Tolerating Uncertainty Practice

When to Use

Use when intolerance of uncertainty has been identified as a core maintaining factor in the client's worry, typically within Dugas' intolerance of uncertainty model. Introduce after psychoeducation about the role of uncertainty intolerance in GAD.

How to Introduce

Use the analogy of building a tolerance through gradual exposure, similar to building physical stamina. Frame the exercises as experiments in learning to sit with not-knowing rather than trying to eliminate uncertainty.

Adaptations

Start with lower-stakes uncertainty situations (e.g., trying a new restaurant without reading reviews) before progressing to more personally meaningful domains. Tailor the hierarchy to the client's specific areas of intolerance.

Not appropriate if the client has not yet developed a basic understanding of how intolerance of uncertainty maintains their worry. Premature exposure to uncertainty without adequate rationale may increase distress without therapeutic benefit.

Clinical Tips

Monitor for subtle neutralising behaviours that undermine the exposure (e.g., mentally rehearsing contingency plans while ostensibly tolerating uncertainty). The most effective exercises are those that leave the outcome genuinely unknown for an extended period rather than those resolved quickly.