Uncertainty fuels anxiety, causing your mind to conjure up scary scenarios. The pandemic can magnify the angst.

By https://www.sandiegopsychiatricsociety.org/author
September 15, 2020

The Washington Post

By Christine Achwanden

September 12, 2020

As it has become clear that the coronavirus pandemic is here for the foreseeable future, we’re all learning to live in a cloud of uncertainty: When can we venture out safely? Visit loved ones? Go to the doctor? Send children back to school? Return to the workplace? Pay our bills? Find a job?

Feeling uncertain can provoke anxiety and other unhealthy effects, but at the same time, research shows that people are resilient and can learn to cope and even thrive in times of turmoil.

Whether this prolonged period of uncertainty will leave lasting scars or provide an impetus to better adapt to unpredictable events depends in part on individual circumstances and coping styles — for instance, whether you still have a source of income or you or your loved ones become sick. Coping styles also matter — people who react to challenges by planning everything out may struggle when the future is so unpredictable.

We don’t naturally like unpredictability, says Jelena Kecmanovic, a clinical psychologist and adjunct professor at Georgetown University. “It’s fear of the unknown,” she says. “Uncertainty is fertile ground for anxiety and fear, because you don’t know what’s going to happen.”

Kecmanovic’s group practice in the D.C. area, like many others, has seen a large uptick in calls from people seeking treatment for anxiety, especially as it has become clear that this is going to be a prolonged situation, not just a little hump to get over.

“People say, ‘I can’t stand not knowing anything,” she says.

Uncertainty can provoke a vicious cycle of anxiety, says Jack Nitschke, a psychologist at the University of Wisconsin at Madison. “Our brains help us get good at what we’re doing,” he says. Whatever thought patterns we’re having, the brain fortifies the neural pathways (that connect the nervous system’s brain cells) for doing this. And, as Nitschke’s research has shown, that means that if we’re feeling anxious, “the brain is strengthening the neuropathways for anxiety.”

Uncertainty fuels anxiety, by creating room for the mind to conjure up worst-case scenarios, Nitschke says. Studies have shown that lab animals consistently prefer predictable shocks to unpredictable ones, he says, and that predictability can ameliorate the negative effects of stress. In other words, the anticipation of an uncertain threat can be worse than the thing itself. In a paper published in the journal Nature Reviews Neuroscience in 2013, Nitschke found in part that a common feature across anxiety disorders is an overactive anticipatory response when faced with unpredictable conditions.

Psychologists have several tools for measuring how well people handle uncertainty. For instance, the intolerance of uncertainty scale asks people to rate how much they agree with such statements as “uncertainty makes life intolerable” and “my mind can’t be relaxed if I don’t know what will happen tomorrow.” Intolerance of uncertainty is a risk factor for many disorders involving anxiety, from obsessive compulsive disorder to depression, eating disorders and generalized anxiety, Kecmanovic says.

Beth Meyerowitz, a professor of psychology and preventive medicine at the University of Southern California who has studied how people cope with the uncertainty that comes with a cancer diagnosis, has found that people with a strong intolerance for uncertainty were more likely to engage in avoidance coping strategies, such as preventing themselves from thinking about or experiencing the feelings they’re having, and that those methods of coping were associated with higher degrees of emotional distress.

Avoidance coping mechanisms can take a lot of energy and prevent the person from developing more effective coping strategies, Meyerowitz says. For covid-19, the disease caused by the novel coronavirus, “a person might have a cough and a fever, but avoid seeking medical attention.”

Uncertainty can leave us exhausted, as even the simple tasks of everyday life these days require more thought and cause more anxiety. Decisions that were once trivial — such as where and when to go grocery shopping, when to visit friends — have become anxious calculations about risks that can’t be fully quantified, says Lisa Kath, an occupational health psychologist at San Diego State University who is looking at how people are coping with the pandemic.

Some people are more naturally tolerant of uncertainty than others. Having a “planner” personality can predispose someone to feeling extra anxiety in response to uncertainty, says Lacie Barber, an occupational health psychologist at San Diego State University. “Trying to exert control on an uncontrollable situation can leave you feeling even more stressed,” she says.

Some people can’t sleep the night before a road trip unless they have everything prepacked and every detail about the route and playlist planned out. But the people who cope best with uncertainty are the ones who have a more flexible coping style, Barber says, pointing to a 2014 meta-analysis that found a positive link between coping flexibility and psychological adjustment.

