12 November 2020
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Many young people with anxiety difficulties struggle to manage future uncertainty.
For example: a socially anxious teenager doesn’t know what people think of them and so holds back from contributing to conversations; a student with OCD attempts to make things safer and more certain through habits, rituals and excessive reassurance-seeking; a young person with health anxiety spends much of their time catastrophising about the possibility of having an illness or becoming ill.Uncertainty compels them to check and scan their body for signs of illness, to make GP appointments and to spend time surfing the internet in search of reassuring information. All of these young people want to be sure – or at least, reassured – that nothing terrible will happen to them. However, whilst tolerating the ‘unknown-ness’ of the future is difficult for all of us at different times, as we know, complete certainty is not an option. We don’t know what people think of us and there are no guarantees that we will be safe or healthy in the future. However, efforts to try and reduce uncertainty, often result in more anxiety and worry, not less. So, how can we support young people to learn to think about, manage and respond to uncertainty in a more helpful way?
In this article, I want to share some practical tips which we sometimes use in Cognitive Behavioural Therapy (CBT) to help young people become more tolerant of uncertainty.
Although young people who worry are sensitive to uncertainty, they don’t always notice what triggers their worry, or what they do to try and feel more certain. By paying attention to everyday events, it’s possible to increase awareness by inviting young people to interrupt their worry and to jot down their answers to the following questions: What is the worry about? Is the worry about something concrete and real that you can respond to by taking action now, e.g. worry about a school presentation? Or is it an imaginary, hypothetical worry that can’t be immediately solved, e.g. concerns about a terrorist attack if you go to London on a school trip? If it’s an imagined worry, which behaviours do they rely on to manage the uncertainty, e.g. seeking reassurance, procrastinating, avoiding or gathering lots of information?
Helping young people to explore and check out any beliefs they have about worry can also be useful. For example, worriers often believe that the very act of worrying will help them to arrive at a solution to a problem. For example, they may believe that the answer is out there if only they can find it. However, it’s just not possible to eradicate uncertainty by gathering more and more information and if anything, it’s far more likely that worrying will increase rather than reduce the level of anxiety. Recognizing that worrying is not helpful can help young people to feel less compelled to let the worrying run on unchecked.
Using small, manageable and realistic steps, young people can start to challenge themselves to regularly practice tolerating uncertainty. This may involve seeking out uncertainty on purpose and changing the way they react rather than avoiding it. Examples may include taking the risk of answering a question in class when unsure whether the answer is correct; making a decision to manage gathering lots of information when feeling uncomfortable; and resisting asking for reassurance when unsure about the clothes you’re wearing.
It is helpful for young people to then record what happened when they challenged themselves to take risks. Over time, they will build up evidence of being able to tolerate uncertainty and gradually increase their ability to manage not knowing. Even in the event of things not turning out, they can look at what they did to cope with the negative outcome.
As suggested by Kevin Meares and Mark Freeston in their book ‘Overcoming Worry’ there are a number of questions which can help the young person discover whether their tolerance for uncertainty is changing:
If the young person’s answers to at least some of these questions are in the right direction, then they are making progress and making changes.
Article date 12 November 2020
Article written by Dr Kate Donoghue, Director, Bristol CBT Clinic