Help Clients with Health Anxiety Learn to Tolerate Uncertainty

Understanding the Intolerance of Uncertainty in Health Anxiety

Everyone struggles with uncertainty at times, and that is entirely normal. However, for some clients, the desperate need for certainty can begin to take over their lives. This phenomenon is known as the intolerance of uncertainty (IU). It involves perceiving uncertain situations as inherently threatening and highly likely to result in negative outcomes. In other words, when clients can’t be certain about a future event, they may assume that the outcome will be catastrophic and that they will be unable to cope.

Clients with health anxiety often experience high levels of IU. They may inaccurately believe it is both possible and necessary to achieve 100% certainty that they will not experience a negative health outcome. Of course, as clinicians, we know this is unattainable. Uncertainty is an inevitable part of life, and health is no exception.

What Drives the Intolerance of Uncertainty

Broadly speaking, clients with elevated IU tend to make three faulty assumptions about uncertain situations:

1. Uncertainty about a future event likely means something bad will happen (e.g., “If I have a random headache with no identifiable cause, it probably means something serious.”)

2. The bad outcome will be catastrophic (e.g., “If it is something, it’s probably a brain tumor.”)

3. They will not be able to cope with the outcome (e.g., “I’ll be inconsolable. Doctors won’t be able to save me, and I’ll die within months.”)

Revising Assumptions About Uncertainty

Helping clients build tolerance for uncertainty begins with helping them revise these assumptions. The therapeutic goal is to help clients view uncertainty differently and to practice becoming more comfortable with it over time, particularly in health-related contexts.

We want clients to stop equating uncertainty with doom. For example, many individuals assume something terrible will happen simply because they do not know the cause of every bodily change or sensation. By learning to tolerate a small amount of uncertainty, clients can begin to disengage from the exhausting and futile efforts to achieve absolute certainty about their health.

Ideally, clients can learn to hold more adaptive and realistic beliefs about uncertainty, such as:

• Uncertain situations will probably turn out okay (e.g., “This headache is likely something minor or benign.”)

• Even if something bad does occur, it probably won’t be catastrophic (e.g., “If it’s related to a medical issue, it will most likely be manageable.”)

• Even if something bad does occur, I will be able to cope (e.g., “I can handle it better than I think I can, and effective treatment will likely be available.”)

When clients shift from rigid, catastrophic interpretations of uncertainty toward these more adaptive perspectives, they typically experience a significant reduction in anxiety. The more clients can tolerate uncertainty about their health, the less driven they feel to control every variable and the less they engage in reassurance-seeking and other safety behaviors that perpetuate distress.

Four Strategies to Strengthen Tolerance for Uncertainty

Strategy 1: Identify and Challenge Thinking Errors

Clients who struggle with IU often engage in distorted thinking patterns when faced with health uncertainty. As clinicians, we can help them identify these patterns in day-to-day situations. Examples include:

• Jumping to conclusions about symptoms simply because the cause is unknown

• Holding unrealistic expectations for medical certainty (e.g., assuming doctors or tests must always provide exact answers)

• Engaging in black-and-white thinking (e.g., “If my condition could get worse, it definitely will”)

Once identified, these thoughts can be challenged through Socratic questioning:

• Do I tend to predict negative outcomes simply because I am uncertain?

• Is it equally or more likely that the outcome could be neutral or positive?

• Have I faced uncertainty before and found that things turned out okay?

• What aspects of my health are within my control, and what are not?

• How can I take reasonable steps to care for my health while accepting a degree of uncertainty?

Strategy 2: Reframe Uncertainty as a Natural and Even Positive Part of Life

While uncertainty can feel threatening, it also makes life rich and dynamic. In therapy, you can invite clients to imagine a world that is 100% predictable, where every detail of the next day is already known. Such a world would quickly become dull and lifeless.

Encouraging clients to reflect on moments when unexpected events led to joy, connection, or personal growth can help them view uncertainty as not only tolerable but sometimes desirable. This may include meeting a partner by chance, discovering a new passion, receiving a surprise promotion, or experiencing a meaningful life transition that was not planned. These reflections help soften the association between uncertainty and danger.

Strategy 3: Harness Existing Skills

Many clients already tolerate uncertainty successfully in other domains. Highlighting these examples can be empowering and help them recognize that the skill set exists—they simply need to generalize it to health-related fears.

Ask clients to identify everyday examples of tolerated uncertainty or small risks they take without excessive anxiety. Examples may include:

• Eating food prepared by others

• Driving or crossing busy streets

• Sending children to school

• Traveling by plane

• Trusting a babysitter or childcare provider

• Trying new foods or restaurants

Once identified, invite clients to see these as transferable skills. They already have evidence that they can function in the face of uncertainty; now, they can apply that same mindset to health-related situations.

Strategy 4: Practice Sitting with Uncertainty About Symptoms

When clients experience new symptoms, IU often drives an urgent need for immediate answers. The goal is to help them practice delaying the certainty-seeking response. One structured way to do this is through a behavioral experiment known as the Waiting Experiment.

Encourage clients to choose a minor symptom or bodily sensation and commit to refraining from immediate investigation for a set period (e.g., 3 days to 1 week). During this period, they agree to avoid researching, excessive checking, or reassurance-seeking.

Predictably, anxiety and uncertainty may initially increase. Frame this as a therapeutic success: it means they are actively practicing the skill of tolerating uncertainty. At the end of the waiting period, if the symptom persists, clients can take appropriate next steps, such as consulting a healthcare provider.

Afterward, guide them through reflection questions such as:

• Was the uncertainty unbearable, or was I able to manage it?

• Did the discomfort lessen over time?

• How did I cope with the anxiety?

• What was the actual outcome? Was the symptom benign or self-resolving?

Clinical Application

These strategies help clients build tolerance for uncertainty gradually, much like strengthening a muscle. The goal is not to eliminate discomfort but to expand capacity to tolerate it without resorting to reassurance-seeking or avoidance. Progress may be incremental, but consistent practice yields measurable change. Over time, clients learn that uncertainty is not synonymous with danger and that their ability to cope is far greater than they once believed.

Want to take the next step to help clients with health anxiety?

If you are a mental health professional and want to better understand health anxiety and how to treat it, take my comprehensive course- Treating Health Anxiety with Exposure-Based Cognitive Behavioral Therapy. If you are a licensed clinical social worker, this course is approved by ASWB for 13 clinical continuing education credits.