Learning to Tolerate Uncertainty
by Samantha Huston, MSW, LCSW, Director of ERP/OCD Services
“Are you sure? Are you really, really, sure? 100% sure? But, what if…”
Ah, yes, uncertainty- part of life most of us have trouble accepting and the familiar, ruminative refrain of the brain’s quest for certainty. As humans, our brains are wired for survival and rely on problem solving to help us stay safe. When we encounter a problem or situation where there is uncertainty, our brains feel a strong urge to “resolve” and find solutions to make the uncertainty go away.
These attributes have promoted the survival of our species for millenia, however, what happens if this quest for certainty is turned up way too loud? Or when there is no certainty to be found?
During this OCD Awareness and Advocacy week (October 9–15, 2022) I would like to address a common unhelpful response to uncertainty (rumination) and the ways it may present. Then, I share helpful strategies to learn to cope with uncertainty.
What is rumination:
Ruminative thoughts are a common mental health symptom. From depression to anxiety, the feature of looping thoughts, second guessing, and resistance to “I don’t know” is prevalent. At times the brain appears to be more comfortable with worst case scenarios than simply accepting, “I don’t know”.
The drawback: rumination feels like we’re being productive in eliminating uncertainty, but in fact this looping thought process becomes an unhelpful habit that fuels more distress and anxiety.
Different types of rumination:
- Solving: the idea that if we just think hard enough or long enough we will have a breakthrough, gain insight, or find certainty. Nope we just wire in a habit?
- Repetition: this can include any repeated phrase, word, idea, or number that is meant to promote a sense of certainty or serve as a distraction from doubt.
- Review: assessing past events: did I hurt someone’s feelings? Say something offensive? Do the right/wrong thing?
- Hypervigilance: scanning the environment and maybe even one’s own mind for danger including thoughts that could be deemed dangerous.
- Comparison: assessing how one adds up to the accomplishments of others and/or comparing oneself to where they think they “should” be in life.
- Neutralizing: replacing negative thoughts with something positive to undo the negative thought or feeling. ex) knocking on wood.
- Reassurance: watching something or checking it repetitively to promote a sense of certainty. ex) staring at a door knob to reassure yourself it is locked.
- Self-punishment: using self-judgment or criticism. ex) Guilt is often used to feel as though someone is “doing something” in a situation where they could not prevent or control outcomes.
Building tolerance for and coping with uncertainty and doubt in therapy:
At AMK Counseling we take a two-pronged approach to support individuals struggling to cope with uncertainty: Exposure + Tolerance and Acceptance of Doubt
Exposure and Response Prevention (ERP) strategies have been the gold standard for the treatment of obsessive compulsive disorder for many years due to the wealth of research indicating the benefits of these methods. Exposure and Response Prevention involves being in the presence of a situation or object that brings anxiety and staying with it until the brain builds the ability to tolerate the trigger and allow anxiety to rise and then fall on its own without the use of rumination or physical compulsions. With practice the brain begins to wire in a new reaction to the trigger.
At AMK Counseling we implement these evidence-based exposure and response prevention techniques but have also realized that for our client’s to benefit long term and internalize skills, we need a more holistic approach that goes beyond the habituation of ERP and also simultaneously promotes a different way of engaging with one’s thoughts in general by promoting acceptance of and tolerance for doubt.
We begin this work by first building awareness and insight through self monitoring skills: habit tracking, journaling, and processing in therapy sessions. Next, we practice mindfulness strategies to introduce the practice of being fully engaged in the present moment, without judgment. Mindfulness breaks down the tension of resistance and promotes one’s ability to accept and build tolerance for difficult emotions.
Next, we build on mindfulness skills by applying acceptance and diffusion techniques. These Acceptance and Commitment Therapy (ACT) techniques first developed by Dr. Steven Hayes are intended to turn ruminative thoughts into background noise or junk mail that does not need our attention.
Here are a couple ACT strategies to try:
- Label and abandon: Name the ruminative thought and let it pass. The idea is to treat it like it doesn’t matter. Like it is background noise. If we pay attention to this thought (even if the way we pay attention is through trying to resist or avoid the thought) it sends a signal to the brain that this is an important thought that needs attention and triggers one to open an on-going rumination investigation.
- Agree with attitude: Say, “fine” to the thought with an irritated and dismissive tone. Roll your eyes and say, “whatever”. We want to tell the brain, I hear you but this thought does not require my time or attention. It’s irrelevant!
Exposure Lifestyle and beyond!
The goal of treatment is not to rid someone of their thoughts (that would be impossible). Nor is the goal to remove doubt and uncertainty (also impossible). The goal of developing an exposure lifestyle is to learn how to engage with thoughts in a more accepting and tolerant way: learning how to be ok with “I don’t know”.
To promote motivation for this on-going journey we use one’s values as an anchor and guide. When focused on what we really care about, our “bigger why” we have the strength and focus to say “ok” to uncertainty.
To learn more about OCD and ERP treatment at AMK, please visit us.
If you liked this AMK Monthly Insight, check out:
How to Help Someone with OCD