By Jeremy Shuman, Psy.D., and Sarah Saffold, MSW, LMSW
For most of us, we like to know how things are going to turn out. We are creatures of habit and we go to great lengths trying to ensure that we are in control of what happens to us each day. In reality, it’s just a sense of control because we end up settling for uncertainty every single day.
When we are anticipating some potentially negative thing happening, it is extremely difficult to accept uncertainty as the final answer to our mind’s searching of “what ifs” and probabilities. When one has generalized anxiety or OCD, there can be a biological component that makes sitting with uncertainty even more difficult. Combined with our lived experiences, we develop a learned component as well. Depending on these dynamics, you can find yourself able to tolerate uncertainty about some things but not others.
For example, if you struggle with one form of OCD known as health anxiety, you may notice every little pain and discomfort in your body and conclude that you have a serious illness. You may perform rituals such as scanning your body for symptoms, reading Web MD to self diagnose, asking loved ones for reassurance, going to the doctor and getting multiple tests run… the list goes on and on.
What happens is that by performing these rituals or safety behaviors, it can reduce anxiety in the moment – maybe for a couple days, a few hours, even minutes, or maybe the relief never comes but the searching felt like the only shot at reducing the anxiety. The problem is that you are stuck in a cycle of anxiety, because the minute you feel another sniffle or have a fever, your anxiety comes right back. You are training your brain to respond to these physical sensations by performing a repetitive and mostly useless process every time a trigger happens.
Instead, we can learn to understand the function of our worry and reassurance seeking as being last ditch efforts to grasp at the fallacy of control. With this insight, we can train a new way to respond to intrusive worry that involves noticing and non-engagement. With some success in inhibiting the maladaptive response, we can move on to intentionally face triggers with a game plan to stay with the sensations rather than run away from them by frantically seeking certainty.
How do we do this? By starting small and exposing ourselves to the things that we fear little by little and decreasing the amount of ritualizing or performing the safety behaviors. We stay with the anxiety for a while, tolerate it, accept that it’s there. We don’t have to like it, it can be very hard and may not feel comfortable. We may not even be able to tolerate it for very long. But we stay with it, we stay anxious, we even invite anxiety in to give it it’s best shot and we still go about our day.
If you suffer from health anxiety, you may find yourself attached to a sensation in your body that makes you uncomfortable, which could be a pain you’ve noticed in your calf. Your thoughts and actions might look like this: “What if I have a blood clot? If that’s the case, I need to look up symptoms for blood clots.” “Oh boy, I can’t be sure, I need to have my friend look at it.” “Geez, my friend doesn’t know either, I guess it’s time to send a picture to my doctor friend.” “They haven’t gotten back to me, I better go to urgent care instead of attending my daughter’s field hockey game.” “Oh thank goodness, urgent care says it’s just a bruise.” A day or two later “I still feel this pain and the bruise looks different, what if that nurse made a mistake.” And this goes on and on.
Instead, we can say to ourselves “I’ve had this looked at in the past and it’s likely just a bruise. I don’t know either way; but, I’m going to sit just for this very moment – not knowing if it is a bruise or a blood clot. I’m going to go about my day and go to my daughter’s game and be unsure if I have a blood clot or not. There’s that funny story my body’s telling me again that a minor pain in my calf is life threatening.”
This shows us that we can still be okay, we can still manage and handle things as we sit with them. It shows us that what we were running away from was the discomfort of not knowing, because whether we spend the time and energy worrying or not, we will still take the same effective problem solving steps of professional medical help seeking at an appropriate frequency without needing to scare ourselves into doing it or figure out the answers through a WebMD page. We can even be OK ultimately accepting uncertainty about an outcome that won’t make itself clear until far in the future. If we stop avoiding, we stop reassurance seeking, checking, scanning, we can live in freedom from many forms of anxiety. Many times what we fear will never come to fruition, but we create such a cycle of anxiety that we cause ourselves to feel as bad as if the worst possible outcome has already come to pass. We can change it, we can rewire how we think and we can learn to live with uncertainty, which gives us time to enjoy our lives and not be ruled by OCD or anxious thoughts. To be free from anxiety, we have to learn to tolerate not being able to be certain.
