Understanding Anxiety, Worry, and Uncertainty

The defining feature of anxiety is worry. Worry is a mental chain of thinking that is persistent, repetitive, and uncontrollable.

Worry mostly focuses on the uncertainty of the future. When we worry constantly and about a number of things, this tends to be a hint that we might be suffering from a type of generalized anxiety.

Worriers tend to predict negative or threatening outcomes. They mentally rehearse various solutions to what they perceive to be a threat. But ironically, rehearsing these solutions doesn't reduce their sense of uncertainty.

In other words, worriers predict that bad things will happen. They have trouble accepting uncertainty, so they try to problem solve in advance. But they still feel uncertain and anxious because they can’t implement the solution immediately.

  • What is the range of topics you worry about?

Intolerance of Uncertainty

Being intolerant of uncertainty is believed to predispose individuals to have mental health issues with anxiety, also known as Generalized Anxiety Disorder. Being intolerant of uncertainty also helps to maintain the disorder once it has developed. People without an anxiety disorder may not like uncertainty, but they generally tolerate it. They generally believe that if bad things happen, they’ll be able to cope.

People with Generalized Anxiety Disorder are different. They believe it is unacceptable to be uncertain or to experience ambiguity. They are afraid that uncertainty or ambiguity will lead to negative outcomes or cause problems in general. They may also believe that it is irresponsible if they don’t try to resolve the uncertainty or ambiguity.

  • Do you have an intolerance for uncertainty?
  • How does it show up?

When people who struggle with anxiety receive ambiguous or uncertain information, they use maladaptive coping strategies to try to guarantee certainty. Their major strategies are worry and avoidance. Another strategy includes using safety behaviors, where they seek reassurance from others, over-prepare, gather excessive amounts of information, or repeatedly check or verify the safety of the information or situation.

For example, if Susan is going to a social event with some new acquaintances, she might be thinking, “What if everyone finds out I’m shy and stops talking to me?” This thought reflects her uncertainty about what might happen. Her attempt to cope involved the use of worry and avoidance in order to try to gain certainty.

  • What do you do to guarantee things will turn out ok?
  • When you feel uncertain about something, what do you do?
  • When you’re worried about something, how do you try to make yourself feel less anxious?

Beliefs About Worry

When we have excessive anxiety and worry, we tend to have several strongly held beliefs about worry itself. Some of these beliefs are positive, and others are negative. For example, “Worrying will help prepare me for danger (positive belief)”, or “Worry is uncontrollable and potentially dangerous (negative belief)”.

Even when we experience worries as uncontrollable, we continue to worry. We continue to believe that worrying is helpful. So it’s important to understand our specific beliefs about the advantages and disadvantages of worry. For example, we might feel that worrying keeps us safe and alert. However, it can lead to more worry, make our mood worse, and get in the way of our relationships.

Poor Problem Orientation

When we experience constant anxiety, we tend to view problems as threats. We have low confidence in our ability to solve problems, so we expect a negative outcome if we try. As a result, we overcompensate in trying to create the perfect solution to our problems. Suddenly, instead of solving the real problem (our worry), we end up getting stuck and focused on solving what we are worrying about, and end up not solving the real problem.

In part, this happens because we keep trying to come up with a solution that we are certain will work. But if the problem we are concerned about is still in the future, we can’t immediately implement our solution. This means that we can’t be certain that our solution will work, so we continue to worry and come up with additional solutions without actually choosing one.

For example, if we’re not certain how to solve a problem, we might ask a friend what we should do. If we are given more that one solution to the problem, we might end up worrying about which one is the best solution. Even if we end up deciding what to do, we will continually second guess ourselves.

  • Think about one problem that you worry about. Did you try to find a perfect solution
  • Was that satisfying?
  • Or did you continue to worry and seek alternate solutions?

Cognitive & Emotional Avoidance

Worrying can serve as a way to avoid threatening images, “Worst Case Scenario” thoughts, and distressing emotions. Worry is usually composed of verbal thoughts, such as, “What if my mind goes blank?” Worry tends not to be composed of images or visual pictures in the mind.

