Why inability to cope with uncertainty may cause mental health problems
Not knowing is an uncomfortable experience. As human beings, we are naturally curious. We seek to understand, predict and control – it helps us learn and it keeps us safe. Uncertainty can feel dangerous because we cannot predict with complete confidence what will happen. As a result, both our hearts and minds may race.
While it is quite natural to experience uncertainty as uncomfortable, for some it is seemingly unbearable. Psychologists have even suggested that finding it difficult to cope with the experience of not knowing (also known as intolerance of uncertainty) could seriously affect our mental health – occurring alongside a number of conditions. But does it play any part in causing them? My review, published in Cognitive Therapy and Research, aimed to find out.
It's easy to see how the concept of uncertainty is linked to mental health. If uncertainty can feel dangerous, then it might feed our worry and anxiety. What's more, if getting rid of that feeling of uncertainty feels essential, then the compulsion to wash our hands again and again to make sure they are clean and safe might also feel essential.
And if we ultimately feel unable to cope with the change and unpredictability life throws at us, then it's understandable that we are at risk of feeling defeated and depressed.
By looking at the scientific evidence as a whole, I asked whether intolerance of uncertainty really has the far reaching influence on mental health difficulties suggested. And importantly, does it cause those difficulties?
The answer is not straightforward. Overall, the evidence is full of mixed findings and there are strikingly few studies that actually test what happens to a person's mental health when their ability to tolerate uncertainty changes. Such change does seem possible. We see it in the lab, such as when people are encouraged to think of uncertainty as a problem versus something that can be accepted. And we see it in therapy, through treatments like cognitive behavioural therapy – which helps people manage their problems by changing how they think or act.
We are certainly not at the point where we can confidently explain what role our response to uncertainty plays in our mental health, but we can cautiously offer some possibilities based on the research as a whole. While the findings are mixed, the best evidence that intolerance of uncertainty may cause mental health difficulties is for anxiety. In fact, a number of studies have found it may cause or increase symptoms of anxiety. That's because when we struggle to cope with the experience of uncertainty, our minds may worry and come up with an increasing number of frightening possibilities.
The struggle with uncertainty might also help us understand depression. Some evidence suggests that we may find that our mood is more negative when we feel less able to cope with the unknown. But low mood is only part of the experience of depression, so fuller investigation is needed.
Perhaps surprisingly, there is little evidence to support the idea that difficulty in dealing with uncertainty plays a part in causing the compulsions and obsessions seen in OCD. But, of the difficulties that have been explored, this is also the area with the least research.
Understanding what underpins mental health difficulties is important because it can help us understand how to provide better support for the many of us who have these experiences. Mental health difficulties are common – in fact, they often occur together. This raises the question: are they really separate things? Over recent years, psychologists have started suggesting that what underpins one mental health difficulty may actually also be shared across others. There is some support for this suggestion. For instance, the process of thinking repeatedly and unhelpfully about our concerns may lead to both anxiety and depression.
So while these difficulties look different on the surface, underneath the same processes may be at work. This is an exciting idea. Instead of having countless treatments, we could have support that targets these shared processes and is helpful for a wide range of issues. But first, we need to be sure what the shared processes are – and serious work is going into efforts to gain this understanding.
Our ability to weather the uncertainty that life presents us with is one process that might be shared across different mental health difficulties. If so, then this understanding could helpfully add to the therapeutic toolkit across different difficulties – a possibility that is already being explored. For example, cognitive behavioural therapy that reduces intolerance of uncertainty might help improve a range of mental health problems. What's more, intolerance of uncertainty may also play a broader role, such as in eating disorders and psychosis. But right now, there's too much guesswork and not enough evidence directly testing these ideas.
Ultimately, people deserve to be supported to make the changes that will help them the most. And so, we need research that clearly shows what those areas of change should be. After some intriguing initial research on the links between uncertainty and mental health, it is clear that this is an area worth figuring out. Until then, we will all have some uncertainty to bear.