kilduff, MA, LCPC

Since you’ve found your way to this article, I can assume you’re like me—that is, coping with uncertainty does not come naturally to you. I often wonder how it comes naturally to anyone. In a world with so many uncontrollable factors, how do you not hopelessly cling to certainty? Of course, certainty is a false savior, as there will always be a wide web of factors and futures we cannot be certain about. 

Dr. Nicholas Farrell, Regional Clinical Director at NOCD, affirms our mutual wish for certainty: “It’s comforting to have the assurance of ‘this is the way things are.’ To be certain of something. When we’re certain of something, it’s reliable. We can come to expect it.” 

Indeed, I like to know what to expect. It’s understandable that uncertainty is hard. However, if it actually feels debilitating or unacceptable, that might be a sign that something bigger is going on. Keep reading for reasons why uncertainty can be so challenging, mental health conditions that can make it even harder to tolerate, and how to get help.

Why is uncertainty so challenging

Our brains, tasked with keeping us alive, are hardwired to detect threats. Uncertainty feels like a threat. Sometimes, it really is a threat. When my mother was ill with cancer, for example, there were many unknowns about how or if she would survive. That was a genuine, terrifying threat to both her life and to the wellbeing of all of us who loved her.

In far more common scenarios, however, uncertainty does not actually threaten us. When I go to my favorite local coffee shop, there is uncertainty about who I will see there. Will I see an acquaintance who I don’t really feel like speaking to? Will I see an old friend who hurt my feelings? Or, conversely, will I see someone I’ve been hoping to reconnect with?

Uncertainty about who I will see at the coffee shop is low-stakes. Yet sometimes, our brains can get stuck in the uncertainty of even low-stakes situations. I like to know what’s next so I can adequately prepare myself. I like to have control where I can, despite the fact that I can’t control who I’ll see at the coffee shop. 

It’s partly human nature to want to detect possible “threats” and know what’s coming. As humans, we like to plan. As Dr.Farrell said, it’s comforting to know what to expect. However, if your need for certainty has become excessively time-consuming and routinely brings you high levels of distress, you could be experiencing a mental health condition. 

Is difficulty handling uncertainty the sign of a mental health condition?

Difficulty handling uncertainty is not automatically grounds for a mental health diagnosis. Some people may just be more naturally inclined to want to plan and have clarity around the future, while others are more naturally laid back.

So when does it become something to worry about? Here are some mental health conditions to know about if a challenging relationship with uncertainty is playing a big role in your life and causing impairment and/or distress:

1. Obsessive-compulsive disorder. “Perceived inability to live with and accept uncertainty lies at the heart of OCD in many, many cases,” Dr. Farrell says. The disorder consists of persistent, unwanted intrusive thoughts, images, urges, sensations, and feelings (obsessions) that the OCD sufferer interprets as significant or even dangerous. The intrusive thoughts spur intense distress, leading the sufferer to engage in mental or physical actions (compulsions) that aim to alleviate that distress. The content of intrusive thoughts vary widely, but here is one example of an intolerance to uncertainty showing up in OCD:

Lila is a college student. She prides herself on maintaining a 4.0 GPA. For many years, she has suffered from repetitive thoughts surrounding her ability to perform well. She worries that if she is not highly responsible, in every area of her life, including academics, that it will mean she’s a ‘bad’ person destined to a ‘bad’ life. When she turns in assignments, wondering what her grade will be on it is all she can think about. She finds herself refreshing her student portal website constantly, even minutes after she’s turned it in, when her professor couldn’t have possibly looked at it yet. She spends hours ruminating on what will happen if she receives a poor grade, reading about others’ experiences on Reddit and texting classmates for reassurance that she understands the coursework well. 

2. Anxiety disorders. This is an umbrella term that includes generalized anxiety disorder, social anxiety disorder, specific phobias, panic disorder, and separation anxiety. “Intolerance of uncertainty is also the chief maintaining factor across anxiety disorders,” Dr. Farrell says. Similarly to OCD, anxiety disorders involve excessive amounts of worry, most commonly over things that have not happened. Consider this example of someone with social anxiety disorder having a hard time accepting uncertainty:

Steven has always been anxious in and leading up to unfamiliar social situations. He’s been invited to a party at a friend’s house, where many of the guests will be people he hasn’t met before. The day before, he can’t stop thinking about the party and what will happen there. What if he trips over his words and everyone laughs at him? What if he does the wrong thing? He is so consumed with worry, that he can’t leave his bed for the day, and he strongly considers canceling on his friend so that he can stop wondering what will happen.

3. Borderline personality disorder. This personality disorder is characterized by intense emotions that the individual has a hard time regulating. Moreover, a distinguishing feature of this disorder is a profound fear of being abandoned and/or being alone. The person often goes to great lengths—which can be inappropriate and, from an outside perspective, “dramatic”—to avoid losing people. Simultaneously, their strong, often quick-shifting emotions tend to push people away and make maintaining relationships hard. Consider this example of someone with borderline personality disorder:

Josh has a small number of close, intense friendships. He has very specific, high expectations of his friends. If any of them hang out without him, he becomes angry and lashes out at them. He can’t help but think that them hanging out without him is a sign that they’re all talking poorly about him and plan to exclude him. He cannot tolerate that uncertainty, and instead, angrily calls and texts all his friends until they answer and reassure him.

In any of these cases, the concept of uncertainty can be debilitating. The sufferers of these conditions feel highly threatened by it and will take drastic action to avoid it. However, all of them have evidence-based treatments that can ease overall symptoms, including difficulties dealing with uncertainty. 

How can you get better at handling uncertainty?

If you related to the information about OCD or anxiety disorders, there’s good news: both are highly treatable, and are treated best with exposure and response prevention (ERP) therapy. Learning to tolerate uncertainty, and get comfortable being uncomfortable, is one of ERP’s primary goals. 

Dr. Farrell says ERP works by “confronting, and even inviting, the uncertainty without doing anything to rid oneself of the uncertainty.” He says ERP teaches us to “allow it to hang out,” which provides us with opportunities to develop a “new relationship” with uncertainty. Essentially, you can teach your brain that uncertainty isn’t necessarily a problem at all—it’s just a part of life.

It works through targeted, guided therapy exercises that trigger feelings of uncertainty, providing opportunities to sit with those feelings without resorting to compulsions, avoidance, or other safety behaviors. Dr. Farrell says our “attitude toward uncertainty can change” as we change our “behavioral response to uncertainty.” Basically, if we learn to treat uncertainty as less of a big deal, it will become less of a big deal.

If you believe you may be struggling with borderline personality disorder, the best form of treatment is dialectical behavioral therapy (DBT), a form of therapy designed for those who experience emotions intensely. It works to help one understand and accept their reality while also teaching them how to alter harmful behavior. For more resources on borderline personality disorder, check out this resource list from the National Education Alliance for Borderline Personality Disorder.

You can change your relationship with uncertainty

No matter your experience, there are trained professionals who know how to help you in living a more full, values-aligned life. While uncertainty will always be around, our relationship to it doesn’t have to remain fraught. We may never like it, but we can learn to get more comfortable with it. 

If you think you may be struggling with OCD or an anxiety disorder, I strongly encourage you to learn more about NOCD’s evidence-based, accessible approach to treatment. Accepting uncertainty in your life is closer than you think—and it may be one of the most freeing experiences you’ll ever have. I know it was for me.

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