My new therapist tells me that many people function happily day to day by maintaining a healthy denial of all the things they cannot control. Until recently, I lived at the other extreme, as if calamity could befall me any minute. Anticipating earthquakes, heart attacks, carbon monoxide poisoning and global famine left me exhausted, with frayed nerves, a body exposed to constant anxiety and stress, and a shortened attention span for work, relationships and pretty much everything that makes life interesting and enjoyable.
I’d felt this way for so long that when this new therapist described my condition–20 years into my treatment for anxiety–I almost didn’t believe it had a name. Intolerance of uncertainty (IU), he said, is characterized by stress and uncontrollable worry in the face of not knowing what might be lying in wait. I’d never realized these could be symptoms. I’d thought they were just me.
But there it is in the Journal of Clinical Psychology, where a study describes IU as a “dispositional characteristic” that “involves the tendency to react negatively on an emotional, cognitive and behavioral level to uncertain situations and events”. Hallmarks of IU include excessive worrying, predicting adverse outcomes, overestimating threats, and performing behaviors that give some sense of control–mine was counting out food in multiples of three, eating three cookies, six chips or nine grapes. Its common for IU sufferers to seek constant reassurance from friends and experts–getting second and third opinions from doctors, asking flight attendants if the whirring noise in the cabin is normal. And they tend to endlessly consume information about scenarios they’re afraid of, a trait that’s kept me up until 4 a.m. googling elevator failures and eye twitches and signs of toxic mold.
It turns out that IU isn’t just a result of negative thinking, but of biology as well. In 2017, neuroscientist Justin Kim and his colleagues at Dartmouth found that people with IU have an “unusually large striatum”–the part of the brain responsible for making decisions and expecting punishment and reward. Those of us with panic or other anxiety disorders score particularly high on the Intolerance of Uncertainty Scale, as do those with PTSD, OCD, depression and eating disorders. In fact, some researchers and psychologists theorize that IU underlies, fuels, and links many of these conditions.
Whether it’s due to the shape of my brain or the characteristics of my personality, (or both), this fear and dread is something I’ve felt most days. And when the Covid-19 pandemic upended the globe, it appeared that everyone around me now felt it, too. My lifetime of anxiety suddenly seemed like practice for this moment and the strategies I’ve learned to use to manage IU can help anyone function better in a stressful situation. These techniques are necessary, by the way, because there is no perfect medicine to treat IU. Selective serotonin re-uptake inhibitors (SSRIs) and other anti-anxiety medications can take the edge off and help with the obsessive rumination but not reliably, and there are common side effects, including dizziness, headache, nausea, and gastric issues.
In my case. the most effective treatment has been cognitive behavioral therapy, which taught me to examine and dismantle my catastrophic thinking and curtail the negative behaviors I used to perform obsessively, like information gathering and reassurance seeking. The approach I use when I feel anxious in day to day life proved effective in quarantine. Step away from the search bar. Call a friend. Do some yoga. Drink a cool glass of water and listen to calming music. Positive self talk can be very soothing, too, so I tell myself This is a time of not knowing. It is scary but I’ll get through it like I’ve gotten through not knowing before.
As my therapist said, what will determine whether you’re unhappy or happy isn’t how many bad or good things happen to you, but how well you’re able to tolerate the uncertainty. For me, that changes minute by minute. But I’ve learned that the unknown is an element of human existence ‘ll never be able to think my way out and that tolerating anxiety is a skill one can practice and strengthen much like building muscle. I sit with the discomfort, the awareness that not knowing is scary and unpleasant. I control what I can: the rest I have to let go of in order to enjoy the good things in my life.
In times of global crisis or personal pain, whenever I’m terrified by the unknown, I try to slow down and focus on physical realities I can be certain of. Here is my breath; here is the blue sky; here are the birds.
Gila Lyons’ writing about health, mental health, and social justice has appeared in The New York Times, Oprah Magazine, Cosmopolitan, Health Magazine, Healthline, Vice, Vox, The Huffington Post, GOOD Magazine, Salon, Poets & Writers, The Millions, Refinery29, The Rumpus, The Morning News, Ploughshares, Brevity, Tablet, The Forward, Fusion, Bitch Magazine, Bust Magazine, and other publications. Her pieces have been anthologized in books and collections, most recently in ABOUT US: Essays from the Disability Series of the New York Times, (W. W. Norton, 2019). Gila has served as one of three “Alices” at Go Ask Alice!, Columbia University’s award-winning health and sexuality website. She teaches writing and literature, and works as a freelance writer, a writing coach and editor, and an anxiety coach and connector to resources. Message her for rates and availability. Connect with her on Twitter, Facebook, Instagram, and LinkedIn, and check out her favorite books here.