Caught up in the future: Uncertainty and its role in anxiety

You recently went to your family doctor for a routine check-up. Afterwards you go on with your normal business until, after a few days, you get an email asking you to schedule a follow-up appointment. A follow-up appointment? This has never happened before. The thoughts in your head start racing. “What does this mean? Did they discover something unusual? Why didn’t they tell me more in the email? Does that mean it is something serious? Of course, it could also just be something minor. But what if it isn’t? What if I’m seriously ill?!”

Uncertainty

What’s unsettling about this situation is that it involves uncertainty. The outcome of the appointment could be anything, from something completely harmless to something seriously life-threatening. We tend to use the information that is available from our past and present experiences to predict what will happen to us in the future. This preparation is an adaptive process, as it can help us move towards our goals, which have desired positive outcomes, and away from potentially negative outcomes. However, uncertainty is an ever-present part of life, as everything that lies in the future is inherently uncertain. We cannot predict exactly what will happen to us, and we don’t like this because it makes it difficult to prepare for and avert potential adversity.

People in general experience uncertainty as unpleasant, but the extent of this varies across individuals. This has been termed intolerance of uncertainty: While some people are hardly bothered by uncertainty, others find it extremely aversive and unacceptable. These beliefs in turn affect how an individual perceives and reacts to uncertain situations. Having a low tolerance of uncertainty has been related to a number of emotional problems, most consistently to anxiety.

In fact, instances of how intolerance of uncertainty affects cognitions and behavior can easily be observed in anxiety. People who are intolerant of uncertainty have the tendency to perceive ambiguous events as threatening (e.g., interpreting a follow-up appointment as a sign of serious illness, or going to a party where one knows nobody except the host) and may overrate both the probability and consequences of uncertain negative outcomes (e.g., thinking that one is seriously ill, or thinking that one is being perceived as weird by new acquaintances). This may lead to maladaptive cognitions (e.g., excessive worry in anticipation of uncertain situations) and behaviors (e.g., avoidance of uncertain situations) that serve the purpose of reducing uncertainty. In short, while a certain degree of intolerance of uncertainty is usually adaptive, intolerance of uncertainty can be dysfunctional if it is excessive.

Dealing with intolerance of uncertainty

If uncertainty is so hardwired, what can we do? One method to help alleviate symptoms of anxiety may be to learn to accept uncertainty instead of engaging in (futile) attempts to reduce it. A treatment approach that might be helpful is based on mindfulness meditation: Mindfulness involves being aware and accepting of one’s subjective experience in the present moment. This involves “giving up the agenda” to change one’s experience and instead promotes accepting it, both the good and the bad, as it is. This acceptance may mitigate negative beliefs about uncertainty and along with this reduce maladaptive responses to it, thereby helping to alleviate anxiety. If you are interested in finding out more about mindfulness, check out this earlier interview with Marieke van Vugt or mindwise post by Brian Ostafin.

I started my PhD project in September of 2017 under the supervision of Dr. Brian Ostafin and Dr. Miriam Lommen. I am investigating whether mindfulness interventions may affect uncertainty-related processes and thereby alleviate anxiety. Additionally, I am interested in how uncertainty affects other areas of life, such as political ideology and dogmatic beliefs. However, this is a topic for another Mindwise post.

Relevant links and publications

Bredemeier, K., & Berenbaum, H. (2008). Intolerance of uncertainty and perceived threat. Behaviour Research And Therapy, 46(1), 28-38. doi:10.1016/j.brat.2007.09.006

Dugas, M. J., Hedayati, M., Karavidas, A., Buhr, K., Francis, K., & Phillips, N. A. (2005). Intolerance of Uncertainty and Information Processing: Evidence of Biased Recall and Interpretations. Cognitive Therapy And Research, 29(1), 57-70. doi:10.1007/s10608-005-1648-9

Grupe, D. W., & Nitschke, J. B. (2013). Uncertainty and anticipation in anxiety: An integrated neurobiological and psychological perspective. Nature Reviews Neuroscience, 14(7), 488-501. doi:10.1038/nrn3524

Kabat-Zinn, J. (2015). Mindfulness. Mindfulness, 6(6), 1481-1483. doi:10.1007/s12671-015-0456-x

Kraemer, K. M., O’Bryan, E. M., & McLeish, A. C. (2016). Intolerance of uncertainty as a mediator of the relationship between mindfulness and health anxiety. Mindfulness, 7(4), 859-865. doi:10.1007/s12671-016-0524-x

Norr, A. M., Oglesby, M. E., Capron, D. W., Raines, A. M., Korte, K. J., & Schmidt, N. B. (2013). Evaluating the unique contribution of intolerance of uncertainty relative to other cognitive vulnerability factors in anxiety psychopathology. Journal Of Affective Disorders, 151(1), 136-142. doi:10.1016/j.jad.2013.05.063

Inka Papenfuss

Inka Papenfuss is currently a PhD student in Clinical Psychology & Experimental Psychopathology. She developed a strong interest in both mindfulness and research during her Bachelor studies at the University of Groningen. For this reason, she pursued the Research Master in Behavioral and Social Sciences, during which her interest for uncertainty and its role in anxiety (as well as other areas of life) was sparked. This led to the development of her current PhD project. Inka investigates the role of uncertainty-related processes in the relationship between mindfulness and anxiety.