Intolerance of Uncertainty
A handout explaining intolerance of uncertainty: what it is, how it shows up in everyday behaviour, why it drives worry and checking, and why the answer is learning to live with not knowing rather than seeking more certainty.
About this resource
Intolerance of uncertainty is a dispositional tendency to find uncertain situations unacceptable, stressful and threatening regardless of how likely a bad outcome actually is. Dugas, Ladouceur and colleagues identified it as the central process in generalized anxiety disorder, and later research established it as a transdiagnostic factor with strong links to OCD, health anxiety, social anxiety and eating disorders. People high in intolerance of uncertainty tend to interpret ambiguous information as threatening, to seek reassurance and information excessively, to over-prepare, to avoid situations with unpredictable outcomes, and to worry as a way of mentally reducing the sense of not knowing.
This handout explains the concept without jargon, using everyday examples to show how uncertainty-driven behaviours look sensible in the moment while quietly confirming that uncertainty is dangerous. It contrasts the two possible strategies (trying to eliminate uncertainty versus learning to tolerate it), explains why the first is doomed and the second works, and introduces behavioural experiments as the way forward. A reflection section invites the client to identify their own uncertainty behaviours and to rate how much they currently believe uncertainty is unbearable.
Use for GAD, OCD with doubt and checking, and health anxiety, typically after initial psychoeducation about worry or intrusions and before Tolerating Uncertainty Experiments. The professional version adds a short structured interview for eliciting beliefs about uncertainty, a list of uncertainty behaviours by disorder, and notes on the distinction between adaptive information seeking and reassurance seeking.
How to use it
- Introduce after the client has recognised that worry, checking or reassurance seeking is a problem, and when they begin to notice that these behaviours never seem to settle the question for long.
- Read the everyday examples together and ask the client to spot their own. Prompt with categories: double-checking, asking others, over-researching, avoiding decisions, refusing to delegate, procrastinating.
- Ask the client to rate, 0 to 100, how much they believe that uncertainty is intolerable and that certainty is necessary before acting. Record both for later comparison.
- Discuss the two strategies and ask which one the client has been using. Acknowledge that seeking certainty feels reasonable; the problem is that it does not work.
- Complete the reflection section and move on to Tolerating Uncertainty Experiments, starting with a low-stakes situation.
References
- Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215-226.
- Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30-43.
- Dugas, M. J., & Robichaud, M. (2007). Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice. Routledge.
- Robichaud, M., Koerner, N., & Dugas, M. J. (2019). Cognitive Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice (2nd ed.). Routledge.
