OCD and Intolerance of Uncertainty: Treatment Issues

Abstract

Recognition of the importance of intolerance of uncertainty (IU) as a critical cognitive distortion in anxiety disorders has been growing. The clinical challenge for researchers and clinicians is to understand the nature of IU and what it means to help clients to cope with it. Obsessive compulsive disorder (OCD) is the ideal diagnosis to examine the challenges IU can present, since, in the author’s opinion, it is the core of almost all manifestations of OCD. The article then focuses upon three factors in which IU factors play a role in successful/unsuccessful treatment: (a) the role of the therapist in helping the sufferer to understand IU and the goals of treatment; (b) techniques for helping the sufferer to accept and carry out the goals of treatment; and (c) patient factors/problems leading to “resistance” in coping with IU.

Are “Not Just Right Experiences” (NJREs) Specific to Obsessive-Compulsive Symptoms?: Evidence that NJREs Span across Symptoms of Emotional Disorders

“…As discussed, the desired state for individuals with emotional disorders appears to be perfection and certainty. Intervention strategies developed to reduce perfectionism (Riley, Lee, Cooper, Fairburn, & Shafran, ) and increase tolerance for uncertainty (Dugas & Robichaud, ; Grayson, ) might thus be useful in the treatment of NJREs across emotional disorders. Through such intervention strategies, the desire for a just right state might be reduced and patients would in turn possibly experience less distress in response to NJREs.…”

“…Until such a state can be achieved, Coles, Frost, Heimberg, and Rheaume () noted that individuals with OCD are plagued by not just right experiences (NJREs), which represent a mismatch between perceptions of a current state and a desired state. Although the desired state for individuals with OCD appears to be one of perfection and certainty (Rasmussen & Eisen, ), such a state is unattainable, at least more than temporarily (Grayson, ; Pitman, ). The inability for individuals with OCD to fully attain their desired state purportedly leads them to continually experience NJREs, which in turn engenders further engagement in compulsive behaviors.…”

Intolerance of Uncertainty Moderates the Relationship Between Catastrophic Health Appraisals and Health Anxiety

“…For example, standard cognitive-behavioral treatments for health anxiety, which often incorporate exposure and response prevention (E&RP), typically do not directly target IU (Deacon and Abramowitz 2008). Grayson (2010) articulated how the benefits of E&RP are maximized when IU is initially addressed. Specifically, Grayson noted that ''a successful enduring treatment outcome is the result of the client accepting the goal of living with uncertainty coupled with appropriate E&RP'' (p. 15).…”

Dispositional resilience in treatment‐seeking patients with obsessive‐compulsive disorder and its association with treatment outcome

“…Intolerance of uncertainty has been proposed to be another core component of OCD (Tolin, Abramowitz, Brigidi & Foa, ), and OCD patients have been found to report lower scores on novelty seeking than controls (Kusunoki et al ., ). Grayson () claims intolerance of uncertainty must be understood and targeted by clinicians in order to succeed with ERP treatment for OCD. Kashdan and Silvia (, p. 371) argue that curiosity and novelty seeking should be included in studies of psychological disorders, as “people suffering from psychological disorders, intrusive thoughts and anhedonic processes can blunt the experience and expression of appetitive activity”.…”