A central feature of anxiety, especially in Generalized Anxiety Disorder, is an intolerance of uncertainty. We would venture to say that most people don’t particularly enjoy uncertainty—job interviews, upcoming tests, moving—they are all stressful in their very nature because of the uncertainty involved. The difference between a person with an anxiety disorder and one without is that the person who has anxiety is likely to spend a lot more time worrying, trying to control the outcome, seeking reassurance from others, or avoiding the task altogether, than a person who has a greater ability to tolerate uncertainty.
We work with a lot of perfectionists who use worry as their primary coping tool for anxiety and uncertainty. By the time they come to therapy, the worry is usually unpleasant at best, or debilitating at worst, impacting normal levels of functioning and mood. The worry can feel paralyzing and uncontrollable, though underneath these negative aspects of worry, there are usually beliefs that somehow worry will protect them. For example: “If I think about the worst case scenario, then I’m better prepared to handle it.” In order for treatment to be successful, these beliefs must be scrutinized and challenged. I often use a cost-benefit analysis, to help the client tap into their intrinsic motivation to decrease worrying and increase their tolerance for uncertainty.
Another hallmark of an anxiety disorder is focusing on threats rather than safety signals or internal resources to cope. When this happens, the result is a feeling of helplessness, vulnerability, and increased anxiety. When clients feel anxious, they engage in “safety behaviors” in an attempt to take the anxiety away or reduce its intensity, such as drinking before an event or rereading an email five times before sending it.
In therapy, an important step in treating anxiety is to identify which maladaptive safety behaviors the client uses to cope and to then reduce them in order to actually address the anxiety. To make it more concrete, take an example of how a socially anxious client uses avoidance to cope with his fear of uncertainty. The client feels anxious about an upcoming first date and fears that he won’t have anything to talk about (uncertainty) and that his date will think he’s boring (threat), and in order to cope, he worries (safety behavior 1) all day at work, barely able to focus on his tasks, and eventually avoids the date by canceling (safety behavior 2). Unfortunately, these behaviors reinforce that he can’t tolerate uncertainty and strengthens his beliefs about dating as threatening. In therapy, we might use behavioral interventions to help him reduce his avoidance, while also teaching him cognitive skills to cope with and shift his anxious thoughts.
At its core, uncertainty is a central part of our reality, no matter how much we delude ourselves into believing we can control everything. In order to reduce anxiety, worry, and avoidance, a therapist can help clients learn the necessary skills to manage anxiety and ultimately accept uncertainty as a natural part of a life worth living.
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