In the last post, we discussed the role of Intolerance of Uncertainty (IU) in the worry process. IU, which involves one having particular difficulty with uncertainty, can have a negative impact on one’s functioning in life. Why? Because we live in an uncertain world. As hard as it may be for all of us at times, uncertainty is an inevitable part of life! We aren’t doing ourselves any favors by trying to cling to some notion of certainty, whether it be through spending endless hours ruminating over different options, excessive lists, planning, overpreparing or the like. After taking reasonable steps to ensure safety or plan, it is time to let go and embrace the uncertainty. Cognitive behavioral therapy (CBT) uses several cognitive and behavioral interventions to help people cozy up with the inevitable unknown of the future. In this post, we will talk about cognitive strategies that can help you make this change.
When I am working with a client, one of the initial tasks we do prior to using cognitive and behavioral interventions is to help them develop “worry awareness.” This allows us to see their worry trends, such as worry content and frequencies. One way to do this is to use a worry log, in which the client completes a log documenting all of their worries over a week period. We then use this information to inform the cognitive and behavioral interventions. So, let’s get to the point here. What are some cognitive strategies?
One cognitive strategy is conducting a cost-benefit analysis. This strategy helps us to see the short and long-term benefits of engaging in excessive worry (the maladaptive coping mechanism) versus living more in the present moment and accepting that we cannot be certain about the future (the adaptive coping mechanism). We always behave in a certain way because we think there is at least SOME benefit to it… or we wouldn’t do it. So, what are the reasons that you think worrying is helpful to you? And what are the reasons it is unhelpful and makes your life more difficult? By examining both of these together, we can see whether the disadvantages of worrying outweighs the advantages. In all the times I have done this intervention with a client, I don’t think I have ever seen someone conclude that the advantages of worrying outweigh the disadvantages. I typically use this intervention in the first stages of treatment because clients are much more motivated to reduce their worrying when they realize how negatively it has impacted their life.
Once we have explored how the individual sees both sides of the equation (i.e., the perceived advantages and disadvantages of worrying), then we can move to the next cognitive strategy: engaging in Socratic dialogue. Socratic dialogue involves the therapist asking several reflection questions to help client examine the validity of their thoughts around a given issue (in this case, their thoughts about uncertainty). Here are a few examples of some of these types of questions below:
• Is uncertainty always bad? In other words, have there ever been times when uncertainty led to positive outcomes? People report many positive things arising from uncertain situations, such as having met their partner at a party where they didn’t know many people or meeting a best friend at a new job.
• Are there times when you enjoy uncertainty but call it something different? For example, a surprise, spontaneity or an adventure?
• Would you really want to live in a certain world? How boring would life be if you knew every detail of what was going to happen? What you were going to think, say, do, eat, drink? What other people were going to think, say and do? Isn’t the uncertainty of life a big part of what makes it interesting and worth getting up for?
• Was there a time in your life when uncertainty was a real threat? For example, living in poverty and with food insecurity, dealing with a severe illness of you and a loved one, being unemployed or living in a chaotic, traumatic or violent environment? These strategies of worrying and planning or preparing might have made sense then. But perhaps these are outdated strategies that are no longer necessary.
These are just a few general examples of the types of questioning. We could spend pages discussing the various types of questioning. This whole process is very idiosyncratic and dependent on the person’s unique automatic thoughts and core beliefs. This is why it can be especially helpful to have a skilled cognitive therapist guide the client through a very specific and relevant line of questioning. Ultimately, the goal is for the client to become their own cognitive therapist and learn to ask themselves these types of questions as a way to challenge inaccurate thoughts, beliefs and assumptions.
