Health Anxiety and the 'Intolerance of Uncertainty'
- Britney Chesworth Ph.D., LCSW
- 13 hours ago
- 4 min read
Learn 4 CBT strategies to improve your tolerance of uncertainty.
The 'intolerance of uncertainty' is associated with health anxiety.
One key strategy to improve health anxiety is to learn how to tolerate a little uncertainty about health.
Learn several cognitive behavioral therapy (CBT) strategies to help improve tolerance of uncertainty.
Everyone experiences uncertainty at times, and that’s normal. But for some people, the need for absolute certainty can become overwhelming, taking over daily life. This is called the “intolerance of uncertainty” (IU). IU involves interpreting uncertain situations as threatening and assuming that unknown outcomes will inevitably be negative. In other words, if you can’t be sure about what will happen, you might feel certain that the outcome will be terrible and unmanageable.
People with health anxiety often have particularly high levels of IU. They may believe it’s possible and necessary to be 100% certain that they won’t experience a negative health outcome. In reality, certainty about the future is impossible, and health is no exception. Those with high IU often make three assumptions about uncertain situations: that uncertainty predicts something bad will happen, that the bad outcome will be catastrophic, and that they won’t be able to cope if it does. For example, noticing a random headache might lead to assuming it’s a brain tumor, and imagining that if it is, treatment won’t help, and the worst will happen.
The good news is that IU can be addressed. The goal is to gradually become more comfortable with uncertainty, especially regarding your health. Learning to tolerate even small amounts of uncertainty can help you stop equating minor unknowns with disaster and reduce the exhausting need for complete control.
To reframe your approach to uncertainty, it helps to adopt three adaptive beliefs. First, uncertain situations will probably turn out okay. Second, even if something negative occurs, it probably won’t be catastrophic. Third, even if the outcome is negative, you are likely capable of coping, and medical interventions are usually effective and manageable. Comparing these beliefs with your usual thoughts about uncertainty can reveal how much unnecessary worry and anxiety you may be carrying.
The key takeaway is that tolerating uncertainty reduces the desperate need to control every health outcome. When you practice accepting uncertainty, you also reduce excessive worry, compulsive checking, and other safety behaviors that maintain health anxiety.
To start building this skill, there are practical strategies you can implement right away. By taking small steps to face uncertainty and challenge catastrophic thinking, you can gradually retrain your mind to handle health-related ambiguity more calmly and confidently, ultimately reducing anxiety and improving your quality of life.
Strategy 1: Identify & Challenge Thinking Errors
When you have health anxiety, it’s common to jump to conclusions about symptoms, think in black-and-white terms, or assume the worst-case scenario. For example, you might notice a headache and immediately worry it’s a brain tumor, even though it’s far more likely to be something minor like tension or dehydration. These thinking errors often play out automatically and can make uncertainty feel unbearable.
The key is to notice these patterns and challenge them. Ask yourself questions like:
Am I assuming something bad will happen just because I don’t know the cause?
Is it just as likely (or even more likely) that there is a neutral or benign explanation?
Have I faced uncertainty before, and it turned out to be okay? What aspects of this situation are within my control, and what isn’t?
By practicing this, you start to see that your thoughts are not always facts and that uncertainty doesn’t have to mean catastrophe.
Strategy 2: Embrace the Beauty of an Uncertain World
It can be terrifying to live with uncertainty, especially when it comes to health. But uncertainty also allows for surprises, growth, and unexpected joy. Imagine if your world were 100% predictable. Imagine if you knew exactly what was going to happen every day, from the taste of your food to every interaction with others. Life would be predictable and boring.
Try reflecting on times when something unexpected turned out to be amazing. Maybe it was meeting someone important, getting a promotion, having a brilliant idea, discovering a new passion, or experiencing a meaningful life change. These positive experiences only happen because the outcome was uncertain. Recognizing the beauty of unpredictability can help you feel less threatened by uncertainty and more open to life’s surprises, even when it comes to your health.
Strategy 3: Harness Your Existing Skills
Even if you struggle with health anxiety, you already tolerate uncertainty in other parts of your life, often without realizing it. Think about the small risks you take every day: cooking new foods, walking across a busy street, sending your kids to school, or letting someone else handle a task. You accept these small uncertainties because the risks are manageable, and the benefits outweigh the potential downsides.
You can transfer these skills to health-related situations. For example, you already have experience managing small amounts of risk without disaster. Remind yourself that just like other areas of life, tolerating uncertainty about health is possible. Focus on the benefits of living fully rather than trying to control every outcome. Your ability to cope is stronger than you think.
Strategy 4: Practice Sitting with Uncertainty about Symptoms
When you notice a new symptom, the instinct is often to get answers immediately, whether by checking online, asking loved ones, or visiting a doctor. The Waiting Experiment is a practical way to build tolerance for uncertainty. Choose a minor symptom or bodily sensation and deliberately pause before seeking reassurance or engaging in body checking. This could be for a few hours, a day, or even a week.
During this time, you will likely feel an increase in uncertainty and anxiety. This is expected and is a sign that the exercise is working. By resisting the urge to seek immediate reassurance, you practice tolerating the anxiety and uncertainty that naturally arises. At the end of the period, reflect: Was the anxiety unbearable, or could you manage it? How did it change over time? Was the symptom serious, minor, or gone entirely? Repeated practice reduces compulsive behaviors and helps you see that uncertainty is tolerable and safe.
Your Homework
Try these strategies out this week to build your tolerance of uncertainty. It won't happen overnight, but you will likely notice improvement if you put a little work each day into strengthening this muscle.
