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CBT for Intolerance of Uncertainty: Practical Steps to Overcome Anxiety

Written By Dr Elaine Ryan.

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Dr Ryan is a psychologist with over 20 years of experience. She specialises in OCD and anxiety-related conditions and worked in the NHS in the UK before setting up a private practice in Dublin. Dr Ryan obtained her PsychD from The University of Surrey and is a Member of The British Psychological Society, The UK Society for Behavioural Medicine and EuroPsy registered.

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Do you find yourself feeling paralysed by the unknown? For instance, imagine waiting for test results or hearing an unexpected knock at the door—your mind immediately jumps to the worst-case scenario. When I was younger and experiencing quite high anxiety, the knock at the door could create anxiety so high, that I couldn’t answer. I did not know it then, but years later, as a psychologist, I can clearly see how difficult it was for me to tolerate, ‘not knowing.’ Intolerance of uncertainty (IU) can make life’s unpredictability overwhelming, fuelling cycles of worry and anxiety. In my article I want to offer solutions by showing you how Cognitive Behavioural Therapy (CBT) offers practical strategies to help make sense of this fear of uncertainty and how to make it better.

What is Intolerance of Uncertainty?

Intolerance of uncertainty refers to when you tend to see the unknown as somehow threatening, like the example I gave when younger and and heard an unexpected knock at the door, my brain would never go to the scenario that this could be a wonderful surprise. Rather it was a threat. I should make it clear, that these thoughts are not not at the front of your mind, it is usually the resulting feeling that you feel, but models like CBT that break situations into smaller pieces help us to discover the thought processes. Back to explain what IU is. It’s a key factor in anxiety disorders like Generalised Anxiety Disorder (GAD) and Obsessive-Compulsive Disorder (OCD). People with IU often:

  • Overestimate the likelihood of negative outcomes.
  • Underestimate their ability to cope with challenges.
  • Engage in behaviours like avoidance or excessive reassurance-seeking.

Struggling with worry and uncertainty? Take control with CBT.

My CBT Online Course – Retrain Your Brain® is designed to help you break free from the cycle of worry. With step-by-step guidance and practical exercises, you’ll gain the tools you need to face uncertainty, reduce anxiety, and build lasting resilience. Dr Elaine Ryan

When writing this I am trying to think of my own experiences to make sure I expand on points when necessary. When I wrote the above points, I want to clarify that (like with the examples above) these might not be conscious thoughts. In my years working as a psychologist I’ve lost count of the times I try to get clients to see that they can cope much better than they realise, but it just occurred to me, that when my anxiety was at its highest, I didn’t stop to wonder if I was underestimating my ability to cope, rather it is more implicit it’s the fear that comes from the unknown – uncertainty probably wouldn’t be so anxiety provoking if you knew we would cope with whatever happens, which is rarely the negative things we predict.

Why Does IU Make Anxiety Worse?

When uncertainty arises, it can trigger catastrophic thoughts (e.g., “What if everything goes wrong?”). These thoughts lead to behaviours designed to eliminate uncertainty, such as over-preparing, avoiding situations, or constantly checking. While these actions provide temporary relief, they reinforce the idea that uncertainty is dangerous and unmanageable, perpetuating anxiety.

How CBT Can Help with Intolerance of Uncertainty

CBT offers a structured approach to managing intolerance of uncertainty by addressing unhelpful thoughts, behaviors, and emotional responses. In this section, you’ll learn how to identify your triggers, challenge catastrophic thinking, face uncertainty gradually, and develop mindfulness practices to navigate uncertainty with greater confidence.

CBT provides evidence-based techniques to change how you think, feel, and act around uncertainty. Here’s how it works:

Recognize Your IU Triggers

Begin by identifying situations that cause uncertainty and anxiety. Reflect on how you typically respond and the impact these behaviours have on your life.

Write down three recent situations where uncertainty made you anxious. For example, you might recall waiting for feedback on a work project, deciding whether to attend a social event, or feeling uneasy about unexpected bills. For each situation, note your thoughts (e.g., “What if they hated my work?”), feelings (e.g., anxious, tense), and behaviours (e.g., avoided checking emails or procrastinated). Ask yourself: Did my response help or hinder me?

Challenge Catastrophic Thinking

CBT helps you examine and reframe unhelpful thoughts about uncertainty. For example:

  • Catastrophic Thought: “If I don’t prepare perfectly, everything will fall apart.”
  • Balanced Thought: “I can do my best and handle any challenges that arise.”

