On engaging with anxiety and uncertainty

I’m writing this at the end of March 2020 in the midst of the economic slowdown and public health crisis brought on by COVID-19. This is the last time I will mention these things. The truth is that lots of us deal with anxiety on a daily basis. I can’t speak to everyone’s experience, only my own. I’ve observed our society becoming more conscious of anxiety in the world. Anxiety is starting to take hold as something that people accept as just a part of normal daily life, something that people can talk about more openly. Let’s leave the concept of “normal” here, too. Everyone’s life experience is different. I won’t (or at least I don’t intend to) speak in terms of platitudes that broadly apply to everyone, but rather I will relay my personal experience with anxiety, how I overcame it and how I manage it. Hopefully you’ll take away a few things that I learned the hard way.

Anxiety was brought to the forefront of my attention because I struggle with a separate (but related) issue, that is, Obsessive-Compulsive Disorder. (Aside: I’m going to minimize my discussion of OCD here. For more on my personal experience with OCD note taking you can see this) After seeking help, I learned that OCD is at its core an anxiety disorder (regardless of what the DSM says now). I also learned that people subject to OCD seek to assure with 100% certainty that their obsessions will not come to fruition. In more general terms, the person with hand washing OCD wants to be 100% sure that they don’t have any germs on their hand that could get them sick. More broadly, I came to understand that anxiety is what occurs when we don’t have sufficient confidence that a positive outcome will result. That pit in the stomach of the OCD sufferer experiences when they’re washing their hands trying to be 100% confident that there are no germs is there because no matter how hard they try, they know that they cannot be 100% certain.

At the root of every anxiety is some degree of discomfort with uncertainty.

Let’s start with why anxiety and uncertainty are so tightly intertwined and then we’ll talk about how we can manage it. I struggled with anxiety because I have a tendency to view things as black and white. When it comes to risks, I tended to view things as either 100% assured or 0%. It may seem obvious, but what I found is that my brain wasn’t wired to think of scenarios in terms of probabilities and confidence intervals. For instance, my OCD related to a fear of forgetting important things. When things are black and white, things are either all important or all not important. I would constantly be writing my thoughts down or mentally holding onto my thoughts until I got a hold of some pen and paper or otherwise couldn’t hold onto them anymore (that’s when the anxiety really set in). I subconsciously thought of it as, if I forget anything, there is a 100% chance that it’s something important. The reality is that there’s probably a 5–10% chance that it was important, but I wasn’t comfortable with that probability. As much as I’d like to think it, most of my thoughts just aren’t that important. As I learned with my therapy, the correct response is not to tell myself that there’s a 0% chance that it was important, but rather to sit with the possibility that it may or may not have been important and then to allow my thoughts to move on, taking care not to ruminate. Herein lies two of the keys in me developing a healthy relationship with uncertainty: (a) having a DECENT understanding of the probabilities of things and (b) developing a tolerance for things that are in the lower probability ranges. A third piece would be (c) recognizing how resilient I am (and you are!) when failure scenarios rear their head. If things start looking like the 5–10% likely failure scenario, I’m not going to just take it lying down — I am going to act on it. The probabilities are not static.

Let’s dive into each of these keys starting with (a) having a DECENT understanding of the probabilities of things. The key here is to think of the world in terms of probabilities. We do this all of the time, but generally don’t think of it this way. There are no certainties in life. We have the illusion of certainty with things such as the sun rising, setting, and repeating again tomorrow. Speaking from a place of privilege, I’m “certain” that I know where my next meal is coming from. In that last scenario, the truth is that I’m approximately 99.999% confident because the events that would need to occur for my food source to fail or my access to my food source to fail are extremely unlikely. They are, however, not certain. I could die on my way to the pantry. My living space could burn down before lunch. A meteor could hit the building. On my path to healing I first needed to recognize this truth.

Everything in life is subject to probability. Recognizing this should not be a source of fear, but a source of possibility. I know when I scooter commute to work that there is a possibility that I will not make it to work. I don’t know the exact probability, but I have a decent idea that it’s >95% +/- 4%. Acknowledging that the probability is not 100% and that there is some uncertainty in my guesstimate helps me understand 1) that I can consider that there are other scenarios other than my default scenario and 2) that there are things I can do to increase the chance of a successful scenario (but not guarantee it as certain! — a meteor could hit me on my way to work, after all.).