“Sometimes fixing the problem is good, sometimes being proactive is good, sometimes managing your emotions with self-care is good, and in some cases even avoidance can be fine,” she says. “But doing the same thing regardless of the situation is not going to work. In uncontrollable situations, focusing on what you can control, like your reactions, will be best.”

Experts also say it is important to recognize the external things — such as the weather or the state of the economy — that you can’t control and accept that they are out of your hands.

We’ve all heard the saying about having the serenity to accept the things you can’t change, courage to change the things you can and also wisdom to know the difference. “That’s coping flexibility,” Barber says. She advises people to diversify their coping strategies and then use the one that best fits a particular problem. In some cases, it’s better to focus on changing the situation by adjusting your environment (wearing a mask or staying home). But in other cases, it might be better to change your reaction to the uncertainty by practicing mindfulness or self-compassion.

An analysis of blogs written by parents whose kids were undergoing cancer treatment found that they tended to narrow their scope of view, Kath says. Instead of thinking about what was going to happen six months or a year from now, they focused on what was happening in the present.

“It’s that old adage of taking it one day at a time,” Kath says. And that kind of letting go of the more distant future is a strategy that can be useful for pandemic anxiety, too, Kath says.

Another helpful strategy, Meyerowitz says, is to break the problem down into its component parts. Figure out what you’re anxious about and try to find ways to deal with those specific parts.

“It is really difficult to figure out how best to cope with ‘The Pandemic,’ ” Meyerowitz says. Anxiety about covid-19 might be due to feelings of isolation during stay-at-home orders, worries about losing a job or getting laid off, concerns about how to manage the children’s education or exhaustion because of problems sleeping, Meyerowitz says. It’s easier to address these problems individually than it is to think of them as a single entity.

When the pandemic is finally over, the period of uncertainty could leave lasting marks. One unknown question is how this period will affect children, especially those in families who’ve experienced job losses during the pandemic, says Jungeun Olivia Lee, a social work scholar at the University of Southern California who has studied job insecurity. “What’s the impact of that? We don’t know but it’s going to be a big issue for this generation.”

Depending on how they cope, some people — kids and adults — may also have lasting anxiety issues.

“If we are spending a whole lot of time practicing anxiety circuits and building and strengthening the neural pathways that support anxiety, well, once those are built and fortified, they don’t go way,” Nitschke says. Instead, they prime us to latch on to other sources of uncertainty that come down the pike later on, and become anxious about them, even if they wouldn’t have previously caused anxiety. The antidote, he says, is to build up the neural circuitry for tolerating uncertainty by finding ways to manage anxiety now and in the future.

“The idea here is to link uncertainty to acceptance rather than to danger,” Nitschke says. When you think of uncertainty as a danger, you build up neural connections that support this association, he says. Instead, he says, the better thing to do is build neural connections that help you associate uncertainty with an “acceptance that the future is unknowable, sometimes bringing good outcomes and sometimes bad, which we generally can’t do much about and usually get through.”

Research by George Bonanno at Columbia University shows that most people are very resilient, even after going through traumatic events, Kecmanovic says.

“Times are hard, but this is also an opportunity for us to learn to deal with uncertainty and become more resilient,” Kecmanovic says, adding that cognitive behavioral therapy is one technique that has been shown to help people learn to cope better with uncertainty. It’s okay to feel anxious and have other signs of mental distress, those are normal responses, she says. But know that, chances are, you’ll be fine in the end.

Experiencing a major threat to your life (such as a pandemic) can force you to rethink what’s important to you and how you find meaning in life, Meyerowitz says. In many cases, people may view this as a positive upshot. “Uncertainty intensifies emotions by its very nature, and those intense emotions can lead us to question your sense of values and meaning in the world,” Meyerowitz says.

Some people view uncertainty as a threat or a loss, while others seem more inclined to view it as a challenge, Meyerowitz says. Covid-19 has brought many real and tangible losses — the deaths of loved ones, layoffs, canceled dreams — and those losses should be grieved, she says. But the aspects of the pandemic that can be met as challenges may also provide opportunities for personal growth, she says.

The data suggest that people who recover from cancer do not, by and large, experience post-traumatic stress disorder or other lasting problems, Meyerowitz says. “The quality of their lives recovers.”

People who have survived a period of prolonged uncertainty associated with a cancer diagnosis often say that they’ve derived unexpected benefits from the experience.

“They say things like, ‘I don’t let the little trivial stuff get me down anymore,’ ” Meyerowitz says. “You can come out of it either end feeling like you were stronger than you thought.”


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