We may try to think about something positive if we become aware of a negative thought or emotion, or attempt to “push” it away. We may tell ourselves not to think about certain worries or criticize ourselves for worrying or having anxious thoughts. We may try to distract ourselves from our anxiety or negative emotions.

These techniques tend to backfire and actually reinforce our worry and anxiety. We end up becoming addicted to avoiding the unpleasant emotions that stem from our worries at all cost. We fear that if we get too anxious, we’ll fall apart. Or we mentally tell ourselves not to worry over and over, and it’s no surprise that we end up worrying more, because we are still thinking about what we are worried about.

Different Types of Anxiety Disorders

When discussion mental health, anxiety tends to run in some distinct flavors:

Generalized Anxiety Disorder

The defining feature of Generalized Anxiety Disorder is excessive worry and anxiety about a number of topics. Worries tend to be non-stop, automatic, and unstoppable. Worry about the vagueness and uncertainty of the future is a key component.

Panic Disorder

A sudden surge of intense fear or discomfort. Individuals often change their behavior in a maladaptive way (usually avoidance) and have what is termed a Catastrophic Misinterpretation of Bodily Symptoms. Fear of dying, falling apart, fainting, or feeling detached from your body are common themes.

Social Anxiety Disorder

Socially anxious people fear being evaluated negatively, which is linked to their dysfunctional core beliefs about themselves and other people. They are anxious about appearing anxious in front of others. They tend to avoid certain interpersonal situations or endure them with a source of dread.

Obsessive-Compulsive Disorder

Obsessions are recurrent and persistent thoughts, urges, or images. They are experienced as intrusive and unwanted, and cause anxiety or distress. People with this disorder try to ignore, suppress these thoughts or images. Compulsions are repetitive, somewhat stereotypic, overt rituals, or they can be mental acts. Most often compulsions are triggered by obsessions. People with this disorder often feel compelled to perform the compulsion until they have reached a specific state, such as a reduction of anxiety, a feeling of certainty; a sense of completeness, feeling safety/security, or a “just right” feeling.

Other Anxiety Disorders

These tend to remain in the realm of specific phobias and post-traumatic stress disorder, among others.

Treatment for Anxiety Disorders

Cognitive-Behavioral Therapy (CBT) is considered to be an effective and reliable treatment for anxiety. It is the “gold standard” and the first line of approach that should be considered for treating anxiety disorders (Hofmann et al., 2012). CBT has also demonstrated to substantially improve symptoms of anxiety disorders for two or more years after treatment ended (Ishikawa, Okajima, Matsuoka, & Sakano, 2007). Because research studies often exclude individuals based on certain criteria, such as having other diagnoses, studies have also examined the use of CBT in real-world settings and found it to be an effective treatment under those circumstances as well (Stewart & Chambless, 2009).

When focusing on specific anxiety disorders, research has found CBT to be an effective treatment for panic disorder, with some research suggesting that it may be superior to medication (Mitte, 2005). CBT has been demonstrated to result in a large degree of improvement for generalized anxiety disorder (Cuijpers et al., 2014), as well as to reduce the disorder’s most prominent symptom of worry (Hanrahan, Field, Jones, & Davey, 2013). Research has also found that CBT is highly effective at treating social phobia (Powers, Sigmarsson, & Emmelkamp, 2008), with clients experiencing better outcomes after treatment is discontinued compared to clients who only received medication (Fedoroff & Taylor, 2001). Additionally, research has found that CBT leads to significant improvement in specific phobias, with treatment involving in-vivo exposure leading to greater improvement that imaginal or virtual reality exposure alone (Wolitzky-Taylor, Horowitz, Powers, & Telch, 2008). Finally, CBT that focuses on exposure exercises while preventing clients from using compulsions has been shown to be a highly effective treatment for obsessive-compulsive disorder (Olatunji, Davis, Powers, & Smits, 2013).

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