Anxiety Files

Simple and powerful techniques for coping with anxiety and worry.

Second Week: Accepting Uncertainty to End Your Worries

Second Week: Accepting Uncertainty to End Your Worries

Now that you have been recording your worries and examining whether they are productive (see my previous blogs on this), you have been able to identify which worries you can take action on and which you cannot act on. For example, you can take action on your worry about whether I will get my work done--- by taking the action of doing more work now. But you have also identified some worries that don't lead to an action plan, such as "What if no one likes my talk?" I have called the latter worry, "Unproductive worry".

But now what?

The second step in our approach is to consider accepting limitations. You and I have limitations in terms of what we can do and what we can know. Let's start with the limitation of what we can know.

Tolerating Uncertainty

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In an earlier blog "But what if I'm THE ONE?" How Intolerance of Uncertainty Makes you Anxious" I suggested that many of us worry because we equate uncertainty with a bad outcome-"I don't know if I will fail, therefore I probably will" or "If I don't know for sure, then I should worry about it". You may be thinking that uncertainty means that the outcome will be negative---but uncertainty doesn't necessarily point to a bad outcome. It simply means we don't know. You might even ask yourself, "What could be the worst outcome, the best outcome and the most probable outcome?" And, then you might ask yourself what the probabilities are for these different alternatives. It may be that the probability of the worst outcome is close to zero. But then you might say, "But it's still possible". You want certainty!!!

Simply having uncertainty doesn't mean that worry is the best alternative. For example, let's say that you worry that you might lose your job. You have uncertainty about this. You can worry about it, which might make you a lot more anxious and less productive at work. Or you can think about some productive action---like networking, acquiring new skills, looking for a different job, or budgeting your finances. But no matter what you do, there still will be that uncertainty. So, after you have taken whatever productive action you can take, how do you deal with uncertainty?

Worrying to reduce uncertainty

Take a look at the figure below (from my book The Worry Cure ). If you are like a lot of worriers you start with the assumption that uncertainty is dangerous, irresponsible and intolerable. So you start to worry and collect information to eliminate the uncertainty. In your view, any uncertainty is bad. As you selectively Google disasters or examine your imagination for the worst things that might happen, you notice that you come up with a lot of potential problems. You then start generating solutions to every problem and find that none of the solutions will solve the hypothetical problem with absolute certainty. You might think you have a mole that could be cancer, you examine it, see a doctor, get reassurance, and then a few days later think that doctors are not infallible. Or you might think that you are going to lose your job, you talk to your boss, she tells you that you are doing fine, but then you say to yourself, "I don't know for sure if her job is secure". Your intolerance of uncertainty combines with your perfectionism to lead you to worry more-in search of certainty and perfection.

In the figure below, you can probably see elements of your own quest for certainty-a quest that is doomed to failure, frustration and more worry.

 

 

How to handle your intolerance of uncertainty.

I am going to expand a little on my prior blog on tolerating uncertainty.

First, ask yourself "What are the advantages in accepting some reasonable uncertainty?" You will recognize that an advantage of accepting uncertainty is that you will worry less, you can enjoy your life, you will seek out less reassurance, and you can face your fears. You will probably be less depressed if you accept reasonable uncertainty. If you are honest with yourself you might think that a disadvantage in accepting uncertainty is that you will be surprised by a bad outcome, you will overlook something important, and disaster will happen. Then you will be flooded with regrets because you hadn't listened to your worries. But the question for you is what is reasonable uncertainty? If you are looking for perfect certainty you will continue to worry. And it may be that no matter how much you worry, some things are out of your control anyway.

Second, what uncertainty do you already accept? For example, when you drive, take a plane, eat in a restaurant, interact with someone new, go to a new city, start a new project at work---aren't you already accepting uncertainty? I find that many worriers say, "I have to accept some uncertainty in those situations-or I wouldn't be able to live my life". But what if you accepted a little more uncertainty in other areas of your life? What if you expanded your tolerance of uncertainty? You might say, "I accept uncertainty driving a car because I cannot control what other drivers might do". But what if you expanded your tolerance of uncertainty to other things that you cannot control or cannot know? For example, you really cannot control and often cannot know what people think of you. What if you accepted that uncertainty?

Third, do you know anyone who has absolute certainty? Anyone? How do they live with themselves? Are they irresponsible or in danger? Keep in mind that uncertainty is inevitable. We can never know for the future for sure. There is far too much information that is unknown to us. Do you judge other people who accept reasonable uncertainty?

You can remind yourself that uncertainty is inevitable and that accepting uncertainty allows you to live your life more fully. One patient of mine finally decided to accept the possibility that he could make mistakes simply because he realized that demanding certainty was the biggest mistake he could make. Accepting uncertainty-and the possibility of mistakes-was something he could actually decide to do. "I guess I will have to accept that I could be wrong". In contrast, trying to assure that he would never make a mistake was out of his control.

Fourth, flood yourself with uncertainty. We have found that this is a very powerful technique for some of our patients. We ask them to repeat slowly, while observing the thought, "No matter what I do it's still possible something terrible will happen". I had a patient a few years ago who worried about cancer. He had been a chronic worrier about cancer for 45 years. He had regular checkups-there was nothing wrong with him. But because he believed that he had to have complete certainty, there was no medical exam that would suffice. Using uncertainty training, he began to replace his worry about uncertainty with repeating uncertainty. For example, I told him that whenever he had the intrusive worry, "Maybe I have cancer", he could either worry about it by seeking reassurance or he could repeat the worry 200 times, very slowly, "Maybe I have cancer". Initially the thought about having cancer increased his anxiety---but after he repeated it about 50 times, very, very slowly, he found the thought boring. Ironically, repeating a worried thought hundreds of times takes the power away from the thought. When you repeat the thought---like a zombie, slowly, methodically--- the thought loses its power. We have used this technique for years and it often dissipates worries.

 

See THE WORRY CURE for more ideas on how to handle your worry. My new book, Anxiety Free: Unravel Your Fears Before They Unravel You, will be published in April 2009.  

Robert L. Leahy, Ph.D., is the author of Anxiety Free,The Worry Cure and Beat the Blues. He is Clinical Professor of Psychology at Weill-Cornell Medical School. more...

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