When faced with a worrying thought, ask:

  • What’s the evidence this will happen?
  • What’s the worst, best, and most likely outcome?
  • How would I cope if the worst happened?
Gradual Exposure to Uncertainty

Avoiding uncertainty reinforces fear. CBT encourages you to face uncertain situations gradually, building tolerance over time.

Start small:

Choose one small situation where you usually avoid uncertainty. Commit to facing it and reflect on what you learned.

Behavioural Experiments

Behavioural experiments test your beliefs about uncertainty. For example, if you believe “I can’t function without certainty,” you could experiment by deliberately leaving a decision unresolved and observing the outcome. For instance, try delaying a response to a non-urgent email and note what happens. Did the world fall apart, or were you able to manage the uncertainty? These small experiments can reveal that uncertainty is often less threatening than it feels.

Try the Downward Arrow Technique to uncover the core fears behind your anxious thoughts. Download our free worksheet to guide you.

The Downward Arrow Technique

The downward arrow technique is a powerful tool used in CBT to help you uncover the underlying beliefs and fears that fuel your anxious thoughts. It’s like peeling back the layers of an onion to get to the core of what’s really bothering you.

Here’s how it works:

Identify a specific anxious thought: Start by pinpointing a specific thought that’s causing you distress. For example, “I’m going to mess up this presentation and everyone will think I’m incompetent.”

Ask “What if?” Ask yourself, “What if this thought were true? What would that mean?” For example, “What if I did mess up the presentation?”

Follow the arrow down: Keep asking “What if?” or “What would that mean?” to delve deeper into your fears. For example:

  • “What if I mess up the presentation?”
  • “Then I might get negative feedback.”
  • “What if I get negative feedback?”
  • “Then my boss might think I’m not good at my job.”
  • “What if my boss thinks I’m not good at my job?”
  • “Then I might get fired.”
  • “What if I get fired?”
  • “Then I won’t be able to pay my bills.”
  • “What if I can’t pay my bills?”
  • “Then I might lose my home.”

By following this chain of “what ifs,” you eventually arrive at the core fear driving your anxiety. In this example, the core fear might be a fear of failure, a fear of financial insecurity, or even a fear of homelessness.

Once you’ve identified the core fear, you can start to challenge it. Ask yourself:

  • Is this fear realistic?
  • What evidence do I have to support this fear?
  • What’s the worst that could really happen?
  • How likely is it that the worst will happen?
  • Even if the worst did happen, how would I cope?

Example in the context of IU:

  • Anxious thought: “I can’t go on that trip without a detailed itinerary. What if something goes wrong?”
  • Downward arrow:
    • “What if something goes wrong?”
      • “Then I might not know what to do.”
        • “What if I don’t know what to do?”
          • “Then I might feel lost and helpless.”
            • “What if I feel lost and helpless?”
              • “Then I might panic and have a breakdown.”
  • Core fear: Fear of losing control, fear of being overwhelmed, fear of vulnerability.

Benefits of the Downward Arrow Technique:

  • Increases self-awareness: Helps you understand the underlying beliefs and fears driving your anxiety.
  • Identifies core beliefs: Uncovers the often hidden core beliefs that shape your thoughts and behaviors.
  • Challenges catastrophic thinking: Helps you evaluate the validity of your fears and develop more balanced perspectives.
  • Promotes problem-solving: By identifying the core fear, you can develop more effective coping strategies.

Ready to Tackle Uncertainty with Practical Tools?

The Downward Arrow Technique is just one of many strategies you’ll master in my CBT Online Course – Retrain Your Brain®. Designed to help you break free from the cycle of worry, this course provides step-by-step guidance and practical exercises to build resilience and reduce anxiety.

Practice Mindfulness

Mindfulness helps you stay grounded when uncertainty arises. Instead of resisting discomfort, practice accepting it without judgment. Take five minutes daily to focus on your breath or observe sensations in your body. When anxious thoughts arise, acknowledge them and gently return to the present moment.

Moving Forward

CBT teaches that uncertainty is a normal part of life. By using these strategies to challenge your thoughts, face your fears, and change your behaviors, you can build resilience and confidence. Remember, managing IU isn’t about eliminating uncertainty but learning to live alongside it.


If you’re ready to take the next step in managing anxiety, explore our CBT-based resources for more support. Visit HSE Ireland’s Mental Health Resources or Mind UK for additional guidance. Want structured support at your own pace? 

Our CBT Online Course is designed to help you break free from the cycle of worry and uncertainty. With step-by-step guidance and practical exercises, you’ll gain the tools to manage anxiety and regain control of your life. Learn more and get started today.