Uncertainty in Anxiety Treatment
If you’re going through treatment for an anxiety disorder, you know it’s not easy. As you tackle your cognitive behavioral therapy (CBT), which should include some form of exposure therapy, you’re most likely learning that to overcome anxiety, you need to face the very situations that frighten you in the first place, which is a scary proposition.
What makes it so scary? The triggering content is going to be different for different disorders*, including phobias, generalized anxiety, social anxiety, obsessive compulsive disorder (OCD), or panic disorder. People with the same disorder might also fear different situations. But what makes it all so scary comes down to one word: uncertainty.
Intolerance of uncertainty
Intolerance of uncertainty is a core feature of all anxiety disorders. For instance:
- Phobias: Susan hates snakes. With a passion. When she was a kid, her parents insisted she accompany them on hikes in remote wilderness areas, where they inevitably ran into snakes. Big snakes. Her parents would just casually walk on by the snakes, but they always terrified Susan. She would back away, frightened, and run to catch up to her mom or dad. She felt she could never handle the uncertainty of not knowing when and where a snake might show up, or what would happen if she stepped too close to one that was sunbathing, camouflaged on the trail.
- Generalized Anxiety Disorder (GAD): Recently, Clark was diagnosed with generalized anxiety disorder, or GAD. He seems to be unable to stop worrying about everything in his life. What if our kids don’t do well enough in high school to get into a good college? What if we can’t save enough money to pay for college and we have to dip into retirement savings? What if my wife and I don’t have enough to live on, and we have to work well into our 70s? He has been suffering from back and neck aches for several years due to the stress of all this worrying. If you asked Clark what he thought about uncertainty, he’d tell you that uncertainty in general is pretty threatening, and since life is full of uncertainty, he can feel pretty overwhelmed at times.
- Social Anxiety: Melinda feels panicky whenever she has to go into a room full of people. Her mind races with scary thoughts and questions: What if I can’t find anyone to talk to? What if I say something stupid? What if the person I’m talking to leaves me and I have to stand there all by myself? Worried about the uncertainty of what other people will do, how she will react, and what others might think of her, Melinda tries to avoid going to parties, and she eats at her desk each day instead of going to the company cafeteria.
- OCD: Victoria is living in a nightmare. At random times throughout the day, she sees violent images in her mind of someone murdering her family….and the “someone” she sees doing these horrific acts is…..her. She is mortified by these thoughts. She loves her husband, and she dotes on her two small children. They all mean the world to her. She cannot stand the uncertainty associated with these thoughts. Does seeing these images mean mean I am a killer? Do I want to do these things? And, most horribly, will I one day “lose it” and kill the people I love most in the world because I have these thoughts? Plagued by guilt and fear, she starts avoiding her family, claiming that she has to finish a really big project at work. You can learn more about OCD in excerpts from Daring to Challenge OCD.
- Panic disorder: One day, Gene was in the back of a big discount store when a feeling of pure terror came over him. He felt like he couldn’t breathe, like he was trapped. He raced to the front of the store, bolting through the doors and into the fresh air, which he gulped feverishly. What was that?!? Unfortunately, over the next several months, the same thing happened again, several times in a grocery store and a few times in the mall. Gene, petrified by the uncertainty of not knowing when these awful panic attacks were going to happen again and what would happen if he couldn’t get out of the store when they did, decided he just couldn’t risk going into shopping centers anymore. He made excuses to his wife about why she really needed to run those errands instead of him.
The good news … and the bad news
Fortunately, CBT has been scientifically proven to work quite well for helping people learn how to handle uncertainty associated with anxiety disorders. Unfortunately, CBT, especially exposure therapy, is not easy. If you are suffering from an anxiety disorder, avoiding the situations or people that are causing you anxiety in the first place may seem like a much better option than facing the very things you fear.
But this avoidance just strengthens the anxiety disorder over time. And as the disorder and the avoidance grows, your world shrinks, and shrinks, and shrinks.
The motivation to take your life back
If you are in CBT therapy, you can probably relate to all this. Your therapist gives you homework assignments, and you say in session, “Yes, I will definitely do this before our next visit.” But in the days that follow, you just can’t seem to get yourself to attempt the assignment. You may or may not fess up to your lack of progress in your next session, but you know you aren’t getting any better. And you feel you are throwing your hard-earned money down the drain.
Fortunately, there is a way to motivate yourself to do the hard work necessary to take your life back from anxiety disorders. Join us for an upcoming workshop, and we’ll show you how.
… Living in the gray
*If you are a CBT therapist reading this, yes, we know that OCD was recently moved out of the Anxiety Disorders category into its own category in the DSM-5. As you probably know, some controversy still surrounds this decision, but we aren’t taking sides. As Jeff and Shala know from personal experience, OCD causes a tremendous amount of anxiety, so for simplicity’s sake on this page, we’re bucketing it with anxiety disorders. On other pages, sometimes you’ll see us lump OCD into anxiety disorders, and sometimes we call OCD out separately.
How do we explain our inconsistency? Well, we’re trying to practice “gray” as opposed to “black and white” thinking, and we’re living happily with the uncertainty of not knowing exactly where to put OCD at times!