Why are we interested in coping with uncertainty? There is a lot of psychological research to suggest that poor ability to deal with uncertainty is associated with anxiety, low mood and other emotional health difficulties. So improving our skills in this area can have a very positive impact on our well-being.

So how can we become more tolerant of uncertainty?

Imagine the opposite.
Let’s do a little fantasy exercise. Imagine that you have complete certainty regarding what will happen every single day for the next, say, 40 years. You now know exactly what will happen each hour of each day of your life. You cannot change it. You are a passenger in your own life. Will this be fun? The uncertainty is eliminated, but so is the joy, the human agency, all the unexpected highs and lows, the decision making, the surprises, the feeling that you are in control of your destiny, that you can change things if you choose to. So perhaps 100% certainty is not a good thing.

Now imagine the 0% certainty scenario. You don’t know anything about your future, including where you will sleep, where your next meal is coming from and who you will be with. That’s pretty stressful. So maybe 0% certainty is not a good thing either.

So, as ever,  it looks like we are looking for balance somewhere in the middle. We want to have some comfort around the basic structures of future life, but with enough flexibility and space for decisions, individual judgement and creativity. 

Put your driver’s hat on.
Imagine you are driving a car. You have some idea of where you are going and the route to take. But you don’t know the details. You don’t know what the traffic is going to be like. You don’t know if a particular road is going to be closed and you will need to go a different way. You don’t know if a fox is going to run out on the road and you will need to slow down. But you deal with these events as they come. You react to each of those situations using your judgement as they occur. You don’t know in advance what will happen or how you will deal with it, but you trust yourself to do it in the moment.

Thinking ahead and preparing ourselves for events that cause us worry, such as a work presentation or a social occasion, is completely normal. But we can also remind ourselves that our brain is an amazing tool which has evolved over millions of years to react quickly and appropriately, without any preparation, to what is going on right here, in the present. Don’t underestimate your cognitive capacity. 

Try a behavioural experiment.
Are there any situations where you are uncertain about the outcome that you tend to avoid, for example, social engagements, or going to new places? You can start small and gradually expose yourself to more settings with an element of uncertainty. The important thing is to treat this as a scientific experiment--you cannot go wrong whatever the outcome. Afterwards you can reflect on how you felt, what you did and what happened. Did things turn out ok? If things didn’t turn out ok, were you still able to cope with the negative outcome? 

Gradually embracing uncertainty through this process of exposure and habituation will allow you to build higher tolerance levels for it, increase confidence, reduce negative beliefs and shape a life you want.

Develop a healthy “anchor” structure.
It is helpful to have a broad structure around your day / week to provide a foundation to feel more in control. This can include appropriate self-care, such as eating well, exercising and getting enough sleep, maintaining social relationships, doing meaningful work and helping others.

If you feel that you have the core elements in place, it can be easier to tolerate events with an uncertain outcome. 

How can psychology help?
We work with clients to develop a tailored programme of exposure and CBT exercises, taking into account each client’s unique needs. Your psychologist will provide a safe space to explore worry and anxiety surrounding uncertainty and help you reflect on thoughts and behaviours which are not serving you well. We will monitor progress towards your goals, adjusting therapy if needed.

Best wishes
Fernwood Clinic Team

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A panic attack is a difficult and stressful experience, for both the person experiencing the episode, and for any friends or family. 

Nature of panic attacks.
Panic attacks are characterised by an extreme fear response even if there is no direct threat presented.  Attacks can vary significantly from person to person; as far as possible, talk to your loved one about how best you can support them according to their specific situation.

For someone experiencing a panic attack, sensations may include a feeling of dread, choking, a fast heartbeat, shaking, dizziness, and hyperventilation. The feeling can be overwhelming and feel as if it is dangerous to the person experiencing the attack, but it is important to try to remember that the panic attack itself isn’t dangerous. 

Pay attention to the sensation the person is feeling, and try to be empathetic; though this may be something which occurs frequently, each panic attack can feel as distressing as the one before. Try to not discount what they are feeling, avoid phrases such as ‘At least’.

Panic attacks are typically 5-10 minutes long, but for the person experiencing it they may not have a secure concept of time. 

How to behave.
As far as possible, speak in a slow, relaxed tone. This will help provide a background sensation of calm. If possible, model deep breathing and encourage the person to do the same if this is something which has been helpful for them in the past.

The way the person is behaving may be stressful to you, but try to remember that the panic attack itself isn’t dangerous. 

Depending on the person’s preferences, they may prefer to move to a quiet place where there is less background noise, or visual stimulation. As symptoms may involve nausea and dizziness, they may wish to stay still in one place, sitting on the floor or on a chair.

What to say.
You may want to ask ‘How can I help?’ but remember that the person experiencing the attack might find it hard to communicate. 

Instead, you can try providing reassuring support; ‘I’m here, I’m not going anywhere. I’ll stay with you until this is over.’ The person experiencing the attack may not be able to listen to what you are saying properly. 

Reassure them that the panic attack is not dangerous in itself - it can be hard for someone experiencing the episode to ‘rationalise’ that they are not in a dangerous situation.

Once it is over.
The person you are with may feel exhausted and wish to take a break, alone or with you. Check in with them and be mindful of their own preferences.

Sometimes people who have experienced a panic attack may feel ashamed of how their symptoms have presented themselves, due to internalised stigma (particularly if the episode occurred in a public place). Reassure them that the attack isn’t something they were able to control and mention they were brave to be able to handle it the way they did.

If you are regularly around the person, consider asking them how they can help in future, as individuals can have differing experiences of panic attacks.

How therapy can help someone experiencing panic attacks.
Therapy can help make gradual progress to understand triggers, thoughts and emotions surrounding panic disorder. The therapist can help understand the roots of issues, which for some people can be related to traumatic events. The therapist is there for support at a regular time each week, and draws on clinical experience to help provide a professional perspective.

The impact therapy can have is long-lasting and can help develop the tools necessary to manage the condition independently in day-to-day contexts and build resilience.

Best wishes
Elsa Minns, Fernwood Clinic Team

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