“Some poems don’t rhyme, and some stories don’t have a clear beginning, middle, and end. Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what’s going to happen next.” – Gilda Radner

Uncertainty is part of the human condition, but not everyone reacts to this continual ambiguity in the same way. Of course, some uncertain situations are more serious than others, but regardless of the gravity involved, some individuals are just more distressed about it. The propensity to react negatively to everyday uncertainties has been associated with generalized anxiety disorder (GAD), obsessive-compulsive disorder, social anxiety and panic disorders, depression, and anorexia/bulimia. (The most frequent measure is the Intolerance of Uncertainty (IU) scale, a 27-item report which has been made more methodologically sound through its abbreviation into the IUS-12.) Perhaps there are certain genetic vulnerabilities at play with this syndrome, but it seems more fruitful to focus on developmental issues, specifically, what “unhealthy” environment(s) a “strong reactor” was exposed to in childhood?

Intolerance of uncertainty has been conceptually distinguished from three other constructs (Rosen et al., 2014): intolerance of ambiguity (IA), uncertainty orientation (UO), and need for cognitive closure (NCC). IA focuses on the “here and now”, while IU centers on an apprehension about events occurring in the future. NCC and UO are similar in that they appear to have implications for motivation: approach of avoidance. IU and IA tend to foster indecisiveness, a lack of behavioral reaction to the perception of the situation.

On the psychophysiological level, IU has been shown to be related to reward responding and threat amplification, and may be linked to anterior insula response to uncertainty (Gorka, 2016). More recently, and supporting this, IU has been associated with greater insula and amygdala response to uncertainty, with altered event-related potentials regarding rewards and errors, and with deficiencies in safety learning indexed by skin conductance (Tanovic, 2018).

In addition, cross-sectional survey data has shown a high level of rumination in the association between IU and depression symptoms. This data supports rumination as a moderator and mediator in the relation of IU to both depression and anxiety symptoms (Liao & Wei, 2011). High IU is transdiagnostic and has been proposed as a phenotypic case of internalizing psychopathology.

GAD has as its defining feature  a “free floating” worry that can affix to almost anything. Thus, it is distinguished from specific obsessions. This worry is not necessarily irrational, just “amplified”, out of proportion to what would normally be considered appropriate. In the case of everyday ambiguity, a GAD sufferer will fixate on this as a disturbing aspect of life and wonder why others are nonchalant about it. Attachment theory has explanatory value here in that one can easily see how a small child who was insecurely attached to its parents could develop to see the uncertainty as distressing, even threatening. A good example is the ACOA (Adult Children of Alcoholics) syndrome: the child of alcoholic parents often does not know what to expect from them from day to day or sometimes even hour to hour. “If parental responses are unstable or inconsistent, a child may not learn to adequately regulate distress,” writes Canadian psychologist, Magdalena Zdebik (2017). “Insecurely attached children are more likely to process or interpret ambiguous information or situations as threatening, hostile, or negative than securely attached children.”

Frank personality changes in the parent are especially psychically disruptive and, if the situation is severe and prolonged, could actually make the child entertain thoughts of “body-snatching”.

Arguably, uncertainty and ambiguity would be somewhat mitigated in a more enlightened, rational social system, but, still, a residuum is bound to persist even then, as it is essentially part of the human condition. One function of religion is to alleviate the stress from lack of guidance through the vicissitudes of everyday life and especially painful crises when they arise. Cognitive-behavioral therapy is often cited as effective for anxiety in general, but existential psychotherapy can be useful in helping those who have a problem with UI by framing it in terms of coping with the basic anxiety of inescapable freedom to act, and often action is, as noted, given poor guidelines, the ubiquitous uncertainty. Although it may be overstating the case to say, as Sartre did, “We don’t know where we came from, we don’t where we’re going, and we don’t know what we’re doing while we’re here,” in the face of intractable ambiguity, decisions will still have to be made, which includes the decision to do nothing.

~ Wm. Doe, Ph.D., February 2018

SELECTED REFERENCES

N. O. Rosen et al (2014). Differentiating intolerance of uncertainty from three related but distinct constructs.  Anxiety, Stress, & Coping, 27, 1.

M.A. Zdebik et al (2017). Childhood attachment and behavioral inhibition: Predicting intolerance of uncertainty in adulthood. Development and Psychopathology. Cambridge University Press.

S.M. Gorka et al (2016). Intolerance of uncertainty and insula activation during uncertain reward. Cogn Affect Behav Neurosci, 16: 929-39.

E. Tanovic (2018). Intolerance of uncertainty: Neural and psychophysiological correlates of the perception of uncertainty as threatening. Clin Psychol Rev (e-pub). 1/6/2018.

K.Y. Liao & M. Wei (2011). Intolerance of uncertainty, depression, and anxiety: The moderating and mediating roles of rumination. J Clin Psychol, 67 (12).