Going from a confidence range of +/-20% to +/-10% can take a very real amount of time. Because of this, recognizing how critical the decision is helps dictate whether or not I’m willing to spend the time it takes to increase my confidence and reduce the uncertainty range.

Because the relative likelihood of me making it to work on my scooter okay, I don’t spend too much time lingering on that decision. For things where my gut estimates are less clear one way or the other, I need to decide 1) what can I do to increase/decrease the likelihood of this event to a point where I am comfortable?, 2) how much effort would it take to get to a point where I’m more confident in my assessment?, and 3) is it worth it? If I’m going to invest in a stock, how confident am I that the stock will go up? Let’s say I’m 50% confident+/- 49% because I don’t have much expertise, but am still looking to invest. Rather than dump my money in carelessly or evade investing out of fear, I might spend some time learning about the mechanisms that could drive the stock up or down to try to steer my gut-assessment of the probability one way or the other and shrink my uncertainty range. Maybe after reading a book I still think the probability of it going up or down is 50%, but my confidence interval is smaller, say +/-25%. It takes time to drive out a better estimate for probabilities to shrink confidence ranges. Going from a confidence range of +/-20% to +/-10% can take a very real amount of time. Because of this, recognizing how critical the decision is helps dictate whether or not I’m willing to spend the time it takes to increase my confidence and reduce the uncertainty range. If it’s stocks, then it’s probably worth it. If it’s which ice cream flavor to get at Baskin Robbins, then it’s probably okay winging it with Rocky Road.

Once you start to think of things in terms of probabilities, the next step is (b) developing a tolerance for things that are in the lower probability ranges. When I ride my scooter to work I don’t even think about the probability of failure because it’s so low (<<1%). With things that fall into the 5–10% failure rate range it can be harder to ignore. I, personally, tend to overestimate the failure range and my perception of a 5–10% failure rate may balloon to 50% or more. I think it’s in the deviation in real probability and my perceived probability that anxiety lives. The part of our brain that drives anxiety thinks of things in terms of life or death. Anything with more than 0% failure rate is a potential life-threat as far as it’s concerned. In my world, thankfully, most scenarios are just not that likely to be life threatening.

You want to get used to these minimal anxiety events so that it takes more to trigger an anxious response from your brain.

This part is where I needed help. The gold standard for overcoming OCD (and unease with uncertainty or anxiety caused by uncertainty) is Exposure and Response Prevention (ERP) therapy. The idea is that you lay out things that trigger anxiety on a scale from 1–10. 1 being the least anxiety causing and 10 being absolute fetal-position anxiety. I was encouraged to intentionally expose myself to things in the 1–3 range on my scale that triggered my anxiety and then to…just sit with it. Not to tell myself it would be okay. Not to write down the thought before it escaped me. Just to sit with the anxiety. Writing about my experience still makes me squirm a little bit, but this part is critical. You want to get used to these minimal anxiety events so that it takes more to trigger an anxious response from your brain. Thinking in terms of probabilities that we talked about before, there is still some probability that things won’t work out, but the point is to expect that and to accept it. There’s a lot that’s been written on ERP so I won’t cover it more deeply hear. Whether you struggle with OCD or not, I highly recommend Dr Jonathan Grayson’s book “Freedom from OCD.”

This brings us to the third principle that I outlined above (c) recognizing how resilient you are. Hypothetically if you’re in a situation where things start to take a dive, (thinking again in terms of probability) there is a high likelihood that you will recognize that and then not simply just let it happen to you without taking action. It is not certain, but it is highly likely that you will take action to prevent it happening. The key here isn’t worrying about what could happen. It’s about having confidence in your ability to make a judgement call when the times comes. If it’s a situation that calls for urgency, you will make a call that meets your urgent need. If it’s a situation with a longer horizon, you have time to get your ducks in a row. There’s not much to this point other than for you and me to give ourselves some credit. We’ve been through a lot. This next, new challenge isn’t likely to keep us down.

The end goal in all of this is to reduce your anxiety so you can enjoy life a little bit more. Anxiety (like OCD) consumes a lot of our attention. It robs us of the present moment. In this current moment, there are a trillion things you could be doing other than reading these words. Do you really want to spend another moment with anxiety that is not absolutely necessary? It is my hope that you find something of value in my experiences that’s able to help you. The last thing I’d like to leave you with is this. If the “failure” scenario does happen, don’t just take it as all bad — there is the opportunity to learn something in every situation, even if it’s something about yourself and how you react to certain situations. You are a strong person. You deserve to live a life focused on your values not a life driven by anxiety.